病例報告:轉移性腎集尿管癌之長期存活

陳子双¹、鄭元佐¹

¹高雄長庚紀念醫院泌尿科

Long-term Survival of Metastatic Collecting Duct Renal Cell Carcinoma: A Case Report 

Tzu-Shuang Chen¹, Yuan-Tso Cheng¹

¹Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

Purpose: Collecting duct carcinoma (CDC) of the kidney is a rare and aggressive subtype of renal cancer, with a median survival of less than 17 months for stage IV disease. We herein reported a case with metastatic collecting duct renal cell carcinoma with long term survival.

Case presentation: A 63-year-old man presented with right flank pain and right hydronephrosis, underwent a percutaneous nephrostomy insertion. An abdominal CT scan identified a 6.0cm x 4.5cm infiltrating tumor in the middle pole of the right kidney. The pathology report of the renal tumor biopsy, with PAX 8 staining, suggested an epithelial origin. Subsequently, we performed a radical nephrectomy with lymph node dissection, and the pathology report confirmed stage IV CDC at pT4N0. Six months after surgery, the patient reported significant right abdominal pain. The abdominal CT scan showed a poorly defined, irregular enhanced mass (4cm x 2.6cm) in the right abdominal wall, involving adjacent peritoneum. A CT-guided biopsy confirmed the presence of disease metastasis. The patient underwent sequential treatments involving chemotherapy, radiotherapy, and immunotherapy. The patient reported no discomfort, and CT scans showed continuing shrinkage of the tumor with no signs of recurrent disease for 17 months.
Conclusions: Patients with advanced CDC have poor prognosis and data for effective adjuvant treatment are desperately needed. This case represents a surprisingly good outcome after chemoradiotherapy and immunotherapy. Further research is necessary.