The Correlation Analysis Of Clinical Diagnosis And Management Of Sarcomatoid Renal Cell Carcinoma

ObjectiveSarcomatoid carcinoma(SC)is a rare malignancy mixed with sarcoma-like morphology,and occurs in the respiratory tract,lung,breast,and kidney.Sarcomatoid renal cell carcinoma(SRCC)is a rare type of renal tumor with a high degree of malignancy and a poor prognosis.This study aims to summarize the clinical manifestations,diagnosis,treatment,and prognosis of sarcomatoid renal cell carcinoma and raise awareness of the disease.Subjects and methodsThe clinical data was analyzed retrospectively of the 10 patients diagnosed as sarcomatoid renal cell carcinoma(SRCC)who were admitted to our department from April 2012 to March 2017.Among of them,6 males and 4 females’ median age are(63.4 ± 11.5)years(44-82yrs).7 patients were admitted to hospital with gross hematuria and lumbar pain,2 patients were admitted to hospital by physical examination,and 1 had fever with gross hematuria.CT examinations on the admission line all indicated renal space occupation.The tumor diameter ranged from 54.81 to 98.55 mm.The soft tissue density of the mass was visibly necrotic.There were 4 cases of Clinical stage IV,2 cases of stage III,2 cases of stage II and 2 cases of stage I.One case showed cava thrombosis,2 cases occurred multiple bone metastases and 3 cases occurred lung metastases.5 cases underwent open abdominal approach of radical nephrectomy,4 cases underwent laparoscopic approach of radical nephrectomy,and 1 case underwent thoracoabdominal approach of right kidney radical resection + inferior vena cava tumor embolectomy.Results10 cases of SRCC had the open surgery or laparoscopic radical resection of the kidney.The postoperative pathology were all confirmed as sarcomatoid renal cell carcinoma.Among them,there are 5 cases of simple sarcomatoid renal cell carcinoma,4 cases of clear cell carcinoma with sarcomatoid carcinoma,and 1 case of chromophobe carcinoma with sarcomatoid carcinoma.Immunohistochemical staining shows that 9 cases of cytokeratin(CK)、8 cases of Vimentin and 7 cases of positive epithelial membrane antigen(EMA).The 10 cases of Ki-67 were different degrees of expression(20-60%).9 cases were followed up and 1 case lost.The follow-up time are 4 to 60 months and the median follow-up time are 15 months.Among the 9 cases,5 patients survived and 4 died.The death patients’ average survival time is(14.5 ± 9.1)months.ConclusionSarcomatoid renal cell carcinoma has a high degree of malignancy and poor prognosis.It is necessary for confirming to rely on pathological examination.Active surgery combined with adjuvant therapy can help patients to prolong survival.