Mayorga-Gómez É, Garza-Sainz G, Osornio-Sánchez V, Camacho-Castro A, García-Salcido F, Muñoz-Ibarra E, Ahumada-Tamayo S, Fernández-Noyola G, Martínez JÁ, Fulda-Graue SD, Pérez-Becerra R, Santana-Ríos Z, Urdiales-Ortiz A, Cantellano-Orozco M, Martínez-Arroyo C, Morales-Montor G, Pacheco-Gahbler C, Morales-Leyte AL, Paraguirre-Martínez S

Language: Spanish
References: 8
Page: 27-30
PDF size: 841.51 Kb.

ABSTRACT

Introduction: Chromophobe renal cell carcinoma is a subtype of renal cell carcinoma that is known for its good prognosis. Sarcomatoid transformation in this subtype is rare. Of all renal cell carcinomas, chromophobe renal cell carcinoma has an overall incidence of 4-5%. It arises from the collecting tubule and characteristically stains positive for Hale’s colloidal iron.
Clinical case: Patient is a 73-year-old man with past history of high blood pressure. He presented with two-month progression of abdominal pain predominantly in right hypochondrium and did not complain of urinary symptomatology. Patient was diagnosed with chronic lithic cholecystitis for which laparoscopic cholecystectomy was carried out that revealed increased retroperitoneal volume. Computed tomography scan showed right kidney tumor with probable thrombus in inferior vena cava. Nuclear magnetic resonance image revealed adenopathy compressing inferior vena cava with no thrombus. Open right radical nephrectomy and lymphadenectomy were performed, obtaining 24 x 13 x 5 cm tumor that weighed 1080 g with 17 x 17 x 2.5 cm adenopathy with three nodules. Chromophobe renal cell carcinoma was reported with 80% sarcomatoid differentiation and lymph node invasion. Chest computed tomography scan revealed pulmonary metastases. Tumor was classified as clinical stage IV, pT4N1M1.
Discussion: Sarcomatoid transformation in chromophobe renal cell carcinoma is extremely rare. Sarcomatoid differentiation, microscopic necrosis, small vessel invasion, and tumor size have been established as poor prognosis factors. When there is sarcomatoid histology, survival is less than one year.

REFERENCES

1. Stec R, Grala B, Maczewski M, et al. Chromophobe renal cell cancer - review of the literature and potential methods of treating metastasic disease. J Exp Clin Cancer Res 2009;28:134.

2. Przybycin CG, Cronin AM, Darvishian F, et al. Chromophobe renal cell carcinoma: a clinicopathologic study of 203 tumors in 200 patients with primary resection at a single institution. Am J Surg Pathol 2011;35:962-970.

3. Amin MB, Paner GP, Alvarado-Cabrero I, et al. Crhomophibe renal cell carcinoma: histomorphologic characteristics and evaluation of conventional pathologic prognostic parameters in 145 cases. Am J Surg Pathol 2008;32:1822-1834.

4. Parada D, Peña K. Sarcomatoid chromophobe renal cell carcinoma. A case report and review of the literature. Arch Esp Urol 2006;59:209-214.

5. Brunelli M, Gobbo S, Cossu-Rocca P, et al. Chromosomal gains in the sarcomatoid transformation of chromophobe renal cell carcinoma. Mod Pathol 2007;20:303-309.

6. Altaf YM, Agale SV. Chromophobe Renal Cell carcinoma with sarcomatoid differentiation. Bombay Hospital Journal 2010;52:132-135.

7. Quiroga GG, Khurana H. Sarcomatoid chromophobe renal cell carcinoma with heterologous sarcomatoid elements: a case report and review of the literature. Arch Pathol Lab Med 2009;133:1857-1860.

8. Chakrabarti I, Giri A, Majumdar K, et al. Sarcomatoid chromophobe renal cell carcinoma: cytohistopathological correlation of a case. J Cytol 2010;27:29-31.