Renal metastases from esophageal cancer and retroperitoneal lymphoma detected via chromosome duplications identified by fluorescence in situ hybridization in urine exfoliated cells: First 2 case reports.
Renal metastases from esophageal cancer and retroperitoneal lymphoma detected via chromosome duplications identified by fluorescence in situ hybridization in urine exfoliated cells: First 2 case reports.
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DOI：
10.1097/md.0000000000024010
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发表时间：
2021-03-12
期刊：
影响因子：
1.6
通讯作者：
Yang C
中科院分区：
文献类型：
--
作者：
Hu Z;Ke C;Shen Y;Zeng X;Yang C
尿液荧光原位杂交（FISH）阳性的肾占位性病变通常被认为是尿路上皮癌。在这里，我们描述了 2 例尿液脱落细胞中染色体重复的肾转移病例。患者1，男性，56岁，有食管癌病史，因右腰痛伴镜下血尿1个月入院，于2017年5月入院。磁共振成像（MRI）显示右肾占位性病变（5.4 cm × 4.6 cm），右肾门及腹膜后多发肿大淋巴结。膀胱镜检查结果呈阴性，尿液脱落细胞的 FISH 分析呈阳性，表明 3、7 和 17 号染色体扩增。患者2为50岁男性，2019年5月入院，无明显原因腹痛、腹胀（持续7天），血清肌酐844μmol/L。 2号患者无血尿、发热，MRI显示左肾下、内侧占位性病变，左肾上腺、腹膜后、腹部、骨盆交界处多发肠系膜结节，部分融合。肿瘤病灶大小约为3.1cm×2.3cm。尿液FISH结果呈阳性，表明3、7、17号染色体扩增。两名患者均被诊断患有病理未知的肾肿瘤。 1 号患者接受了腹腔镜肾脏和输尿管切除术以及袖状膀胱切除术。术后病理诊断为转移性角化鳞状细胞癌，右肺门淋巴结鳞状细胞癌。原发性食管癌和肾转移瘤的组织学FISH与尿液FISH检测结果一致。患者2接受了左肾下和腹膜后区域的活检，并被诊断为弥漫性大B细胞淋巴瘤。 1 号患者在泌尿外科手术后存活了 6 个月。 2号患者接受R-CHOP方案和激酶抑制剂治疗后，肾功能明显恢复，肿块也检测不到。我们的结果表明，在进行鉴别诊断时，FISH 阳性的肾占位性病变应被视为具有染色体畸变的潜在肾转移。
Renal-occupying lesions positive for urine fluorescence in situ hybridization (FISH) are usually considered urothelial carcinomas. Here, we describe 2 cases of renal metastases with chromosome duplications in urine exfoliated cells. Patient 1, a 56-year-old male with a history of esophageal cancer, was admitted to our hospital on May 2017 after presenting with right back pain with microscopic hematuria for 1 month. Magnetic resonance imaging (MRI) showed right renal space-occupying lesions (5.4 cm × 4.6 cm) and multiple enlarged lymph nodes in the right renal hilum and retroperitoneum. The cystoscopy results were negative, and FISH analysis of urine exfoliated cells was positive, indicative of chromosome 3, 7, and 17 amplifications. Patient 2 was a 50-year-old male who was admitted to our hospital on May 2019 with no obvious cause of abdominal pain and abdominal distension (lasting for 7 days), with a serum creatinine level of 844 μmol/L. Patient 2 had no hematuria or fever, and MRI showed left renal inferior and medial space-occupying lesions, and multiple mesenteric nodules at the junction of the left adrenal gland, retroperitoneum, abdomen, and pelvis, which were partially fused. The tumor lesions were approximately 3.1 cm × 2.3 cm in size. The urine FISH results were positive, indicating chromosome 3, 7, and 17 amplifications. Both patients were diagnosed with renal tumors with unknown pathology. Patient 1 underwent laparoscopic resection of the kidney and ureter, and sleeve cystectomy. The postoperative pathological diagnosis was metastatic keratinized squamous cell carcinoma, with squamous cell carcinoma in the right hilar lymph node. Histological FISH of the primary esophageal cancer and renal metastases were consistent with the urine FISH test results. Patient 2 underwent a biopsy of the left renal inferior and retroperitoneal areas, and was diagnosed with diffuse large B-cell lymphoma. Patient 1 survived 6 months after urological surgery. After treating patient 2 with the R-CHOP regimen and kinase inhibitors, his renal function recovered significantly and the mass become undetectable. Our results imply that FISH-positive renal occupying lesions should be considered as potential renal metastases with chromosome aberrations when making a differential diagnosis.