Sarcomatoid renal cancer with multiple cutaneous metastases

Abstract

Clinical case description: A 47-year-old man presented with violet-red nodular cutaneous lesions on the face, scalp, and hands. Biopsy report stated metastatic kidney tumor. Physical examination revealed fair general status and a palpable abdominal mass. Urinalysis showed microhematuria. Tomography identified a right kidney tumor infiltrating the perirenal fat. Right radical nephrectomy was performed, and the histopathologic study described a clear cell renal cell tumor, with a 60% sarcomatoid component. Sunitinib was begun, resulting in cutaneous lesion involution. During two weeks of intermittent therapy, the lesions reappeared, and the dose was modified. Three months later, the patient presented with brain, liver, and bone metastases. After showing no improvement, the patient died five months after diagnosis. 
 Relevance: Not only was our case one of a rare form of metastatic kidney cancer that recurred despite treatment with tyrosine kinase therapy, the tumor also had sarcomatoid differentiation, a very aggressive variant of kidney cancer.
 Clinical implications: Cutaneous metastases from kidney cancer have an incidence of approximately 3%. Even though their prognosis is not good, opportune detection is essential for the patient.
 Conclusions: Sarcomatoid renal cancer is a rare tumor with a poor prognosis and is generally associated with distant metastasis. Every patient diagnosed with kidney cancer should undergo a comprehensive skin assessment, for adequate staging and treatment.