Needle-track Tumor Seeding Consequent to Renal Biopsy

A 48-year-old female presented to oncology clinic with a 2-month history of progressively worsening dull aching pain and swelling in the right flank along the inferior costal margin. Skin examination showed raised, erythematous lesion which was tender with induration and palpable subcutaneous nodules (Figure 1a). 15 months prior, the patient was noted to have a 3.5 cm right renal mass; for diagnosis, she underwent a computed tomography-guided needle biopsy percutaneously (at the site of current pain and swelling) (Figure 1b). Histopathology had revealed a papillary renal cell carcinoma, and she was treated with laparoscopic right nephrectomy. A current magnetic resonance imaging of the abdomen (T2, axial) showed infiltrative mass lesion in the right renal fossa extending along the needle track posterior to the caudate lobe and right posterior lateral segment of the liver (Figure 1c). Because of the extensive infiltrative nature of the lesion, it was not amenable for surgical excision. Systemic treatment with temsirolimus was initiated with consideration for local radiation therapy if the pain from the lesion worsens. While tumor recurrence along the needle-track of renal biopsy is a rare event, it is a recognized potential complication with an overall risk of less than 0.01%.[1]