A Case Of Squamous Cell Lung Cancer Presented With Membranoproliferative Glomerulonephritis

Yıl 2014, Cilt: 4 Sayı: 2, 80 - 84, 01.06.2014

Devrim Çabuk Mustafa Volkan Demir Selçuk Yaylacı Savaş Sipahi Tayfun Temiz Ali Tamer

https://doi.org/10.5505/sakaryamj.2014.19870

Öz

The most common renal pathology associated with malignancies is membranous glomerulonephritis but it has been reported that membranoproliferative glomerulenephritis can also rarely accompany malignancies. The occurence of kidney symptoms before the diagnosis of cancer is a rare condition. Our case was admitted to nephrology clinic with symptoms of nephrotic syndrome and diagnosed squamous cell lung cancer.A 60 years old man was admitted with generalized edema to nephrology clinic. There was no significant feature in his medical and family history. The renal biopsy was performed for diagnosis of nephrotic syndrome and reported as membranoproliferative glomerulonephritis (MPGN). Thorax computed tomography (CT) scan was taken for secondary reasons of MPGN. CT scan showed subtracheal and subcarinal lesions (lymphadenopathy?). Fine-needle aspiration biopsy was performed and it was reported as squamous cell lung cancer. Paclitaxel and carboplatin chemotherapy was started with a diagnosis of stage IV non-small cell lung cancer.After 3 cycles of chemotherapy CT scan reported partial remission and the treatment led to an improvement of generalized edema. But after 6 cycles, higher metabolic activity of lung lesions was reported with positron emission tomography (PET/CT). As a second line chemotherapy gemsitabine was started, but the patient died after 2 cycles.It was worthwile for this case presentation because patient presented with nephrotic syndrome findings and diagnosed squamous cell lung cancer. MPGN rarely accompanies to malignancies. The occurence of kidney symptoms before the diagnosis of cancer is a rare condition. Our case was admitted with nephrotic syndrome symptoms and diagnosed squamous cell lung cancer.

Anahtar Kelimeler

Nephrotic Syndrome, Malignancy, Membranoproliferative Glomerulonephritis

Membranoproliferatif Glomerulonefrit İle Prezente Olan Akciğer Skuamöz Hücreli Karsinom Olgusu

Öz

Malignitelere membranöz glomerülonefritler eşlik edebilmekle birlikte daha nadir olarak membranoproliferatif glomerulonefritin de eşlik ettiği bildirilmektedir. Renal bulguların kanser tanısından önce ortaya çıkması da nadir görülen bir durumdur. Olgumuz nefrotik sendrom kliniği ile başvurmuş olup daha sonrasında da akciğer skuamöz hücreli karsinom tanısı almıştır.Altmış yaşında erkek hasta yaklaşık 3 aydır devam eden vücutta yaygın şişlik yakınmasıyla nefroloji kliniğine başvurdu. Özgeçmişinde ve soygeçmişinde özellik yoktu. Nefrotik sendrom tanısıyla yapılan böbrek iğne biyopsisi mempranoproliferatif glomerülonefrit (MPGN) olarak rapor edildi. MPGN etyolojisi araştırılmak üzere çekilen toraks bilgisayarlı tomografide (BT) bilateral plevral efüzyon ve sağ alt paratrakeal ve subkarinal mesafede kitlesel lezyonlar (Lenfadenopati?) saptandı. Bunun üzerine lezyona yönelik yapılan ince iğne aspirasyon biyopsisi (İİAB) akciğer skuamöz hücreli karsinom olarak rapor edildi. Hastaya Evre IV küçük hücreli dışı akciğer karsinomu tanısıyla paklitaksel + karboplatin kemoterapisi başlandı. Diüretik tedavisi ve kemoterapi altında ödemleri geriledi, 3 kür kemoterapi sonrasında akciğer lezyonlarında küçülme saptandı. Ancak 6 kür tedavi sonrasında hastanın kliniğinde kötüleşme oldu, pozitron emisyon tomografisinde (PET/CT) lezyonların metabolik aktivitesinde artış izlendi. İkinci seri gemsitabin kemoterapisine geçilmesine rağmen tedavi altında hasta kaybedildi.Nefrotik sendrom kliniğiyle başvuran hastalarda malignite ile ilişkili paraneoplastik nefrotik sendrom akılda tutulmalıdır ve malignite bulguları ortaya çıkmadan önce hastanın nefrotik sendrom ile prezente olabileceği unutulmamalıdır.

Anahtar Kelimeler

Nefrotik sendrom, Malignite, Membranoproliferatif Glomerülonefrit

Kaynakça

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