Renal Cell Carcinoma with Polycythemia

Abstract

Renal cell carcinoma (RCC) is the most common renal tumor and participates in about 80-85% of primary renal tumors. It is usually diagnosed incidentally during the evaluation for other medical problems; or it may be presented with gross hematuria, loin mass or pain. However, it infrequently presents as a paraneoplastic syndrome (PNS) which includes, hypertension, hypercalcemia, and abnormal liver function. A 75-year-old gentleman presented with an incidental left renal mass following the evaluation of the left loin pain with headache and dizziness. The patient had a history of hypertension for 10 years on control medical therapy and no history of smoking or chronic obstructive airway disease. The complete blood picture was showed a marked elevation in hemoglobin 21.7 g/dl and hematocrit level 65%. Ultrasound was showed left renal mass and a computerized tomography scan was showed the enhancement in the left renal mass picture suggestive of RCC. After phlebotomy of 2 units of blood, the patient underwent radical nephrectomy, then the histopathology was reported clear cell type RCC Fuhrman nuclear grading system II. At 2 months following surgery, the patient's hemoglobin level and hematocrit were returned to normal. The pathogenesis of PNS may be due to an abnormal immune system response to a cancerous cell. There is a wide range of the PNS concerning RCC including non-specific constitutional features for example; cachexia, weight loss, and fever, and specific metabolic and biochemical disorders (i.e. hypercalcemia, non-metastatic hepatic dysfunction, amyloidosis, etc.). PNS is often unrecognized but polycythemia should be considered important biomarkers in RCC, therefore, it can be used as a tumor marker in the diagnosis and follow-up of the patient after surgery.