同時雙側多發性嫌色腎細胞癌之分期手術治療

張祐豪、李亞哲

嘉義基督教醫院 泌尿科

Staged Surgical Management of Synchronous Bilateral Multiple Chromophobe Renal Cell Carcinoma: A Case Report

Yu-Hao Chang, Ya-Che Lee

Department of Urology, Chiayi Christian Hospital, Chiayi, Taiwan

Purpose:

Chromophobe renal cell carcinoma (chRCC) ranks as the third most prevalent form of RCC, exhibiting distinct biological characteristics when compared to other subtypes of kidney cancer. The heterogeneity among RCC subtypes is linked to significant variations in tumor aggressiveness and the likelihood of metastatic progression. ChRCC is identified by chromosomal aneuploidy, along with mutations in genes such as TP53, PTEN, and those related to mitochondrial function.

Case report:

A 75-year-old gentleman visited the urology outpatient department, complaining of right flank pain that had been bothering him for the past two weeks. He had a history of hypertension and cardiovascular issues. During the physical examination, no abnormalities were detected. His laboratory results showed a normal complete blood count and renal function. However, a computed tomography scan of the abdomen using intravenous contrast revealed the presence of multiple kidney tumors, with three on the right kidney and one on the left kidney, raising suspicions of renal cell carcinoma.

Subsequently, the patient underwent a transperitoneal laparoscopic right radical nephrectomy and was discharged on the seventh day after surgery, experiencing no complications. Eight weeks later, he was readmitted for retroperitoneal left partial nephrectomy, and once again, he was discharged smoothly on the seventh postoperative day. The tumors were confirmed as chromophobe renal cell carcinoma (CHRCC) with clear surgical margins. The presence of CHRCC in both kidneys, occurring simultaneously, was determined based on both imaging findings and pathological results. Six months following the surgeries, Abdominal CT revealed no signs of recurrence, and the patient continued to be closely monitored during follow-up.

Conclusions:

The prevalence of bilateral renal cell carcinoma (RCC) is relatively low, comprising only 1% to 5% of all cases of kidney cancer [1,2]. Typical symptoms include abdominal pain, visible blood in the urine, and the presence of a palpable mass, although most cases of bilateral RCC are asymptomatic. There is no discernible difference in clinical presentation between bilateral multiple RCC and single RCC. Ultrasonography serves as a valuable screening tool for detecting kidney tumors, with our case initially identified through this imaging method. Bilateral RCC can be categorized as sporadic or hereditary, depending on the presence of a family history. Additionally, bilateral RCC can develop either synchronously or metachronously. Synchronous bilateral RCC accounts for approximately 3.0% to 4.2% of all RCC cases, while metachronous bilateral RCC is seen in approximately 0.4% of RCC cases.[3]

This represented an unusual instance of synchronous bilateral multiple chromophobe renal cell carcinoma. Striking a balance between the thorough removal of potentially cancerous tissue and the preservation of renal function while minimizing treatment-related impact poses a significant challenge. Our case report can potentially serve as a valuable point of reference for future research endeavors.

[1] Pahernik S, Cudovic D, Roos F, Melchior SW, Thüroff JW. Bilateral synchronous sporadic renal cell carcinoma: surgical management, oncological and functional outcomes. BJU Int. 2007;100:26–29.

[2] Wang B, Gong H, Zhang X, Li H, Ma X, Song E, Gao J, Dong J. Bilateral Synchronous Sporadic Renal Cell Carcinoma: Retroperitoneoscopic Strategies and Intermediate Outcomes of 60 Patients. PLoS One. 2016;11:e0154578. 

[3] Hu XY, Xu L, Guo JM, Wang H. Surgical strategy of bilateral synchronous sporadic renal cell carcinoma-experience of a Chinese university hospital. World J Surg Oncol. 2017;15:53.