一名 65 岁男性患者，有肉瘤样肾细胞癌病史，曾接受过右肾切除术，在下腔静脉附近出现复发性疾病。患者在开始最大剂量帕唑帕尼治疗后 7 个月以及完成对右肾切除床和复发部位为期 2 个月的姑息性立体定向身体放射治疗方案后不到 1 个月接受了监测影像学检查。 （开始帕唑帕尼治疗 5 个月后开始立体定向全身放射治疗。）开始帕唑帕尼治疗 1 个月后、监测影像检查前 6 个月，患者出现腹泻，需要持续使用洛哌丁胺治疗来控制症状。他否认有任何疲劳、口腔溃疡或四肢疼痛，但描述了与腹泻相关的一些腹痛和不适。他没有发烧，生命体征也正常。白细胞计数正常为5100/μL（5.1×109/L）（正常范围为4200-10 200/μL[4.2-10.2×109/L]），分类计数的所有成分也正常。正常血清白蛋白水平为 3.9 g/dL (39 g/L)（正常范围，3.5-5.0 g/dL [35-50 g/L]），血清总蛋白水平较低为 6.1 g/dL (61 g/L) L)（正常范围，6.3-7.9 g/dL [63-79 g/L]）被记录。进行了全面的代谢检查，显示血清氯化物水平为 98 mmol/L（正常，100-108 mmol/L），碱性磷酸酶水平为 121 U/L（2.02 μkat/L）（正常，45-115 U/L）。 L [0.75-1.92 μkat/L]）。患者在静脉期接受了腹部和骨盆增强 CT 监测成像（图）。

A 65-year-old male patient with a history of sarcomatoid renal cell carcinoma and prior right nephrectomy developed recurrent disease adjacent to the inferior vena cava. The patient underwent surveillance imaging 7 months after initiation of treatment with maximum-dose pazopanib and less than 1 month after completing a 2-month regimen of palliative stereotactic body radiation therapy to the right nephrectomy bed and site of recurrence. (Stereotactic body radiation therapy was initiated 5 months after pazopanib treatment was initiated.) One month after initiating treatment with pazopanib and 6 months before the surveillance imaging, the patient developed diarrhea and required ongoing treatment with loperamide to control symptoms. He denied any fatigue, mouth sores, or extremity pain, but described some abdominal pain and discomfort associated with the diarrhea. He was not experiencing any fevers, and vital signs were normal. White blood cell count was normal at 5100/μL (5.1 ×109/L) (normal range, 4200-10 200/μL [4.2-10.2 ×109/L]), with all components of the differential count also being normal. A normal serum albumin level of 3.9 g/dL (39 g/L) (normal range, 3.5-5.0 g/dL [35-50 g/L]) and low serum total protein level of 6.1 g/dL (61 g/L) (normal range, 6.3-7.9 g/dL [63-79 g/L]) were noted. A comprehensive metabolic panel was performed, indicating a serum chloride level of 98 mmol/L (normal, 100-108 mmol/L) and alkaline phosphatase level of 121 U/L (2.02 μkat/L) (normal, 45-115 U/L [0.75-1.92 μkat/L]). The patient underwent surveillance imaging with contrast-enhanced CT of the abdomen and pelvis in the venous phase (Figure).