Rapid progression of recurrent disease in a patient with renal cell carcinoma with vaginal metastasis

Abstract

Introduction We report a rare case of renal cell carcinoma with vaginal metastasis that recurred with rapid progression and was resistant to sunitinib and nivolumab. Case presentation A 68‐year‐old woman presented with renal cell carcinoma and vaginal metastasis. Multiple lung metastasis appeared 3 months after simultaneous radical nephrectomy and hysterectomy with vaginal resection. Despite the treatment with sunitinib and nivolumab, the patient died 7 months after surgery. Immunohistochemical staining of primary and metastatic tumor specimens was CD8 and programmed death ligand‐1 negative. Conclusion Although vaginal metastasis of renal cell carcinoma is rare, lack of CD8 and programmed death ligand‐1 expression may cause nivolumab resistance and may be useful markers in patients with metastatic renal cell carcinoma.

Efficacy of combination therapy with pembrolizumab and axitinib for metastatic renal collecting duct cell carcinoma: A report on two cases

“…12,13 On the contrary, we also reported rapid progression of advanced RCC after treatment with nivolumab following sunitinib; in this case, there were no expressions of PD-L1 and CD8 on the tumor sample pretreatment. 14 For the present cases, we found no expression of PD-L1 on tumor cells, besides CD4 and CD8 lymphocytes infiltration were observed on biopsy specimens; this result was more pronounced in case 2, which consequently responded almost exclusively to pembrolizumab alone. Therefore, the presence of lymphocyte infiltration into the tumor may be associated with the therapeutic efficacy of anti-PD-1 antibody therapy.…”

“…We previously reported the remarkable efficacy of anti‐PD‐1 antibody based on the presence of marked tumor cell infiltration of lymphocytes after treatment 12,13 . On the contrary, we also reported rapid progression of advanced RCC after treatment with nivolumab following sunitinib; in this case, there were no expressions of PD‐L1 and CD8 on the tumor sample pretreatment 14 . For the present cases, we found no expression of PD‐L1 on tumor cells, besides CD4 and CD8 lymphocytes infiltration were observed on biopsy specimens; this result was more pronounced in case 2, which consequently responded almost exclusively to pembrolizumab alone.…”

Asymptomatic Clear Cell Renal Cell Carcinoma With a “De Novo” Synchronous Vaginal Metastasis and Recurrence of the Disease – A Case Report

“…In most cases, these clinical manifestations precede those of the RCC. In 63% of cases, the primary location is in the left kidney and metastases are most often in the lower third of the anterior vaginal wall 9,10 . Chibuzo et al described a case of vaginal metastasis in the lower third of the lateral wall from papillary RCC, originating from the right kidney 11 .…”

“…In 60-80% of cases, renal neoplasms are discovered incidentally during imaging studies 7 . In 63% of cases, the tumour is located in the left kidney and the vaginal metastasis is found ipsilaterally to the primary lesion 9,13 . For ccRCC, there is a tendency towards infiltration and thrombosis of left renal vein, which is also associated with the path of metastasis to the female genital system 5,11,13,14 .…”

“…Neoplastic vaginal dissemination is a consequence of the retrograde blood flow in the left renal vein to the ovarian vein and to the uterovaginal plexus, and especially in our case it is associated with tumour thrombosis of the renal vein. Mulcahy, with the use of intravenous contrast media, objectified the retrograde blood flow (angiography), through which hematogenous dissemination of RCC to the vagina occurs 8,9 . The anastomoses between the ovarian veins and plexus pampiniformis are the route of metastases to the upper part of the vagina, and the anastomoses between the uterovaginal plexus and the obturator veins are the pathway of metastases to the lower part of the vagina 4,15 .…”