Wasifuddin Mustafa, Ilerhunmwuwa Nosakhare, Hakobyan Narek, Sedeta Ephrem, Uche Ifeanyi, Aiwuyo Henry O, Perry Jamal C, Heravi Omid, Boris Avezbakiyev
Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA.
Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA.
Cureus. 2023 Apr 4;15(4):e37128. doi: 10.7759/cureus.37128. eCollection 2023 Apr.
Renal cell carcinoma is the most common renal neoplasm. Its presentation is often very occult, and it may be discovered incidentally. It may present with the classic symptoms of back pain, flank pain, hematuria, or hypertension. Renal cell carcinoma may also present with malignant pleural effusion at diagnosis; however, it is very rare. In this case report and literature review, we describe a 77-year-old male who was diagnosed with renal cell carcinoma after presenting with a malignant pleural effusion - an extremely rare phenomenon. An analysis of the literature yielded 13 case reports, including ours, where the diagnostic presentation of renal cell carcinoma was a malignant pleural effusion. Our patient presented with left-sided chest pain. Imaging was suggestive of pleural effusion. CT and MRI imaging demonstrated masses in the upper and lower poles of the right kidney suggestive of renal cell carcinoma. CT imaging also showed lung nodules that were suggestive of pulmonary metastases. Biopsy and immunostaining of pleural tissue were positive for clear cell renal cell carcinoma. Therapeutic thoracentesis was performed. Despite this, the patient developed recurrent large-volume pleural effusions requiring drainage and placement of a pleural catheter. Our patient's extremely rare presentation of malignant pleural effusion as the diagnostic presentation of renal cell carcinoma along with recurrent, large-volume effusions requiring drainage has only been reported in the form of case reports in the literature.
肾细胞癌是最常见的肾脏肿瘤。其表现往往非常隐匿，可能是偶然发现的。它可能表现为背痛、侧腹痛、血尿或高血压等典型症状。肾细胞癌在诊断时也可能出现恶性胸腔积液；然而，这种情况非常罕见。在本病例报告和文献综述中，我们描述了一名77岁男性，他在出现恶性胸腔积液后被诊断为肾细胞癌——这是一种极其罕见的现象。对文献的分析产生了13例病例报告，包括我们的病例，其中肾细胞癌的诊断表现为恶性胸腔积液。我们的患者表现为左侧胸痛。影像学检查提示胸腔积液。CT和MRI成像显示右肾上下极有肿块，提示肾细胞癌。CT成像还显示肺部有结节，提示肺转移。胸腔组织活检和免疫染色显示透明细胞肾细胞癌呈阳性。进行了治疗性胸腔穿刺术。尽管如此，患者仍出现复发性大量胸腔积液，需要引流并放置胸腔导管。我们的患者以恶性胸腔积液作为肾细胞癌的诊断表现，以及需要引流的复发性大量积液，这种极其罕见的情况在文献中仅以病例报告的形式出现。
