Unusual Upper Gastrointestinal Bleeding due to Late Metastasis from Renal Cell Carcinoma: A Case Report

惡性腫瘤轉移至消化道的病例，在臨床上並不常見，機率僅約0.06-4%，因此轉移而導致消化道出血者又更為罕見，其中又以十二指腸侵犯的機率為最低。本文報告一相當罕見的病例，病患在住院九年前因右側腎臟腎細胞而接受根治性右側腎臟切除術，而在九年後，因大量上消化道出血而住院，經內視鏡檢查發現有十二指腸腫瘤併出血，因此接受次全胃切除術；經病理切片證實為九年前之腎細胞癌的晚期復發。由於腎細胞癌在切除後的變化較難預測且可能在較長的時間後才會復發。因此對腎細胞癌術後之患者必須長時間加以追蹤。由本病例可以得知即使患者在腎臟切除後許久才發生消化道出血，腎細胞癌併消化道轉移的可能性亦必須加以考慮及詳加檢查。若患者狀況允許，則手術切除轉移處為首選之治療方式。

關鍵字

腎細胞癌；十二指腸轉移；消化道出血

並列摘要

A case of recurrent massive upper gastrointestinal bleeding originating from metastatic renal cell carcinoma is reported. A 63-year-old woman underwent right nephrectomy 9 years previously and experienced no recurrence during follow-up. A gradually enlarging ulcerative tumor over the bulb of the duodenum and four subsequent episodes of massive bleeding from this tumor occurred between June 2001 and March 2002. The patient underwent surgery in April 2002 for intractable bleeding from the tumor. Renal cell carcinoma metastasis to the duodenum was confirmed from the surgical specimen. Upper gastrointestinal bleeding due to malignancy is very rare and the duodenum is the least frequently involved site. Furthermore, a solitary late renal cell carcinoma metastasis 9 years after a nephrectomy is extremely uncommon. This case suggests that life-long follow-up of renal cell carcinoma patients is necessary, owing to unpredictable behavior and the possibility of long disease-free intervals. In nephrectomized patients suffering from gastrointestinal bleeding, complete evaluation, especially endoscopic examination, is indicated. The possibility of late recurrent renal cell carcinoma metastasis to the gastrointestinal tract should be kept in mind, although it is rare. If the patient is fit for surgery, metastatectomy is the first choice of treatment.

並列關鍵字

duodenal metastasis ； renal cell carcubina ； upper gastrointestinal bleeding

國際替代計量

Unusual Upper Gastrointestinal Bleeding due to Late Metastasis from Renal Cell Carcinoma: A Case Report

未授權

主題瀏覽