Abstract
A case of 45 years old female, Caucasian with anemia for more than anone year which was unnoticed for unknown period, not responding to any treatment like iron therapy and blood transfusions is reported here. Repeated Blood pictures showed severe anemia with severe reactive thrombocytosis. Fecal occult blood test done was found to be negative. Upper and lower gastrointestinal examination showed no evidence of bleed from any site. Abdominal ultrasound followed by CT scan abdomen and pelvis revealed right heterogeneously enhancing solid cystic mass. A US-guided biopsy was then taken; the histopathology revealed malignant tumor with pleomorphic/anaplastic morphology. On immunohistochemistry, atypical cells express PAX8 which is suggestive of either clear cell or papillary or chromophobe tumors. And so patient was advised for additional immunohistochemistry panel. So it mandates considering renal cell carcinoma in the workup part of the causes of iron deficiency anemia along with reactive thrombocytosis.
Keywords: iron deficiency anemia, reactive thrombocytosis, clear cell carcinoma.
References
- Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang XS, et al. Global surveillance of cancer survival 1995–2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet. 2015;385(9972):977–1010. Epub 2014/12/04. pmid:25467588; PubMed Central PMCID: PMC4588097.
- Padala SA, Barsouk A, Thandra KC, Saginala K, Mohammed A, Vakiti A, et al. Epidemiology of Renal Cell Carcinoma. World J Oncol. 2020;11(3):79–87. Epub 2020/06/05. pmid:32494314; PubMed Central PMCID: PMC7239575.
- Thorstenson A, Harmenberg U, Lindblad P, Holmstrom B, Lundstam S, Ljungberg B. Cancer Characteristics and Current Treatments of Patients with Renal Cell Carcinoma in Sweden. BioMed research international. 2015;2015:456040. Epub 2015/11/06. pmid:26539495; PubMed Central PMCID: PMC4619844.
- Sun M, Shariat SF, Cheng C, Ficarra V, Murai M, Oudard S, Pantuck AJ, Zigeuner R, Karakiewicz PI. Prognostic factors and predictive models in renal cell carcinoma: a contemporary review. Eur Urol. 2011;60(4):644–61.
- Huszno J, Kolosza Z, Mrochem-Kwarciak J, Rutkowski T, Skladowski K. The role of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and platelets in the prognosis of metastatic renal cell carcinoma. Oncology. 2019;97(1):7–17.
- Hu H, Yao X, Xie X, Wu X, Zheng C, Xia W, Ma S. Prognostic value of preoperative NLR, dNLR, PLR and CRP in surgical renal cell carcinoma patients. World J Urol. 2017;35(2):261–70.
- Peyton CC, Abel EJ, Chipollini J, Boulware DC, Azizi M, Karam JA, Margulis V, Master VA, Matin SF, Raman JD, et al. The value of neutrophil to lymphocyte ratio in patients undergoing cytoreductive nephrectomy with thrombectomy. Eur Urol Focus. 2020;6(1):104–11.
- Bezan A, Mrsic E, Krieger D, Stojakovic T, Pummer K, Zigeuner R, Hutterer GC, Pichler M. The preoperative AST/ALT (De Ritis) ratio represents a poor prognostic factor in a cohort of patients with nonmetastatic renal cell carcinoma. J Urol. 2015;194(1):30–5.
- Kroll MH, Jiji V, Jiji R. Microcytic hypochromic anemia associated with renal cell carcinoma. South Med J. 1984 May;77(5):635-7. doi: 10.1097/00007611-198405000-00024. PMID: 6719167.
- RJ Motzer, NH Bander, DM nanus Renal-cell carcinoma New England Journal of Medicine, 335(September (12)) (1996), pp. 865-875.
- Amar A.Dowd,Faisal I. Ibrahim, Mutwkil M. Mohammed Renal cell carcinoma as a cause of iron deficiency anemiaAfrican Journal of Urology,Volume 20,Issue 1,March 2014,pages 25-27
- HT Cohen, FJ McGovern Renal-cell carcinoma New England Journal of Medicine, 353 (December (23)) (2005), pp. 2477-2490
- BI Rini, WK Rathmell, P Godley Renal cell carcinoma Current Opinion in Oncology, 20(May (3)) (2008), pp. 300-306
- Harrison’s principles of internal medicine 20th edition volume 1 pages 390-392, 685-687.
Corresponding Author
Dr Roshni Mallepaka
KNR University of Health sciences
DOI: https://dx.doi.org/10.18535/jmscr/v11i2.04
