Author(s) :
Bogdan Silviu Ungureanu1, Victor Mihai Sacerdoțianu1, Dan Nicolae Florescu1, Lucian Mihai Florescu2, Ion Rogoveanu1, Tudorel Ciurea1, Dan Ionuț Gheonea1
1 Gastroenterology Department, University of Medicine and Pharmacy of Craiova, Romania
2 Radiology Department, University of Medicine and Pharmacy of Craiova, Romania
Corresponding author: Bogdan Silviu Ungureanu, Email: boboungureanu@gmail.com
Published: Journal of Medical and Radiation Oncology 1 (2021) 69-73, , , - DOI: 10.53011/JMRO.2021.01.07
Abstract
Cholestatic jaundice is usually linked to a malignant disease if it is secondary to a mechanical obstruction of the bile duct or due to hepatic metastasis. As a paraneoplastic syndrome, cholestasis has been described in lymphoproliferative disorders, in prostate cancer, and as the Stauffer syndrome with non-metastatic dysfunction in patients with renal cell carcinoma (RCC). We present the case of a 61 year old patient with a paraneoplastic manifestation with cholestatic jaundice due to RCC with kidney and lung metastases. Clinical characteristics of patients with RCC vary and sometimes manifest in a peculiar way. Paraneoplastic syndrome in RCC may present cholestatic jaundice, and with the exclusion of more frequent causes, it should be taken into account in the differential diagnosis for icteric liver disease. This rare but possible situation requires prompt recognition, as treatment correlates with disease spread and therefore will influence patients’ overall survival rates.
Table 1. Laboratory Values
| Relapse | First Episode | ||
| Hemoglobin (Normal 13 – 16)
MCV |
6.3
85.5 |
10.1
87.2 |
g/dl
|
| Hematocrit (Normal 40-48) | 19.6 | 37 | % |
| Platelets | 226.000 | 245.000 | mmc |
| Leukocytes | 4.700 | 5.900 | mmc |
| Urea | 39 | 35 | mg/dl |
| Creatinine | 1.09 | 1.07 | mg/dl |
| Glycemia (Normal 70 – 110) | 226 | 150 | mg/dl |
| Colesterol | 203 | 179 | mg/dl |
| AST | 39 | 25 | U/l |
| ALT | 56 | 34 | U/l |
| Total Bilirubin (Normal 0,2 -1,2)
Direct Bilirubin Alkaline Phosphatase (Normal 13-45) γ-glutamiltransferase (Normal 9 – 50) CRP (Normal < 5) ESR (Normal 10/15) Total Protein Albumin Prothrombin Time |
5.19
3.76 667 770 178.9 >160 7.3 2.57 13 |
1.5
0.9 320 270
48/110
10 |
mg/dl –
mg/dl U/l – U/l – mg/dl 1h/2h mg/dl mg/dl s |
MCV, mean corpuscular volume; AST, aspartate aminotransferase; ALT, alanine aminotransferase; CRP, C-reactive protein; ESR, erythrocytes sedimentation rate;