Renal cell carcinoma, clear cell type with secondary polycythemia in a young Filipino male: A case report
- Author:
Hanna Claire P. Bejarasco
1
;
Ramcis Pelegrino
1
Author Information
- Publication Type:Case Reports
- Keywords: Radical nephrectomy; Case report
- MeSH: Carcinoma, Renal Cell; Polycythemia
- From: Philippine Journal of Internal Medicine 2024;62(1):320-325
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Clear Cell Renal Cell Carcinoma, a renal cortical tumor characterized by malignant epithelial cells with clear
cytoplasm and compact alveolar or acinar growth pattern interspersed with intricate arborizing vasculature.1 This is rare in
people less than 45 years old. Though it has varied clinical manifestations, its classical triad: abdominal mass, hematuria,
and groin pain only present in four to 17% of cases.2 We therefore present a case of renal cell carcinoma occurring in an
unusual age group who presented with vague gastrointestinal symptoms and polycythemia which accounts only less than
5% of cases.3
Case Presentation:This is a case of a 28-year-old Filipino male who presented with epigastric pain with abdominal fullness and anorexia who later complained of frequent vomiting after solid and liquid intake. CBC revealed polycythemia. Gastroscopy with biopsy showed esophagitis Los Angeles classification Grade A and duodenal mass obstructing 95% of the lumen. Computed tomographic scan of whole abdomen revealed large renal mass, right of 15.9x9.35x11.34cm extending superiorly at the antropyloric region causing gastric luminal narrowing down to first and second segments of duodenum with a 4.2cm enlarged lymph node in aortocaval area. Magnetic resonance imaging revealed a huge complex right renal mass of 12x12x10cm in size extending beyond Gerota’s fascia with 8x5.2x6.2cm lymph node compressing the vena cava. Right radical nephrectomy was done for both supportive management to relieve the obstruction and for histologic diagnosis which revealed clear cell renal cell carcinoma. JAK2 gene mutation test was done to determine the cause of polycythemia and phlebotomy was performed to address the problem.
Conclusion:This case presents with vague gastrointestinal symptoms which is atypical of renal cell carcinoma, hence highlights the importance of properly investigating its cause. Furthermore, a multidisciplinary approach involving different subspecialties plays a significant role in the diagnosis and management in this patient. - Full text:11 2023-241 Case OK.pdf
