Young Woman With Renal Medullary Cancer
This is a 27 year-old AAF who presented to the ER with a sharp right-sided abdominal and back pain associated with nausea who found to have a 7.5 cm right sided medullary kidney cancer. She was seen by surgery and eventually underwent a R2 resection of the right medullary lesion. Pathology revealed this to be a high grade adenocarcinoma with invasion beyond the renal capsule into adipose tissue, adrenal and lymphovascular invasion, and retroperitoneal LN involvement. TNM stage was T4, N1, Mx. Her pathology specimen was sent for a second opinion that also confirmed medullary kidney cancer. Her tumor was OCT-4, EMA, and mammaglobin positive and negative for BAF-47 (INI-1), PAX-8, and PLAP. She then followed up with oncology and had a PET scan that did not show metastatic disease, but did show residual disease. It is also noted from her history that she had Hemoglobin S trait.
It was planned to treat the patient with cisplatin and gemcitabine in hopes of then decreasing the residual tumor burden and then going for re-resection. She tolerated 2 cycles of chemotherapy and then had a repeat CT scan that showed disease progression with new liver metastases.
How would this patient be best treated? Would you send this patient for a clinical trial? If so, would you attempt to get her on a trial with a PD-1 or PD-L1 inhibitor? Would you consider starting her on a VEGF or MTOR inhibitor vs conventional chemotherapy?
George Yaghmour
Jul 08, 2015
Andrew Fintel
Jul 14, 2015
Eric Wiedower
Jul 14, 2015
May 19, 2024
Pending Moderator approval.