Extensive Metastatic Sarcomatoid Renal Cell Carcinoma Evaluated by 18F-FDG PET/CT: a Case Report and Review of Literature

Main Article Content

Dominique Fuser
Matthew L. Hedberg
Louis P. Dehner
Farrokh Dehdashti
Barry A. Siegel

Keywords

FDG PET/CT, metastasis, PET/CT, renal cell carcinoma, sarcomatoid

Abstract

Sarcomatoid renal cell carcinoma (sRCC) is a highly aggressive form of dedifferentiated renal cell carcinoma. We report a 62-year-old man who presented with respiratory symptoms and a lung mass on chest computed tomography (CT). The patient underwent positron emission tomography/computed tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG) and was found to have extensive metastatic disease. Based on the history and imaging findings, there were possible primary malignancies, including bronchogenic carcinoma, melanoma, or an aggressive lymphoma. An excisional biopsy surprisingly revealed a high-grade sarcomatoid carcinoma with no evidence of differentiation, and immunohistochemical (IHC) studies showed that the tumor cells were positive for markers of genitourinary origin (PAX-8 and vimentin). The histologic and IHC results, along with multiple FDG-avid exophytic lesions in both kidneys, were considered diagnostic of sRCC. Here we have highlighted the potential role of 18F-FDG-PET-CT in patients with sRCC, discussed the diagnostic challenges, and presented a brief review.

Abstract 3214 | PDF Downloads 1140 HTML Downloads 3019 XML Downloads 823 Supplemetary File Downloads 573

References

1. Farrow GM, Harrison EG Jr, Utz DC. Sarcomas and sarcomatoid and mixed malignant tumors of the kidney in adults. Cancer. 1968;22:545–63. http://dx.doi.org/10.1002/1097-0142(196809)22:3%3C545::AID-CNCR2820220308%3E3.0.CO;2-4
2. Wei S, Al-Saleem T. The pathology and molecular genetics of sarcomatoid renal cell carcinoma: A mini-review. J Kidney Cancer. 2017;4:19–23. http://dx.doi.org/10.15586/jkcvhl.2017.70
3. Peralta-Venturina MD, Moch H, Amin M, Tamboli P, Hailemariam S, Mihatsch M. Sarcomatoid differentiation in renal cell carcinoma: A study of 101 cases. Am J Surg Pathol. 2001;25:275–84. http://dx.doi.org/10.1097/00000478-200103000-00001
4. Shuch B, Bratslavsky G, Linehan WM, Srinivasan R. Sarcomatoid renal cell carcinoma: A comprehensive review of the biology and current treatment strategies. Oncologist. 2012;17:46–54. http://dx.doi.org/10.1634/theoncologist.2011-0227
5. Ramdave S, Thomas GW, Berlangieri SU, Bolton DM, Davis I, Danguy HT. Clinical role of F-18 fluorodeoxyglucose positron emission tomography for detection and management of renal cell carcinoma. J Urol. 2001;166:825–30. http://dx.doi.org/10.1016/S0022-5347(05)65845-4
6. Kumar R, Chauhan A, Lakhani P, Xiu Y, Zhuang H, AlavI A. 2-Deoxy-2-[F-18] fluoro-D-glucose-positron emission tomography in characterization of solid renal masses. Mol Imaging Biol. 2005;7:431–9. http://dx.doi.org/10.1007/s11307-005-0026-z
7. Ma H, Shen G, Liu B, Yang Y, Ren P, Kuang A. Diagnostic performance of 18F-FDG PET or PET/CT in restaging renal cell carcinoma: A systematic review and meta-analysis. Nuc Med Commun. 2017;38:156–63. http://dx.doi.org/10.1097/MNM.0000000000000618
8. Liu Y. The place of FDG PET/CT in renal cell carcinoma: Value and limitations. Front Oncol. 2016;6:201. http://dx.doi.org/10.3389/fonc.2016.00201
9. Thambugala GM, Mohamed A, Neill GFO, Fulham MJ. Sarcomatoid renal cell carcinoma: Rapid dissemination detected on FDG PET-CT. Australas Radiol. 2006;50:604–6. http://dx.doi.org/10.1111/j.1440-1673.2006.01664.x
10. Hyodo T, Sugawara Y, Tsuda T, Yanagihara Y, Aoki K, Tanji N. Widespread metastases from sarcomatoid renal cell carcinoma detected by 18F-FDG positron emission tomography/computed tomography. Jpn J Radiol. 2009;27:111–14. http://dx.doi.org/10.1007/s11604-008-0305-0
11. Nadebaum DP, Hofman MS, Mitchell CA, Siva S, Hicks RJ. Oligometastatic renal cell carcinoma with sarcomatoid differentiation demonstrating variable imaging phenotypes on 68Ga-PSMA and 18F-FDG PET/CT: A case report and review of the literature. Clin Genitourin Cancer 2017. http://dx.doi.org/10.1016/j.clgc.2017.08.009
12. Mian BM, Bhadkamkar N, Slaton JW, Pisters PW, Daliani D, Swanson DA, et al. Prognostic factors and survival of patients with sarcomatoid renal cell carcinoma. J Urol. 2002;167:65–70. http://dx.doi.org/10.1016/S0022-5347(05)65384-0
13. Maiti A, Nemati-Shafaee M, Msaouel P, Pagliaro LC, Jonasch E, Tannir NM, et al. Phase 2 trial of capecitabine, gemcitabine, and bevacizumab in sarcomatoid renal-cell carcinoma. Clin Genitourin Cancer. 2017. http://dx.doi.org/10.1016/j.clgc.2017.07.028
14. 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;3(12):1303–7. http://dx.doi.org/10.1158/2326-6066.CIR-15-0150
15. McDermott DF, Sosman JA, Sznol M, Massard C, Gordon MS, Hamid O, et al. Atezolizumab, an anti-programmed death-ligand 1 antibody, in metastatic renal cell carcinoma: Long-term safety, clinical activity, and immune correlates from a phase Ia study. J Clin Oncol. 2016;34:833–42. http://dx.doi.org/10.1200/JCO.2015.63.7421
16. Chan JK. Newly available antibodies with practical applications in surgical pathology. Int J Surg Pathol. 2013;21:553–72. http://dx.doi.org/10.1177/1066896913507601
17. Outlines P. SOX10. (c) 2014–2015 [Internet]. PathologyOutlines.com, Inc.; 2015. [Accessed 2017 Nov 5]. Available from: www.pathologyoutlines.com/topic/stainssox10.html