![]() ![]() The pathology of lymph node was evaluated and formed to be metastatic papillary adenocarcinoma ( Fig. A year later, the patient went to Chulabhorn hospital for a second opinion. After the 2nd cycle, he lost follow up for 1 year because of chemotherapy side effect. Treatment was switched to 2nd line with cisplatin and Etoposide for 2 cycles. CT chest and abdomen in January 2009 revealed left superior mediastinal node slightly increased and the mass at the pararenal region and necrotic node, paravertebral node were about the same. The physician started treatment in October 2008 with 2 cycles of palliative chemotherapy, carboplatin and paclitaxel. Some mass effect is noted with mildly dilated left renal pelvis.Īt that time, preliminary diagnosis was metastatic adenocarcinoma of lung cancer as the primary site. The mass displaces the left renal vein anteriorly. Pretreatment CT scan of abdomen in October 2008 (Pre-contrast on left side and post-contrast on right side) showing enlargement of multilobulated left paraaortic node at the renal level, 7.4 cm in size. Pretreatment CT scan of abdomen in October 2008 (Pre-contrast on left side and post-contrast on right side) showing paraaortic lymph nodes enlargement on left side partially abuts wall of aorta and body of pancreas.įigure 3. Pretreatment CT scan of chest in October 2008 (Pre-contrast on left side and post-contrast on right side) showing lobulated heterogeneous soft tissue density lesion at the apex of left lung.įigure 2. 1- 3).Tumor markers including AFP, LDH and CEA were within normal limit.įigure 1. The 7.4 cm lesion partially abutted wall the aorta and body of the pancreas ( Fig. Some mass effect was noted with mildly dilated left renal pelvis. The mass displaced the left renal vein anteriorly. Left paraaortic multi-lobulated nodes were enlarged at the renal level. Direct tumor invasion was seen at left common carotid and subclavian arteries and left lobe of thyroid gland and partially abuts wall of esophagus. It revealed mildly reticular densities at right lung apex, malignant lobulated heterogeneous soft tissue mass at left neck extending downward to level of the aortic arch. CT chest and abdomen was done to search for the primary site. The lymph node was biopsied and sent to pathologist and the result showed metastatic well differentiated adenocarcinoma. In October 2008, a 37-year-old previously healthy Thai male, with 3cm left supraclavicular lymph node enlargement. In this case report, we will discuss about a renal cell carcinoma patient who presented with supraclavicular lymph node enlargement as first symptoms and no renal mass could be detected. A quarter of the patients present with advanced disease, including locally invasive or metastatic renal-cell carcinoma but it is very uncommon to present without primary lesion at kidney. The target for metastasis are lungs, bone, lymph node, adrenal gland, brain, liver and contralateral kidney. ![]() However, the disease is well-known for metastatic ability. Approximately half of cases are now detected because of accidental finding of renal mass from imaging. Still, only about 10% of patients presented with triad which defines advanced disease. The classical triad of the renal cell carcinoma symptoms consists of hematuria, abdominal mass and flank pain. It occurs mainly in male 6th - 8th decade of life. In Thailand, renal cell carcinoma (RCC) is a rare malignant condition among men and women, accounting for 0.7% of all cancers. ![]() Keywords: Renal cell carcinoma Unknown primary cancer Lymph node metastasis Without primary site Introduction ![]() Sunitinib, a tyrosine kinase inhibitor, is the treatment of choice for renal cell carcinoma since it improves objective response rate and shows longer progression free survival than IFNα. The diagnosis was renal cell carcinoma, papillary cell type. CD10, Vimentin and RCC were all positive and all are specific for renal cell carcinoma. Immunohistochemistry result were negative for TTF-1, Thyroglobulin, CD7 and CD20 which ruled out non-small cell lung adenocarcinoma, thyroid cancer and gastrointestinal tract cancer respectively. The differential diagnoses were papillary thyroid cancer, gastrointestinal tract carcinoma such as pancreato-biliary cancer, non small cell lung cancer, and renal cancer. The pathology of supraclavicular lymph node was papillary cell adenocarcinoma. In this case report, we presents a case of male patient who manifested with supraclavicular lymph node enlargement and CT scan of chest and abdomen showed multiple sites lymph node metastasis but there was no primary mass detected anywhere. Most of the patients present in advanced metastatic stage with identifiable renal mass. Renal cell carcinoma is a rare cancer in Thailand. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |