OLGU SUNUMU Karaciğere nadir olarak kistik metastazla seyreden renal hücreli karsinom: Olgu sunumu

Abstract

Renal cell carcinoma is an uncommon cancer type. In this cancer, metastasis to several sites of the body occurs. The classic triad of renal cell carcinoma includes hematuria, flank pain and mass, but it usually has an asymptomatic course tumors are small. Metastasis frequently occurs to lung, bone, skin, liver and brain. A 52-year-old man was admitted to our department with complaint of weight loss and abdominal swelling for the past two months. The patient reported a 5 kilogram weight loss during this period. Physical examination revealed hepatomegaly and a mass measuring 6-7 cm, localized in the left upper quadrant. Abdominal ultrasonography demonstrated liver enlargement (215 mm) with multiple septated cystic lesions and a hypoechoic mass lesion (160x98 mm) with cystic components in the left kidney. Abdominal tomography demonstrated multiple cystic lesions of variable size in the liver and a heterogeneous mass measuring 10x15x16 mm in the left kidney. Kidney biopsy with fine needle aspiration of cystic lesions in the liver was performed. Renal biopsy revealed malignant tumoral cells with hyperchromatic nucleus and large clear cytoplasm. Aspirated material of liver cysts was macroscopically gelatinous. Microscopic examination of cystic material obtained from liver lesions demonstrated tumor cells with large clear cytoplasm, hyperchromatic nucleus and occasional prominent nucleolus. In bacteriological examination of cyst content, no microorganism was detected. The patient was diagnosed as stage 4 renal cell carcinoma by the American Joint Commission on Cancer TNM staging system. Cystic metastasis of the liver is rarely encountered in renal cell carcinoma. Histopathological diagnosis is crucial since some other carcinomas might also have similar metastases. The patient was accepted as an unresectable case with respect to the staging system. He had a performance status score of more than 3 by Eastern Cooperative Oncology Group and rejected any type of treatment, and thus received only supportive care.