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Organo Oficial de la Sociedad Mexicana de Urología

2020, Número 5

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Rev Mex Urol 2020; 80 (5)


Carcinoma renal sarcomatoide con múltiples metástasis cutáneas

Rojas-Ramírez DC, Ricardez-Espinosa AA, Jiménez-López LA, Velázquez-Méndez AA, Sandoval-Téllez JG

Idioma: Español
Referencias bibliográficas: 34
Paginas: 1-12
Archivo PDF: 344.70 Kb.


RESUMEN

Descripción del caso clínico: Masculino de 47 años que presentó lesiones cutáneas nodulares rojo-violáceas en cara, cuero cabelludo y manos, biopsia con reporte de metástasis de tumor renal. Estado general conservado, masa palpable abdominal y microhematuria. Tomografía reportó tumor renal derecho infiltrando grasa perirrenal. Se realizó nefrectomía radical derecha, reporte histopatológico tumor de células claras con 60% de componente sarcomatoide. Inició sunitinib con involución de las lesiones cutáneas, tras 2 semanas de intermitencia presentó recurrencia modificándose la dosis. Tres meses después presentó actividad metastásica cerebral, hepática y ósea evolucionando tórpidamente, falleciendo a cinco meses del diagnóstico.
Relevancia: Particularmente nuestro caso no solo presenta una forma infrecuente de metástasis de cáncer renal recidivante a pesar del tratamiento con inhibidores de la tirosincinasa, sino también diferenciación sarcomatoide, una variante muy agresiva de cáncer renal.
Implicaciones clínicas: Las metastásis cutáneas de cáncer renal presentan una incidencia aproximada de 3%, si bien no es de buen pronóstico encontrarlas, su detección oportuna es primordial en todo paciente.
Conclusiones: El carcinoma renal sarcomatoide es un tumor raro y de pronóstico sombrío, generalmente asociado a metastásis a distancia. Es necesaria la valoración cutánea completa de todo paciente diagnosticado con cáncer renal para el adecuado estadiaje y tratamiento.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Zhang L, Wu B, Zha Z, Zhao H, Feng Y. The prognostic value and clinicopathological features of sarcomatoid differentiation in patients with renal cell carcinoma: a systematic review and meta-analysis. Cancer Manag Res. 2018;10:1687-703. DOI: https://dx.doi. org/10.2147%2FCMAR.S166710

  2. Kyriakopoulos CE, Chittoria N, Choueiri TK, Kroeger N, Lee JL, Srinivas S, et al. Outcome of patients with metastatic sarcomatoid renal cell carcinoma: results from the International Metastatic Renal Cell Carcinoma Database Consortium. Clin Genitourin Cancer. 2015;13(2):e79-85. DOI: https://doi. org/10.1016/j.clgc.2014.08.011

  3. Yang HJ, Kang SY. Cutaneous metastatic renal cell carcinoma to the scalp. Arch Craniofac Surg. 2019;20(6):392-6. DOI: https://doi. org/10.7181/acfs.2019.00206

  4. Ljungberg B, Albiges L, Abu-Ghanem Y, Bensalah K, Dabestani S, Fernandez-Pello S, et al. European Association of Urology Guidelines on Renal Cell Carcinoma: The 2019 Update. Eur Urol. 2019;75(5):799-810. DOI: https://doi. org/10.1016/j.eururo.2019.02.011

  5. Zhang H, Majeed NK, Sharifi R, Guzman G. A Case of Sarcomatoid Renal Cell Carcinoma With Osseous Metaplasia and Papillary Renal Cell Carcinoma Metastasis. Clin Pathol. 2019;12:2632010X19848005. DOI: https://doi. org/10.1177/2632010X19848005

  6. Comperat E, Varinot J. Classification of Adult Renal Tumors: An Update. Semin Ultrasound CT MR. 2017;38(1):2-9. DOI: https://doi. org/10.1053/j.sult.2016.08.004

  7. Lopez-Beltran A, Carrasco JC, Cheng L, Scarpelli M, Kirkali Z, Montironi R. 2009 update on the classification of renal epithelial tumors in adults. Int J Urol. 2009;16(5):432- 43. DOI: https://doi.org/10.1111/j.1442- 2042.2009.02302.x

