Młodożeniec Piotr, Balawender Krzysztof, Zasadny Mateusz
Clinical Department of Urology and Urological Oncology, Municipal Hospital in Rzeszow, Poland.
Morphological Sciences Department, Institute of Medical Sciences, Medical College of Rzeszow University, Poland.
Case Rep Oncol Med. 2021 Jul 30;2021:2428820. doi: 10.1155/2021/2428820. eCollection 2021.
Renal cell carcinoma is responsible for 3% of all cancers, with the highest incidence occurring in Western countries. Additionally, in patients with osseous metastasis, only 3% occur within the tibia. Rarely, a patient presents with a primary complaint of lower limb pain in advanced metastatic renal cell carcinoma. . The patient arrived at the emergency department with a primary complaint of left ankle pain. Ankle X-rays demonstrated a lytic lesion involving the medial malleolus with possible metastatic disease. CT scan confirmed a tumor within the right kidney. The patient was treated with a laparoscopic radical nephrectomy with histopathologic confirmation of clear cell renal cell carcinoma. Biopsy was then performed of the tibial lesion, confirming metastatic clear cell renal cell carcinoma. The tibial lesion was treated with local radiotherapy, and because of the progression of the tibia lesion, a decision was made to amputate the leg. Additionally, the patient was enrolled to sunitinib treatment and was disease free at one year of follow-up. 13 months after diagnosis of cancer, she was suffering a major stroke of the brain that caused her to die.
The treatment of patients with osseous metastases of renal cell cancer depends on the number of metastases, location of metastases, and overall health of the patient. We performed an overview of available literature and provided a summary regarding the use of cytoreductive nephrectomy, local therapy, target therapy, and bone-targeting agents in the treatment of metastatic renal cell cancer.
肾细胞癌占所有癌症的3%，在西方国家发病率最高。此外，在发生骨转移的患者中，仅3%发生于胫骨。晚期转移性肾细胞癌患者很少以下肢疼痛为主诉就诊。该患者因左踝疼痛为主诉来到急诊科。踝关节X线显示累及内踝的溶骨性病变，可能为转移性疾病。CT扫描证实右肾有肿瘤。患者接受了腹腔镜根治性肾切除术，组织病理学确诊为透明细胞肾细胞癌。随后对胫骨病变进行活检，证实为转移性透明细胞肾细胞癌。胫骨病变接受了局部放疗，由于胫骨病变进展，决定截肢。此外，该患者开始接受舒尼替尼治疗，随访1年时无疾病进展。癌症诊断13个月后，她发生了严重的脑卒中和死亡。
肾细胞癌骨转移患者的治疗取决于转移灶数量、转移部位及患者的整体健康状况。我们对现有文献进行了综述，并总结了减瘤性肾切除术、局部治疗、靶向治疗和骨靶向药物在转移性肾细胞癌治疗中的应用。
