Shields Lisa Be, Kalebasty Arash Rezazadeh
Norton Neuroscience Institute, Norton Healthcare, Louisville, KY 40202, United States.
Norton Cancer Institute, Norton Healthcare, Louisville, KY 40202, United States.
World J Clin Oncol. 2020 Feb 24;11(2):103-109. doi: 10.5306/wjco.v11.i2.103.
Retroperitoneal lymph node dissection (RPLND) plays a diagnostic, therapeutic, and prognostic role in myriad urologic malignancies, including testicular carcinoma, renal cell carcinoma (RCC), and upper urinary tract urothelial carcinoma. RCC represents 2% of all cancers with approximately 25% of patients presenting with advanced disease. Clear cell RCC (CCRCC) is the most common RCC, accounting for 75%-80% of all RCC.
A 71-year-old man presented with a history of benign prostatic hypertrophy. He was asymptomatic without any hematuria, pain, or other urinary symptoms. A computed tomography (CT) scan of the abdomen and pelvis showed a 1.8 cm left retroperitoneal lymph node. There was no evidence of renal pathology. A core biopsy was performed of the left para-aortic lymph node. Although the primary tumor site was unknown, the morphological and immunohistochemical features were most consistent with CCRCC. A RPLND was performed which revealed a single mass 5.5 cm in greatest dimension with extensive necrosis. The retroperitoneal lymph node was most compatible with CCRCC. A nephrectomy was not conducted as a renal mass had not been detected on any prior imaging studies. The patient did not receive any type of adjuvant therapy. The patient underwent surveillance with serial CT scans with contrast of the chest, abdomen, and pelvis for the next 5 years, all of which demonstrated no recurrent or metastatic disease and no evidence of retroperitoneal adenopathy.
Our unique case emphasizes the therapeutic role of metastasectomy in metastatic CCRCC even in the absence of primary tumor in the kidneys.
腹膜后淋巴结清扫术（RPLND）在多种泌尿系统恶性肿瘤中发挥着诊断、治疗和预后评估的作用，这些肿瘤包括睾丸癌、肾细胞癌（RCC）和上尿路尿路上皮癌。RCC占所有癌症的2%，约25%的患者表现为晚期疾病。透明细胞肾细胞癌（CCRCC）是最常见的RCC类型，占所有RCC的75%-80%。
一名71岁男性，有良性前列腺增生病史。他没有任何血尿、疼痛或其他泌尿系统症状，无症状。腹部和盆腔计算机断层扫描（CT）显示左腹膜后淋巴结有一个1.8厘米的肿块。没有肾脏病变的证据。对左主动脉旁淋巴结进行了核心活检。尽管原发肿瘤部位不明，但形态学和免疫组化特征最符合CCRCC。进行了RPLND，发现一个最大直径为5.5厘米的单一肿块，伴有广泛坏死。腹膜后淋巴结最符合CCRCC。由于之前的任何影像学检查都未检测到肾脏肿块，因此未进行肾切除术。患者未接受任何类型的辅助治疗。在接下来的5年里，患者接受了胸部、腹部和盆腔增强CT扫描的监测，所有检查均未显示复发或转移性疾病，也没有腹膜后淋巴结肿大的证据。
我们的独特病例强调了即使在肾脏没有原发肿瘤的情况下，转移灶切除术在转移性CCRCC中的治疗作用。
