黃詩孟¹、謝昆霖¹、黃冠華¹

¹奇美醫療財團法人永康奇美醫院外科部泌尿外科

Shih-Meng Huang¹、Kun-Lin Hsieh¹、Steven Kuan-Hua Huang¹

¹Division of Urology,Department of Surgery,Chi Mei Medical Center,Tainan,Taiwan

 

Paraneoplastic symptoms are presented in 20~40% of patients with renal cell carcinoma during the disease course,but it is rarely associated with urothelial carcinoma. It may confers poor prognosis on urothelial carcinoma.

We introduced the diagnosis and management of our case and reviewed the literature about  

paraneoplastic syndromes associated with urothelial carcinoma

A 74-year-old man with hypertension and chronic anemia presented with painless gross hematuria,flank pain and LUTS for weeks. The laboratory data showed impaired renal function with hematuria and suspicious for high-grade urothelial carcinoma in urine cytology analysis. The sonography and urotract-CT revealed left renal pelvis tumor with perirenal fat invasion,mild hydronephrosis and suspicious thrombosis of the left renal vein. No distant metastasis or lymphadenopathy was noted. The diagnostic ureterorenoscopy revealed tumor occupying whole renal pelvis and endoscopic biopsy revealed papillary urothelial carcinoma. The bone scan was no bony metastasis. However,persistent unexplained leukocytosis(Max:78000/ul) with hyponatremia and hypercalcemia(Max:18.54mg/dl) was noted during the course of admission. The bone marrow biopsy was no acute leukemia or non-Hodgkin lymphoma. Calcitonin, diuretics and hydration were prescribed for electrolyte imbalance. Neoadjuvant chemotherapy with nephroureterectomy was suggested for the cancer but it was suspended due to patient’s poor condition with trauma. However, he was found to have multiple metastasis including liver,spleen,bone and skin upon further evaluation in 2 months later. He received hospice care then and expired within 3 months from the time of first diagnosis.

Paraneoplastic syndrome occur due to the substances produced by tumor,such as parathyroid hormone-related peptide (PTH-rp), prostaglandin or granulocyte colony-stimulating factor (G-CSF) which were described in previous study. However, it was rarely associated with urothelial carcinoma,especially paraneoplastic leukocytosis. In our case,the patient was diagnosed as non-metastatic upper tract urothelial carcinoma initially with paraneoplastic syndrome,including leukocytosis, hypercalcaemia and hyponatremia,and he expired with the disease progressing rapidly with multiple metastasis within 3 months. As previous evidence of reviewed study,paraneoplastic syndrome may be associated with the tends to be high grade and aggressive with a poor prognosis which was similar to renal cell carcinoma.