Severe hypercalcemia as the initial presentation of renal cell carcinoma

Annals of Medicine and Surgery, Journal Year: 2025, Volume and Issue: 87(5), P. 3016 - 3022

Published: April 3, 2025

Introduction and importance: Renal cell carcinoma (RCC) represents 90% of renal malignancies with rising global incidence. While the classic triad includes hematuria, flank pain, palpable masses, paraneoplastic hypercalcemia occurs in 17% cases indicates aggressive disease behavior. This case documents severe as initial manifestation metastatic RCC. Case presentation: A 64-year-old male presented malaise, bloating, weight loss. Laboratory evaluation revealed (15.1 mg/dL), suppressed parathyroid hormone (4.2 pg/mL), elevated hormone-related peptide (83 pg/mL). Imaging identified a 5.5 × 5.0 5.3 cm left mass metastases to lungs, brain, possibly bone. Biopsy confirmed clear-cell Management comprised hydration, zoledronic acid, combined immunotherapy (pembrolizumab/lenvatinib), palliative radiation for cerebral lesions. Clinical discussion: illustrates PTHrP-mediated humoral malignancy The pathophysiology differs from alternative mechanisms such calcitriol-mediated or cytokine-driven osteoclast activation. Diagnostic markers demonstrated pattern PTHrP elevation pg/mL) PTH suppression multimodal imaging protocol effectively delineated primary tumor dimensions, vascular invasion, burden. Treatment efficacy was objectively measured through serial calcium levels documented radiographic regression aligns recent data on combination (anti-PD-1) tyrosine kinase inhibition advanced RCC, supporting current therapeutic paradigms disease. Conclusion: Prompt recognition RCC facilitates timely intervention. demonstrates value comprehensive diagnostic multidisciplinary management combining supportive care targeted immunotherapy. Further prospective studies are needed optimize strategies patients presenting metabolic derangements suggestive underlying malignancy.

Language: Английский

Role of 18F-FDG-PET in renal tumors: insights from WHO 2022 classification

Japanese Journal of Radiology, Journal Year: 2025, Volume and Issue: unknown

Published: April 7, 2025

Abstract The objective of this article is to provide a comprehensive overview the imaging characteristics various renal cell tumors using 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET), based on latest WHO-2022 classification. Due physiological accumulation FDG in kidneys, clinical utility FDG-PET evaluation has traditionally been considered limited. However, recent studies have re-evaluated its potential value. demonstrated particular detecting metastases and postoperative recurrence carcinoma (RCC), as well identifying RCC patients with chronic kidney failure, where excretion into urinary tract reduced. Renal are occasionally detected incidentally FDG-PET, uptake varies depending tumor subtype. Therefore, understanding these clinically important, it may serve valuable guide for subsequent diagnostic evaluations. Furthermore, advancements development novel PET tracers hold promise future applications tumors. We believe that insights gained from study will contribute routine practice planning research.

Language: Английский