一名年輕男性紅斑性狼瘡患者，合併多個進展迅速原發性惡性腫瘤之病例報告

蔡正晏、陳汶吉、張議徽、王又德、蕭博任、陳冠亨、連啟舜、謝博帆、邱鴻傑、鄒頡龍

陳國樑、葉進仲、張士三、黃志平、張兆祥、楊啟瑞、吳錫金

中國醫藥大學附設醫院 泌尿部

Multiple Primary Malignancies with Rapid Progress in a Young Male Patient with Systemic Lupus Erythematosus: A Case Report

Cheng-Yen Tsai, Wen-Chi Chen, Yi-Huei Chang, Yu-De Wang, Po-Jen Hsiao, Guan-Heng Chen, Chi-Shun Lien, Po-Fan Hsieh, Hung-chieh Chiu, Chieh-Lung Chou, Kuo-Liang Chen, Chin-Chung Yeh, Shih-San Chang, Chi-Ping Huang, Chao-Hsiang Chang, Chi-Rei Yang, Hsi-Chin Wu   

Divisions of Urology, China Medical University Hospital, Taichung, Taiwan

Introduction: Systemic lupus erythematosus (SLE) is an autoimmune systemic disease with female predominant. SLE is associated with many clinical disorders included nephritis, end-stage renal disease, hematological disorders, cardiovascular disorder, neurological disorders, skin disorders, and cancers. We report a male patient with SLE who have end stage renal disease, cardiovascular disease and multiple primary malignancies. The clinical presentation was unusual and rapid progress.

Case report: This is a 42-year-old male patient with history of SLE diagnosed at age of 15-year-old. He developed lupus nephritis with end-stage-renal-disease 2 years later and underwent regular hemodialysis since June, 1994. He has been diagnosed of hepatocellular carcinoma of right lobe at 2000 during survey of possible renal transplantation and been treated by trans-arterial chemoembolization. He first found of a 6 mm left renal tumor from abdominal CT at Feb, 2015. He underwent right radical nephrectomy at March 2015. The pathology report was acquired cystic disease-associated with renal cell carcinoma. At September 2015, hematuria occurred. Cystourethroscopy and retrograde pyelography disclosed a papillary lesion in urinary bladder. Pathology report from transurethral resection of bladder tumor (TURBT) specimen was non-invasive papillary urothelial carcinoma (UC), low grade (Ta). That painless hematuria occurred again. CT revealed a left renal mass. He underwent laparoscopic left NU+BCE due to suspicious urothelial cell carcinoma of upper urinary tract. However, the pathology report yielded multifocal grade 2-3/4 mixed papillary and chromophobe/eosinophilic renal cell carcinoma.Follow-up abdomen CT reveals stable disease at December 2022. Cytogenetic study of chromosome from blood sample has been performed for further analysis possible genetic association. The result yield normal 46 XY karyotype chromosome.

Discussion: SLE is highly associated with some cancers. A meta-analysis from Song et al reported SLE is significantly associated with 16 cancers which included non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, leukemia, multiple myeloma, cervix, vagina/vulva, renal, bladder, esophagus, gastric, hepatobiliary, lung, oropharynx, larynx, non-melanoma skin, and thyroid cancers in both gender. However, the risk of prostate cancer and melanoma was decreased. Our patient had a rapid progress renal cell carcinoma was rarely reported by previous literature.