Sarcomatoid renal cell carcinoma: a case report and literature review

BMC Nephrol. 2018 Apr 10;19(1):84. doi: 10.1186/s12882-018-0884-7.


Background: The poorly differentiated renal cell carcinoma (RCC) with rhabdomyosarcomatous sarcomatoid differentiation shows a severely aggressive biological behavior characterized by rapid disease progression. Preoperative identification of the subtype with the prognostic factors and imaging features of sarcomatoid renal cell carcinoma (SRCC) would be of great clinical significance.

Case presentation: A 45-year-old male patient presented a nine day history of gross hematuria without any other symptoms. A computed tomography (CT) and a full-body fluorine-18 fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) - computed tomography (CT) scan urogram were performed. An initial diagnosis identified a space-occupying lesion of the right kidney, retroperitoneal and right renal hulum lymph node metastases, as well as a space-occupying lesion of the third thoracic vertebra (T3). A right radical nephrectomy was performed. Pathologic analysis revealed poorly differentiated RCC with rhabdomyosarcomatous sarcomatoid differentiation that extends into the renal sinus and the ureteral (T3N1M1). Five days later, the Magnetic Resonance imaging (MRI) evidenced a diffused osseous metastatic disease in the thoracic and lumbar vertebra and multiple retroperitoneal lymph node metastases. The disease progressed quickly to multiple organ dysfunction syndrome (MODS) in half a month and the patient died of respiratory failure two days later. The patient refused any chemoradiotherapy in the hospital.

Conclusions: Our case presents a SRCC with severe, aggressive, and rapid disease progression. Classifying SRCC imaging features by CT, MRI as well as PET-CT techniques could potentially be helpful for preoperative identification of the subtype. The prognostic factors of SRCC would be of great clinical interest.

Keywords: Imaging features; Sarcomatoid renal cell carcinoma; Targeted therapies.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Carcinoma, Renal Cell / complications
  • Carcinoma, Renal Cell / diagnostic imaging
  • Carcinoma, Renal Cell / pathology*
  • Disease Progression
  • Fatal Outcome
  • Fluorodeoxyglucose F18
  • Hematuria / etiology
  • Humans
  • Kidney Neoplasms / complications
  • Kidney Neoplasms / diagnostic imaging
  • Kidney Neoplasms / pathology*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neoplasm Metastasis
  • Positron Emission Tomography Computed Tomography
  • Radiopharmaceuticals
  • Rhabdomyosarcoma / complications
  • Rhabdomyosarcoma / diagnostic imaging
  • Rhabdomyosarcoma / pathology*
  • Tomography, X-Ray Computed


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18