yemenjmedYemen Journal of MedicinecoVolume 2 Issue 2 MultidisciplinaryEnglishMay-August 2023NNY20230928ArticleA rare case of bilateral lung metastasis from renal cell carcinoma 26 years after nephrectomyEnglishY108111Waleed KhaledKaleem1EnglishNSamira Awad BaNser2EnglishYRasheed MohammedBamekhlah3EnglishYWadeea Saaeed BinGouth4EnglishYMohammed AhmadBakrmom5EnglishY10.32677/yjm.v2i2.4035Renal cell carcinoma (RCC) is a malignant tumor that often metastasizes early. About 33% of RCC patients present with metastatic masses, mostly in the lungs. Our patient was a 66-year-old woman who had a left-sided nephrectomy for RCC 26 years ago. Prior to the current presentation, she sought medical advice for about a year because of her easy fatigability, which was attributed to her normocytic normochromic anemia. Incidentally, a mass was discovered in each lung, which was found histopathologically and immunohistochemically to be a metastasis of RCC. The patient received sunitinib, which is the standard treatment for patients with advanced RCC and metastases without benefit at initial doses and cycles. Consequently, the dose was increased up to four times the initial dose, and by the third cycle, side effects appeared in the form of impaired consciousness up to deep coma, hypertension, hypercarotenemia, pancytopenia, hyponatremia, hypokalemia, and subclinical hypothyroidism. She was taken to the hospital and then sadly passed away.EnglishLung metastasis, Renal cell carcinoma, Side effects, Sunitinibhttps://yemenjmed.com/admin/abstract?id=66References1619Bianchi M, Sun M, Jeldres C, et al. Distribution of metastatic sites in renal cell carcinoma: a population-based analysis. Ann of Oncol. 2012;23(4):973and;ndash;80.Rautiola J, Donskov F, Peltola K, et al. Sunitinib-induced hypertension, neutropaenia and thrombocytopaenia as predictors of good prognosis in patients with metastatic renal cell carcinoma. BJU Int 2016;117:110and;ndash;7.Ljungberg B, Bensalah K, Canfield S, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 2015;67:913-24.Ljungberg B. The role of metastasectomy in renal cell carcinoma in the era of targeted therapy. Curr Urol Rep 2013;14:19-25.Tapper H, Klein H, Rubenstein W, et al. Recurrent renal cell carcinoma after 45 years. Clin Imaging 1997;21:273-5. McNichols DW, Segura JW, DeWeerd JH. Renal cell carcinoma: long-term survival and late recurrence. J Urol 1981;126:17-23.Featherstone JM, Bass P, Cumming J, et al. Solitary, late metastatic recurrence of renal cell carcinoma: two extraordinary cases. Int J Urol 2006;13:1525-7. Correa AF, Rini BI, Linehan WM, et al. Cancers of the genito-urinary tract. In: DeVita Hellman and Rosenbergand;rsquo;s Cancer principles and practice of oncology. 12th. Edition, Volume 4, section 4, Chapter 43. Publisher Wolters Kluwer 2023; pp 729-755.Houk BE, Bello CL, Michaelson MD, et al. Exposure-response of sunitinib in metastatic renal cell carcinoma (mRCC): A population pharmacokinetic /pharmacodynamic (PKPD) approach. ASCO Meeting Abstracts. 2007;25(18 suppl):502.Albiges L, Oudard S, Negrier S, et al. Complete remission with tyrosine kinase inhibitors in renal cell carcinoma. J Clin Oncol 2012;30:482and;ndash;7.Kazama A, Katagiri A, Ishikawa S, et al. Continuous remission of renal cell carcinoma with tumour thrombus after severe adverse events following short-term treatment with sunitinib. BMJ Case Rep 2017 Aug 28;2017:bcr2017221494Larochelle P, Kollmannsberger C, Feldman RD, et al. Hypertension management in patients with renal cell cancer treated with anti-angiogenic agents. Curr. Oncol. 2012;19:202and;ndash;208.Schwandt A, Wood LS, Rini1 B, et al. Management of side effects associated with sunitinib therapy for patients with renal cell carcinoma. OncoTargets and Therapy 2009;2:51and;ndash;61.Rini BI, Tamaskar I, Shaheen P, et al. Hypothyroidism in patients with metastatic renal cell carcinoma treated with sunitinib. J Natl Cancer Inst. 2007;99(1):81and;ndash;83.Rini BI, Sosman JA, Motzer RJ. Therapy targeted at vascular endothelial growth factor in metastatic renal cell carcinoma: biology, clinical results and future development. BJU Int 2005;96:286-90. Motzer RJ, Bukowski RM. Targeted therapy for metastatic renal cell carcinoma. Clin Oncol 2006;24:5601-8.Motzer RJ, Hutson TE, Tomczak P, et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med. 2007;356(2):115and;ndash;124. Chu TF, Rupnick MA, Kerkela R, et al. Cardiotoxicity associated with tyrosine kinase inhibitor sunitinib. Lancet 2007;370(9604):2011and;ndash;2019Telli ML, Witteles RM, Fisher GA, et al. Cardiotoxicity associated with the cancer therapeutic agent sunitinib malate. Ann Oncol. 2008;19(9):1613and;ndash;1618.Sica DA. Angiogenesis inhibitors and hypertension: An emerging issue. J Clin Oncol. 2006;24(9):1329and;ndash;1331.Aparicio-Gallego G, Blanco M, Figueroa A, et al. New insights into molecular mechanisms of sunitinib-associated side effects. Mol Cancer Ther 2011; 10: 2215-23.Pelletier K, and;Scaron;krtić M, Kitchlu A. Cancer therapy-induced hyponatremia: A case-illustrated review. Journal of Onco-Nephrology 2021;5(1):70and;ndash;78.Takasaki S, Kikuchi M, Kawasaki Y, et al. Severe toxicity induced by accumulation of active sunitinib metabolite in a Japanese patient with renal cell carcinoma: a case report. J Med Case Reports. 2017;11(1):1-4.