Malhotra Kiran P, Gupta Anurag, Shukla Saumya, Agarwal Gaurav R, Malhotra Hardeep S
Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Gomti Nagar, Lucknow, Uttar Pradesh, India.
Department of Radiodiagnosis, Dr. Ram Manohar Lohia Institute of Medical Sciences, Gomti Nagar, Lucknow, Uttar Pradesh, India.
Indian J Cancer. 2021 Apr-Jun;58(2):273-277. doi: 10.4103/ijc.IJC_160_20.
The capacity to metastasize after long periods of discovery and resection of the primary renal lesion or to present as metastasis with undisclosed primary lesions grant renal cell carcinomas (RCC) a formidable and unpredictable behavior. We report three unusual cases of metastasis from RCC. The first patient presented with metastatic clear cell adenocarcinoma in the right shoulder muscles, with unknown primary and revealed an undetected clear cell right RCC on radiology. The second patient presented with a hemorrhagic nasal metastasis of RCC. A history of nephrectomy for RCC, 10 years prior to the development of nasal metastasis was elicited. The third patient presented with axillary and later abdominal wall metastasis of papillary RCC. He had a history of RCC 3 years prior to the discovery of metastasis. RCC has the propensity to appear as a metastatic carcinoma with unknown primary, requiring exclusion of several diagnostic pathologic entities. The appearance of metastasis many years after disease quiescence is challenging and clinicians need to be sensitized to the need for long-term surveillance in RCC. Though the prognosis remains poor, immune checkpoint inhibitors are currently the modalities of choice in such cases.
在原发性肾病变被发现并切除很长一段时间后发生转移，或者以未发现原发性病变的转移灶形式出现的能力，赋予了肾细胞癌（RCC）一种可怕且不可预测的行为。我们报告了3例罕见的肾细胞癌转移病例。首例患者右肩部肌肉出现转移性透明细胞腺癌，原发灶不明，影像学检查发现未被检测到的右侧透明细胞肾细胞癌。第二例患者出现肾细胞癌的鼻腔出血性转移灶。在鼻腔转移灶出现前10年有因肾细胞癌行肾切除术的病史。第三例患者出现乳头状肾细胞癌的腋窝及随后的腹壁转移。在发现转移灶前3年有肾细胞癌病史。肾细胞癌有表现为原发灶不明的转移性癌的倾向，需要排除几种诊断性病理实体。疾病静止多年后出现转移具有挑战性，临床医生需要意识到对肾细胞癌进行长期监测的必要性。尽管预后仍然很差，但免疫检查点抑制剂目前是此类病例的首选治疗方式。
