Case: 46 years old male is admitted to ICU with flank pain, hematuria, and a palpable abdominal renal mass and diagnosed with Renal Cell Carcinoma (RCC). No distant metastasis was found but found to have an unproportionate elevation of serum alkaline phosphatase. What is the diagnosis?
Answer: Stauffer syndrome
The triad of flank pain, hematuria, and a palpable abdominal renal mass strongly suggests RCC. The triad has been known for more than five decades now. Patients with RCC without hepatic metastasis may develop hepatic dysfunction without liver metastases. The most common finding is an elevation in serum alkaline phosphatase. This is due to the paraneoplastic phenomenon. Hepatic dysfunction usually ameliorates after RCC removal. This is known as Stauffer syndrome and was first described in 1968.
If hepatic dysfunction continues to recur in such patients after cancer removal, local recurrence of RCC or distant metastasis is highly suspected.
#oncology
#hepatology
References:
1. Skinner DG, Colvin RB, Vermillion CD, et al. Diagnosis and management of renal cell carcinoma. A clinical and pathologic study of 309 cases. Cancer 1971; 28:1165.
2. Walsh PN, Kissane JM. Nonmetastatic hypernephroma with reversible hepatic dysfunction. Arch Intern Med 1968; 122:214.
3. Chuang YC, Lin AT, Chen KK, et al. Paraneoplastic elevation of serum alkaline phosphatase in renal cell carcinoma: incidence and implication on prognosis. J Urol 1997; 158:1684
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