Sarcomatoid Carcinoma Metastasis to the Colon from a Small Renal Mass: Case Report with Review of Literature

Main Article Content

Shailesh Patidar
Arun Ramdas Menon
Shirley Sundersingh
Ramakrishnan Ayloor Seshadri
Anand Raja


metastasis from small renal mass, renal cell carcinoma, sarcomatoid differentiation, solitary metastasis, synchronous metastasis in RCC


A third of patients with renal cell carcinoma (RCC) present with metastatic disease. Metastasis in RCC from small renal mass (SRM) (≤4 cm) is rare. We report a case of stage cT1a clear-cell RCC with low-risk features on pathology presenting with disproportionately large synchronous solitary metastasis to the transverse colon. He underwent resection of the mass with the involved transverse colon and adjoining mesocolon. Intestinal continuity was restored, following which partial nephrectomy was performed for the right renal tumor. Final pathology of the right renal mass confirmed clear-cell RCC. The large mass after immunohistochemistry profile confirmed metastasis from the renal tumor.

Abstract 236 | PDF Downloads 486 HTML Downloads 0 XML Downloads 8


1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7–30. 10.3322/caac.21442

2. DiNatale RG, Xie W, Becerra MF, Silagy AW, Attalla K, Sanchez A, et al. The association between small primary tumor size and prognosis in metastatic renal cell carcinoma: Insights from two independent cohorts of patients who underwent cytoreductive nephrectomy. Eur Urol Oncol. 2020;3(1):47–56. 10.1016/j.euo.2019.10.002

3. Pecoraro A, Palumbo C, Knipper S, Mistretta FA, Rosiello G, Tian Z, et al. Synchronous metastasis rates in T1 renal cell carcinoma: A surveillance, epidemiology, and end results database-based study. Eur Urol Focus. 2021;7(4):818–26. 10.1016/j.euf.2020.02.011

4. Takayama T, Sugiyama T, Kai F, Suzuki T, Nagata M, Imanishi T, et al. Characteristics of aggressive variants in T1a renal cell carcinoma. J Cancer Res Clin Oncol. 2011;137(11):1653–9. 10.1007/s00432-011-1040-y

5. Lee H, Lee JK, Kim K, Kwak C, Kim HH, Byun SS, et al. Risk of metastasis for T1a renal cell carcinoma. World J Urol. 2016;34(4):553–9. 10.1007/s00345-015-1659-4

6. Patel HD, Semerjian A, Gupta M, Pavlovich CP, Johnson MH, Gorin MA, et al. Surgical removal of renal tumors with low metastatic potential based on clinical radiographic size: A systematic review of the literature. Urol Oncol. 2019;37(8):519–24. 10.1016/j.urolonc.2019.05.013

7. Pierorazio PM, Johnson MH, Ball MW, Gorin MA, Trock BJ, Chang P, et al. Five-year analysis of a multi-institutional prospective clinical trial of delayed intervention and surveillance for small renal masses: The DISSRM registry. Eur Urol. 2015;68(3):408–15. 10.1016/j.eururo.2015.02.001

8. Klatte T, Patard JJ, de Martino M, Bensalah K, Verhoest G, de la Taille A, et al. Tumor size does not predict risk of metastatic disease or prognosis of small renal cell carcinomas. J Urol. 2008;179(5):1719–26. 10.1016/j.juro.2008.01.018

9. Gallan AJ, Antic T. Clinicopathologic features of small renal masses associated with distant metastatic disease. Am J Clin Pathol. 2020;153(5):613–17. 10.1093/ajcp/aqz202

10. Menon A, Ahmed A, White T, James G, Kauffman E. Female gender and non-clear cell histology are protective against postoperative metastasis in small renal mass patients. J Urol. 2020;203(4S):e1229. 10.1097/JU.0000000000000972.010

11. Mueller JL, Guyer RA, Adler JT, Mullen JT. Metastatic renal cell carcinoma to the small bowel: Three cases of GI bleeding and a literature review. CEN Case Rep. 2018;7(1):39–43. 10.1007/s13730-017-0288-8

12. Weiss L, Harlos JP, Torhorst J, Gunthard B, Hartveit F, Svendsen E, et al. Metastatic patterns of renal carcinoma: An analysis of 687 necropsies. J Cancer Res Clin Oncol. 1988;114(6):605–12. 10.1007/BF00398185

13. Lebacle C, Pooli A, Bessede T, Irani J, Pantuck AJ, Drakaki A. Epidemiology, biology and treatment of sarcomatoid RCC: Current state of the art. World J Urol. 2019;37(1):115–23. 10.1007/s00345-018-2355-y

14. Nguyen MM, Gill IS. Effect of renal cancer size on the prevalence of metastasis at diagnosis and mortality. J Urol. 2009;181(3):1020–7; discussion 7. 10.1016/j.juro.2008.11.023

15. 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 Oct 1;15(5):e897–901. 10.1016/j.clgc.2017.05.018

16. Joseph RW, Millis SZ, Carballido EM, Bryant D, Gatalica Z, Reddy S, et al. PD-1 and PD-L1 expression in renal cell carcinoma with sarcomatoid differentiation. Cancer Immunol Res. 2015 Dec 1;3(12):1303–7. 10.1158/2326-6066.CIR-15-0150

17. Bi M, Zhao S, Said JW, Merino MJ, Adeniran AJ, Xie Z, et al. Genomic characterization of sarcomatoid transformation in clear cell renal cell carcinoma. Proc Natl Acad Sci. 2016 Feb 23;113(8):2170–5. 10.1073/pnas.1525735113

18. Nassif E, Thibault C, Vano Y, Fournier L, Mauge L, Verkarre V, et al. Sunitinib in kidney cancer: 10 Years of experience and development. Expert Rev Anticancer Ther. 2017;17:129–42. 10.1080/14737140.2017.1272415