[The clinical and pathological comments from a case of sarcomatoid renal carcinoma]

Sarcomatoid renal carcinoma represents 1-5% of primitive tumours of the kidney. MATERIALS AND METHODS. A young man aged 34 presented with left side colic pain, preceded two days earlier by hematuria without pain; no previous complaints. Echotomography was performed revealing a tumour lesion of the upper left renal pole, which was subsequently confirmed by computerized tomography scanning, with a maximum diameter of approximately 6cm, and evidence of multiple lymph nodes with increased volume. A left-side nephroadrenalectomy was performed with locoregional lymphadenectomy; a sarcomatoid renal carcinoma with massive metastases in 4/19 excised lymph nodes was shown through histological examination. IL-2 therapy was commenced but interrupted due to intolerance. After only three months the disease resumed locally with diffuse lymph nodes metastases and multiple encephalic metastases. A carboplatinum and vinorelbine therapy was started; the possibility of an allogeneic transplant with non-myeloablative conditioning ("miniallogeneic") was suggested, though being impossible to be performed due to the further rapid disease progression. The patient died after approximately 10 months. CONCLUSIONS. Sarcomatoid renal carcinoma is characterised histologically by closely interconnected epithelial and connective tissue elements; sarcomatous cells seem to originate from a phenotype conversion to carcinomatous cells, as they both belong to the same DNA clone. Their behaviour is very aggressive and the prognosis is unfavourable: 6-month average survival after diagnosis. Radical nephrectomy is still the main therapeutic approach, although it is has no significant influence on prognosis and survival rate. This case showed an approximately 10-month patient's survival, with some different chemotherapeutic approaches being followed (first IL-2 and then carboplatinum) after surgery.