Abstract
We report a case of sarcomatoid renal cell carcinoma (sarc-RCC) with hemodialysis for a long period of time. In May 2011, a 56-year-old woman who had been on hemodialysis for 20 years was admitted to our hospital for fever of unknown origin. Computed tomography showed a 3 cm tumor in the right kidney and an 8 cm one in the pubic bone. Because a needle biopsy of the pubic bone tumor showed sarcomatoid cancer, we made a diagnosis of metastatic bone tumor from right renal cancer. The patient’s condition worsened rapidly, despite shortterm molecular targeted therapy with sunitinib, and she died of cachexia at 40 days of hospitalization. An autopsy confirmed papillary renal cell carcinoma with sarcomatoid component in the right kidney and sarcomatoid cancer in the liver, right adrenal gland, vertebra and pubic bone. A literature review revealed that 23 cases of sarc-RCC have been reported in patients receiving hemodialysis in Japan, with 87% (20/23) of the cases occurring in patients receiving hemodialysis longer than 10 years and 74% (16/23) of the cases having a tumor less than 7 cm in diameter. There was no relationship between tumor size and duration of hemodialysis. It is noteworthy that sarc-RCC might exist in a small renal tumor in patients receiving hemodialysis for a long period of time. Physicians should consider the duration of hemodialysis as important when indicating surgery for a renal tumor in patients receiving hemodialysis.
