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Renal medullary-like carcinoma in an adult without sickle cell hemoglobinopathy

Nature Reviews Urology volume 7, pages 110–114 (2010)Cite this article

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Abstract

Background. A 42-year-old white man with no significant prior medical history presented with macroscopic hematuria of 2 months' duration. His family history was notable for a maternal grandfather with kidney cancer.

Investigations. Urinalysis, CT, microscopic examination of tumor, immunohistochemical analysis of tumor, hemoglobin electrophoresis, molecular cytogenetic analysis, gene sequencing.

Diagnosis. Renal medullary-like carcinoma in an adult without sickle cell trait, sickle cell disease or other hemoglobinopathies.

Management. The patient underwent laparoscopic nephrectomy to remove the tumor and received adjuvant sorafenib (400 mg per day) as part of the E2805 ASSURE (Adjuvant Sorafenib or Sunitinib for Unfavorable Renal Carcinoma) trial. Metastatic recurrence of the tumor occurred 9 months after nephrectomy, for which the patient underwent tumor debulking and retroperitoneal lymph node dissection, followed by chemotherapy consisting of gemcitabine (2,000 mg/m2) and doxorubicin (50 mg/m2), both given on day 1 of a 14-day cycle. After six cycles of drug treatment, the patient had achieved a partial response. The patient was managed by active surveillance for 4 months, when he developed further symptoms and disease progression was detected. Third-line systemic therapy in the form of 21-day cycles of cisplatin (80 mg/m2 on day 1) and etoposide (100 mg/m2 on days 1–3) has recently been initiated.

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Figure 1: CT of the abdomen.
Figure 2: Gross appearance of left renal mass.
Figure 3: Microscopic analysis of left kidney mass.

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Authors and Affiliations

  1. Section of Hematology/Oncology and Department of Medicine, The University of Chicago, 5841 South Maryland Avenue, MC 2115, Chicago, 60637, IL, USA

    Peter H. O'Donnell, Ana Jensen, Edwin M. Posadas & Walter M. Stadler

  2. Department of Pathology and Microbiology, The University of Nebraska Medical Center, 983135 Nebraska Medical Center, Omaha, 68198, NE, USA

    Julia A. Bridge

  3. Department of Pathology, Northwestern University, Feinberg Pavilion, 251 East Huron Street, Chicago, 60611, IL, USA

    Anjana V. Yeldandi & Ximing J. Yang

  4. Department of Pathology, Memorial Sloan–Kettering Cancer Center, 1275 York Avenue, New York, 10065, NY, USA

    Hikmat Al-Ahmadie

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  1. Peter H. O'Donnell
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Correspondence to Hikmat Al-Ahmadie.

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O'Donnell, P., Jensen, A., Posadas, E. et al. Renal medullary-like carcinoma in an adult without sickle cell hemoglobinopathy. Nat Rev Urol 7, 110–114 (2010). https://doi.org/10.1038/nrurol.2009.255

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