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NDT Advance Access originally published online on December 15, 2006
Nephrology Dialysis Transplantation 2007 22(3):952-953; doi:10.1093/ndt/gfl746
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
(Section Editor: G. H. Neild)

A giant sarcomatoid renal cell carcinoma

Mei-Yi Wu1, Chuang-Chi Liaw2, Yung-Chang Chen1, Ya-Chung Tian1, Swei Hsueh3, Chang-Chyi Jenq1, Ji-Tseng Fang1 and Chin-Wei Yang1

1Department of Nephrology, 2Division of Hematology-Oncology and 3Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan

Correspondence and offprint requests to: Ji-Tseng Fang, MD, Division of Critical Care Nephrology, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, 105, Taipei, Taiwan. Email: cyc2356{at}adm.cgmh.org.tw

Keywords: metabolic acidosis; paraneoplastic syndrome; sarcomatoid renal cell carcinoma

Case report

A 42-year-old male patient was hospitalized for lower leg oedema, shortness of breath and body-weight loss of 5 kg over a 2-month period. Physical examination identified a pale appearance, cachexia, and a palpable abdominal mass of about 20 x 18 cm2 in the right abdomen. Ultrasound study verified the existence of a massive right-side abdominal heterogenous tumour. Due to renal failure with severe metabolic acidosis, the patient underwent haemodialysis.

Abdominal computed tomography (CT) with contrast (Figure 1) and angiography (Figure 2) demonstrated a substantial right-side renal tumour, roughly 28 cm in size. The tumour directly invaded the right lobe and caudate lobe of the liver, right retroperitoneum space and hepatic flexure of the colon. Close attachment of the tumour with the duodenum and pancreatic head was noted in addition to displacement. Inferior vena cava (IVC) was effaced and the adrenal gland was encased by the huge tumour. Kidney biopsy confirmed the diagnosis of sarcomatoid RCC.


Figure 1
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  		Fig. 1. Contrast computed tomography demonstrated a right-side renal tumour with heterogeneous density invading the right lobe and caudate lobe of the liver.

 

Figure 2
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  		Fig. 2. (A and B). Angiography indicated that the IVC is compressed and severely invaded by the tumour without intraluminal thrombosis.

 
Sarcomatoid renal cell carcinoma (RCC), first described by Farrow et al. in 1968, is defined pathologically by highly pleomorphic spindle cells and/or giant cells resembling sarcoma, with varying degrees of clear or granular epithelial cells that characterize RCC. A sarcomatoid component is indicative of an aggressive tumour [1]. RCC can generate many paraneoplastic manifestations. Common paraneoplastic syndromes of RCC are cachexia, hypertension, anaemia, non-metastatic hepatic dysfunction, erythrocytosis and amyloidosis. Clinically, sarcomatoid RCC is associated with poor prognosis, due to locally aggressive and potential metastasis [2]. Recognizing paraneoplastic syndrome can facilitate prompt diagnosis and intervention. Cytoreduction of the primary malignancy is the mainstay therapy.

Conflict of interest statement. None declared.

References

  1. Cohen HT and McGovern FJ. (2005) Renal cell carcinoma. N Engl J Med 353:2477–2490.[Free Full Text]
  2. Cangiano T, Liao J, Naitoh J, Dorey F, Figlin R, Belldegrun A. (1999) Sarcomatoid renal cell carcinoma: biologic behavior, prognosis, and response to combined surgical resection and immunotherapy. J Clin Oncol 17:523–528.[Abstract/Free Full Text]
Received for publication: 31. 7.06
Accepted in revised form: 15.11.06


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This Article
Right arrow Extract Freely available
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Right arrow All Versions of this Article:
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gfl746v1
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