RESUMEN
A 71-year-old woman was admitted with fever up and weight loss. Abdominal computed tomography (CT) revealed right renal tumor 7 cm in diameter and inferior vena caval thrombus and multiple lymph node metastases and lung metastases. Transabdominal right nephrectomy and thrombectomy was performed and pathological examination was renal cell carcinoma (clear cell carcinoma, G3, INFbeta, v (+), pT3b, pN2) with adrenal invasion and lymph node metastases. She received 600 x 10(4) IU/day of interferon alpha (IFN-alpha) intramuscularly 3 times a week for 16 weeks from the 20th post-operative day. The disease showed progression and liver metastases 5 cm in diameter appeared. Then she received 140 x 10(4) JRU/day of IL-2 (div) 5 times a week for 4 weeks. CT showed a complete response on lung metastases and lymph node metastases and marked decrease of liver metastases after the first course of IL-2. After the second course, the liver mass remained 2 cm in diameter and then radiofrequency ablation (RFA) under CT was performed. CT after RFA showed a low density area at the liver tumor without enhancement. About five years after the operation, she is alive without evidence of disease.
Asunto(s)
Carcinoma de Células Renales/tratamiento farmacológico , Interferón-alfa/uso terapéutico , Interleucina-2/uso terapéutico , Neoplasias Renales/tratamiento farmacológico , Anciano , Carcinoma de Células Renales/cirugía , Ablación por Catéter , Terapia Combinada , Resistencia a Medicamentos , Femenino , Humanos , Neoplasias Renales/cirugía , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Neoplasias Pulmonares/secundario , Metástasis Linfática , NefrectomíaRESUMEN
A 70-year-old man was admitted with slight dyspnea and fever up. The patient had had total cystectomy for urothelial carcinoma of urinary bladder 14 months earlier and had a ureterocutaneostomy. At 2 days after the admission, he had a sudden attack of dyspnea. He was transferred to the intensive care unit, and mechanical ventilation was initiated. The pulmonary arterial pressure was measured at 65/30 mmHg, but the etiology for the pulmonary hypertension was unclear. Although highly suggestive of pulmonary embolism, chest roentgenogram and chest computed tomography (CT) showed clear lung fields. Pulmonary angiography disclosed no evidence of embolism. Despite anticoagulation therapy he died of respiratory failure. Autopsy revealed diffuse microscopic pulmonary tumor embolism with urothelial cacinoma in the pulmonary arterial vasculature. Microscopic pulmonary tumor embolism has rarely been reported with urothelial carcinoma.