Maestroni Umberto, Gasparro Donatello, Ziglioli Francesco, Guarino Giulio, Campobasso Davide
Department of Urology, University Hospital of Parma/Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, Parma 43126, Italy.
Medical Oncology Unit, University Hospital of Parma/Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, Parma 43126, Italy.
World J Oncol. 2021 Oct;12(5):178-182. doi: 10.14740/wjon1406. Epub 2021 Oct 21.
Metastatic renal cell carcinoma (mRCC) may present with a wide range of clinical pictures. Reportedly, paraneoplastic syndromes are the first sign in 20% of cases and only 15% of cases show the classic triad (flank pain, gross hematuria, and palpable abdominal mass) at presentation. The remaining cases present with signs and symptoms related to the site of distant metastases. These data may explain the reason why about 20-30% of patients are metastatic at presentation. We report the case of a 63-year-old woman who came to our attention for lower back pain. After imaging studies, we detected a left kidney mass of 86 × 61 × 79 mm, multiple right pulmonary nodules and six bone lesions. She underwent left radical nephrectomy. After 1 month, she developed signs of spinal cord compression with neurological deficits and she underwent emergency spinal decompression. In order to allow complete motor recovery, the subsequent stereotactic body radiation therapy was not performed, and she is currently taking combination immunotherapy regimens. Management of mRCC is in a continuous evolution due to availability of new target therapies and the possibility of a multimodal approach with surgical, focal and radiotherapy treatments. However, the ideal treatment algorithm is yet to come. This is why mRCC diagnosis and management are still challenging for the clinicians.
转移性肾细胞癌（mRCC）可能呈现出广泛的临床表现。据报道，副肿瘤综合征在20%的病例中是首发症状，仅有15%的病例在初诊时表现出典型三联征（胁腹痛、肉眼血尿和可触及的腹部肿块）。其余病例则表现出与远处转移部位相关的体征和症状。这些数据或许可以解释为何约20% - 30%的患者在初诊时就已发生转移。我们报告一例63岁女性患者，因下背部疼痛前来就诊。经影像学检查，我们发现左肾有一个大小为86×61×79 mm的肿块，右肺有多个结节以及6处骨病变。她接受了左肾根治性切除术。1个月后，她出现脊髓压迫症状及神经功能缺损，随后接受了急诊脊髓减压手术。为了实现完全的运动功能恢复，后续未进行立体定向体部放射治疗，她目前正在接受联合免疫治疗方案。由于新的靶向治疗方法的出现以及采用手术、局部治疗和放射治疗的多模式治疗方法的可能性，mRCC的治疗方法在不断演变。然而，理想的治疗方案尚未出现。这就是为什么mRCC的诊断和治疗对临床医生来说仍然具有挑战性。
