Widely Metastatic ccRCC in 40-Year-Old Female
LP is a 40 year old female with a h/o complex cystic lesion in the right kidney, partially calcified since 2011. CT scan in 2014 showed a mass in the right kidney measuring 8.6 x 6.6 x 6.5 cm, previously stable x 2 years. CT scan in March 2016 showed the mass in the right kidney mass 9 x 7 x 6.7 cm in addition to a 10 x 7.4 mm nodule in LLL (new). She did not have follow up until January 2017 and CT scans at that time showed the LLL mass to measure 2.5 cm in addition to multiple nodules in right and left lungs; a 3.5 x 2 cm RLL mass and a 3cm retrocaval necrotic node with omental caking in left mid abdomen, suggesting carcinomatosis. A biopsy of the omentum returned metastatic poorly differentiated non small cell carcinoma and upon workup and urologic pathologist review it was thought to be clear cell carcinoma of the kidney.
In 2/17, PET/CT showed a right renal tumor in addition to lung, pleural, LN, omental and bilateral ovarian metastases. There was diffuse marrow hypermetabolic uptake. LDH was 639, CA-125 179. She then underwent cytoreductive nephrectomy, ovarian resection and biopsy of the omentum all consistent with clear cell carcinoma of the kidney.
Assessment:
Stage IV metastatic clear cell carcinoma of the kidney
MSKCC criteria- intermediate risk (anemia, kidney mass)- LDH 639
IMDC risk criteria- poor risk (anemia, thrombocytosis, kidney mass @ dx)
NGS sequencing: ALK-, VHL-, ATM-, BRCA1/2-, PDL1-
What is the optimal way to treat this woman?
Additional Info
Disclosure statements are available on the authors' profiles:
rebaz haji
Nov 24, 2017
Huan Wang
Jan 29, 2018
May 25, 2024
Pending Moderator approval.