Adenocarcinoma of unknown primary in a 20-year-old African American male Journal Article
| Authors: | Power, D.; Lagunes, D. R. |
| Article Title: | Adenocarcinoma of unknown primary in a 20-year-old African American male |
| Abstract: | A 20-year-old African American male presented with a history of left flank pain and passing of light pink urine. Medical history included sickle cell trait. Urine analysis was positive for protein and blood. Metabolic profile, autoantibody screen, and complement levels were normal. Hemoglobin electrophoresis revealed an 41.8% HbS diagnostic of sickle cell trait. Creatinine clearance was normal and proteinuria was nonnephrotic. A noncontrast computed tomography (CT) scan showed left proximal hydronephrosis. Urology follow-up was arranged and the differential included renal papillary necrosis, or renal cyst rupture. He presented 3 months later with sudden onset left flank pain and gross hematuria. Serum creatinine was 1.8 mg/dL. Computed tomography scan with contrast revealed innumerable lung lesions, an enlarged heterogenously enhancing left kidney, and retroperitoneal adenopathy. Ultrasound revealed an obstructed left collecting system and a 14-cm enlarged left kidney with no discrete mass. Testicular markers/ultrasound, upper/lower endoscopies were normal. Lung biopsy revealed poorly differentiated adenocarcinoma positive for cytokeratin 7. Renal, sarcoma, and gastrointestinal markers were negative. By exclusion, it appeared that the patient had a carcinoma of unknown primary. However, with the clinical and personal history, a diagnosis of renal medullary carcinoma (RMC) was made. RMC is a rare and highly malignant tumor that should always be included in the differential of a patient with sickle cell disorder and hematuria. Renal biopsy typically fails to sample the renal medulla and radiologic findings might not raise the suspicion of a renal tumor. Thus, clinical suspicion must always be high in order to preserve the patient's only chance of prolonged survival. |
| Keywords: | adult; cancer chemotherapy; young adult; case report; cisplatin; gemcitabine; follow up; cancer diagnosis; adenocarcinoma; computer assisted tomography; protein; creatinine; hemoglobin; creatinine blood level; hemoglobin blood level; tumor marker; hematuria; kidney carcinoma; ultrasound; kidney neoplasms; blood; flank pain; contrast enhancement; urology; endoscopic surgery; cytokeratin 20; cancer of unknown primary site; cytokeratin 7; urinalysis; autoantibody; protein urine level; endoscopy; lung biopsy; proteinuria; fluid intake; lymphadenopathy; african american; thoracoscopy; electrophoresis; creatinine clearance; renal medullary carcinoma; sickle cell disease; video-assisted thoracoscopic surgery; cell adhesion molecule; complement; cytokeratin ae1; cytokeratin ae3; epithelial membrane antigen; thyroid transcription factor 1; cyst rupture; hydronephrosis; kidney collecting tubule; kidney cyst; kidney papilla necrosis; lung lesion; sickle cell; kidney medulla; neoplasms, unknown primary |
| Journal Title: | Clinical Genitourinary Cancer |
| Volume: | 7 |
| Issue: | 2 |
| ISSN: | 1558-7673 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2009-08-01 |
| Start Page: | E45 |
| End Page: | E48 |
| Language: | English |
| DOI: | 10.3816/CGC.2009.n.023 |
| PUBMED: | 19692325 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Export Date: 30 November 2010" - "Source: Scopus" |
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