Kanaki Tomohiro, Tanaka Ryo, Nakai Yasutomo, Yamamoto Akinaru, Yamamoto Yoshiyuki, Nagahara Akira, Nakayama Masashi, Kakimoto Kenichi, Nishimura Kazuo
The Department of Urology, Osaka International Cancer Institute.
Hinyokika Kiyo. 2022 Apr;68(4):113-116. doi: 10.14989/ActaUrolJap_68_4_113.
A 52-year-old man complained of asymptomatic gross hematuria and cough. Chest and abdominal computed tomography (CT) revealed a right renal tumor, mediastinal lymph node metastasis, and right endobronchial metastasis. The right endobronchial metastasis was causing obstructive atelectasis in the lower lobe of the right lung. After tumor biopsy, the pathological diagnosis was clear cell renal cell carcinoma. Combination immunotherapy with ipilimumab and nivolumab was initiated, but CT showed enlargement of the metastatic lesion and lung abscess after two courses of treatment. The therapy was then switched to axitinib. Six days after initiation of axitinib, the lung abscess perforated into the pleural cavity, which resulted in the formation of pleural empyema with fistula. Ten days after initiation of axitinib, obstruction of the bronchus was relieved due to shrinkage of the right endobronchial metastasis, which resulted in development of a pneumothorax. Placement of a thoracic drainage tube and administration of an antimicrobial agent improved the pneumothorax and inflammatory response, but the drainage tube could not be removed. Long-term insertion of the thoracic drainage tube considerably diminished the patient's quality of life, and after 4 months, he was transferred to another hospital to receive the best supportive care.
一名52岁男性主诉有无症状肉眼血尿和咳嗽。胸部及腹部计算机断层扫描（CT）显示右肾肿瘤、纵隔淋巴结转移及右支气管内转移。右支气管内转移导致右肺下叶阻塞性肺不张。肿瘤活检后，病理诊断为透明细胞肾细胞癌。开始使用伊匹木单抗和纳武单抗联合免疫治疗，但两个疗程治疗后CT显示转移灶增大且出现肺脓肿。随后治疗改为阿昔替尼。开始使用阿昔替尼6天后，肺脓肿穿破进入胸腔，导致形成伴有瘘管的胸膜脓胸。开始使用阿昔替尼10天后，由于右支气管内转移灶缩小，支气管阻塞得以缓解，进而导致气胸。放置胸腔引流管并给予抗菌药物改善了气胸及炎症反应，但引流管无法拔除。长期留置胸腔引流管严重降低了患者的生活质量，4个月后，他转至另一家医院接受最佳支持治疗。
