以顽固性剧烈咳嗽为主要表现的肾癌一例及文献复习

Renal cell carcinoma presenting with intractable and severe cough:one case report and literature review

目的探讨以顽固性剧烈咳嗽为主要表现肾癌患者的临床特点,以提高对该病的认识。方法分析1例以顽固性剧烈咳嗽为主要表现肾癌患者的病史资料、病理检查、治疗过程及随访结果,并回顾以顽固性剧烈咳嗽为主要表现肾癌的相关文献。结果 43岁男性患者,早期表现为顽固性剧烈咳嗽,当出现胸腔积液时院外误诊为结核性胸膜炎。四川大学华西医院经淋巴结、胸膜活检并行免疫组织化学证实为肾透明细胞癌。患者拒绝手术及化疗,随访1个月后去世。复习文献国内外共报道了21例以顽固性剧烈咳嗽为主要症状的肾癌患者,早期易误诊或漏诊,预后差。结论顽固性剧烈咳嗽为主要症状属于肾癌一种罕见的副肿瘤综合征。

Objective To explore the clinical characteristics of patients with renal cancer whose main manifestation is intractable and severe cough,in order to improve the understanding of the disease.Methods The medical history data,pathological examination,treatment course,and follow-up results of one patient with intractable and severe cough as the main manifestation of renal cancer were analyzed,and the relevant literatures of patients with intractable and severe cough as the main manifestation were reviewed.Results A 43-year old male patient with an early presentation of intractable and severe cough who was out of hospital misdiagnosed with tuberculous pleurisy when pleural effusion was present.Renal clear cell carcinoma was confirmed in West China Hospital,Sichuan University by lymph node and pleural biopsy in parallel with immunohistochemistry.The patient refused surgery and chemotherapy and died after one month follow-up.A total of 21 cases of renal cancer with intractable and severe cough as the main symptom were reported by reviewing the literatures at home and abroad.It is easily misdiagnosed or missed diagnosed in early stage,and the prognosis is poor.Conclusions Intractable and severe cough as the main symptom belongs to renal cancer as a rare paraneoplastic syndrome.