Valdespino-Castillo Víctor Edmundo, Ruiz-Jaime Alejandro
Hospital General de Zona 1, Instituto Mexicano del Seguro Social, Campeche, Campeche.
Cir Cir. 2008 Jul-Aug;76(4):339-42.
Renal cell carcinoma (RCC) represents approximately 3% of malignant tumors in adults and occurs in a M:F ratio of 1.5:1.0. Although in most cases it occurs in persons 50 to 70 years of age, there are also reports in children. Clear cell carcinoma is the most frequent histological type, and 30% of renal carcinomas have metastasized at the time of diagnosis. The objective of the present study is to report colon metastasis of clear cell carcinoma that required surgery and chemotherapy.
We report the case of a 60-year-old male with a history of metastatic RCC. His treatment consisted of cytoreductive radical nephrectomy and interferon because of pulmonary disease. He was followed-up for 8 years. Nevertheless, he presented with hematochezia and underwent colonoscopy where a splenic flexure tumor was demonstrated. Biopsy reported a clear cell tumor. We performed a left hemicolectomy. Pathology report was clear cell carcinoma with involvement of the colon from the mucosa to serosa. The patient again received interferon. Currently, there is no evidence of tumor activity and the patient is being followed-up.
RCC metastases are most frequent in lung, liver, and bone and less frequent in brain, skin, and soft tissue. Metachromic metastases are identified in the first to second year after nephrectomy in most cases. Survival of patients who present metastasis <1 year after nephrectomy is 33 months vs. patients who present metastasis after 1 year from nephrectomy (55 months). Metastatic clear cell carcinoma requires surgery and immunotherapy. Surgery is the first step for disease control and metastatecomies are indicated in localized disease or when one organ is affected and surgically accessible.
肾细胞癌（RCC）约占成人恶性肿瘤的3%，男女发病率之比为1.5:1.0。虽然大多数病例发生在50至70岁的人群中，但也有儿童病例的报道。透明细胞癌是最常见的组织学类型，30%的肾癌在诊断时已有转移。本研究的目的是报告需要手术和化疗的透明细胞癌结肠转移病例。
我们报告一例60岁男性转移性肾细胞癌患者。由于肺部疾病，他接受了减瘤性根治性肾切除术和干扰素治疗。他接受了8年的随访。然而，他出现便血，接受了结肠镜检查，发现脾曲部有肿瘤。活检报告为透明细胞瘤。我们进行了左半结肠切除术。病理报告为透明细胞癌，累及结肠黏膜至浆膜层。患者再次接受干扰素治疗。目前，没有肿瘤活动的证据，患者正在接受随访。
肾细胞癌转移最常见于肺、肝和骨，而在脑、皮肤和软组织中较少见。大多数情况下，变色转移在肾切除术后第一至二年被发现。肾切除术后<1年出现转移的患者生存期为33个月，而肾切除术后1年出现转移的患者生存期为55个月。转移性透明细胞癌需要手术和免疫治疗。手术是控制疾病的第一步，对于局限性疾病或当一个器官受影响且可手术切除时，应进行转移灶切除术。
