Jain Nikita, Bharat Anchit, Ludhwani Dipesh, Khaddour Karam, Weyburn Thomas
Internal Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science, McHenry, USA.
Internal Medicine, Indiana University Health Ball Memorial Hospital, Muncie, USA.
Cureus. 2020 Jul 12;12(7):e9154. doi: 10.7759/cureus.9154.
Renal cancers are one of the common causes of cancer-related morbidity and mortality worldwide. Most primary cases are localized at presentation and are treated with partial or radical nephrectomy with curative intent. However, renal cell carcinoma (RCC) is known for its potential recurrence, sometimes several years after initial management. Many of these recurrent cases commonly metastasize to the liver, kidney, or bone and herald a poor prognosis. We present a case study of nonclear cell RCC, which recurred 33 years after nephrectomy and masqueraded as a duodenal ulcer -- an extremely rare site for metastasis. This is unique as it describes a presentation only sparingly documented in the medical literature and highlights a more extended period of recurrence than currently reported. Moreover, our patient's tumor was chromophobe cell variety, a rare sub-type of nonclear cell RCC, which to our knowledge has never been known to cause duodenal metastasis. Studies have implicated a prognostic role of lymph node involvement at the time of initial diagnosis to predict future recurrence. This case is a drop in the mighty ocean to prompt further investigation on the utility of life-long surveillance protocols and further research evaluating the role of lymph node dissection in preventing such recurrences and high mortality.
肾癌是全球范围内癌症相关发病和死亡的常见原因之一。大多数原发性病例在初诊时为局限性，采用保留肾单位手术或根治性肾切除术进行治疗，目的是治愈。然而，肾细胞癌（RCC）以其潜在的复发而闻名，有时在初始治疗后的数年才复发。许多这些复发病例通常会转移至肝脏、肾脏或骨骼，预示着预后不良。我们报告一例非透明细胞肾细胞癌的病例研究，该病例在肾切除术后33年复发，表现为十二指肠溃疡——这是一个极其罕见的转移部位。这一病例很独特，因为它描述了一种在医学文献中记载极少的表现形式，并且突出了比目前报道更长的复发时间。此外，我们患者的肿瘤是嫌色细胞型，这是一种罕见的非透明细胞肾细胞癌亚型，据我们所知，从未有过导致十二指肠转移的报道。研究表明，初始诊断时淋巴结受累对预测未来复发具有预后作用。这个病例只是沧海一粟，旨在促使人们进一步研究终身监测方案的效用，并进一步开展研究，评估淋巴结清扫在预防此类复发和高死亡率方面的作用。
