Sun Yunji, Xu Baoqun, Zhang Heng, Li Lihua, Gao Yulan, Sun Maokun
Department of Urology, Shandong Provincial Third Hospital, Shandong University, Jinan 250012, China; Shandong Stone Disease Prevention and Treatment Center, Jinan 250012, China.
Department of Pathology, Shandong Provincial Third Hospital, Shandong University, Jinan 250012, China.
Int J Surg Case Rep. 2024 Oct;123:110198. doi: 10.1016/j.ijscr.2024.110198. Epub 2024 Aug 22.
We presented a case diagnosed the renal clear cell carcinoma undergoing cystic change (RCCCC) with detailed clinical data. Along with literature review, we aimed to investigate clinical diagnosis and treatment of RCCCC and explore the differential diagnosis of RCCCC and multilocular cystic renal cell carcinoma (MCRCC).
The patient was diagnosed with a right renal cyst after physical examination, which was misdiagnosed as a renal cyst by imaging examination. Intraoperative surgical treatment was performed to remove the roof and decompress the renal cyst. Rapid pathology revealed MCRCC with low malignant potential during laparoscopic right renal cyst decompression. Radical nephrectomy was performed with the family's signature. The postoperative pathological diagnosis was clear cell carcinoma cystic lesion of kidney (RCCCC). No recurrence or metastasis during 1 year follow-up.
RCCCC cases were similar to classical clear cell renal carcinoma. Radical nephrectomy should be avoided in patients with MCRCC, and radical nephrectomy should be chosen in patients with RCCCC, with postoperative and close follow-up. Unroofing decompression of renal cyst was performed during the operation, and the risk of tumor implantation and metastasis was worried after the operation. The patient agreed to receive eight cycles of immune checkpoint inhibitor therapy after surgery. Adrenal insufficiency occurred after 8 cycles of immune checkpoint inhibitor therapy(ICIs), then the immunotherapy was discontinued.
RCCCC is a rare and special type of renal clear cell carcinoma, and its prognosis is the same as that of renal clear cell carcinoma. The preoperative diagnosis of RCCCC mainly depends on imaging examination (CT or B-ultrasound). The early differential diagnosis from multilocular cystic renal cell carcinoma is difficult, and the diagnosis usually depends on postoperative pathological diagnosis.
我们报告了一例诊断为肾透明细胞癌伴囊性变（RCCCC）的病例，并提供了详细的临床资料。结合文献复习，旨在探讨RCCCC的临床诊断与治疗，并探索RCCCC与多房囊性肾细胞癌（MCRCC）的鉴别诊断。
患者体检时被诊断为右肾囊肿，影像学检查误诊为肾囊肿。术中进行手术治疗，切除囊肿顶部并减压。腹腔镜下右肾囊肿减压术中快速病理显示为低恶性潜能的MCRCC。经家属签字后行根治性肾切除术。术后病理诊断为肾透明细胞癌囊性病变（RCCCC）。随访1年无复发或转移。
RCCCC病例与经典的透明细胞肾癌相似。MCRCC患者应避免行根治性肾切除术，而RCCCC患者应选择根治性肾切除术，并进行术后密切随访。术中对肾囊肿进行去顶减压，术后担心有肿瘤种植和转移的风险。患者术后同意接受8周期免疫检查点抑制剂治疗。8周期免疫检查点抑制剂治疗（ICIs）后出现肾上腺功能不全，随后停止免疫治疗。
RCCCC是一种罕见且特殊类型的肾透明细胞癌，其预后与肾透明细胞癌相同。RCCCC的术前诊断主要依靠影像学检查（CT或B超）。早期与多房囊性肾细胞癌鉴别困难，诊断通常依赖术后病理诊断。
