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Abstract：
Skin and soft tissue diffusion metastasis (also known as occult cancer) is rare in renal cell carcinoma (RCC). Here, we report an extremely rare case of a 67-year-old male patient with occult primary RCC who developed metastases to the gums, skin, and diffuse soft tissue. The primary renal lesion was missed by computed tomography (CT), ultrasound, and 18F-fluorodeoxyglucose positron emission tomography (PET)/CT, and the diagnosis was confirmed by biopsy of gums and subcutaneous nodules. Subsequent enhanced CT revealed a lesion in the left kidney. The patient had progression-free survival of 16 months after treatment with axitinib and pembrolizumab. Pseudoprogression and tumor heterogeneity pose major challenges in the evaluation of immunotherapy. PET/CT is indispensable especially for cases with multiple metastases, widespread distribution of lesions, and major heterogeneity. In this case, the total lesion glycolysis was calculated by PET/CT and was used to evaluate systemic tumor load before and after immunotherapy, which was calculated as the product of the metabolic tumor volume and the mean standardized uptake value of the target lesion, which increased the accuracy of assessing diffuse lesions. Total lesion glycolysis can be used as a new method to quantitatively evaluate the efficacy of immunotherapy.
摘要：
皮肤和软组织扩散转移（也称为隐匿性癌症）在肾细胞癌（RCC）中很少见。这里,我们报道了一例极为罕见的病例，一位67岁男性隐匿性原发性RCC患者发生牙龈转移，皮肤,和弥漫性软组织。原发性肾脏病变通过计算机断层扫描（CT）漏诊，超声，和18F-氟代脱氧葡萄糖正电子发射断层扫描（PET）/CT，诊断通过牙龈和皮下结节活检证实。随后增强CT显示左肾脏有病变。患者在接受阿西替尼和派姆单抗治疗后，无进展生存期为16个月。假性进展和肿瘤异质性是免疫治疗评估的主要挑战。PET/CT是必不可少的，特别是对于多发转移的病例，病变分布广泛，和主要的异质性。在这种情况下,通过PET/CT计算总病变糖酵解，并用于评估免疫治疗前后的全身肿瘤负荷，计算为代谢性肿瘤体积与靶病变的平均标准化摄取值的乘积，这增加了评估弥漫性病变的准确性。总病变糖酵解可作为定量评价免疫治疗疗效的新方法。
