肉瘤樣分化型腎細胞癌合併多處皮膚轉移 - 病例報告及文獻回顧
陳正哲1、楊晨洸1、陳韋辰1
台中榮民總醫院 外科部 泌尿外科
Sarcomatoid differentiation of papillary renal cell carcinoma with multiple cutaneous metastasis – case report and literature review
Cheng-Che Chen1、Cheng-Kuang Yang1、Wei-Chen Chen1
1Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital
Abstract:
Cutaneous metastases of renal tumors is about 3 %. Among these patients, sarcomatoid differentiation type of renal cell carcinoma (RCC) with cutaneous metastasis is much rarely published before. Scalp and face were the most metastatic sites. The prognosis is poor and the mean tumor-specific survival is less than six months.
Here, we report a 64 years old male with initial presentation of multiple nodular lesions over face, trunk and four limbs within six months. The largest one is on right forearm, 9cm in size. Diagnostic biopsy of fascial lesion, 1.5cm in size, showed metastatic malignant neoplasm, high grade. Abdominal computer tomography revealed an 8.4 cm tumor located at lower pole of right kidney, RCC was impressed. Lapascopic radical nephrectomy of right kidney and excisional biopsy of skin lesion over right lower abdomen were performed. Pathology revealed papillary RCC with sarcomatoid change, Fuhrman nuclear grade 3 and metastatic papillary RCC of skin lesion, Fuhrman nuclear grade 3-4.
Due to advanced stage, interferon therapy was started 2 weeks after operation. However, high fever to 40 degrees Celsius was noted after initial interferon administration. Treatment was shifted to Sorafenib. After two-week Sorafenib treatment, cutaneous metastases almost disappeared, but the tumor on his right forearm. The tumor size decreased to 4 cm in length.
We conclude that primary nephrectomy with subsequent interferon and target therapy may have benefit in patient with Sarcomatoid differentiation of papillary RCC with multiple cutaneous metastasis.