Hwang S M, Kuyava J M, Grande J P, Swetz K M
Mayo Medical School, Rochester, Minnesota, USA.
Section of Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
BMJ Case Rep. 2015 Jan 7;2015:bcr2014206101. doi: 10.1136/bcr-2014-206101.
We present an unusual case of metastatic renal cell carcinoma (RCC) mimicking diverticulitis in a 76-year-old man with a 16-year history of chronic lymphocytic leukaemia (CLL) and a 2 cm left renal mass. The patient presented with severe abdominal pain and lower gastrointestinal bleeding with anticoagulation from recent pulmonary embolism. His clinical course was troubled by recurrent hospitalisations and complications that delayed investigations and potential treatments. Radiographic findings revealed stable CLL, mild sigmoid diverticulitis and a small renal mass. Small renal masses (less than 4 cm) are considered low risk for metastasising and are, thus, often observed or ablated, rather than resected. Furthermore, gastrointestinal metastases from RCC are rare. This case adds new perspective to the unpredictable nature of RCC and how synchronous malignancies may be masked in patients with long-standing CLL.
我们报告了一例不寻常的转移性肾细胞癌（RCC）病例，该病例在一名76岁男性中表现为类似憩室炎，患者有16年慢性淋巴细胞白血病（CLL）病史，左肾有一个2 cm的肿块。患者因近期肺栓塞接受抗凝治疗，出现严重腹痛和下消化道出血。他的临床病程因反复住院和并发症而受到困扰，这些延误了检查和潜在治疗。影像学检查结果显示CLL稳定，轻度乙状结肠憩室炎和一个小的肾肿块。小的肾肿块（小于4 cm）被认为转移风险低，因此通常进行观察或消融，而不是切除。此外，RCC的胃肠道转移很少见。本病例为RCC不可预测的性质以及长期CLL患者中同步恶性肿瘤如何被掩盖提供了新的视角。
