Undifferentiated metastatic renal cell carcinoma presenting as a cutaneous nodular lesion

Abstract

Cutaneous metastases may be the first sign of clinically silent visceral cancer. Approximately 30% of patients with primary renal cell carcinoma present with metastatic disease, and only 8% of them have skin metastases. We present the case of a 59-year-old male patient with a subcutaneous nodular on the upper chest extending to the jugular region. The lesion appeared skin colored and was not painful and 5 cm x 3.5 cm in diameter. The histological examination of the cutaneous biopsy showed an infiltration of undifferentiated epithelial cells positive to cytokeratins AE1/AE3, whereas they were negative to CK-20, CK5/6, cluster of differentiation 10, vimentin, thyroid transcription factor-1, S-100, human melanoma black-45, hepatocytespecific antigen, carcinoembryonic antigen, and chromogranin A. A total-body computed tomography (CT) showed the presence of a tumoral lesion in the left kidney with multiple metastases in the lung, brain, and bones. According to the cutaneous biopsy and total-body CT, a final diagnosis of an undifferentiated renal carcinoma presenting as a subcutaneous metastasis was made. A chemotherapeutic treatment with gemcitabine and cisplatin resulted in the stabilization of the renal and metastatic lesions with an improvement in the quality of life of the patient. Considering that the prognosis of patients with cutaneous metastases is very poor, it is necessary to obtain an appropriate diagnosis in order to identify patients with treatable disease with the purpose of starting a therapeutic protocol.

Cutaneous metastasis as the first sign of renal cell carcinoma – crossroad between literature analysis and own observations

“…However, the prevalence has been reported as high as 26% [ 6 , 9 ]. It is said that cutaneous metastases might be the first signs of clinically silent visceral cancer [ 10 ]. Analysis of recent reports shows that the mean period of time between a nephrectomy and diagnosed cutaneous metastasis was 4.5 years, with the longest period reported to be 19 years [ 9 ].…”

Sarcomatoid renal cancer with multiple cutaneous metastases

“…La identificación de metástasis cutáneas sugiere generalmente enfermedad avanzada, tomando en cuenta que la supervivencia promedio posterior al diagnóstico de metástasis cutáneas es aproximadamente 3 a 7.5 meses, es necesario el abordaje de estudio del tumor primario para identificar pacientes con enfermedad tratable. (17) La incidencia de metástasis cutáneas en el cáncer renal es de aproximadamente 3-7%, y pueden tratarse de la manifestación inicial en el 10-20% de los casos. Las características morfológicas de acuerdo a las series de casos y reportes aislados consultados en la literatura demuestran que se trata de nódulos intradérmicos redondos u ovalados de consistencia elástica o indurada, que pueden ser color piel, marrón, violáceas u oscuras y en ocasiones ulceraradas, pueden simular quistes epidermoides, fibromas, papilomas, lipomas, neurofibromas u otros padecimientos como el granuloma piógeno.…”

“…(20) La decisión terapéutica es individualizada y requiere de manejo multidisciplinario dependiendo el estadio, la extensión y el estado funcional del paciente en cuestión, como podemos observar en la Tabla 1 donde se presenta el manejo de las metástasis cutáneas por cáncer renal en casos reportados de 2015 a 2020 y su evolución posterior. (3,(16)(17)19,(21)(22)(23)(24)(25)(26)(27)(28) Debido a que se trata de una entidad rara, nos encontramos ante pocos datos sobre el manejo óptimo de estos pacientes, encontrándose que en la actualidad no existe un tratamiento estándar o de primera línea para pacientes con sRCC. (29) La diferenciación sarcomatoide presenta pobre respuesta a tratamientos actualmente empleados, como el sunitinib, al compararlo con carcinomas renales sin este tipo de diferenciación incluso en estadios avanzados.…”

A Rare Subcutaneous Manifestation of Metastatic Renal Cell Carcinoma

“…However, there are 2 case reports in literature where patients with solitary skin lesions have been reported to be stable for more than 6 months after targeted chemotherapy was delivered [14, 31]. Another case was reported to have been disease-free two and a half years after a left radical nephrectomy, intralesional interferon, and targeted radiotherapy to the cutaneous metastasis at the chin and a subsequent lump resection.…”