Proteinuria in a Patient with Transitional Cell Carcinoma of Renal Pelvis with Extension into Inferior Vena Cave

重度蛋白尿表現於腎移形細胞癌侵犯至下腔靜脈之病人

高劍虹(Chien-Hung Gow) ； 馮祥華(Shyang-Hwa Ferng) ； 王宗熙(Tsung-Hsi Wang)

《Acta Nephrologica》 15卷2期 (2001/04) Pp. 71-76

摘要

腎移形細胞癌並不常見，約只佔腎原發性腫瘤百分之七，若有腎移形細胞癌侵犯下腔靜脈併有腫瘤栓塞發生則更為罕見，至今僅有十九例在世界文獻被報告過。多數病人之臨床表現為大量血尿，其次為腰腹疼。此病例為一位六十八歲女性，初始症狀為長期混濁泡狀尿液，後檢測為重度蛋白尿，腎臟超音波及電腦斷層掃描均發現右腎腫瘤並疑似侵犯下腔靜脈，尿液細胞學診斷並無發現癌細胞，術前診斷為腎細胞癌，右腎切除後病理診斷為腎移形細胞癌併下腔靜脈腫瘤栓塞，此種腫瘤侵犯以重度蛋白尿來表現可為首例。腎移形細胞癌併下腔靜脈腫瘤栓塞之預後極差，僅百分之六十在診斷及手術切除後存活六個月。此病例在右腎切除二週後蛋白尿、血尿之症狀均消失，而在沒有併用化學治療清況下，術後十二個月並無腫瘤複發現象。因此重度蛋白尿伴隨偶發血尿或腰腹痛，應將腎移形細胞癌併下腔靜脈腫瘤栓塞列為鑑別診斷。本篇並將此病例與迄今世界文獻之報告做一比較及分析。

關鍵字

移形細胞癌 ； 腫瘤栓塞 ； 下腔靜脈 ； 蛋白尿

並列摘要

Transitional cell carcinoma (TCC) of the renal pelvis and upper uncommon, accounting for only 7% of all primary tumors of the kidney. Tumor thrombus of transitional cell carcinoma invading reported. Gross hematuria is the most common symptom in these documented cases, followed by flank pain. Besides episodic hematuria and flank pain, the persistent foamy and cloudy urine, initially noticed by our patient, was disclosed to be heavy proteinuria after laboratory tests. Renal ultrasonography and subsequent computerized tomography (CT) showed a huge tumor occupying the right renal pelvis with a suspicious thrombus in the inferior vena cava. Under the impression of renal cell carcinoma, right radical nephrectomy with vena cava thrombectomy was perfomed. The final pathological diagnosis was transitional cell carcinoma with an inferior vena cava thrombus. The prognosis for such patients is relatively poor in the previous reports, only 60% of them surviving longer than six months with or without adjuvant chemotherapy. In our case, hematuria, flank pain, proteinuria all disappeared spontaneously two weeks after tumor rmoval and, without adjuvant chemotherapy, no obvious recurrence was observed during the follow up for twelve months. In clinical practice, physicians should be alerted by heavy proteinuria with gross hematuria and/or flank pain and consider TCC with invasion of the vena cava as one of the possible differential diagnosis.

並列關鍵字

Transitional cell carcinoma ； Tumor thrombus ； inferior vena cava ； proteinuria