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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
CASE REPORT  
Year : 2011  |  Volume : 22  |  Issue : 1  |  Page : 120-122
Sarcomatoid renal cell carcinoma


1 Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
2 Department of Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India

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Date of Web Publication30-Dec-2010
 

   Abstract 

Sarcomatoid renal cell carcinoma (SRCC) is an aggressive tumor variant thought to arise predominantly from differentiation of clear cell carcinoma. A few reports of SRCC asso­ciated with non-clear cell tumors led to the presumption that SRCC may arise from any renal cell carcinoma, although direct evidence of this is lacking. We report a case of a 70-year-old male patient, who presented with acute left upper quadrant abdominal pain and was diagnosed to have SRCC after pathological examination. The patient is on high dose interleukin (IL-2)-based immunotherapy and is apparently free of disease six months after surgery.

How to cite this article:
Akhtar K, Shamshad A, Sufian Z, Tariq M. Sarcomatoid renal cell carcinoma. Saudi J Kidney Dis Transpl 2011;22:120-2

How to cite this URL:
Akhtar K, Shamshad A, Sufian Z, Tariq M. Sarcomatoid renal cell carcinoma. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2019 Jul 20];22:120-2. Available from: http://www.sjkdt.org/text.asp?2011/22/1/120/74381

   Introduction Top


Sarcomatoid renal cell carcinoma (SRCC) is an uncommon but particularly aggressive va­riant of renal cell carcinoma, accounting for 1- 5% of all renal malignant neoplasms. [1],[2],[3] Until recently, SRCC was thought to represent a primary renal sarcoma, [4],[5],[6] but since these tu­mors co-express both epithelial and stromal markers, they are now believed to represent a form of dedifferentiated carcinoma. Most sar­comatoid carcinomas are found in association with conventional (clear cell) renal carcinoma, but there are occasional descriptions of sarco­matoid transformation of chromophobe carcinoma, collecting duct carcinoma and papillary carcinoma. [7],[8] This report documents a case of SRCC in a 70-year-old male patient.


   Case Report Top


A 70-year-old male patient presented to the emergency room with acute left upper quad­rant abdominal pain. A pelvic computed tomo­graphic (CT) scan showed a large heteroge­nous mass measuring 8 × 5 cm without any calcification in the center of the left kidney. The medical history was non-contributory, and the patient underwent radical nephrectomy. Gross examination revealed a firm, yellowish­white, well-circumscribed mass measuring 8 × 6 cm, noted in the center of the kidney in­volving the pelvis [Figure 1]. Five micrometer sections were cut from the paraffin blocks of the tumor for light microscopy. The sections were stained with hematoxylin and eosin. For immunocytochemical analysis, the avidin- biotin complex (ABC) method was applied to for­malin-fixed, paraffin-embedded tumor tissue. The primary antiserum used was Vimentin (1/100, vimentin, Dakopatts).
Figure 1: Sarcomatoid renal cell carcinoma (SRCC): Gross examination showing a firm, well-circumscribed, yellowish white mass involving the renal pelvis.

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Histological examination of the renal mass revealed anaplastic spindle cells with a high mitotic rate, including atypical mitosis [Figure 2]. The neoplastic matrix was intermingled with poorly differentiated, pleomorphic tumor cells. Immunohistochemically, the mesenchymal marker vimentin was diffusely positive in the tumor cells [Figure 3].
Figure 2: Tissue section showing anaplastic spindle cells with a high mitotic rate intermingled with poorly-differentiated pleomorphic tumor cells (Hematoxylin & Eosin, × 400).

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Figure 3: Immunohistochemistry showing positivity for vimentin in the tumor cells (Immunostain vimentin, ×400).

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The patient is on high dose interleukin (IL-2)­based therapy and apparently free of disease six months after surgery.


   Discussion Top


SRCC is considered a late and almost inva­riably fatal cancer, with a mean survival time of less than six months. [2] Our patient remains well and apparently free of disease six months after surgery. It usually evolves from conven­tional (clear cell) renal cell carcinoma. [9],[10] Al­though it is acknow-ledged that SRCC may be associated with multiple renal tumor subtypes of differing biological behavior, direct evolu­tion from non-clear cell tumors has not pre­viously been proven and SRCC remains cla­ssified as a single pathological entity with a uniformly poor prognosis. [10] Similarly, Congiano et al [1] have reported im-proved survival of 1-2 years in 48 and 37% cases, respectively, in their study on 31 cases of SRCC treated with a combination of surgical resection and immu­notherapy.


   Conclusion Top


Surgical resection and high dose interleukin (IL-2)-based immunotherapy may play a role in the treatment of SRCCs.

 
   References Top

1.Cangiano T, Livo J, Naitoh J, Dorey F, Figlin R, Belldegrun A. Sarcomatoid renal cell carci­noma: biologic behavior, prognosis and res­ponse to combined surgical resection and immunotherapy. J Clin Oncol 1999;17:523-8.  Back to cited text no. 1
    
2.Delahunt B. Sarcomatoid renal cell carcinoma - - the final common dedifferentiation pathway of renal epithelial malignancies. Pathology 1999;31:185-90.  Back to cited text no. 2
[PUBMED]    
3.Theil K, Schinelle R, Golimbi M, Waisman J. Prediction of survival in renal tubular adeno­carcinoma. Lab Invest 1985;52:67-70.  Back to cited text no. 3
    
4.Tomera K, Farrow G, Lieber M. Sarcomatoid renal cell carcinoma. J Urol 1983;130:657-9.  Back to cited text no. 4
    
5.Ro T, Ayala A, Sella A, Samuels M, Swanson D. Sarcomatoid renal cell carcinoma: Clinico­ pathologic study of 42 cases. Cancer 1987;59: 516-26.  Back to cited text no. 5
    
6.Weisel W, Dockerty M, Priestley J. Sarcoma of the kidney. J Urol 1943;50:564-73.  Back to cited text no. 6
    
7.Akhtar M, Tubah A, Kardar AH, Ali MA. Sarcomatoid renal cell carcinoma with chro­mophobe connection. Am J Surg Pathol 1997; 21:1188-95.  Back to cited text no. 7
    
8.Storkel S, Van-den Berg E. Morphological classifications of renal cancer. World J Urol 1995;13:153-8.  Back to cited text no. 8
    
9.Ronald JC, John EM, Marleen S, Loryn NS, Barey JI. Sarcomatoid renal cell carcinoma of papillary origin. Arch Pathol Lab Med 2000; 124(12):1830-2.  Back to cited text no. 9
    
10.Kovacs G, Akhtar M, Beckwith B. The Heidel­berg classification of renal tumors. J Pathol 1997;183:131-3.  Back to cited text no. 10
    

Top
Correspondence Address:
Kafil Akhtar
Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh
India
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PMID: 21196626

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    Abstract
    Introduction
    Case Report
    Discussion
    Conclusion
    References
    Article Figures
 

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