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

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...

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Bibliographic Details
Published in:Journal of cutaneous pathology 2020-07, Vol.47 (7), p.617-620
Main Authors: Gradecki, Sarah E., Gru, Alejandro A.
Format: Article
Language:English
Subjects:
Antibiotics
Carcinoma, Renal Cell - secondary
Carcinoma, Renal Cell - surgery
Cell proliferation
Clear cell-type renal cell carcinoma
Dermis
Fibrosis
Humans
Keratin
Kidney cancer
Kidney Neoplasms - pathology
Kidney Neoplasms - surgery
laparoscopic port site metastasis
Laparoscopy
Laparoscopy - adverse effects
Lesions
Male
Metastases
Metastasis
metastatic carcinoma
Middle Aged
Neoplasm Seeding
Nephrectomy
Nodules
Pax8 protein
Renal cell carcinoma
Skin
Skin Neoplasms - secondary
Surgery
Vimentin
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Summary: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.
ISSN:0303-6987
1600-0560
DOI:10.1111/cup.13657