Al- Anbar Medical Journal

Renal Cell Carcinoma with Polycythemia

Document Type : Case reports

Authors

1 Department of Surgery (Urology), Al-Jumhory Teaching hospital, Nineveh Health Directorate, Mosul, Nineveh, Iraq

2 Department of Surgery (Urology), Al-Salam Teaching hospital, Nineveh Health Directorate, Mosul, Nineveh, Iraq

Abstract

Renal cell carcinoma (RCC) is the most common renal tumor and participates in about 80-85%of primary renal tumors. It is usually diagnosed incidentally during the evaluation for othermedical problems; or it may be presented with gross hematuria, loin mass or pain. However, itinfrequently presents as a paraneoplastic syndrome (PNS) which includes, hypertension, hypercalcemia, and abnormal liver function. A 75-year-old gentleman presented with an incidentalleft renal mass following the evaluation of the left loin pain with headache and dizziness. Thepatient had a history of hypertension for 10 years on control medical therapy and no history ofsmoking or chronic obstructive airway disease. The complete blood picture was showed a markedelevation in hemoglobin 21.7 g/dl and hematocrit level 65%. Ultrasound was showed left renalmass and a computerized tomography scan was showed the enhancement in the left renal masspicture suggestive of RCC. After phlebotomy of 2 units of blood, the patient underwent radicalnephrectomy, then the histopathology was reported clear cell type RCC Fuhrman nuclear gradingsystem II. At 2 months following surgery, the patient’s hemoglobin level and hematocrit werereturned to normal. The pathogenesis of PNS may be due to an abnormal immune system responseto a cancerous cell. There is a wide range of the PNS concerning RCC including non-specificconstitutional features for example; cachexia, weight loss, and fever, and specific metabolic andbiochemical disorders (i.e. hypercalcemia, non-metastatic hepatic dysfunction, amyloidosis, etc.).PNS is often unrecognized but polycythemia should be considered important biomarkers in RCC,therefore, it can be used as a tumor marker in the diagnosis and follow-up of the patient after surgery.

Keywords

Main Subjects

References
[1]        J.-L. Da Silva et al., “Tumor cells are the site of erythropoietin synthesis in human renal cancers associated with polycythemia,” 1990.
[2]        K. Ito et al., “Impact of increased erythropoietin receptor expression and elevated serum erythropoietin levels on clinicopathological features and prognosis in renal cell carcinoma,” Exp. Ther. Med., vol. 3, no. 6, pp. 937–944, 2012.
[3]        C. Lacombe et al., “Peritubular cells are the site of erythropoietin synthesis in the murine hypoxic kidney.,” J. Clin. Invest., vol. 81, no. 2, pp. 620–623, 1988.
[4]        B. Ljungberg, T. Rasmuson, and K. Grankvist, “Erythropoietin in renai celi carcinoma: evaluation of its usefulness as a tumor marker,” Eur. Urol., vol. 21, pp. 160–163, 1992.
[5]        K. Ueda et al., “Successful treatment of erythropoietin-producing advanced renal cell carcinoma after targeted therapy using sunitinib: Case report and review of the literature,” Mol. Clin. Oncol., vol. 1, no. 1, pp. 112–116, 2013.
[6]        R. L. Siegel and K. D. Miller, “Cancer Statistics , 2020,” vol. 70, no. 1, pp. 7–30, 2020.
[7]        J. Kopel, P. Sharma, I. Warriach, and S. Swarup, “Polycythemia with Renal Cell Carcinoma and Normal Erythropoietin Level,” Case Rep. Urol., vol. 2019, 2019.
[8]        J.-J. Patard et al., “Prognostic value of histologic subtypes in renal cell carcinoma: a multicenter experience,” J. Clin. Oncol., vol. 23, no. 12, pp. 2763–2771, 2005.
[9]        G. Ding et al., “Paraneoplastic symptoms: Cachexia, polycythemia, and hypercalcemia are, respectively, related to vascular endothelial growth factor (VEGF) expression in renal clear cell carcinoma,” in Urologic Oncology: Seminars and Original Investigations, 2013, vol. 31, no. 8, pp. 1820–1825.
[10]      M. Okuyama, M. Nishihara, H. Hashimoto, S. Kaneko, and S. Yachiku, “A case of erythropoietin-producing renal cell carcinoma with polycythemia,” Hinyokika Kiyo., vol. 48, no. 9, p. 531, 2002.
[11]      K. Ito, T. Asano, S. Tominaga, H. Yoshii, H. Sawazaki, and T. Asano, “Erythropoietin production in renal cell carcinoma and renal cysts in autosomal dominant polycystic kidney disease in a chronic dialysis patient with polycythemia: A case report,” Oncol. Lett., vol. 8, no. 5, pp. 2032–2036, 2014.
Al- Anbar Medical Journal
Volume 17, Issue 1
June 2021
Page 41-43
Files
Share
Export Citation
Statistics