Clinical & Medical Case Reports

Renal cell carcinoma (RCC) is a highly vascular tumour which metastasise via lymphatic or haematogenous route. Classically, RCC presents as a triad of flank pain, haematuria and a palpable renal mass. Extra renal manifestations of metastatic RCC includes pulmonary, inferior venacave, bones and liver involvement. Sarcoid- like reaction (SLR) is a phenomenon used to describe non caseating granulomas which does not fulfi l the criteria for systematic sarcoidosis. The aetiology of SLR remains unclear, however they are commonly observed in haematological malignancies such as lymphomas. Only few reports have documented the presence of non-caseating granulomas of SLR in the context of RCC. We present a rare case of 38 old gentleman initially presented to the cardiology team with dyspnoea associated with junctional bradycardia and right bundle branch block on ECG. A CT scan revealed bilateral pulmonary nodules with reticular changes, diff use small lesions in liver and spleen indicative of granulomatous inflammation. However, the CT scan also showed a solid lesion in the left kidney suggestive of RCC. Ten months later, radical nephrectomy was performed and G1 pT1a N0M0 renal cell carcinoma, Conventional/clear cell subtype was confi rmed. The tumour showed extensive epithelioid granulomatous (sarcoid-like) reaction affecting both peritumoral and intratumoral area. Follow up images 28 months

after nephrectomy demonstrated almost complete resolution of granulomatous lesions. The remarkable resolution of granulomas after removing RCC confi rms the interesting association between malignancy and SLR. Our case supports the hypothesis that non-caseating granulomas of SLR could be a manifestation of an immunologically mediated antitumor response.