  8. Humphrey PA, Moch H, Cubilla AL, Ulbright TM, Reuter VE. The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part B: Prostate and Bladder Tumours. Eur Urol. 2016;70(1):106-19. DOI: https://doi.org/10.1016/j.eururo.2016.02.028

  9. Farrow GM, Harrison EG, Jr., Utz DC, ReMine WH. Sarcomas and sarcomatoid and mixed malignant tumors of the kidney in adults. I. Cancer. 1968;22(3):545- 50. DOI: https://doi.org/10.1002/1097- 0142 (196809) 22:3 < 545::AID-CNCR2820220308>3.0.CO;2-4

  10. Vélez DM, Gual JB, Gravalos RG-M, Rodríguez IM. Carcinoma renal sarcomatoide localizado.¿ Qué factores pueden prever su evolución? Actas Urológicas Españolas. 2002;26(1):60- 5. DOI: https://doi.org/10.1016/S0210- 4806(02)72732-0

  11. Kim T, Zargar-Shoshtari K, Dhillon J, Lin HY, Yue B, Fishman M, et al. Using percentage of sarcomatoid differentiation as a prognostic factor in renal cell carcinoma. Clin Genitourin Cancer. 2015;13(3):225-30. DOI: https://doi. org/10.1016/j.clgc.2014.12.001

  12. Kunene V, Miscoria M, Pirrie S, Islam MR, Afshar M, Porfiri E. Sarcomatoid renal cell carcinoma: clinical outcome and survival after treatment with sunitinib. Clin Genitourin Cancer. 2014;12(4):251-5. DOI: https://doi. org/10.1016/j.clgc.2013.12.001

  13. Achkar T, Arjunan A, Wang H, Saul M, Davar D, Appleman LJ, et al. High-dose interleukin 2 in patients with metastatic renal cell carcinoma with sarcomatoid features. PLoS One. 2017;12(12):e0190084. DOI: https://doi. org/10.1371/journal.pone.0190084

  14. Glockner JF, White LM, Sundaram M, McDonald DJ. Unsuspected metastases presenting as solitary soft tissue lesions: a fourteen-year review. Skeletal Radiol. 2000;29(5):270-4. DOI: https://doi.org/10.1007/s002560050606

  15. Nibhoria S, Tiwana KK, Kaur M, Kumar S. A clinicopathological and immunohistochemical correlation in cutaneous metastases from internal malignancies: a five-year study. J Skin Cancer. 2014;2014:793937. DOI: https://doi. org/10.1155/2014/793937

  16. Fernandez-Rueda P, Ruiz-Lopez P, Ramirez- Negrin MA, Fuentes-Suarez A, Toussaint-Caire S, Vega-Memije ME. [Cutaneous metastasis of renal cell carcinoma: A case report and review of the literature]. Gac Med Mex. 2015;151(4):533-7.

  17. Paolino G, Lido P, Bei R, Polisca P. Undifferentiated metastatic renal cell carcinoma presenting as a cutaneous nodular lesion. Turk J Urol. 2015;41(4):228-30. DOI: https://doi. org/10.5152/tud.2015.53254

  18. Amin A, Burgess EF. Skin manifestations associated with kidney cancer. Semin Oncol. 2016;43(3):408-12. DOI: https://doi. org/10.1053/j.seminoncol.2016.02.016

  19. Ohlsson R, Geertsen L, Berge Stuveseth S, Lund L. Cutaneous metastases in renal cell carcinoma: a systematic review and a case report. Scand J Urol. 2019;53(1):9-13. DOI: https://doi.org/10 .1080/21681805.2019.1585473

  20. Koga S, Tsuda S, Nishikido M, Matsuya F, Saito Y, Kanetake H. Renal cell carcinoma metastatic to the skin. Anticancer Res. 2000;20(3B):1939- 40.

