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Guan HY, Wang J, Wang JX, Chen QH, Lu J, He L. Renal pelvis sarcomatoid carcinoma with renal vein tumor thrombus: A case report and literature review. World J Clin Cases 2023; 11:7690-7698. [DOI: 10.12998/wjcc.v11.i31.7690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/06/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Renal pelvis sarcomatoid carcinoma (RPSC) is a rare and aggressive malignancy whose diagnosis is difficult because radiological imaging results can lead to misclassification as a more common type of renal tumor. In addition, clinical management of patients with RPSC is difficult because of the limited efficacy of available treatments. In this study, we present a comprehensive description of a patient who presented with RPSC and a simultaneous renal vein tumor thrombus.
CASE SUMMARY During April, 2020, a 64-year-old female presented with an isolated episode of hematuria accompanied by abdominal pain. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a lesion in the right renal pelvis. We therefore performed a radical nephrectomy of the right kidney. The subsequent histopathological and immunological results verified the diagnosis of RPSC. Despite administration of 6 cycles of a gemcitabine-cisplatin regimen, the patient's condition progressively deteriorated, and she died about 15 mo after the nephrectomy.
CONCLUSION We performed a comprehensive analysis of a patient with RPSC that included CT, MRI, immunohistochemistry, and genetic testing. The insights from our detailed analysis of this patient and our concomitant review of the literature may assist clinicians in their diagnosis and treatment of RPSC.
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Affiliation(s)
- Huai-Yong Guan
- Department of Urology, Jilin University First Hospital, Changchun 130000, Jilin Province, China
| | - Jin Wang
- Department of Urology, Jilin University First Hospital, Changchun 130000, Jilin Province, China
| | - Ji-Xue Wang
- Department of Urology, Jilin University First Hospital, Changchun 130000, Jilin Province, China
| | - Qi-Hui Chen
- Department of Urology, Jilin University First Hospital, Changchun 130000, Jilin Province, China
| | - Ji Lu
- Department of Urology, Jilin University First Hospital, Changchun 130000, Jilin Province, China
| | - Liang He
- Department of Urology, Jilin University First Hospital, Changchun 130000, Jilin Province, China
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Chu Y, Ning H, Yin K, Chen T, Wu H, Wang D, Liu F, Zhao Z, Lv J. Case report: Sarcomatoid urothelial carcinoma of the renal pelvis masquerading as a renal abscess. Front Oncol 2023; 13:1055229. [PMID: 36756151 PMCID: PMC9899929 DOI: 10.3389/fonc.2023.1055229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/05/2023] [Indexed: 01/24/2023] Open
Abstract
Sarcomatoid urothelial carcinoma (SUC), a rare tumor of the urinary tract epithelium, exhibits a high degree of malignancy and therefore a poor prognosis. Due to the absence of specific clinical presentations and imaging findings, SUC of the renal pelvis masquerades as a renal abscess is frequently under-recognized or misdiagnosed as benign inflammatory disease, resulting in delayed or erroneous treatment. Here, we report a patient with SUC of the renal pelvis who presented with a renal abscess. Repeated anti-inflammatory treatment was ineffective. Unexpectedly, cancerous cells were detected in subsequent exfoliative cytology of nephrostomy drainage fluid. In accordance with this, radical surgery and postoperative chemotherapy were conducted. Fortunately, neither recurrence nor metastasis occurred during a one-year follow-up.
