Postoperative Recurrence And Metastasis Of Renal Chromophobe Cell Carcinoma:A Case Report And Literature Review

Objective:Renal cell carcinoma is second only to bladder cancer in the incidence of urinary system tumors,accounting for about 2% ~ 3% of adult tumors.The pathological types of renal cell carcinoma mainly include renal clear cell carcinoma,papillary renal cell carcinoma,chromophobe cell carcinoma,multilocular cystic renal cell tumor with low malignant potential,collecting duct carcinoma and renal medullary carcinoma.Renal chromophobe cell carcinoma was first reported by Thoenes et al.in 1985.The typical manifestation of CRCC is relatively transparent cytoplasm,forming a delicate network,similar to the state of "plant cells".Renal chromophobe cell carcinoma is a rare type of renal cell carcinoma with good prognosis.This article discussed the clinical characteristics,metastasis mechanism and treatment of renal chromophobe cell carcinoma from a rare clinical case,so as to provide more basis for its differential diagnosis,treatment and prognosis.Methods:The symptoms,signs,diagnosis and treatment process,treatment effect and adverse drug reactions of the patients were summarized through case report.Combined with relevant literature,the treatment methods of metastatic renal cell carcinoma were elaborated and analyzed to guide clinical practice.Results: Patients with renal chromophobe cell carcinoma generally have no special clinical symptoms and signs,and are often found through physical examination.CT examination provides certain help for the diagnosis and selection of reasonable surgical methods,but pathological examination is the gold standard for the diagnosis.In this case,the patient was mainly admitted to the hospital for intermittent painless gross hematuria for 2 months,and the right kidney was found to be occupying on the CT of the urinary system.Considering the high possibility of malignancy,radical nephrectomy was performed on the right kidney,and postoperative pathological diagnosis was that the right kidney had chromophobe cell carcinoma.Right retroperitoneal mass was found 2.5 years later,right retroperitoneal mass resection + terminal ileum resection + right semicolon resection + ileal transverse colon anastomosis was performed,and postoperative pathological diagnosis was right kidney chromophobe cell carcinoma postoperative recurrence with ascending colon metastasis.Reexamination of abdominal CT 3 years later revealed hepatic occupation,and hepatic metastasis was considered.After 8 months of treatment with oral targeted drug(sorafenib),regular reexamination of whole-abdominal CT showed that the liver occupation area was gradually reduced from 6cm 5cm at the initial detection to 1cm 0.5cm.At present,the patient has been followed up for 44 months with stable condition and survival with tumor.Conclusion: Early renal chromophobe cell carcinoma has no specific clinical symptoms and signs.Most of them were found by imaging during physical examination.CT examination provides some help for its diagnosis and selection of reasonable surgical methods.Pathological examination is the gold standard for its diagnosis.Surgical treatment is the main treatment for early renal chromophobe cell carcinoma.Tumor reduction surgery combined with targeted drug(sorafenib)has a good effect on this case of metastatic renal chromophobe cell carcinoma.