Abstract:

This article reports a case of diagnosed sarcomatoid renal cell carcinoma due to hematuria. The patient was admitted to Maoming People's Hospital due to intermittent gross hematuria in the whole process of urination for more than 1 month. CT scan showed that mass lesion in the left kidney which required further differential diagnosis between tumor and infection, the left adrenal gland was partially thickened, and hyperplasia was not excluded. CTA images showed that the lesion lacked blood supply and was supplied by the left renal artery branches. After multidisciplinary consultations on difficult cases in the Urology department of Guangdong Medical Association, experts suggested to conduct renal biopsy to determine the nature of the lesion. The puncture pathological result indicated the presence of irregular spindle shaped cells with necrosis in the puncture tissue, which was consistent with malignant tumors and tended to be sarcomatoid changes. Based on the opinions of multidisciplinary consultations on difficult cases in the Urology department of Guangdong Medical Association, the patient underwent laparoscopic left radical nephrectomy and left adrenalectomy via the retroperitoneal approach. The patient recovered well during postoperative follow-up, with normal renal function and no tumor recurrence or metastasis. Therefore, for certain renal masses lesions such as sarcomatoid renal cell carcinoma that cannot be clearly diagnosed before surgery, preoperative needle biopsy can be considered to obtain a clear pathological type to guide treatment. Sarcomatoid renal cell carcinoma is highly invasive, and radical nephrectomy is recommended. Close follow-up is necessary after surgery. Comprehensive treatments such as combined targeted therapy, immunotherapy, or radiotherapy may be considered for patients with stage II or above.

Key words: Sarcomatoid renal cell carcinoma, Needle biopsy, Radical nephrectomy, Comprehensive treatment, Targeted therapy, Immunotherapy, Radiotherapy