Report Describes Rare Combination of Abdominal Aortic Aneurysm, Kidney Cancer With Polycythemia

A recent report described the surprising finding of an abdominal aortic aneurysm (AAA) and renal cell carcinoma in a patient with secondary polycythemia and normal erythropoietin (EPO) levels.

The authors said the finding was surprising given the amount of literature that associates elevated EPO levels with renal cell carcinoma.

The case study involved a 61-year-old obese Caucasian male with a medical history of smoking, hypertension, chronic obstructive pulmonary disease (COPD), and sleep apnea, who initially presented to the hematology clinic with polycythemia. The patient did not report any significant symptoms or a history of blood clots; physicians identified a large renal mass suspicious for renal cell carcinoma of the right kidney after a computerized tomography (CT) and ultrasound.

Renal cell cancer usually presents with a palpable mass, hematuria, and flank pain, the authors wrote, but about 10% to 40% of patients show paraneoplastic syndromes, particularly hypercalcemia, hypertension, and polycythemia, with the renal cell carcinoma hiding and affecting multiple organs from a primary cancer.

The patient had his aorta repaired and underwent a radical nephrectomy; preoperative hemoglobin and erythropoietin level was 18.3 g/dL and 8.5 IU/L respectively, which normalized to a hemoglobin level of 13.1 g/dL within 2-3 days post-surgery. Measured hemoglobin months afterward was 12.0 g/dL.

“Surgical removal of the renal cell carcinoma and repair of surrounding vasculature successfully resolve most complications. Specifically, it is unknown whether serum EPO levels correlate with the severity of renal cell carcinoma evaluated through the TNM,” the authors said. “Given the rising interest and reports of surgical complications of concomitant conditions with renal cell carcinoma, more investigation into the mechanism, occurrence, and additional risk factors posed by these paraneoplastic syndromes secondary to renal cell carcinoma remains open to investigation.”

The researchers concluded that further investigation into paraneoplastic syndromes secondary to renal cell carcinoma is necessary.

Reference

Kopel J, Sharma P, et al. Polycythemia with renal cell carcinoma and normal erythropoietin level [published online December 11, 2019]. Case Rep Urol. doi: 10.1155/2019/3792514.