An unusual case of sarcomatoid renal cell carcinoma presenting in the skin by direct extension at a laparoscopic port site

Abstract

Although renal cell carcinoma (RCC) is known for its propensity to metastasize widely throughout the body, cutaneous metastases are uncommon and seen in less than 3% of RCCs. A 56‐year‐old man presented with a painful red lesion with satellite nodules on his abdomen at a laparoscopic port site from a partial nephrectomy for a pT1a clear‐cell RCC that was performed 28 months prior. The lesion was excised; however, after excision the lesion recurred with continued pain and drainage from the surgical site. This was treated with multiple courses of antibiotics. Because of the persistent nature of the lesion, it was re‐biopsied, and an atypical, keratin‐positive, spindle‐cell proliferation was identified within the dermis. The patient's previous skin excision was reexamined, and the same atypical cells were identified within large areas of necrosis, granulation tissue, and fibrosis. Further workup was performed on the initial excision, and the atypical cells showed expression of CD10, CAIX, PAX8, EMA, and vimentin, consistent with cutaneous involvement by RCC. Because of the rarity of skin metastases in RCC and the location at a previous laparoscopic port site, this lesion is presumed to have resulted from direct extension of tumor at the time of surgery.

Localised non‐metastatic sarcomatoid renal cell carcinoma: a 31‐year externally verified study

“…In all, 204 patients with sRCC and 217 with Grade 4 non-sRCC had recurrence data available. The median (95% CI) RFS between sRCC and non-sRCC was 14 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20) months compared to 23 (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) months, respectively (P = 0.059; Fig. 1).…”

“…This risk is in addition to the general risk of surgical manipulation also experienced in open surgery. While there have been reports of port-site metastasis in sRCC [21] and concerns about aerosolization in pneumoperitoneum-requiring procedures [22], conclusions from these data remain speculative without larger studies. Indeed, external verification analysis from ASSURE [11] data did not confirm this MIS finding.…”

Cutaneous Metastasis of Sarcomatoid Renal Cell Carcinoma, A Clinicopathologic Challenge

“…Although the lung is the most frequent site of metastasis, skin involvement is rarely reported in the literature. 6,7 Skin metastasis usually presents with nodules or masses, which can be easily mistaken for other benign or malignant skin lesions, making accurate diagnosis challenging.…”