3 Case 2-2007: A 60-year-old male with breathlessness and weight loss

Spontaneous regression of metastatic renal cell carcinoma: case report. Journal Of Medical Case Reports,2007, 1(1). doi: 10.1186/1752-1947-1-89 

Lekanidi, K., Vlachou, P., Morgan, B., & Vasanthan, S.

Case Summary 1

A 60-year-old male with a medical history of myelofibrosis was presented with increased shortness of breath, lethargy, and weight loss at a routine clinic visit. Clinical examinations for this patient included a chest x-ray and a computed tomography (CT) scan that revealed splenomegaly and multiple pulmonary metastases in both lungs. Further investigations were conducted to determine the diagnosis of this patient.  

 


Learning Objectives

  • Investigating the clinical history of the patient and selecting appropriate examinations to be conducted for further analysis.
  • Interpreting physical symptoms and test results to infer possible diagnosis.
  • Familiarizing and defining new medical terminology associated with renal disease.
  • Extrapolating key lifestyle factors that have contributed to renal disease and preventative measures that can be put in place, if applicable.

Clinical History 1

  • Age: 60 years old
  • Sex: Male

Medical History 1

Symptoms 1

  • Shortness of breath
  • Weight loss
  • Lethargy

 

Examinations (Clinical Assays/Tests/Imaging) 1

Physical Examination 1

  • Normal 

Chest X-Ray (CXR) 1

  • Results showed multiple lung lesions consistent with metastatic deposits.  
Chest X-Ray Images
Figure 1: Chest X-Ray shows multiple lung lesions aligned with metastatic deposits (yellow arrows).1

Staging Computed Tomography (CT) Scan1

  • Images showed marked splenomegaly, causing displacement of the left kidney medially.
  • The left kidney had a 5 cm soft tissue mass arising from the middle of the kidney.
  • Characterized to potentially be renal cancer.
  • Multiple pulmonary metastases in both lungs were shown in the staging CT chest.
Computed Tomography images
Figure 2: Computed Tomography shows splenomegaly and left renal carcinoma (yellow arrow).1

Laparoscopic Cytoreductive Nephrectomy  1

  • No complications and immunotherapy with alpha-interferon. 

Histology 1

  • Revealed clear cell renal cell carcinoma. 

Post-operation 1

  • The patient attended a routine follow-up at the hematology clinic, six weeks post-operation and prior to beginning immunotherapy.
    • A repeat chest radiography of his lungs showed completely resolved symptoms with evidence of metastatic deposits.
Chest X-Ray from routine follow-up showing no metastases six weeks after operation
Figure 3: Chest X-Ray from routine follow-up showing no metastases six weeks after the operation.1

 

Question & Answers Leading to Diagnosis: 

Question 1: Based on this patients’ previous medical history, current symptoms, and imaging tests, what may be the preliminary diagnosis of this patient? 

Question 2: After the successful laparoscopic cytoreductive nephrectomy, histology was used to characterize the morphology of this patient’s cells, what was the patient’s diagnosis? What other methods could have been used to assistin the diagnosis?

Question 3: Post-operation and immunotherapy, what investigations would be appropriate for the follow-up?

** For answers please check the next chapter.

 

Medical terminology/Abbreviations: 

  • Hematological – Relating to blood and body tissue. 4
  • Metastatic/Metastasis – Cancer that can spread to different areas of the body. 3
  • Myelofibrosis – A rare blood cancer, a form of chronic leukemia. 2
  • Nephrectomy – Surgical removal of whole or parts of a kidney. 5
  • Splenomegaly – the enlargement of the spleen. 6 

 

References

  1. Lekanidi, K., Vlachou, P., Morgan, B., & Vasanthan, S. (2007). Spontaneous regression of metastatic renal cell carcinoma: case report. Journal Of Medical Case Reports, 1(1). doi: 10.1186/1752-1947-1-89
  2. Myelofibrosis; Causes, Symptoms, Treatment & Prevention. (2021). Retrieved 15 March 2021, from https://my.clevelandclinic.org/health/diseases/15672-myelofibrosis
  3. What is Metastasis?. (2021). Retrieved 15 March 2021, from https://www.cancer.net/navigating-cancer-care/cancer-basics/what-metastasis
  4. haematological. (2021). Retrieved 15 March 2021, from https://dictionary.cambridge.org/dictionary/english/haematological
  5. Nephrectomy (kidney removal) – Mayo Clinic. (2021). Retrieved 15 March 2021, from https://www.mayoclinic.org/tests-procedures/nephrectomy/about/pac-20385165
  6. Enlarged spleen (splenomegaly) – Symptoms and causes. (2021). Retrieved 15 March 2021, from https://www.mayoclinic.org/diseases-conditions/enlarged-spleen/symptoms-causes/syc-20354326#:~:text=Your%20spleen%20is%20an%20organ,during%20a%20routine%20physical%20exam. 
  7. Topics, H. (2021). Alpha-1 Antitrypsin Deficiency | Alpha 1 Antitrypsin | MedlinePlus. Retrieved 19 March 2021, from https://medlineplus.gov/alpha1antitrypsindeficiency.html#:~:text=Alpha%2D1%20antitrypsin%20(AAT),can’t%20reach%20the%20lungs.
  8. Kidney cancer – Diagnosis and treatment – Mayo Clinic. (2021). Retrieved 19 March 2021, from https://www.mayoclinic.org/diseases-conditions/kidney-cancer/diagnosis-treatment/drc-20352669
  9. Tefferi, A. (2020). Primary myelofibrosis: 2021 update on diagnosis, risk‐stratification and management. American Journal Of Hematology, 96(1), 145-162. doi: 10.1002/ajh.26050
  10. What is Metastatic Cancer? Diagnosing and Treatment. (2021). Retrieved 4 June 2021, from https://www.cancercenter.com/metastasis
  11. Learn About Alpha-1 Antitrypsin Deficiency. (2021). Retrieved 4 June 2021, from https://www.lung.org/lung-health-diseases/lung-disease-lookup/alpha-1-antitrypsin-deficiency/learn-about-alpha-1-antitrypsin-defiency
  12. Content – Health Encyclopedia – University of Rochester Medical Center. (2021). Retrieved 4 June 2021, from https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=34&contentid=17768-1‘
  13. McGuire, B. B., & Fitzpatrick, J. M. (2009). Biomarkers in renal cell carcinoma. Current opinion in urology, 19(5), 441–446. https://doi.org/10.1097/MOU.0b013e32832f0c68

Further Reading

 

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This post is adapted for the Health & Medical Case Studies created by the Master of Medical Biotechnology program of the University of Windsor. This work licensed under a Creative Commons Attribution-NonCommercial (CC BY-NC-ND) 4.0 International License.

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Case 2-2007: A 60-year-old male with breathlessness and weight loss Copyright © 2023 by Lekanidi, K., Vlachou, P., Morgan, B., & Vasanthan, S. is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, except where otherwise noted.

Digital Object Identifier (DOI)

https://doi.org/10.1186/1752-1947-1-89 

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