- 期刊
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Recurrent Renal Cell Carcinoma Presenting as Metastatic Lesions and Membranous Glomerulopathy: Coincident or Associated?
再發性腎細胞癌以轉移病灶合併膜性腎病變來表現：巧合發生或相關性？
摘要
腎細胞癌(Renal cell carcinoma, RCC)合併膜性腎病變(membranous glomerulonephropathy, MN)是很少見的。再發性腎細胞癌以MN來表現，以之前文獻未曾報告過。我們在此報告一位51歲男性有左邊腎腫瘤合併主動脈淋巴結的侵犯，在開刀前之尿液檢查沒發現蛋白尿且腎功能正常。他後來接受左邊全腎切除(radical nephrectomy)和淋巴結清除(lymphadenectomy)，並且接受化學治療其病理報告顯示腎細胞癌(Robson's stage Ⅲ b)，而病灶旁的腎絲球及間質在光學及電子顯微鏡下都沒有特殊變化。病人在門診追蹤接受腹部超音波、電腦斷層攝影、全身骨骼和鎵腫瘤核醫掃瞄(Gallium-67 tumor scan)，但都沒有腫瘤復發跡象，這段期間也沒發現蛋白尿。兩年半之後，病人出現腎病症候群。此時的電腦斷層攝影和鎵(Ga67)腫瘤核醫掃描都顯示復發性腎細胞癌合併主動脈旁、腸繫膜(mesenteric)和左邊鎖股上(supraclavicular)之淋巴結腫大，右邊腎臟病理切片顯示是MN。此一病例為再發性腎細胞癌併發轉移病灶和膜性腎病變來表現，其為同時巧合發生或是有相關性，則無法證實，我們將討論再發性腎細胞癌和膜性腎病變相關的可能病理機制。
並列摘要
Renal cell carcinoma (RCC) associated with membranous glomerulonephropathy (MN) is rare. Furthermore, recurrent RCC presented with MN was never reported before, and we hereby describe such a case. A 51-year-old man had left renal tumor and para-aortic lymph nodes involvement. Before operation, routine urinalysis did not reveal proteinuria, and the serum creatinine was normal. He received left radical nephrectomy, lymphadenectomy, and subsequent immunotherapy. Renal pathology revealed RCC, nuclear grading 3/4, Robson stage Ⅲb. The glomeruli and interstitium nearby the tumor did not show any pathological finding by light and electron microscopic examination. He received follow-up abdominal computed tomography, bone scan, and Gallium-67 tumor scan every six months, and no tumor recurrence was noted. There is no significant proteinuria during this tumor-free follow-up period. Two and a half years after resecting primary tumor, nephrotic syndrome developed. Enlarged left supraclavicular lymph nodes were also noted, and aspirational cytology showed metastatic carcinoma. Computed tomography and Gallium-67 tumor scan showed recurrent RCC with metastatsis to para-aortic, mesenteric and left supraclavicular lymph nodes. And the finding of renal biopsy revealed MN. This is a case of recurrent RCC presenting as metastatic lesions and MN, whether they are associated or just coincident is unknown. We discuss the possible pathogenetic mechanism of the association between recurrent RCC and MN.
延伸閱讀
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