Case report: Sarcomatoid renal cell carcinoma in two transplant recipients

Ready to upload
Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Note that the following Council of Europe recommendations refer mainly to typical well differentiated renal cell carcinoma. The sarcomatoid variant is an unusual and aggressive type that is considered a high grade histologic variant. (Council of Europe, 2022): To provide valid histological staging, complete tumour resection (R0) is required for acceptance of all organs; additionally, tumour-free margins are a prerequisite for transplant of the affected kidney. Paraffin section is superior to frozen section for the assessment of such biopsies. The contralateral kidney should always be examined for synchronous RCC (5 % of patients). RCC < 1 cm (stage T1a AJCC 8th edn) and WHO/ISUP grade I/II (Fuhrman grade I/II) can be considered minimal-risk for transmission; RCC 1-4 cm (stage T1a AJCC 8th edn) and WHO/ISUP grade I/II (Fuhrman grade I/II) are considered low-risk; RCC > 4-7 cm (stage T1b AJCC 8th edn) and WHO/ISUP grade I/II (Fuhrman grade I/II) are considered intermediate-risk; RCC > 7 cm (stage T2 AJCC 8th edn) and WHO/ISUP grade I/II (Fuhrman grade I/II) are considered high-risk; RCC with extension beyond the kidney (stages T3/T4 AJCC 8th edn) is considered a contraindication to transplant; All RCC with WHO/ISUP grade III/IV (Fuhrman grade III/IV) are considered high-risk for transmission; Contralateral kidneys and other organs that are un¬involved in carcinoma are considered to represent minimal risk for transplantation when the RCC in the involved kidney is 4 cm or less and WHO/ISUP grade I-II. In all cases, follow-up surveillance is desirable. RCC in the donor history: The transmission risk of treated RCC depends on the histological type of tumour [159] and its recurrence-free follow-up period. In general, in the first 5 years after initial diagnosis, risk categories correspond to those stated above (RCC diagnosed during donor procurement) if there is no suspicion of tumour recurrence in the donor. After this time, the risk of advanced stages may decrease.
Time to detection: 
7 months
Alerting signals, symptoms, evidence of occurrence: 
Patient #1: Several days of fever, dyspnea, orthopnea, edema, decreased urine output, loose stools; Patient #2: No symptoms, MRI performed after tumor diagnosed in patient #1. Nephrectomy was performed on patient #1 because of continued renal failure and for progress. At that time pathologic study of allograft explant showed sarcomatoid renal carcinoma. In patient #2, 3 tumors were found by MRI within the kidney and PET CT scan showed increased activity in the iliac nodes.
Demonstration of imputability or root cause: 
FISH analysis for XY chromosomes in female patient #1 showed the tumor cells to contain Y chromosome consistent with origin form the male donor.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
Case report
Kidney transplant
Deceased donor
Sex chromosomes
Renal cell carcinoma
Suggest references: 
Llamas F, Gallego E, Salinas A, Virseda J, Pérez J, Ortega A, et al. Sarcomatoid renal cell carcinoma in a renal transplant recipient. Transplantation Proceedings. 2009;41(10):4422-4.
Carl-Ludwig: agree to Michael. It is a very rare entity and we have to be careful mixing up sarcomatid renal cell Ca not with other tumors (especially when reading the words renal cell Ca only) Carl-Ludwig- you apparently hit the rejected button by mistake, this article belongs in the library. Mike 7/1/21
Expert comments for publication: 
Sarcomatoid renal cell carcinoma is an uncommon variant. Recommendations for excision of small tumors in donor kidneys and use in transplant refer only to well differentiated renal cell carcinomas. Kidneys that contain sarcomatoid carcinomas of any size are not recommended for transplant. In this report, there was no pretransplant evidence that the donor had tumor.