左側腎臟透明細胞腫瘤併右側肱骨病理性骨折與肉瘤細胞變化:
病例和文獻回顧
詹凱勝、蕭志豪、方嘉郎、李良明
臺北醫學大學市立萬芳醫院 泌尿科
臺北醫學大學市立萬芳醫院 病理科
Huge left clear cell renal cell carcinoma present as right humeral pathologic fracture with predominant sarcomatoid change: a case and literature review
Kai-Sheng Chan, Chi-Hao Hsiao, Chia Lang Fang, Liang-Ming Lee
Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
Department of Pathology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
A 83 year old male presented to ER with progressive right arm pain for 1 month. Further image survey revealed osteolytic lesion of right humerus suspecting pathologic fracture. Whole body CT scan showed a tumor 15.7cm x 12.6cm with central necrosis at lower pole at left kidney suspecting renal cell carcinoma. Later surgery of ORIF revealed pathology of bone as metastatic renal sarcomatoid carcinoma. After surgery of open left radical nephrectomy, pathology report showed left clear cell renal cell carcinoma with no regional lymph node involvement, and sarcomatoid feature < 5%, pStage IV pT3aN0M1. The composition of sarcomatoid feature was described as a final common dedifferentiation pathway, caused by extensive chromosomal rearrangement, which does not represent a distinct subtype entity, but rather used to predict a worse prognosis than those without sarcomatoid differentiation. In addition, recent studies showed that a cutoff of greater or equal than 25% of sarcomatoid component represent significant predictor for worse prognosis. As a result, the treatment strategy designed for our patient was based on 2014 NCCN Guideline for Stage IV clear cell renal tumor; and Pazopanib was chosen over Sunitinib for better quality of life, with mainly less side effects of fatigue, hand-foot syndrome and mucosal inflammation.