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Affiliation(s)
- Yaru Chu
- Department of Urology, Provincial Hospital Affiliated to Shandong First Medical University, Shandong First Medical University, Jinan, China
| | - Hao Ning
- Department of Urology, Provincial Hospital Affiliated to Shandong First Medical University, Shandong First Medical University, Jinan, China,Department of Urology, Shandong Provincial Hospital, Shandong University School of Medicine, Jinan, China
| | - Ke Yin
- Department of Pathology, Shandong Provincial Hospital, Shandong University School of Medicine, Jinan, China
| | - Tong Chen
- Department of Urology, Shandong Provincial Hospital, Shandong University School of Medicine, Jinan, China
| | - Haihu Wu
- Department of Urology, Provincial Hospital Affiliated to Shandong First Medical University, Shandong First Medical University, Jinan, China,Department of Urology, Shandong Provincial Hospital, Shandong University School of Medicine, Jinan, China
| | - Delin Wang
- Department of Urology, Provincial Hospital Affiliated to Shandong First Medical University, Shandong First Medical University, Jinan, China
| | - Feifan Liu
- Department of Urology, Shandong Provincial Hospital, Shandong University School of Medicine, Jinan, China
| | - Zhenlin Zhao
- Department of Urology, Provincial Hospital Affiliated to Shandong First Medical University, Shandong First Medical University, Jinan, China
| | - Jiaju Lv
- Department of Urology, Provincial Hospital Affiliated to Shandong First Medical University, Shandong First Medical University, Jinan, China,Department of Urology, Shandong Provincial Hospital, Shandong University School of Medicine, Jinan, China,*Correspondence: Jiaju Lv,
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Mantica G, Benelli A, Ackermann H, Nxumalo Z, Solaiman A, Dotta F, van der Merwe A, Terrone C. Clinical and histopathological features of carcinosarcoma of the renal pelvis: a systematic review of a rare tumor. MINERVA UROL NEFROL 2019; 71:121-126. [DOI: 10.23736/s0393-2249.18.03192-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sarcomatoid variant of urothelial carcinoma (carcinosarcoma, spindle cell carcinoma): a review of the literature. ISRN UROLOGY 2014; 2014:794563. [PMID: 24587922 PMCID: PMC3920806 DOI: 10.1155/2014/794563] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 11/09/2013] [Indexed: 01/09/2023]
Abstract
Background. Sarcomatoid variant of urothelial carcinoma (SVUC) was added to the WHO classification in 2004. Aims. To review the literature. Materials and Method. Various internet databases were used. Result. SVUCs are rare biphasic malignant neoplasms exhibiting morphologic/immunohistochemical evidence of epithelial and mesenchymal differentiation with the presence or absence of heterologous elements. Some cases of SVUC have been associated with radiation therapy and cyclophosphamide treatment. Patients' ages range from 50 to 77 years (mean age 66). Patients tend to be younger and they more commonly presented with high-grade histology and advanced stage disease, in comparison with patients who had conventional urothelial carcinoma (CUC). Results of molecular/genetic studies strongly argue for a common monoclonal cell origin of both the epithelial and mesenchymal components in SUVC. The cancer specific survival of SVUC is poor in comparison with CUC. Radical surgical excision and chemoradiation may be associated with improved prognosis; chemoradiation as an organ preserving alternative to radical excision may be associated with improved outcome. There is no consensus opinion on the best treatment modalities for SUVC. Conclusions. SVUC is rare and is associated with inferior outcome compared with CUC. A multicentre trial of various treatment options is required. Cases of SVUC should be reported.
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Terada T. Synchronous squamous cell carcinoma of the kidney, squamous cell carcinoma of the ureter, and sarcomatoid carcinoma of the urinary bladder: A case report. Pathol Res Pract 2010; 206:379-83. [DOI: 10.1016/j.prp.2009.07.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 06/16/2009] [Accepted: 07/21/2009] [Indexed: 10/20/2022]
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MCCASH SAMUELI, UNGER PAMELA, DILLON ROBERT, XIAO GUANGQIAN. Undifferentiated carcinoma of the renal pelvis with osteoclast-like giant cells: a report of two cases. APMIS 2010; 118:407-12. [DOI: 10.1111/j.1600-0463.2010.02608.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Thiel DD, Igel TC, Wu KJ. Sarcomatoid carcinoma of transitional cell origin confined to renal pelvis. Urology 2006; 67:622.e9-11. [PMID: 16504263 DOI: 10.1016/j.urology.2005.09.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2004] [Revised: 08/22/2005] [Accepted: 09/20/2005] [Indexed: 10/25/2022]
Abstract
Thirteen reported cases of renal pelvic sarcomatoid carcinoma have been documented since 1961, and all patients presented with metastatic disease or advanced renal parenchyma involvement. The mean survival was shorter than 9 months, and adjuvant therapy appeared to offer no benefit. We present the case of a 61-year-old man with gross hematuria and a large filling defect on computed tomography excretory urography. Surgical pathologic examination after laparoscopic nephroureterectomy was consistent with renal pelvis-confined sarcomatoid carcinoma of transitional cell origin. Adjuvant therapy was not given secondary to the organ-confined nature of disease. The patient was without recurrence for more than 1 year.
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Affiliation(s)
- David D Thiel
- Department of Urology, Mayo Clinic Jacksonville, Florida 32224, USA
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Shimasaki N, Inoue K, Nishigawa H, Kuroda N, Shuin T. Combined small cell carcinoma and sarcomatoid squamous cell carcinoma in the renal pelvis. Int J Urol 2006; 12:686-9. [PMID: 16045564 DOI: 10.1111/j.1442-2042.2005.01134.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We report here a case of combined small cell carcinoma and sarcomatoid squamous cell carcinoma in the renal pelvis. A 61-year-old female presented with right flank discomfort, microhematuria and progressive renal dysfunction. Following diagnosis of right renal pelvic carcinoma, radical nephroureterectomy with lymph node dissection was performed through a midline incision. The tumor was pathologically diagnosed to be combined small cell carcinoma and sarcomatoid squamous cell carcinoma in the renal pelvis. The patient had no evidence of recurrence or metastasis, 16 months postoperatively. Small cell carcinoma or sarcomatoid squamous cell carcinoma of the renal pelvis is very rare. We believe this is the first such case to be reported in the world.
