PDF(Pubmed)
Abstract：
BACKGROUND: Renal cancer is a significant global cause of death and clear cell being the most common subtype. Bilateral synchronous renal cancers with different histologies are extremely rare and less reported. Managing bilateral renal cancer is challenging.
METHODS: A 51-year-old woman with a history of hypertension and hypothyroidism presented with right loin pain, leading to the discovery of a 7 cm right renal mass and a 2.3 × 2.6 cm mass on the upper pole of the left kidney, associated with reactive right para-aortic lymph nodes. The right kidney mass was identified as leiomyosarcoma with liver metastasis while the left kidney mass was diagnosed as clear cell renal carcinoma. Patient was managed with right side nephrectomy, left side microwave ablation and follow-up chemotherapy.
CONCLUSIONS: Primary leiomyosarcoma of kidney is extremely rare and aggressive, leading to poor outcome. Synchronous bilateral renal cancer pose surgical challenges due to potential loss of renal function. In this case of differing histologies in synchronous bilateral renal masses, a nephron-sparing approach was taken, but despite aggressive treatment, the patient developed metastases in the liver and peritoneum.
CONCLUSIONS: Bilateral synchronous renal cancer, particularly with differing histologies in each kidney, are exceptionally uncommon, making their management challenging. Despite the limited guidance available due to their rarity, addressing these cases aggressively and promptly is crucial, as their prognosis is generally unfavorable, necessitating further research to advance management strategies.
METHODS: A 51-year-old woman with a history of hypertension and hypothyroidism presented with right loin pain, leading to the discovery of a 7 cm right renal mass and a 2.3 × 2.6 cm mass on the upper pole of the left kidney, associated with reactive right para-aortic lymph nodes. The right kidney mass was identified as leiomyosarcoma with liver metastasis while the left kidney mass was diagnosed as clear cell renal carcinoma. Patient was managed with right side nephrectomy, left side microwave ablation and follow-up chemotherapy.
CONCLUSIONS: Primary leiomyosarcoma of kidney is extremely rare and aggressive, leading to poor outcome. Synchronous bilateral renal cancer pose surgical challenges due to potential loss of renal function. In this case of differing histologies in synchronous bilateral renal masses, a nephron-sparing approach was taken, but despite aggressive treatment, the patient developed metastases in the liver and peritoneum.
CONCLUSIONS: Bilateral synchronous renal cancer, particularly with differing histologies in each kidney, are exceptionally uncommon, making their management challenging. Despite the limited guidance available due to their rarity, addressing these cases aggressively and promptly is crucial, as their prognosis is generally unfavorable, necessitating further research to advance management strategies.
摘要：
背景：肾癌是全球死亡的重要原因，透明细胞是最常见的亚型。具有不同组织学的双侧同步肾癌极为罕见，报道较少。管理双侧肾癌具有挑战性。
方法：一名有高血压和甲状腺功能减退症病史的51岁女性，表现为右腰部疼痛，导致在左肾上极发现7厘米的右肾肿块和2.3×2.6厘米的肿块，与反应性右主动脉旁淋巴结有关。右肾肿块被确定为平滑肌肉瘤伴肝转移，而左肾肿块被诊断为透明细胞肾癌。患者接受右侧肾切除术，左侧微波消融并随访化疗。
结论：原发性肾平滑肌肉瘤极为罕见且具有侵袭性，导致糟糕的结果。由于肾功能的潜在丧失，同步双侧肾癌构成了手术挑战。在这种情况下，同步双侧肾脏肿块的组织学不同，采取了保留肾单位的方法，但是尽管积极的治疗，患者出现肝脏和腹膜转移。
结论：双侧同时性肾癌，特别是每个肾脏的组织学不同，异常罕见，使他们的管理具有挑战性。尽管由于它们的稀有性，可用的指导有限，积极及时地处理这些案件至关重要，由于他们的预后通常是不利的，需要进一步研究以推进管理策略。
方法：一名有高血压和甲状腺功能减退症病史的51岁女性，表现为右腰部疼痛，导致在左肾上极发现7厘米的右肾肿块和2.3×2.6厘米的肿块，与反应性右主动脉旁淋巴结有关。右肾肿块被确定为平滑肌肉瘤伴肝转移，而左肾肿块被诊断为透明细胞肾癌。患者接受右侧肾切除术，左侧微波消融并随访化疗。
结论：原发性肾平滑肌肉瘤极为罕见且具有侵袭性，导致糟糕的结果。由于肾功能的潜在丧失，同步双侧肾癌构成了手术挑战。在这种情况下，同步双侧肾脏肿块的组织学不同，采取了保留肾单位的方法，但是尽管积极的治疗，患者出现肝脏和腹膜转移。
结论：双侧同时性肾癌，特别是每个肾脏的组织学不同，异常罕见，使他们的管理具有挑战性。尽管由于它们的稀有性，可用的指导有限，积极及时地处理这些案件至关重要，由于他们的预后通常是不利的，需要进一步研究以推进管理策略。
