Carcinoma renal sarcomatoide con múltiples metástasis cutáneas

  • Diana Carolina Rojas-Ramirez Instituto Mexicano del Seguro Social, Hospital de Especialidades No. 14 "Adolfo Ruiz Cortines", Veracruz, México https://orcid.org/0000-0002-9283-228X
  • Abel Antonio Ricardez-Espinosa Instituto Mexicano del Seguro Social, Hospital de Especialidades No. 14 "Adolfo Ruiz Cortines", Veracruz, México https://orcid.org/0000-0002-8754-1277
  • Luis Alfredo Jiménez-López Instituto Mexicano del Seguro Social, Hospital de Especialidades No. 14 "Adolfo Ruiz Cortines", Veracruz, México https://orcid.org/0000-0003-1959-5561
  • Alejandro Anastacio Velázquez-Méndez Instituto Mexicano del Seguro Social, Hospital de Especialidades No. 14 "Adolfo Ruiz Cortines", Veracruz, México https://orcid.org/0000-0002-8877-9391
  • Jorge Gerardo Sandoval-Téllez Instituto Mexicano del Seguro Social, Hospital General de Zona Número 76, Estado de México, México https://orcid.org/0000-0001-5309-4598
Palabras clave: Cancer renal, sarcomatoide, metastasis, factor sarcomatoide, pronóstico

Resumen

Descripción del caso clínico: Masculino de 47 años que presentó lesiones cutáneas nodulares rojo-violáceas en cara, cuero cabelludo y manos, biopsia con reporte de metástasis de tumor renal. Estado general conservado, masa palpable abdominal y microhematuria. Tomografía reportó tumor renal derecho infiltrando grasa perirrenal. Se realizó nefrectomía radical derecha, reporte histopatológico tumor de células claras con 60% de componente sarcomatoide. Inició sunitinib con involución de las lesiones cutáneas, tras 2 semanas de intermitencia presentó recurrencia modificándose la dosis. Tres meses después presentó actividad metastásica cerebral, hepática y ósea evolucionando tórpidamente, falleciendo a cinco meses del diagnóstico.

Relevancia: Particularmente nuestro caso no solo presenta una forma infrecuente de metástasis de cáncer renal recidivante a pesar del tratamiento con inhibidores de la tirosincinasa, sino también diferenciación sarcomatoide, una variante muy agresiva de cáncer renal.

Implicaciones clínicas: Las metastásis cutáneas de cáncer renal presentan una incidencia aproximada de 3%, si bien no es de buen pronóstico encontrarlas, su detección oportuna es primordial en todo paciente.

Conclusiones: El carcinoma renal sarcomatoide es un tumor raro y de pronóstico sombrío, generalmente asociado a metastásis a distancia. Es necesaria la valoración cutánea completa de todo paciente diagnosticado con cáncer renal para el adecuado estadiaje y tratamiento.

Citas

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Publicado
2020-10-28
Sección
Casos clínicos