Pathology reports- clear cell with extensive rhabdoid features grade 4

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FaerieQueen
FaerieQueen Member Posts: 5
in Kidney Cancer #1

Hello. I have posted previously here about my father and his kidney cancer spreading to the brain. We just now saw a specalist for the first time and was shocked to find out he actually has a rare subtype of renal cell cancer. Here is what the pathology report from his total nephrectomy in June 2012 says. & in case anyone is wondering my dad is 57 years old and aside from the cancer has no other health problems aside from high blood pressure and cholestrol that is controlled with meds.

 

Kidney, left, total robotic nephrectomy:

Renal cell carcinoma, clear cell type with extensive rhabdoid features (>90%) and focal glandular (3%) and sarcomatoid (1%) areas

 

Immunostains performed at OSU:

positive HMWK (glandular area positive, clear cell area negative), p504s, PAX8, vitentin, CD10, CAIX (focal)

negative p63, CK7, CK20, CD141, p63, HMB45 (Anyone know what any of this means?)

 

Lymph nodes, hilar, lyphadenectomy:

No evidence of neoplasia in 4 lymph nodes

 

Synoptic Report:

Nephrectomy type: Total

Tumor location: Lower

Focality: Unifocal

Tumor size: 6.4cm

Histologic type: clear cell [EXTENSIVE RHABDOID MORPHOLOGY (>90%) AND FOCAL GRANDULAR (3%) AND SARCOMATOID (1%) FEATURES]

Tumor grade: 4

pTNM: pT3a

 

Then in March when we realized it has metastisized to the brain, they removed both brain lesions and they were "left frontal lesion" 1.7 x 1.2 x 0.8 cm and "left occipital lesion" 2.4 x 2.0 x 1.5 cm. The brain suergon estimated the brain tumors were in there for about 3 months...so it would have been after the nephrectomy that it mestastized.

Any feedback on these reports are much appriciated. Anyone else here of Rhabdoid? I know it's rare and even when I look it up I can't find much of anything... So scared for my dad. :'(

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  • NanoSecond
    NanoSecond Member Posts: 653
    #2
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    Be careful what you ask for

    Yes, I can help shed some light on what those Immunostains might mean. These are markers that help to reveal the "true" nature of the cells that make up the tumor.

    Here is an article that will shed more light on the subject.  Then again, it may serve to make this data even more confusing:

    http://www.archivesofpathology.org/doi/full/10.5858/arpa.2011-0472-RA

    If you are still interested (but also confused) by all this I can try to further translate what it means.  But the bottom line is that this information is primarily of interest to the experts in evaluating the actual pathology of the tumor cells - and what approach or therapy may be most effective for treatment.

    I think you already realize that this is not only a very rare form of RCC - but one that can be extremely aggressive. That means it may respond to more traditional kinds of chemotherapy drugs that normally do not work on most manifestations of ccRCC.

    Hope that helps.

     

    -N

     

     

     

  • NanoSecond
    NanoSecond Member Posts: 653
    #3
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    Some more thoughts

    I should have added that your dad's case really needs to be evaluated by an expert RCC oncologist.  Someone who only deals with RCC and who has had experience with Rhabdoid cases.

    Also, you might want to join Smart Patients to see if there are any other patients or care-givers for this form of RCC.

  • Texas_wedge
    Texas_wedge Member Posts: 2,798
    #4
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    NanoSecond said:

    Some more thoughts

    I should have added that your dad's case really needs to be evaluated by an expert RCC oncologist.  Someone who only deals with RCC and who has had experience with Rhabdoid cases.

    Also, you might want to join Smart Patients to see if there are any other patients or care-givers for this form of RCC.

    Yet more thoughts

    Neil's right that you need an expert and it sounds as though you already have one?  It won't be easy to find someone with much experience with rhabdoid and that probably doesn't matter too much. Rhabdoid is not good news but is better than having a large sarcomatoid element.   Not too much is really known about the best treatments for rhabdoid and sarcomatoid transformations and the scene is moving very fast so the prospects are improving considerably.

    Your Father actually has a lot in his favour.  He's still quite young, otherwise healthy, his tumor was not very large, there seems to be no lymphatic involvement, the tumor was on the lower pole so perhaps they were able to save the ipsilateral adrenal gland? 

    With the brain mets close continuing monitoring will be essential but with luck the surgeon has done the necessary.  Since the brain is not usually the first location for RCC mets, doubtless he has had CT scans with contrast of thorax, abdomen and pelvis to ensure there are no other mets?

    Regular scans are called for but your Father may be back in clear water.  

     

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