Van Wynsberge L K, Vierling P, Lampel A
Klinik für Urologie und Kinderurologie der Stadt Villingen-Schwenningen.
Aktuelle Urol. 2004 Nov;35(6):505-7. doi: 10.1055/s-2004-818528.
Renal tumors are often diagnosed during routine radiological-imaging. A newly diagnosed renal tumor next to an existing cancer is challenging since a primary or a secondary renal neoplasm has to be considered in the differential diagnosis.
A 64-year-old woman underwent radical mastectomy and axillary lymphadenectomy for cancer of the right breast. After surgery, the patient underwent chemotherapy and radiotherapy because of multiple metastases. Six years later, computed tomography (CT) obtained as follow-up examination revealed a solid mass in the left kidney. Because radiological differentiation between metastatic breast cancer and primary kidney tumor was impossible and fine needle biopsy of renal tumors should be avoided, a nephrectomy was performed. Histologic diagnosis was a metastatic breast cancer within a primary renal cell carcinoma. Whereas the primary tumor was receptor negative, the breast cancer metastasis was estrogen receptor positive.
In a renal mass of unknown nature in patients in good general condition and acceptable life-expectancy, surgical exploration with partial or radical nephrectomy is justified in spite of a synchronous metastatic tumor of different origin. This is the only way to obtain a definitive histologic diagnosis. A primary renal tumor can be treated curatively, preventing secondary complications, such as hematuria. In this case, the changed receptor state of the breast cancer metastasis also offered the patient the possibility of new palliative chemotherapy and hormonal manipulation.
肾肿瘤常在常规影像学检查时被诊断出来。新诊断出的肾肿瘤毗邻已有的癌症具有挑战性，因为在鉴别诊断中必须考虑原发性或继发性肾肿瘤。
一名64岁女性因右乳癌接受了根治性乳房切除术和腋窝淋巴结清扫术。术后，由于多处转移，患者接受了化疗和放疗。六年后，作为随访检查进行的计算机断层扫描（CT）显示左肾有一个实性肿块。由于无法通过影像学鉴别转移性乳腺癌和原发性肾肿瘤，且应避免对肾肿瘤进行细针穿刺活检，因此进行了肾切除术。组织学诊断为原发性肾细胞癌内的转移性乳腺癌。原发性肿瘤受体阴性，而乳腺癌转移灶雌激素受体阳性。
对于一般状况良好且预期寿命可接受的患者，其肾肿块性质不明时，尽管存在不同起源的同步转移性肿瘤，进行部分或根治性肾切除术的手术探查仍是合理的。这是获得明确组织学诊断的唯一方法。原发性肾肿瘤可以得到根治性治疗，预防诸如血尿等继发性并发症。在本病例中，乳腺癌转移灶受体状态的改变也为患者提供了新的姑息性化疗和激素治疗的可能性。
