Candura Stefano Massimo, Boeri Riccardo, Teragni Cristina, Chen Yao, Scafa Fabrizio
Unit of Occupational Medicine, Department of Public Health, Experimental and Forensic Sciences, University of Pavia, Italy Unit of Occupational Medicine, Salvatore Maugeri Foundation, Work and Rehabilitation, IRCCS, Scientific Institute of Pavia, Italy.
Med Lav. 2016 May 26;107(3):172-7.
Asbestos is the main causal factor for malignant mesothelioma (MM), a relatively rare and aggressive malignancy. Some epidemiological evidence suggests a role of this agent also in the etiology of renal cell carcinoma (RCC), the most common form of kidney cancer.
After 7 years of asbestos exposure, a 76-year-old asbestos-cement worker came to our notice with left flank pain. Diagnostic imaging disclosed a neoplasm in the upper two thirds of the left kidney, without evidence of metastases. After surgery (nephrectomy with para-aortic lymphadenectomy), histopathology revealed clear cell RCC. One year later, the patient was hospitalized for abdominal pain. Laparoscopy showed diffuse neoplastic infiltration of the peritoneum and liver. Histological and immunohistochemical examination of the bioptic samples led to the diagnosis of biphasic MM. The subject died 2 months later. Autopsy disclosed ascites and diffuse infiltration of the abdominal wall and viscera, without evidence of RCC relapse.
This is the second reported case of association between RCC and peritoneal MM in the scientific literature. Asbestos might be involved in the causation of both malignancies.
石棉是恶性间皮瘤（MM）的主要致病因素，MM是一种相对罕见且侵袭性强的恶性肿瘤。一些流行病学证据表明，这种物质在最常见的肾癌——肾细胞癌（RCC）的病因中也起作用。
一名76岁的石棉水泥工人在接触石棉7年后，因左侧腰痛引起我们的注意。诊断性影像学检查发现左肾上部三分之二处有肿瘤，无转移迹象。手术后（肾切除术加主动脉旁淋巴结切除术），组织病理学显示为透明细胞肾细胞癌。一年后，患者因腹痛住院。腹腔镜检查显示腹膜和肝脏有弥漫性肿瘤浸润。对活检样本进行组织学和免疫组化检查后诊断为双相性MM。该患者2个月后死亡。尸检发现有腹水，腹壁和内脏有弥漫性浸润，无肾细胞癌复发迹象。
这是科学文献中第二例报告的肾细胞癌与腹膜间皮瘤相关的病例。石棉可能与这两种恶性肿瘤的发生有关。
