Paraneoplastic syndromes can occur in 8% to 20% of individuals with malignancies. They can occur in a variety of cancers that include breast, gastric, leukemia, lung, ovarian, pancreatic, prostate, testicular, as well as kidney. The classic presentation of the triad of mass, hematuria, and flank pain occurs in less than 15% of patients with renal cancer. Because of the protean presentations of renal cell cancer, it has been referred to as the internist's tumor or the great masquerader. This article will provide a review of the causes of these symptoms.

The severity of the poststreptococcal acute glomerulonephritis is considered to be modulated by the immune response of each individual, although there had been few reports regarding specific factors. Renal cell carcinoma is a cancer frequently associated with paraneoplastic syndrome, characterized by fever, leukocytosis, elevated cytokines, and elevated hormone levels. All of these symptoms resolve after tumor resection. A girl with renal cell carcinoma developed renal failure rapidly, which resolved promptly right after nephrectomy for the carcinoma. She was diagnosed as having poststreptococcal acute glomerulonephritis according to the results of pathological and serological examinations. In addition, elevated serum interleukin-6 level before the surgery was detected. Six and a half years after the diagnosis, the patient's renal function was within normal range and she was tumor free. Because of the quick resolution of her renal dysfunction after the nephrectomy, paraneoplastic syndrome induced by renal cell carcinoma seemed to play a key role in the accentuation of poststreptococcal acute glomerulonephritis.

We aim to investigate the prognostic significance of the hemoglobin X lymphocyte / neutrophil ratio (HLNR) and hemoglobin x lymphocyte / platelet ratio (HLPR) with tumor aggressivity in patients with renal cell carcinoma. We retrospectively analyzed 127 patients' data who had diagnosed as renal cell carcinoma between 2008 and 2019 in Suleyman Demirel University Hospital. Tumor and patient characteristics, hemoglobin, neutrophil, lymphocyte, platelet values HLNR and HLPR were calculated in preoperative hemogram parameters. The relationship between tumor pathological stage, Fuhrman nuclear grade and tumor necrosis with HLPR and HLNR analyzed with statistically. There was a negative correlation between pathologic stage, Fuhrman nuclear grade and tumor necrosis with HLNR. P values are 0.003, 0.012 and 0.015 respectively. HLNR was lower in patients with high pathologic stage, high Fuhrman nuclear grade and accompanying tumor necrosis positiveness. There was a negative correlation between pathologic stage, Fuhrman nuclear grade and tumor necrosis with HLPR. P values are 0.001, 0.014 and 0.047 respectively. HLPR was lower in patients with high pathologic stage, high Fuhrman nuclear grade and accompanying tumor necrosis positiveness. High pathological stage, high Fuhrman nuclear grade and existence of tumor necrosis are associates with preoperative low HLNR and low HLPR in renal cell carcinoma patients. They can be used as prognostic markers in patients with renal mass preoperatively.

Various paraneoplastic syndromes are encountered in renal cell carcinomas. This case report illustrates that a paraneoplastic leukemoid reaction may precede the diagnosis of renal cell carcinoma and be explained by cytokine production from the cancer cells.

A 64-year-old man was referred for hematology workup due to pronounced leukocytosis. While being evaluated for a possible hematologic malignancy as the cause, he was found to have a metastasized renal cell carcinoma, and hyperleukocytosis was classified as a leukemoid reaction. A multiplex panel for measurement of 25 serum cytokines/chemokines showed highly elevated levels of granulocyte colony-stimulating factor (G-CSF) and CXCL8 (C-X-C-motif chemokine ligand 8, previously known as interleukin [IL]-8). By immunohistochemistry it was shown that the renal carcinoma cells expressed both these cytokines. Two additional, consecutive patients with renal cell carcinoma with paraneoplastic leukocytosis also showed elevated serum levels of CXCL8, but not of G-CSF. Nonparametric statistical evaluation showed significantly higher serum concentrations of CXCL8, IL-6, IL-10, monocyte chemoattractant protein 1 (MCP-1), and tumor necrosis factor, but lower interferon gamma (IFN-γ) and IL-1α, for the 3 renal cell carcinoma cases compared with healthy blood donors.

In suspected paraneoplastic leukocytosis, multiplex serum cytokine analyses may facilitate diagnosis and provide an understanding of the mechanisms for the reaction. In the index patient, combined G-CSF and CXCL8 protein expression by renal carcinoma cells was uniquely documented. A rapidly fatal course was detected in all 3 cases, congruent with the concept that autocrine/paracrine growth signaling in renal carcinoma cells may induce an aggressive tumor phenotype. Immune profiling studies could improve our understanding for possible targets when choosing therapies for patients with metastatic renal cell carcinoma.