  21. Logunova V, Sokumbi O, Iczkowski KA. Metastatic sarcomatoid renal cell carcinoma manifesting as a subcutaneous soft tissue mass. J Cutan Pathol. 2017;44(10):874-7. DOI: https:// doi.org/10.1111/cup.12998

  22. Walton J, Li J, Clifton MM, Mori RL, Park AM, Sumfest JM. Metastatic clear cell renal cell carcinoma to the forearm without identifiable primary renal mass. Urol Case Rep. 2019;27:100989. DOI: https://doi. org/10.1016/j.eucr.2019.100989

  23. Kostopoulos N, Platsidaki E, Tzanetakou V, Petraki K, Lekarakou M, Bafaloukos D, et al. Nodular Lesions on the Upper Trunk: An Uncommon Anatomical Site of Renal Tumor Metastases. Indian J Dermatol. 2019;64(3):251. DOI: https://doi.org/10.4103/ijd.ijd_634_16

  24. Kesireddy M, Correa A, Correa R, Venkatesan R. A Pedunculated Skin Lesion in a Case of Clear Cell Renal Carcinoma. Cureus. 2019;11(6):e5021. DOI: https://doi. org/10.7759/cureus.5021

  25. Cui P, Cong X, Yin J, Liu M, Wang X, Yang L, et al. Metastases to the nose from clear cell renal cell carcinoma: A case report. Medicine (Baltimore). 2019;98(4):e14012. DOI: https:// doi.org/10.1097/md.0000000000014012

  26. Basic-Jukic N, Mesar I, Kirincich J. Cutaneous Metastasis as a Presenting Feature of Renal Adenocarcinoma in a Renal Transplant Recipient: A Case Report. Transplant Proc. 2019;51(9):3072-3. DOI: https://doi. org/10.1016/j.transproceed.2019.04.021

  27. Georgy JT, Mathuram AJ, George AA, Chandramohan J. Renal cell carcinoma presenting as a cutaneous horn and nodules on the gingiva and scalp. BMJ Case Rep. 2017;2017. DOI: http://dx.doi.org/10.1136/bcr-2017- 220913

  28. Gradecki SE, Gru AA. An unusual case of sarcomatoid renal cell carcinoma presenting in the skin by direct extension at a laparoscopic port site. J Cutan Pathol. 2020;47(7):617-20. DOI: https://doi.org/10.1111/cup.13657

  29. Raychaudhuri R, Riese MJ, Bylow K, Burfeind J, Mackinnon AC, Tolat PP, et al. Immune Check Point Inhibition in Sarcomatoid Renal Cell Carcinoma: A New Treatment Paradigm. Clin Genitourin Cancer. 2017;15(5):e897-e901. DOI: https://doi.org/10.1016/j.clgc.2017.05.018

  30. Maiti A, Nemati-Shafaee M, Msaouel P, Pagliaro LC, Jonasch E, Tannir NM, et al. Phase 2 Trial of Capecitabine, Gemcitabine, and Bevacizumab in Sarcomatoid Renal-Cell Carcinoma. Clin Genitourin Cancer. 2017. DOI: https://doi.org/10.1016/j.clgc.2017.07.028

  31. Park I, Cho YM, Lee JL, Ahn JH, Lee DH, Song C, et al. Prognostic factors of metastatic renal cell carcinoma with extensive sarcomatoid component. J Cancer Res Clin Oncol. 2013;139(5):817-27. DOI: http://dx.doi. org/10.1007/s00432-013-1386-4.

  32. Shuch B, Bratslavsky G, Linehan WM, Srinivasan R. Sarcomatoid renal cell carcinoma: a comprehensive review of the biology and current treatment strategies. Oncologist. 2012;17(1):46-54. DOI: https://doi. org/10.1634/theoncologist.2011-0227

  33. Karashima T, Fukuhara H, Tamura K, Ashida S, Kamada M, Inoue K, et al. Expression of angiogenesis-related gene profiles and development of resistance to tyrosine-kinase inhibitor in advanced renal cell carcinoma: characterization of sorafenib-resistant cells derived from a cutaneous metastasis. Int J Urol. 2013;20(9):923-30. DOI: https://doi. org/10.1111/iju.12084

  34. Hammers HJ, Verheul HM, Salumbides B, Sharma R, Rudek M, Jaspers J, et al. Reversible epithelial to mesenchymal transition and acquired resistance to sunitinib in patients with renal cell carcinoma: evidence from a xenograft study. Mol Cancer Ther. 2010;9(6):1525-35 DOI: https:// doi.org/10.1158/1535-7163.mct-09-1106




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