Jelleli Nejmeddine, Loghmari Ahmed, Belkacem Oussama, Tlili Ghassen, Jellali Bilel, Chouaya Sabrine, Bouassida Khaireddine, Hmida Wissem, Jaidane Mehdi, Hmissa Sihem
Department of Urology, Sahloul Hospital, Sousse, Tunisia.
Pathology Department, Sahloul University Hospital, Sousse, Tunisia.
Ann Med Surg (Lond). 2022 Aug 27;81:104480. doi: 10.1016/j.amsu.2022.104480. eCollection 2022 Sep.
Lung, bone, lymph nodes and liver are the most common metastatic sites. This observation presents a metastatic renal cell carcinoma (RCC) with atypical secondary sites and a rare mode of revelation corresponding to diabetes mellitus.
We report the case of a 64-year-old woman recently diagnosed with diabetes mellitus. A thoracic parietal nodule was palpated. An uro-CT scan had shown a renal tumor with unusual metastatic sites: pleura, pancreas, and contralateral kidney. The patient underwent a biopsy of the pleural nodule. The pathology report concluded to the diagnosis of clear cell RCC. She had a targeted therapy. Three months after admission, the patient had altered general condition and total hematuria.
RCC commonly metastasizes haematogenously via renal veins. Atypically, secondary lesions may involve pleura. Such a metastatic site may be of particular interest for percutaneous biopsy, as in our case. The rare metastatic invasion of the pancreas is most likely the cause of the inaugural diabetes in our patient. The controlateral kidney was involved in 1.4% of secondary lesions. For patients with poor prognosis, according to International Metastatic RCC Database Consortium classification, anti-angiogenic treatment is recommended. The median overall survival of patients with poor prognosis is 8 months.
Pancreas and contralateral kidney are rare secondary sites of RCC. The clinical expression of pancreas metastatic invasion can rarely fit with diabetes. Metastatic dissemination to these organs is most often associated with an unfavorable prognosis.
肺、骨、淋巴结和肝脏是最常见的转移部位。本病例报告了一例转移性肾细胞癌（RCC），其转移部位不典型，且以糖尿病为罕见的首发表现形式。
我们报告一例64岁近期诊断为糖尿病的女性患者。触诊发现一个胸壁结节。泌尿系统CT扫描显示一个肾肿瘤伴有不寻常的转移部位：胸膜、胰腺和对侧肾脏。患者接受了胸膜结节活检。病理报告确诊为透明细胞肾细胞癌。她接受了靶向治疗。入院三个月后，患者一般状况变差并出现全程血尿。
肾细胞癌通常通过肾静脉血行转移。非典型情况下，继发性病变可能累及胸膜。正如我们的病例所示，这样的转移部位对于经皮活检可能具有特殊意义。胰腺的罕见转移浸润很可能是我们患者首发糖尿病的原因。对侧肾脏受累于1.4%的继发性病变。对于预后较差的患者，根据国际转移性肾细胞癌数据库联盟的分类，推荐进行抗血管生成治疗。预后较差患者的中位总生存期为8个月。
胰腺和对侧肾脏是肾细胞癌罕见的转移部位。胰腺转移浸润的临床表现很少与糖尿病相符。转移至这些器官通常与不良预后相关。
