Cem UZAL, Kamuran İBİŞ, Bengü DENİZLİ, Hakan KARAGÖL, Coşar Ruşen ALAS, Murat ÇALOĞLU, Mert SAYNAK, Yürüt Vuslet ÇALOĞLU, Bayır Gülden ANGIN

Böbrek hücreli karsinomda mediastinal lenf nodu metastazı: Olgu sunumu ve literatür derlemesi

Böbrek hücreli karsinom böbreğin en sık görülen malign tümörüdür ve yetişkinlerdeki böbrek tümörlerinin %90-95'ini oluşturur. Tanı sırasında hastaların %30'unda uzak organ yayılımı vardır. Tanı anında uzak yayılım olması kötü prognozun güçlü bir göstergesidir. Yayılım lenf yoluyla ya da kan yoluyla olabilir. Akciğerler, kemikler, karaciğer, lenf nodları ve mediasten en sık yayılım görülen bölgelerdir. Akciğer parankim lezyonları böbrek hücreli tümörlerde sık görülmesine rağmen parankim tutulumu olmaksızın mediastinal lenf nodlarına yayılım nadirdir.Bu yazıda böbrek hücreli karsinom tanılı 71 yaşındaki erkek hasta sunuldu. Radikal nefrektomi ve ameliyat sonrası radyoterapi uygulanan hastanının toraks tomografisinde mediastinal lenfadenopati belirlendi. Olgumuz güncel literatür ışığında tartışıldı.

Renal cell carcinoma metastases in the mediastinum lymph node: case report and literature review

Renal cell carcinoma (RCC) is the most common malignant lesion of the kidney, accounting for 90-95% of all renal cancers in adult. Approximately, 30% of patients present with metastatic disease at diagnosis, and one-third of the remainder will develop metastasis during follow-up. Presence of distant metastases at diagnosis is a strong independent predictor of poor survival in patients with RCC. RCC metastasizes by haematogeneous and lymphogeneous ways. Pulmonary metastases are common in patients with renal cell carcinoma and usually consist of multiple nodules of varying sizes that develop in both lung fields. In contrast, metastases to the supradiaphragmatic nodes but no pulmonary paranchymal metatases are rare. A 71-year-old male with renal cell carcinoma whom radical nefrectomy and postoperative radiotherapy was performed. After the treatment, computed tomography of the thorax showed the conglomerate lymph node enlargement in subcarinal region. Histology of this lesion was revealed renal cell carcinoma after the broncoscopic biopsy. The present case is discussed in light of the recent literature.

PDF

___

1) Golimbu M, Joshi P, Sperber A, Tessler A, Al-Askari S, Morales P. Renal cell carcinoma: survival and prognostic factors. Urology 1986;27(4):291-301.
2) Motzer RJ, Bander NH, Nanus DM. Renal-cell carcinoma. N Engl J Med 1996;335(12):865-75.
3) Ritchie AW, Chisholm GD. The natural history of renal carcinoma. Semin Oncol 1983;10(4):390-400.
4) Motzer RJ, Mazumdar M, Bacik J, Berg W, Amsterdam A, Ferrara J. Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol 1999;17(8):2530-40.
5) Schrader AJ, Varga Z, Hegele A, Pfoertner S, Olbert P, Hofmann R. Second line strategies for metastatic renal cell carcinoma: classics and novel approaches. J Cancer Res Clin Oncol 2006;132(3):137-49.
6) Catton CN, Warde P, Gospodarowicz MK, Panzarella T, Catton P, McLean M, et al. Transitional cell carcinoma of the renal pelvis and ureter - outcome and patterns of relapse in patients treated with postoperative radiation. Urol Oncol 1996;2(6):171–176.
7) Finney R. The value of radiotherapy in the treatment of hypernephroma--a clinical trial. Br J Urol 1973;45(3):258-69.
8) Fugitt RB, Wu GS, Martinelli LC. An evaluation of postoperative radiotherapy in hypernephroma treatment-a clinical trial. Cancer 1973;32(6):1332-40.
9) van der Werf-Messing B. Proceedings: Carcinoma of the kidney. Cancer 1973;32(5):1056-61.
10) Frydenberg M, Gunderson L, Hahn G, Fieck J, Zincke H. Preoperative external beam radiotherapy followed by cytoreductive surgery and intraoperative radiotherapy for locally advanced primary or recurrent renal malignancies. J Urol 1994;152(1):15-21.
11) Flanigan RC, Salmon SE, Blumenstein BA, Bearman SI, Roy V, McGrath PC, et al. Nephrectomy followed by interferon alfa-2b compared with interferon alfa 2b alone for metastatic renal-cell cancer. N Engl J Med 2001;345(23):1655-9.
12) Bukowski RM. Natural history and therapy of metastatic renal cell carcinoma: the role of interleukin2. Cancer 1997;80(7):1198-220.
13) Minasian LM, Motzer RJ, Gluck L, Mazumdar M, Vlamis V, Krown SE. Interferon alfa-2a in advanced renal cell carcinoma: treatment results and survival in 159 patients with long-term follow-up. J Clin Oncol 1993;11(7):1368-75.
14) Negrier S, Escudier B, Lasset C, Douillard JY, Savary J, Chevreau C, et al. Recombinant human interleukin2, recombinant human interferon alfa-2a, or both in metastatic renal-cell carcinoma. Groupe Francais d'Immunotherapie. N Engl J Med 1998;338(18):12728.
15) Jacobsen J, Grankvist K, Rasmuson T, Ljungberg B. Different isoform patterns for vascular endothelial growth factor between clear cell and papillary renal cell carcinoma. BJU Int 2006;97(5):1102-8.
16) Minervini A, Lilas L, Morelli G, Traversi C, Battaglia S, Cristofani R, et al. Regional lymph node dissection in the treatment of renal cell carcinoma: is it useful in patients with no suspected adenopathy before or during surgery? BJU Int 2001;88(3):169-72.
17) Phillips CK, Taneja SS. The role of lymphadenectomy in the surgical management of renal cell carcinoma. Urol Oncol 2004;22(3):214-24.
18) McLoud TC, Kalisher L, Stark P, Greene R. Intrathoracic lymph node metastases from extrathoracic neoplasms. AJR Am J Roentgenol 1978;131(3):403-7.
19) Kutty K, Varkey B. Incidence and distribution of intrathoracic metastases from renal cell carcinoma. Arch Intern Med 1984;144(2):273-6.
20) Chae EJ, Kim JK, Kim SH, Bae SJ, Cho KS. Renal cell carcinoma: analysis of postoperative recurrence patterns. Radiology 2005;234(1):189-96.
21) Pfannschmidt J, Klode J, Muley T, Dienemann H, Hoffmann H. Nodal involvement at the time of pulmonary metastasectomy: experiences in 245 patients. Ann Thorac Surg. 2006;81(2):448-54.