异时性序贯转移灶切除术治疗转移性肾细胞癌：一例病例报告及文献综述

Metachronous Sequential Metastasectomy in Metastatic Renal Cell Carcinoma: A Case Report and Literature Review

摘要: 肾细胞癌(RCC)术后发生对侧肾上腺及腰大肌转移者极为罕见。本文报告一例48岁男性患者，因右肾下极透明细胞型RCC (T1bN0M0)行根治性肾切除术，术后3年于左侧腹膜后脂肪发现孤立性转移灶并切除；术后2年又出现左肾上腺、左腰大肌及左肺多发转移，经手术完全切除所有转移灶，病理及免疫组化均证实为转移性透明细胞型RCC。据我们所知，这是腹腔镜肾肿瘤切除术后RCC转移至对侧腰大肌的首例报道。本例提示RCC转移具有不可预测性和异时性，可累及多个罕见部位；定期术后CT随访有助于早期发现转移灶，及时行转移灶切除术可能延长患者生存。

Abstract: Metastasis to the contralateral adrenal gland and psoas major muscle following surgery for renal cell carcinoma (RCC) is extremely rare. Herein, we report a 48-year-old male patient who underwent radical nephrectomy for clear cell RCC (T1bN0M0) located in the lower pole of the right kidney. Three years after surgery, a solitary metastatic lesion was detected in the left retroperitoneal fat pad and was subsequently resected. Two years later, multiple metastases developed in the left adrenal gland, left psoas major muscle, and left lung, all of which were completely surgically removed. Pathological and immunohistochemical examinations confirmed metastatic clear cell RCC. To the best of our knowledge, this is the first report of RCC metastasis to the contralateral psoas major muscle after laparoscopic renal tumor resection. This case demonstrates that RCC metastasis is unpredictable and metachronous, potentially involving multiple rare sites. Regular postoperative CT follow-up may facilitate early detection of metastases, and timely metastasectomy may prolong patient survival.