Department of Pathology, Faculdade de Medicina de São José do Rio Preto, São Paulo, Brazil.
Ren Fail. 2010;32(10):1223-5. doi: 10.3109/0886022X.2010.516852.
Immune complex (IC) deposition in renal tissue is considered as a possible tumor marker. This raised the hypothesis that some tumor markers might be related to the patient prognosis, with emphasis in the possibility to detect them in tissue sample, not only in blood. We report a patient with membranous glomerulonephritis (MGN) and tumoral IC deposition that were detected previous to the diagnosis of melanoma.
A 55-year-old male was admitted to our department with symptoms of renal disease; a kidney biopsy was performed and the diagnosis was phase II MGN. A few months later he returned to the hospital with ascites, dyspnea, anorexia, and macular erythematous skin lesions in the body. A new urinalysis showed proteinuria, hematuria, and leukocyturia; the chest X-ray showed a lung nodule; and a brain CT scan revealed a frontal nodular lesion, suggesting metastasis. The brain biopsy suggested the diagnosis of metastatic melanoma and a posterior kidney immunohistochemistry study with S-100 and HMB-45 antibodies showed glomerular and tubular positivity for these markers.
MGN and deposition of tumoral IC as a first manifestation of melanoma has not been previously reported. This case reinforces the importance of a clinical evolution focused on the diagnosis of a hidden cancer in patients with MGN. Oncologists should also be aware of the potential occurrence of glomerular lesion in their patients and that could be important during tumor therapy.
免疫复合物（IC）在肾组织中的沉积被认为是一种潜在的肿瘤标志物。这就提出了一个假设，即某些肿瘤标志物可能与患者的预后有关，重点是有可能在组织样本中而不仅仅在血液中检测到它们。我们报告了一例膜性肾小球肾炎（MGN）和肿瘤免疫复合物沉积的患者，这些沉积在黑色素瘤诊断之前就已被检测到。
一名 55 岁男性因肾脏疾病症状入院，进行了肾活检，诊断为 II 期 MGN。几个月后，他因腹水、呼吸困难、食欲不振和身体出现红斑性皮肤病变再次回到医院。新的尿液分析显示蛋白尿、血尿和白细胞尿；胸部 X 射线显示肺部结节；脑 CT 扫描显示额叶结节，提示转移。脑活检提示转移性黑色素瘤的诊断，随后对肾脏进行了 S-100 和 HMB-45 抗体的免疫组织化学研究，显示肾小球和肾小管对这些标志物呈阳性。
MGN 和肿瘤免疫复合物的沉积作为黑色素瘤的首发表现以前没有报道过。该病例强调了在 MGN 患者中对隐匿性癌症进行诊断的临床演变的重要性。肿瘤学家还应意识到其患者中可能发生肾小球病变，这在肿瘤治疗过程中可能很重要。
