Goldman F D, Dayton P D, Hanson C J
J Am Podiatr Med Assoc. 1989 Dec;79(12):618-25. doi: 10.7547/87507315-79-12-618.
Renal cell carcinoma is one of the great mimics in medicine. The diagnosis is complicated by clinical presentations involving a multitude of symptoms, often associated with the sites of metastasis. A high percentage of renal cell carcinomas have metastasized at the time of initial presentation, and symptoms associated with this metastasis may actually initiate the diagnosis. Because the site of tumor origin is frequently unknown, a diagnostic strategy for identifying the primary source has been proposed. The prognosis for renal cell carcinoma with metastasis is poor, with fewer than 9% of patients surviving at 5 years. Consequently, treatment is directed primarily at palliation of painful symptoms and stabilization of bony structures. With these goals in mind, treatment modalities run the gamut from radiotherapy, to curettage with polymethyl methacrylate augmentation, to amputation. In the case reported here, renal cell carcinoma was diagnosed in the course of evaluation of a painful lytic lesion of the foot. Treatment alternatives and associated risks and complications were discussed at some length and the patient chose curettage and packing with polymethyl methacrylate in combination with radiotherapy. This approach was successful in palliation of pain and maintenance of walking ability and independence.
肾细胞癌是医学上极具迷惑性的病症之一。其诊断较为复杂，临床表现包含多种症状，且常与转移部位相关。相当比例的肾细胞癌在初次就诊时就已发生转移，而与这种转移相关的症状实际上可能促使诊断的做出。由于肿瘤起源部位常常不明，因此有人提出了一种识别原发灶的诊断策略。发生转移的肾细胞癌预后较差，5 年生存率不到 9%。因此，治疗主要针对缓解疼痛症状和稳定骨质结构。鉴于这些目标，治疗方式多种多样，从放射治疗到聚甲基丙烯酸甲酯增强刮除术，再到截肢。在本文报道的病例中，肾细胞癌是在对足部疼痛性溶骨性病变进行评估的过程中被诊断出来的。对各种治疗选择以及相关风险和并发症进行了详细讨论，患者选择了聚甲基丙烯酸甲酯刮除填充联合放射治疗。这种方法成功缓解了疼痛并维持了行走能力和独立性。
