Lu Jun, Zhou Weijiang, Wei Xuyong, Wang Kai, Zhou Lixin, Xu Xiao
Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China.
Zhejiang Provincial Key Laboratory of Integrated Oncology and Intelligent Medicine, Hangzhou 310006, China.
Diagnostics (Basel). 2022 Feb 23;12(3):571. doi: 10.3390/diagnostics12030571.
Although clear cell renal cell carcinoma (ccRCC) is easy to diagnose early and most can be radically resected, nearly one-third of patients still experience metastases after radical nephrectomy. The most common distant metastases sites of ccRCC are lung, bone and liver. However, periampullary metastasis of ccRCC is very rare and easy to misdiagnose. A 59-year-old male patient was hospitalized for recurrent hematochezia. He had a history of nephrectomy 16 years ago due to ccRCC. Enhanced upper abdominal computed tomography (CT) suggested a mass in the ampulla of vater, and active hemorrhage of duodenal papilla was observed by endoscopy. He underwent an emergency pancreaticoduodenectomy because endoscopic hemostasis and transcatheter arterial embolization (TAE) both failed. Intraoperatively, we found that the tumor located in the ampulla and invaded the pancreatic tissue. The operation was successful, with no postoperative complications. Postoperative pathology suggested metastatic ccRCC.
尽管透明细胞肾细胞癌（ccRCC）易于早期诊断且大多数能够进行根治性切除，但仍有近三分之一的患者在根治性肾切除术后发生转移。ccRCC最常见的远处转移部位是肺、骨和肝。然而，ccRCC的壶腹周围转移非常罕见且容易误诊。一名59岁男性患者因反复便血入院。他16年前因ccRCC行肾切除术。上腹部增强计算机断层扫描（CT）提示 Vater壶腹有肿块，内镜检查发现十二指肠乳头活动性出血。由于内镜止血和经导管动脉栓塞术（TAE）均失败，他接受了急诊胰十二指肠切除术。术中，我们发现肿瘤位于壶腹并侵犯了胰腺组织。手术成功，无术后并发症。术后病理提示为转移性ccRCC。
