Renal cancer palliative care, Terapia Ţintită În Carcinomul Renocelular


We report the case of a year-old male with a second primary lung cancer in stage IV, with intracardiac mass, developed after a clear renal cell carcinoma. The particular features of the case are discussed, highlighting the important aspects of diagnosis, with reference to known data.

According to these aspects, the patient was included in the intermediate risk group, with median survival estimated at CT exam reassessment for thorax, abdomen, and pelvis with contrast substance scans renal cancer palliative care performed in Augustand then in Januaryboth suggesting stable disease. It was decided to continue the treatment with sunitinib, with the same doses, with good tolerance and no side effects. In Augustthe patient was admitted to the nephrology hospital section with elevated levels of nitrates.

Prezentăm cazul unui pa­cient de 57 de ani, cu un al doilea cancer pulmonar primar în stadiul IV, cu o masă intracardiacă, dezvoltată în urma unui ciuperci agaricus renal cu celule clare. Sunt discutate particularităţile aces­tui caz, subliniind aspectele importante privind diag­nos­ti­cul, referindu-ne şi la datele existente.

Terapia Ţintită În Carcinomul Renocelular

Cuvinte cheie cancer renal cancer pulmonar metastaze cardiace Introduction Although the outcome of patients diagnosed with renal cell carcinoma RCC has improved over the past years, there is a lack of information on the risk of developing a second cancer after RCC.

Other studies reported an increased risk of subsequent bladder and prostate cancer for papillary RCC 3,4. On the other hand, metastatic spreads to the heart are not as renal cancer palliative care as considered, their incidence ranging from 2.

Tratamentul cu bevacizumab plus interferon-alfa a fost aprobat de ctre ageniile de reglementare din Europa decembrie ; se ateapt rezultatul unei recenzii efectuate n SUA de ctre Food and Drug Administration. Everolimus a fost aprobat recent martie de ctre FDA a SUA pentru pacienii cu RCC avansat dup apariia progresiei bolii n condiiile tratamentului cu sunitinib sau sorafenib.

Case presentation A year-old male, non-smoker, with history of clear renal cell carcinoma T3N1M0diagnosed infor which he had undergone radical nephrectomy on his left side, radiotherapy and received treatment with interferon-alpha, presented to our clinic in May complaining of progressive dyspnea, productive cough, chest pain and important weight loss 14 kg in two months.

The chest X-ray and the CT scan revealed a tumor mass in the right lower lobe of his lung 6. The biopsy of a mediastinal lymph node by Carlens mediastinoscopy, and the histopathological findings revealed metastatic adenocarcinoma G3.

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Palliative chemotherapy was initiated, the pacient receiving two cycles of carboplatin with vinorelbine. After that, without any symptomatic change, trans­thoracic echocardiography detected in his left ventricular apex a high echogenic mass 1. Figure 1.

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Transthoracic echocardiography imaging The differential diagnosis included thrombus. However, taking into account that no hipokinesia or left ventricular hyperthrophy was detected and he had a normal ejection fraction, we considered the mass as a cardiac metastasis.

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The chemotherapy was changed, the patient receiving one cycle of pemetrexed plus cisplatin. Unfortunately, soon after, the family informed us that he passed away, and no autopsy was performed.

Discussion There are two important aspects worth highlighting in our clinical case, namely the development of a second primary lung malignancy after clear RCC, and the appeareance of a solitary cardiac metastasis in the evolution.

Therefore, in order to establish an optimal follow-up program for patients with RCC, we should consider the risk of developing other subsequent primary cancer, and promote an effective surveillance for early detection.

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Regarding cardiac malignancies, most of them are secondary tumors, produced by lung cancer or many other cancers, with a small size, multiple, commonly asymptomatic and indicating widespread metastases. Despite the fact that majority of them are clinically silent, the risk of embolism is high and can lead to death; thus, echocardiography is important in oncologic patients, with or without cardiac symptoms.

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To the best of our knowledge, solitary cardiac metastases with intracavitary growth are rare. Conflict of interests: The authors declare no conflict of interests.

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Multiple primary malignancies in patients with renal cell carcinoma: a national population-based cohort study. BJU Int. Incidence and prognostic significance of second primary cancers in renal cell carcinoma.

Citate duplicat

Am J Clin Oncol. Second primary malignancies associated with renal cell carcinoma: influence of histologic type. Renal cancer and second renal cancer palliative care critical review of the literature. Prog Urol. Cardiac metastases.

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J Clin Pathol. Renal cell carcinoma: Evolving and emerging subtypes.

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