Sarcomatoid Renal Cell Carcinoma: Clinicopathologic Findings In 27 Cases

Öz

Introduction: Renal cell carcinoma (RCC) is the most common malignant neoplasm of the kidney, and sarcomatoid RCC is an aggressive variant. The prognosis of sarcomatoid RCC is much more aggressive than that of nonsarcomatoid renal cell carcinoma tumors. Sarcomatoid renal cell carcinoma is often incurable, even when patients present with localized disease. In this study, the effects of sarcomatoid differentiation on progression and survival rate were evaluated and discussed in relation to the relevant findings in the literature. Materials and Methods: Between January 1998 and January 2009, a total of 27 patients who underwent radical nephrectomy for renal cell carcinoma were retrospectively evaluated. All patients were evaluated by physical examination, routine hematologic and biochemical analysis, and radiologic studies, including abdominal computed tomography, chest X-ray, renal Doppler ultrasonography, if necessary, and in selected cases, magnetic resonance imaging. Results: The median age of the patients was 59.3 years, and the mean follow-up period was 1.25 years, ranging from 6 months to 4 years. The tumor size ranged from 3.5 cm to 14.0 cm. The stage distribution was pT1 in 2 patients, pT2 in 14 patients, pT3 in 9 patients and pT4 in 2 patients. Histopathological examination of radical nephrectomy material showed sarcomatous differentiation in all patients. All patients had Fuhrman Grade IV tumors. All patients with tumors at stage pT3 and pT4 died. The mean survival rate was 25.9% (n=7) at the end of the follow-up period. Conclusions: The results of this study demonstrate that sarcomatoid RCC is aggressive and that the overall prognosis is very poor with this tumor type. Early diagnosis and radical surgery are the only options available to increase life expectancy for these patients. However, the poor prognosis and short survival times of these patients despite radical surgical approaches should be considered.

Anahtar Kelimeler

• Kidney, cancer, sarcomatoid differentiation, radical nephrectomy, survival.

Sarkomatoid Renal Hücreli Karsinom: 27 Olgunun Klinik Ve Patolojik Bulguları

Öz

Giriş: Renal hücreli karsinom (RCC) böbreğin en sık görülen malign neoplazmı olup sarkomatoid renal hücreli karsinom agresif bir tipidir. Sarkomatoid RCC’nin prognozu sarkomatoid olmayan RCC’lere göre oldukça agresiftir. Sarkomatoid RCC’de olgular lokalize evrede olsalar bile kür sıklıkla mümkün olmamaktadır. Bu çalışmada sarkomatoid diferansiasyonun literatürler eşliğinde progresyon ve sağkalıma olan etkisi değerlendirildi. Materyal ve metod: Ocak 1998 ve Ocak 2009 tarihleri arasında, renal hücreli karsinom ön tanısı ile radikal nefrektomi yapılan toplam 27 hasta retrospektif olarak değerlendirildi. Bütün hastalar fizik muayene, rutin hematolojik ve biyokimyasal tetkikler, abdominal tomografi, akciğer grafisi ve gerektiğinde Doppler ultrasonografi olmak üzere radyolojik tetkiklerle ve selektif bazı olgularda manyetik rezonans inceleme ile değerlendirildiler. Bulgular: Hastaların ortanca yaşı 59.3 yıl ve ortalama takip süreleri 6 ay ile 4 yıl arasında değişmekte olup ortalama 1.25 yıl idi. Tümör çapları 3.5 cm ile 14 cm arasındaydı. Hastaların evrelere göre dağılımında pT1 evresinde 2 olgu, pT2 evresinde 14 olgu, pT3 evresinde 9 olgu ve pT4 evresinde ise 2 olgu bulunmaktaydı. Radikal nefrektomi materyalinin incelenmesi bütün hastalarsa sarkomatoid RCC olduğunu gösterdi. Bütün hastalarda Fuhrman Grade IV tümör bulunduğu görüldü. Evre pT3 ve pT4’de bulunan bütün hastalar kaybedildi. Takipler sonunda ortalama sağkalım oranı %25.9 (n=7) idi. Tartışma: Bu çalışmanın sonuçları sarkomatoid RCC’nin agresif olduğunu ve genel sağkalımın bu tümör tipinde olukça kötü olduğunu göstermiştir. Erken tanı ve radikal cerrahi yaklaşım bu hastalarda yaşam beklentisinin artırılmasındaki temel seçeneklerdir. Bununla birlikte bu hastalarda radikal cerrahi yaklaşımlara rağmen kötü prognoz ve kısa sağkalım oranlarının olduğu gözönünde bulundurulmalıdır.

Anahtar Kelimeler

• Böbrek, kanser, sarkomatoid diferansiasyon, radikal nefrektomi, sağkalım.

Kaynakça

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