病例報告－罕見病理學型態的原發性後腹腔腫瘤(後腹腔神經內分泌瘤)

鄭存翔¹、陳慧雅¹、何東儒¹、林健煇¹、黃國財¹、劉昱良¹、陳志碩^1、2、黃雲慶^1、2

¹嘉義長庚紀念醫院外科部泌尿外科; ²長庚大學醫學院醫學系

A Case of Primary Retroperitoneal Tumor with Rare Pathology – Neuroendocrine tumor

Tsun-Hsiang Cheng¹, Wai-Nga Chan¹, Dong-Ru Ho¹, Jian-Hui Lin¹, Kuo-Tsai Huang¹, Yu-Lian Liu¹, Chih-Shou Chen^1,2, Yun-Ching Huang^1,2

¹Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan;

²Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan;

Abstract: This is a 66-year-old man, also a vegetarian, with the past history of chronic kidney disease and anemia. He had no alcohol drinking, betel nuts chewing and smoking history. There was no known cancer history in his family members.

He visited the emergency department on September, 15^th, 2018, presented with bilateral flanks pain and decreased urine amount. He also had long-term urinary frequency. On physical examination, mild right flank knocking pain was noted. The initial blood test revealed acute kidney injury, with Creatinine 4.18, which add on the chronic kidney disease. Kidney sonography revealed bilateral severe hydronephrosis. Besides, the abdominal CT accidentally found a huge left suprarenal mass, which was 13.2x 12.1x 15.7cm in size and containing mixed fat, soft tissue, was suspicious for adrenal myelolipoma. He was admitted to the Nephrologist’s service under the diagnosis of 1) Acute kidney Injury, KDIGO-stage 3, obstructive uropathy related, 2) chronic kidney disease, Stage G4, chronic glomerulonephritis related.

The Urologist was consulted on September, 21th, 2018. The PSA level was 10.09 ng/mL. Transrectal ultrasound of prostate showed prostate hyperplasia with prostatitis change and the prostate size was 169.5 mL. Transurethral resection of prostate was arranged on 2018.10.15. The pathology results were nodular hyperplasia. After the obstructive uropathy was solved. The family and the patient himself refused surgical resection of the adrenal tumor. Therefore, he was under the Nephrologist’s and Urologist’s follow-up.

    He was found markedly body weight loss from 54 kg to 45 kg in 2 months on 2020.05.13. The tool occult blood test was positive. He also had deteriorated proteinuria. Under the suspicion of cancer cachexia, he was admitted to the Nephrologist’s service for malignancy survey. The examination, including ENT fiberscopy, abdominal echo, GI tract panendoscopy, was performed, which showed no tumor. The tumor marker test showed elevated CA19-9 and SCC. The whole body CT reported mild progression in the retroperitoneal mass and multiple metastatic lesions. The Oncologist suggested that the tumor was teratoma with SCC differention or primary retroperitoneal SCC, with possible lung and bone metastasis. Therefore, en bloc resection for pathology proving was performed on May, 25^th, 2020. The pathology results were neuroendocrine tumor, grade 3, arising from mature cystic teratoma. The subsequent Bone scan showed negative for metastasis. After the surgery, he was on the Oncologist’s follow-up.