摘要 Objective: With today's modern imaging modalities, patients diagnosed with renal cell carcinoma (RCC) rarely present symptomatically. In some cases, however, they can develop paraneoplastic syndromes with associated symptoms. To date, only three cases of RCC presenting with chronic dry cough have been reported. We describe six patients who presented with cough that improved following radical nephrectomy.Methods: A retrospective review of patients undergoing partial or radical nephrectomy for renal masses between January 2015 and March 2016 was performed, and patients presenting with a cough were examined.Results: Six patients presented with chronic cough and were discovered to have a large renal mass. Postoperative spontaneous resolution of cough was noted in all but one patient, in whom coughing was reduced and limited to the mornings. Cough duration ranged from 3 months to just over a year. All patients were treated with radical nephrectomy, which was cytoreductive in four patients. Average tumor size was 10.9 cm (SD=2.2 cm). Five of the tumors had clear cell pathology, and every tumor was Fuhrman grade IV, unifocal, and demonstrated necrosis. Sarcomatoid features were reported in four of the tumors..Conclusion: Our study presents the largest series of patients with RCC who presented with a chronic cough that was significantly improved following radical nephrectomy. We believe the cause of cough is multifactorial and further investigation is needed to clearly elucidate the etiology.
Abstract: Objective: With today's modern imaging modalities, patients diagnosed with renal cell carcinoma (RCC) rarely present symptomatically. In some cases, however, they can develop paraneoplastic syndromes with associated symptoms. To date, only three cases of RCC presenting with chronic dry cough have been reported. We describe six patients who presented with cough that improved following radical nephrectomy.Methods: A retrospective review of patients undergoing partial or radical nephrectomy for renal masses between January 2015 and March 2016 was performed, and patients presenting with a cough were examined.Results: Six patients presented with chronic cough and were discovered to have a large renal mass. Postoperative spontaneous resolution of cough was noted in all but one patient, in whom coughing was reduced and limited to the mornings. Cough duration ranged from 3 months to just over a year. All patients were treated with radical nephrectomy, which was cytoreductive in four patients. Average tumor size was 10.9 cm (SD=2.2 cm). Five of the tumors had clear cell pathology, and every tumor was Fuhrman grade IV, unifocal, and demonstrated necrosis. Sarcomatoid features were reported in four of the tumors..Conclusion: Our study presents the largest series of patients with RCC who presented with a chronic cough that was significantly improved following radical nephrectomy. We believe the cause of cough is multifactorial and further investigation is needed to clearly elucidate the etiology.
通讯作者:
Vinay R. Patel,E-mail address:patel.r.vinay@gmail.com
E-mail: patel.r.vinay@gmail.com
引用本文:
Vinay R. Patel, Bradley A. Morganstern, Louis R. Kavoussi. Persistent cough as a paraneoplastic presenting symptom in six patients with renal cell carcinoma[J]. Asian Journal of Urology, 2017, 4(1): 10-13.
Vinay R. Patel, Bradley A. Morganstern, Louis R. Kavoussi. Persistent cough as a paraneoplastic presenting symptom in six patients with renal cell carcinoma. Asian Journal of Urology, 2017, 4(1): 10-13.
[1] Chow WH, Devesa SS, Warren JL, Fraumeni JF. Rising incidence of renal cell cancer in the United States. JAMA 1999;281:1628e31.
[2] Palapattu GS, Kriso B, Rajfer J. Paraneoplastic syndromes in urologic malignancy:the many faces of renal cell carcinoma. Rev Urol 2002;4:163e70.
[3] Fujikawa A, Daidoh Y, Taoka Y, Nakamura S. Immediate improvement of a persistent cough after tumor embolization for renal cell carcinomaea rare manifestation of paraneoplastic syndrome. Scand J Urol Nephrol 2002;36:393e5.
[4] Okubo Y, Yonese J, Kawakami S, Yamamoto S, Komai Y, Takeshita H, et al. Obstinate cough as a sole presenting symptom of non-metastatic renal cell carcinoma. Int J Urol 2007;14:854e5.
[5] Tatzel S, Sener A. Persistent dry cough:an unusual presentation of renal cell carcinoma. CMAJ 2014;186:136.
[6] Chung KF, Pavord ID. Prevalence, pathogenesis, and causes of chronic cough. Lancet 2008;371:1364e74.
[7] Blay JY, Rossi JF, Wjdenes J, Menetrier-Caux C, Schemann S, Negrier S, et al. Role of interleukin-6 in the paraneoplastic inflammatory syndrome associated with renal-cell carcinoma. Int J Cancer 1997;72:424e30.
[8] Walther MM, Johnson B, Culley D, Shah R, Weber J, Venzon D, et al. Serum interleukin-6 levels in metastatic renal cell carcinoma before treatment with interleukin-2 correlates with paraneoplastic syndromes but not patient survival. J Urol 1998; 159:718e22.
[9] Maher SA, Birrell MA, Belvisi MG. Prostaglandin E2 mediates cough via the EP3 receptor:implications for future disease therapy. Am J Respir Crit Care Med 2009;180:923e8.
Christopher Hartman, Nikhil Gupta, David Leavitt, David Hoenig, Zeph Okeke, Arthur Smith. Advances in percutaneous stone surgery[J]. Asian Journal of Urology, 2015, 2(1): 26
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