腎細胞癌併惡性腹水
張哲維, 曾一修, 吳維哲, 張效駿, 鍾旭東
亞東紀念醫院外科部 泌尿科
Renal cell carcinoma with malignant ascites
Che-Wei Chang, Yi-shiou Tseng, Wei-Che Wu, Hsiao-Chun Chang, Shiu-Dong Chung
Division of Urology, Department of Surgery, Far Eastern Memorial Hospital
Introduction:
Ascites is rarely seen in the patients with renal cell carcinoma (RCC), with less than 2% of those who diagnosed of RCC. We present a case of a 37-year-old man who was diagnosed with renal cell carcinoma and received radical nephrectomy. Malignant ascites was diagnosed in the follow up.
Case presentation:
A 37-year-old man presenting with left flank pain and hematuria. Clinical examination revealed a lobulated tumor measuring 5.1 x 6.2 x 5.6 cm in middle pole of left kidney with enlarged lymph nodes in left upper paraaortic region. Left radical nephrectomy and lymph nodes dissection was performed and final diagnosis was renal cell carcinoma, pT 1bN1M0, Fuhrman grade 3-4. The pathology revealed that the tumor had focal clear cell pattern and prominent papillary growth pattern. During post operative follow up in 3 and 6 months, lymphadenopathy in left paraaortic region was noted and the size was increasing with time. Laparoscopic lymph node dissection was done and metastatic renal cell carcinoma was noted. After operation, the patient was treated with Sunitinib and follow up CT was done every 3 months.
After sunitinib treated for around one year, the patient presented abdominal pain and abdominal distention. CT revealed prominent lymph node in paraaortic and paracaval region. Diffuse carcinomatosis with massive ascites was also noted. Paracentesis was performed and cytology revealed metastatic carcinoma. Medication was switched to Pazopanib and the progression of ascites improved.
Conclusion:
Although malignant ascites is rare in RCC, literature review showed that it is a relatively common manifestation of metastatic papillary RCC. The presentation of malignant ascites is associated with a worse outcome in metastatic papillary RCC.