腎細胞癌合併同時性輸尿管轉移:案例報告

任駿逸、陳建旭

高雄長庚紀念醫院 泌尿科

Synchronous ureteral metastasis of renal cell carcinoma- A case report

Chun-Yi Jen, Chien-Hsu Chen

Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine

Background:

Approximately 20-30% of patients with renal cell carcinoma (RCC) have synchronous metastatic disease at the time of initial diagnosis. Common sites of metastasis are the lungs, bones, lymph nodes, liver, adrenals, and brain, but all organs can be affected. Ureteral metastasis of RCC is very rare; only a few case reports have been described in the literature, and most of them describe metachronous events. We present a rare case of synchronous ipsilateral ureteral metastasis of clear cell renal cell carcinoma.

Case presentation:

A 50-year-old man, who had hypertension with medication control before, suffered from intermittent painless hematuria for 1 month. Associated symptoms included left flank pain and body weight loss 7kgs in 3 months. He visited other hospital firstly, where kidney sonography revealed a huge left renal tumor. He then went to our outpatient department for second opinion. Abdominal computed tomography (CT) revealed a large heterogenous enhanced left renal mass about 12x15x16cm with tumor thrombi in left renal vein, which favor RCC. Chest CT did not demonstrate suspicious metastasis. Considering the large size, and tumor invasion nearly whole kidney, we performed radical nephrectomy with lymph node dissection. Pathology report of kidney revealed a clear cell renal cell carcinoma; ureter revealed a metastatic clear cell renal cell carcinoma instead of direct invasion from the kidney. The pathologic stage was T3aN0M1. To rule out other possible metastases, thorough evaluation with brain MRI, bone scan was done and found negative for other metastases. We will arrange adjuvant immunotherapy with pembrolizumab for this patient.

Discussion:

Because of the rare and uncommon nature of the disease, the standard of treatment is not well established. Patients with metastatic RCC generally have a poor prognosis. Recent trials have demonstrated that humanized antibodies that block PD-1 (e.g., nivolumab or pembrolizumab), PD-L1 (e.g., atezolizumab), or CTLA-4 (e.g., ipilimumab) can lead to complete and durable responses for patients with metastatic RCC. We will follow up the treatment effect and compare with previous similar cases presented before.