Patil Rahul S, Kore Tejas A, Vikhe Vikram B, Faruqi Ahsan A, Lapsiwala Vivek H
General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed-to-be-University), Pune, IND.
Cureus. 2024 Nov 13;16(11):e73627. doi: 10.7759/cureus.73627. eCollection 2024 Nov.
Renal cell carcinoma (RCC) of the clear cell type is the most common form of renal malignancy. Malignant pleural effusion (MPE) as the initial presentation of RCC is very rare. This case report presents a case of RCC that initially manifested as a pleural effusion, without the typical symptoms of flank pain, hematuria, or a palpable abdominal mass. The patient, a 45-year-old male, arrived with complaints of dyspnea and a dry cough, with no notable medical history or risk factors. Imaging revealed a left-sided pleural effusion, which was identified as MPE based on pleural fluid analysis, cytology, and immunohistochemistry. Subsequent investigation revealed a large, solid cystic mass in the left kidney, with a biopsy confirming RCC. Uniquely, the patient exhibited pleural metastasis without involvement of the lung parenchyma, a rare scenario in RCC that is linked to a poor prognosis. This case emphasizes the variable presentation of RCC and the need to consider malignancy in patients with unexplained pleural effusion. An indwelling pleural catheter was placed for the patient considering the poor prognosis; furthermore, he declined to undergo sessions of palliative chemotherapy and was subsequently lost to follow-up.
透明细胞型肾细胞癌（RCC）是最常见的肾脏恶性肿瘤形式。以恶性胸腔积液（MPE）作为RCC的初始表现非常罕见。本病例报告介绍了一例最初表现为胸腔积液的RCC病例，无典型的胁腹痛、血尿或可触及腹部肿块症状。该患者为一名45岁男性，因呼吸困难和干咳前来就诊，无明显病史或危险因素。影像学检查显示左侧胸腔积液，根据胸腔积液分析、细胞学检查和免疫组化确定为MPE。随后的检查发现左肾有一个巨大的实性囊性肿块，活检证实为RCC。独特的是，该患者出现胸膜转移而未累及肺实质，这在RCC中是一种罕见情况，与预后不良相关。本病例强调了RCC表现的多样性以及对不明原因胸腔积液患者考虑恶性肿瘤的必要性。考虑到预后不良，为患者放置了胸腔留置导管；此外，他拒绝接受姑息化疗疗程，随后失访。
