Rapidly progressing sarcomatoid cell renal cell carcinoma in a hemodialysis patient： A case report

Abstract

Keywords： sarcomatoid cell renal carcinoma, hemodialysis 〈Abstract〉The patient was a 58 year old man who had been receiving maintenance hemodialysis therapy since he was 37 years old. Computed tomography (CT) for screening showed a renal tumor of 41 mm in diameter of the right kidney. He was referred to our department in August X. However, he suddenly developed cardiac tamponade and his planned visit to our department was postponed. After treatment for cardiac tamponade, he visited our department in September X. The kidney tumor had developed to 90 mm in diameter based on MRI in October X. Laparoscopic nephrectomy was performed in November X. We found that the tumor had spread to the liver. The pathology of the tumor was sarcomatoid renal cell carcinoma with spindle cells. Three months after the surgery, CT showed local recurrence. Pazopanib at 800 mg, a molecular targeted drug which is effective against sarcomatoid tumors, was started. Lesion shrinkage was temporarily observed. However, seven months after the surgery, the lesion progressed. As second line therapy, Avelumab at 540 mg plus Axitinib at 10 mg, combination treatment of a PD L1 antibody and molecular targeted drug, was started. Regardless of this, the lesion rapidly progressed, the general condition of the patient worsened, and he died 9 months after the surgery. Generally, renal cell carcinoma in patients on hemodialysis develops very slowly, but the disease may progress rapidly in some cases, as it did in the present case. When we identify a tumor, it is desirable to treat it without missing the optimal timing for treatment.