Clear cell renal carcinoma brain metastases

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Clear cell renal carcinoma brain metastases treatment.

1. Psoriasis.
2. Left ankle fracture, surgically treated.
3. Breast cancer treated with surgery and radiotherapy.
4. 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:

- 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.

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.

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.