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Affiliation(s)
- Nobuyuki Shimasaki
- Department of Urology and Pathology I, Kochi Medical School, Kochi, Japan.
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Alwaheeb S, Chetty R. Adenosquamous carcinoma of the pancreas with an acantholytic pattern together with osteoclast-like and pleomorphic giant cells. J Clin Pathol 2005; 58:987-90. [PMID: 16126885 PMCID: PMC1770836 DOI: 10.1136/jcp.2004.025221] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A 45 year old man presented with abdominal pain, loss of appetite, and significant weight loss over a period of about four weeks. Imaging of the abdomen showed a mass in the region of the head of the pancreas. In view of the size of the mass and the clinical picture, a Whipple's procedure was performed. Histological evaluation of the pancreatic tumour showed an adenosquamous carcinoma (predominantly composed of squamous carcinoma), which was extensively infiltrative with perineural invasion and involvement of peripancreatic lymph nodes. Areas of pancreatic intraepithelial neoplasia grade III and merging of the squamous and adenocarcinoma components were evident. Unusual histological features that characterised this case included a pronounced acantholytic pattern within the squamous carcinoma component, and the presence of both osteoclastic and pleomorphic giant cells. Giant cells have not been documented previously in association with an adenosquamous carcinoma. Although an acantholytic pattern has been noted in squamous carcinomas in other sites, this is the first report of such a pattern in an adenosquamous carcinoma of the pancreas.
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Affiliation(s)
- S Alwaheeb
- Department of Pathology, University Health Network/Toronto Medical Laboratories, University of Toronto, Toronto, Ontario, Canada
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Acikalin MF, Kabukcuoglu S, Can C. Sarcomatoid carcinoma of the renal pelvis with giant cell tumor-like features: Case report with immunohistochemical findings. Int J Urol 2005; 12:199-203. [PMID: 15733116 DOI: 10.1111/j.1442-2042.2005.01002.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sarcomatoid transitional cell carcinoma is a rare entity, in which a malignant, overtly epithelial component coexists with areas having a sarcoma-like appearance. Histological distinction of sarcomatoid carcinomas from carcinosarcomas is often difficult and immunohistochemistry is a helpful diagnostic adjunct in the correct diagnosis. In the present report, we describe an uncommon case of sarcomatoid transitional cell carcinoma of the renal pelvis, associated with giant cell tumor-like features. Immunoperoxidase staining for cytokeratin was positive in spindle cell component, indicating an epithelial origin. The carcinomatous component showed a diffuse membranous reactivity for E-cadherin, whereas the reactivity was sporadic and weaker in the sarcomatoid component, suggesting that the decrease of E-cadherin expression might be associated with the acquisition of sarcomatous morphology. Osteoclast-like multinucleated giant cells were positive for CD68 and negative for p53 oncoprotein, suggesting that they represent a non-neoplastic component that is reactively induced in the tumor stroma.
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Kayaselçuk F, Bal N, Guvel S, Egilmez T, Kilinc F, Tuncer I. Carcinosarcoma and squamous cell carcinoma of the renal pelvis associated with nephrolithiasis: a case report of each tumor type. Pathol Res Pract 2004; 199:489-92. [PMID: 14521266 DOI: 10.1078/0344-0338-00451] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Both squamous cell carcinoma and carcinosarcoma of the renal pelvis are uncommon. We report on two cases, one carcinosarcoma and one squamous cell carcinoma of the renal pelvis. In the patient with squamous cell carcinoma of the left kidney, the tumor was neither detectable on preoperative radiological evaluation nor grossly visible in the surgical specimen. This patient, a 56-year-old man, presented with left lumbar pain, hematuria, fever, 4-5 kg weight loss, and untreated nephrolithiasis of the left kidney that had been diagnosed 20 years earlier. The second patient, an 87-year-old woman, also had a long history of left kidney nephrolithiasis and presented with left lumbar pain and hematuria. Both patients underwent nephrectomy for removal of the non-functioning hydronephrotic left kidney. In both cases, microscopic examination of the surgical specimen revealed squamous metaplasia and dysplasia in the pelvicalyceal mucosa, and islands of atypical squamous cells in the renal parenchyma. In the second case, the kidney also showed sarcomatous changes in the pelvis.
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Affiliation(s)
- Fazilet Kayaselçuk
- Department of Pathology, Başkent University Faculty of Medicine, Adana Teaching and Medical Research Center, Yüreğir, Turkey.
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