Tumoră primară ovariană sau metastaze ale unui carcinom cu celule renale – prezentare de caz

Renal cell carcinoma represents the most frequent type of kidney cancer and accounts for 2-3% of all adult malig­nant tumors. Papillary renal cell carcinoma (pRCC) is the second most common type of renal carcinoma. RCC usually metastasizes to the lungs, lymph nodes, bones, brain and liver. Renal carcinoma dissemination to the ovaries is an exceptional occurrence. A 60-year-old woman was ad­mit­ted in January 2018 due to acute back pain and ab­do­mi­nal discomfort. An abdominal computed to­mo­gra­phy (CT) scan with intravenous contrast revealed a solid mass with malignant features located on the left kidney, multiple enlarged lymph nodes, and pulmonary metastases – cT3N1M1(pul). The patient underwent radical left nephrectomy and para-aortic lymphadenectomy fol­lowed by treatment with pazopanib. The pathologic study revealed papillary renal cell carcinoma. In June 2018, the patient presented with abdominal pain, postprandial bloa­ting, nausea, vomiting and abdominal distension (ECOG 3). CT imaging showed stable pulmonary metastases and left ovarian mass. An exploratory laparotomy was per­formed, revealing a 8x7 cm ovarian mass, followed by left adnexectomy. The histopathological report described car­ci­no­ma­tous infiltration of the left ovary and fallopian tube, while the immunohistochemical staining could not clearly differentiate between a primary ovarian tumor and a metastasis. Corroborating the histopathological and im­mu­no­his­to­che­mi­cal reports with the clinical status, the diagnosis of a synchronous primary ovarian tumor was decided. The treatment was continued with paclitaxel 125 mg/m2 + carboplatin AUC 6, q3w, and pazopanib 800 mg/daily, with clinical benefit after the first administration, although before the fifth cycle the patient’s clinical status rapidly deteriorated.