一個巨大腎臟細胞癌-病例報告

陳祥來 許兆畬 童敏哲 殷約翰 戴浩平 謝肇新 黃鐘銘 翁瑋駿 黃立華 李毅彥 溫柏樺

劉家豐 王世農 許秋潤¹

童綜合醫院 外科部 泌尿科 ¹病理科

Hsiang-Lai Chen, Jow-Yu Sheu, Min-Che Tung, Jue-Hawn Yin, Haoping Tai, Siu-San Tse,

Zhon-Min Huang, Wei-Chun Weng, Li-Hua Huang, I-Yen Lee, Bo-Hua Wen, Ka-Fung Lau,

Shih-Nung Wang, Chiew-Loon Koo¹

Divisions of Urology, Department of Surgery, Tungs’ Taichung Metroharbor Hospital

¹Department of Pathology, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan

 

   A case of renal cell carcinoma (RCC) presenting to the Emergency Department with pyrexia and gross hematuria is discussed.

   An 82 years old female patient presented to the Emergency Department with feeling unwell, pyrexia, gross hematuria, nausea and abdominal pain. She gave a history of type 2 Diabetes mellitus with regular follow-up in our hospital. A large right renal mass was detected near 4 years ago. However, she and family refused operation since then due to old age. On examination she looked weakness. A mass was palpable in the right upper quadrant and lumbar region. Liver and spleen were not palpable. There were no signs of peritonitis. Her pulse rate was 121/minute, BP 189/104 and temp 39.3 degree. She had blood tests in the Emergency Department which revealed the following: Hb 15.6 g/dL, WBC 11,400 and platelets 202,000. Electrolytes were as follows: Na 136 mmol/litre, K 3.3 mmol/litre, BUN: 12, creatinine: 0.8, blood sugar: 213. Chest X ray showed 1) Mild coarse and crowding lung markings, some infiltration in bilateral lungs; but no focal active lung lesion. 2) Borderline cardiomegaly and mild tortuosity of aorta with some calcified atheroma plaques of aortic arch wall.. The patient had ultrasound scan which showed mass in the right kidney.Computerised tomography (CT) scan image of abdomen showed anterior upper pole tumor 9.5 x 12 x9.0 cm in size with heterogeneous enhancement and area of necrosis.Extension to perirenal fat and renal sinus fat but not Gerota fascia. Positron emission tomography (PET) revealed: 1. F-18 FDG avid lesion in the left thyroid, malignancy should be considered. 2. Right paraaortic lymph node metastases should be considered.

   She underwent right-side radical nephrectomy after full staging procedures and appropriate investigations.