ApstraktRenocelularni karcinom (RCC) je najčešći maligni tumor bubrega kod odraslih. Čini oko 3% adultnih maligniteta i 90-95% neoplazmi bubrežnog porekla. Renocelularni karcinom može biti asimtomatski tokom najvećeg dela svoje evolucije a klasična trijada koja obuhvata lumbalni bol, hematuriju i lumbalnu masu je neuobičajena. RCC se karakteriše čestom pojavom paraneoplastičnog sindroma. Muškarac starosti 46 godina se žalio na uporan kašalj koji je trajao oko godinu dana. Negirao je druge tegobe i nije uzimao blokatore angiotenzin konvertujućeg enzima. Fizikalni nalaz po sistemima je bio u granicama normale. Rezultati laboratorijskih analiza su ukazali na ubrzanu sedimentaciju (SE 92 mm/1.h), leukocitozu i sideropenijsku anemiju (hemoglobin 103 g/L, serumsko gvožđe 4.3 μmol/l). Radiografija srca i pluća i spirometrija su bili uredni. Test na okultno krvarenje u stolici je bio negativan a vrednosti tumor markera su bile u referentnim granicama. Ultrazvuk abdomena je pokazao postojanje tumorske mase duž desnog bubrega. Kompjuterizovana tomografija abdomena je potvrdila postojanje tumorske mase veličine 93x72 mm duž celog desnog bubrega bez znakova invazije okolnih organa. Postavljena je radna dijagnoza renocelularnog karcinoma i izvršena je otvorena desna radikalna nefrektomija. Postoperativni tok je protekao uredno uporni kašalj je nestao 2 dana nakon operacije sa brzim poboljšanjem anemije i normalizacijom SE a uporni kašalj je nestao 2 dana nakon operacije. Tri meseca nakon operacije pacijent nije imao nikakve tegobe niti je bilo znakova rekurencije tumora. Veoma je važno imati u vidu čitav spektar simptoma i znakova kojima se renocelularni karcinom može prezentovati. AbstractRenal cell carcinoma (RCC) is the most common type of kidney cancer in adults. It accounts for approximately 3% of adult malignancies and 90-95% of neoplasms arising from the kidney. RCC may remain clinically occult for most of its course and the classic triad of flank pain, hematuria and flank mass is uncommon. RCC is a challenging tumor because of the frequent occurrence of paraneoplastic syndromes. Fourty-six years old male suffered from persistent coughing for approximately 1 year. He had no history of taking angiotensin converting enzyme inhibitors. Physical examination was insignificant. Blood tests revealed an elevated sedimentation rate (ESR 92 mm/1.h), leucocytosis and sideropenic anaema (hemoglobin 103 g/L, iron level 4.3 μmol/l). The chest radiograph and spirometry results were normal. Fecal occult blood test was negative and the tumor markers' levels were within normal ranges. Abdominal ultrasound revealed a mass on the right kidney. Computed tomography (CT) scan of the abdomen demonstrated a 93x72 mm mass arising from the right kidney with no evidence of invasion into surrounding organs. The patient underwent open right radical nephrectomy for renal cell carcinoma. Postoperative recovery was uneventful and the persistent cough disappeared 2 days postoperatively with rapid improvement of anemia and normalization of ESR. Three ...
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