Clear cell renal carcinoma brain metastases [Neurosurgery Wiki]

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====== Clear cell renal carcinoma brain metastases ======

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===== Treatment =====

[[Clear cell renal carcinoma brain metastases treatment]].


===== Q10447 =====

  - [[Psoriasis]].
  - Left ankle fracture, surgically treated.
  - [[Breast cancer]] treated with surgery and radiotherapy.
  - Renal [[neoplasm]] with [[nephrectomy]].

**Current Illness:**
- A 62-year-old patient with [[asthenia]], [[headache]], [[apathy]], [[bradypsychia]], lack of concentration, and changes in personality and behavior. A right frontal lesion measuring 5 cm and a left cerebellar lesion measuring 1 cm were identified.

**Physical Examination:**
- Bradypsychia, left central facial paresis, mild paresis in the left arm, and positive neurological signs on the left side were observed.

**Complementary Examination:**

{{:pasted:20241009-180458.png}}

- **Imaging studies:** Right frontal lesion measuring 5x4x4 cm with edema, ventricular collapse, and a 1 cm lesion in the left cerebellum. Ventricular system compression and [[subfalcine herniation]] were noted.

**Previous Intervention:**
- A craniotomy with excision of the right frontal lesion was performed.

**Histopathology:**
- [[Clear cell renal carcinoma]], consistent with metastasis from a known renal primary tumor.

**Oncological Evolution:**
- Brain recurrence with lesions in the right frontal lobe and left cerebellum. Treatment with radiotherapy and radiosurgery was administered.
- Systemic immunotherapy was initiated but discontinued due to complications.
- Progression of brain metastases.

**Treatment Plan:**
- Referral for postoperative radiotherapy.

===== Q11864 =====

Age: 59 years
Relevant Medical History: Hypertension (HTA), Type 2 Diabetes Mellitus (DM2).

Current Medications:

[[Bisoprolol]] 5mg, 1 tablet every 24 hours.

[[Metformin]] 1000mg, 1 tablet every 12 hours.

[[Omeprazole]] 20mg, 1 capsule every 24 hours.

Ferbisol (Iron) 100mg, 1 capsule every 24 hours.

Escitalopram 10mg, 1 tablet every 24 hours.

Oncological History:

Stage IV [[clear cell carcinoma]] with pulmonary metastases.

Previous treatments: Right [[nephroureterectomy]], SBRT RADICAL TOTAL DOSE 60Gy, [[Nivolumab]]-[[Ipilimumab]], [[Cabozantinib]].

Clinical Presentation:

Progressive weakness and asthenia.
Dizziness, instability, intense holocranial headache.

Radiological Findings:

Brain MRI: Space-occupying lesion in the right frontal lobe suggestive of brain metastasis.

{{:pasted:20240418-110427.png?300}}

TAP CT: Findings secondary to known oncological history, without significant progression signs.
Postoperative Brain CT: Post-right frontal craniotomy changes without clear evidence of residual tumor.
Surgical Procedure:

Craniotomy and resection of the brain tumor.


Postoperative Evolution:

Improvement of preoperative clinical status.
Conscious, oriented, without new neurological focal deficits.
Autonomous ambulation

Afebrile, no signs of wound infection.
Postoperative images without complications or significant tumor remnants.

Management Plan:

Referral to Oncology and Radiotherapy for evaluation and management on the surgical bed.
Hospital discharge with follow-up in Neurosurgery outpatient clinics.
Comment:
The patient has experienced a favorable evolution after the resection of the brain tumor, without significant postoperative complications. Multidisciplinary follow-up is planned to address the primary and secondary diseases.