Shimomura Tatsuya, Ikemoto Isao, Yamada Hiroki, Hayashi Norihiro, Ito Hiroyuki, Oishi Yukihiko
Department of Urology, Jikei University School of Medicine, Tokyo, Japan.
Int J Urol. 2005 Sep;12(9):835-7. doi: 10.1111/j.1442-2042.2005.01156.x.
We report a case of sarcomatoid renal cell carcinoma with a chromophobe component showing significant elevation of beta-human chorionic gonadotropin (beta-HCG) in the peripheral blood. A 35-year-old man was hospitalized because of a large tumor of the left kidney and elevated serum levels of beta-HCG. Extended nephrectomy was performed, after which the serum beta-HCG level decreased. However, 3 months later, masses were discovered in the left renal bed and in the lung in association with elevated serum levels of beta-HCG. The patient was rehospitalized and received combination therapy with interferon-alpha and doxorubicin-based multiple chemotherapy (cyclophosphamide, vincristine, doxorubicin, and dacarbazine). The recurrent mass responded extremely well to treatment, and beta-HCG normalized. However, the patient died 14 months after nephrectomy because of eventual resistance to chemotherapy. Sarcomatoid renal cell carcinoma containing beta-HCG positive cells were pathologically diagnosed with immunohistochemical staining in the left kidney. Sarcomatoid renal cell carcinoma is a variant of renal adenocarcinoma which has a poor prognosis. This patient had an extremely rare sarcomatoid renal cell carcinoma associated with serum levels of beta-HCG which were elevated and strongly correlated with morphologic cancer activity. beta-HCG might be a useful serum marker for detecting and monitoring this renal cell carcinoma.
我们报告一例伴有嫌色细胞成分的肉瘤样肾细胞癌病例，该病例外周血中β-人绒毛膜促性腺激素（β-HCG）显著升高。一名35岁男性因左肾巨大肿瘤及血清β-HCG水平升高入院。行扩大肾切除术，术后血清β-HCG水平下降。然而，3个月后，左肾床及肺部发现肿块，同时血清β-HCG水平升高。患者再次入院，接受了α-干扰素联合以多柔比星为基础的多种化疗（环磷酰胺、长春新碱、多柔比星和达卡巴嗪）。复发肿块对治疗反应极佳，β-HCG恢复正常。然而，患者在肾切除术后14个月因最终对化疗耐药而死亡。左肾经免疫组化染色病理诊断为含β-HCG阳性细胞的肉瘤样肾细胞癌。肉瘤样肾细胞癌是肾腺癌的一种变异型，预后较差。该患者患有极其罕见的肉瘤样肾细胞癌，其血清β-HCG水平升高且与形态学癌症活性密切相关。β-HCG可能是检测和监测这种肾细胞癌的有用血清标志物。
