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I. Sokolakis [1] and C. Kalogirou [1] and L. Frey [2] and M. Oelschläger [1] and M. Krebs [1] and H. Riedmiller [1] and H. Kübler [1] and D. Vergho [1]
Academic Editor: Mohamed A. Ghoneim
1, Department of Urology and Paediatric Urology, Julius Maximilian University of Würzburg, Würzburg, Germany, uni-wuerzburg.de
2, Institute of Pathology, Julius Maximilian University of Würzburg, Würzburg, Germany, uni-wuerzburg.de
Received Sep 28, 2017; Accepted Oct 26, 2017
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
1. Background
Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare subtype of renal cell carcinoma (RCC), which was first recognized as a distinct entity in the 2004 World Health Organization (WHO) tumour classification as well as in the newly revised 4th edition published in 2016 [1]. It is characterised by small, elongated tubules lined by cuboidal cells and/or cords of spindled cells separated by pale mucinous stroma [2]. Although it is described in the literature as a low-grade, relatively indolent tumour, it has a broad histological spectrum ranging from low to high grade tumours including sarcomatoid differentiation, which can contribute to an aggressive clinical course. A “mucin-poor” pattern of MTSCC has also been described where there is little or no extracellular mucin to be found [3]. Because of its rarity (around 100 cases reported in the literature), the clinical behaviour and metastatic potential of MTSCC remain unclear. There are only a few metastatic cases of MTSCC, which all either featured sarcomatoid differentiation or were synchronously metastasised [4]. Therefore, to contribute to the further reconditioning of MTSCC, we present a case of mucin-poor mucinous tubular and spindle cell carcinoma of the kidney presenting with metastases two years after bilateral nephrectomy.
2. Case Presentation
A 49-year-old male was presented at our department with lower back pain and walking instability for the last few days. The patient suffered from end-stage renal disease on dialysis for the last 15 years and had a history of successful renal transplantation about 25 years ago. The initial renal insufficiency resulted from a chronic glomerulonephritis and the allograft was rejected 9 years after transplantation due to the same underlying...