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Spontaneously ruptured breast metastasis from renal cell carcinoma 20 years post-nephrectomy: a case report and literature review
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DOI：10.3389/fmed.2026.1859653.png)
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Abstract
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BackgroundBreast metastases from extramammary malignancies are rare; and those originating from renal cell carcinoma (RCC) are exceptionally uncommon. These lesions often follow an indolent course; delaying recognition until acute; life-threatening complications such as hemorrhagic rupture occur. The lack of standardized management guidelines further impedes timely intervention.Case presentationAn 88-year-old woman with a history of radical nephrectomy for clear cell RCC 20 years prior presented with active hemorrhage from a spontaneously ruptured right breast mass. Two years earlier; a 2.5 × 1.5 cm nodule (BI-RADS 3) had been detected but managed conservatively without biopsy; gradually enlarging over the following two years. On admission; physical examination revealed a large; tender mass (∼6.5 × 6 × 7.5 cm) with skin erythema; ulceration; and active bleeding. CT demonstrated the breast mass and revealed two additional imaging-suspected lesions: a right pulmonary nodule and a right adrenal mass. After hemodynamic stabilization; right simple mastectomy was performed; achieving definitive hemostasis. Histopathology and immunohistochemistry (CAIX+; PAX-8+; vimentin+; GATA-3-; GCDFP-15−; ER−; PR−) confirmed metastatic clear cell RCC. The patient declined systemic therapy. At 30-month telephone follow-up; she reported no symptomatic local recurrence or new symptoms; however; no postoperative imaging was performed to confirm this.ConclusionThis case illustrates a critical two-stage progression of breast metastasis from RCC—indolent growth followed by rapid enlargement and hemorrhagic rupture. It underscores that while a BI-RADS 3 lesion in an RCC survivor may be managed with standard short-interval imaging; any interval enlargement or morphological change should prompt a lower threshold for tissue confirmation. An IHC panel (PAX-8/CAIX positivity with negative breast-specific markers) is essential for confirming metastatic RCC. The absence of postoperative imaging in this case—with follow-up limited to symptom-based telephone assessment—highlights the critical importance of radiological surveillance to objectively evaluate disease status.
Keywords:
case report
renal cell carcinoma
metastasectomy
oligometastasis
breast metastasis
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