Unusual progression of renal cell carcinoma with carcinomatosis peritoneii and Krukenberg tumour and alopecia with sunitinib therapy in young female

Abstract

Background: Sunitinib is a multiple receptor tyrosine kinase inhibitor (TKI) used for the treatment of renal cell carcinoma (RCC). It increases the median survival considerably with minimum side effects. Alopecia is one of the rare side effects. Metastasis to the ovary is also rare. We report a case of RCC metastasizing to the ovary developing alopecia early on starting sunitinib.

Case presentation: A 22-year-old hypothyroid girl underwent right radical nephrectomy for T₂N₀ RCC. Histopathology was clear cell carcinoma. Six months later, she presented with right iliac fossa pain, imaging revealed metastasis to the ileocolic junction and the ovary, an exploratory laparotomy was carried out and, after debulking, the patient was started on sunitinib. Four weeks after the start of the treatment, she developed alopecia. She was continued with sunitinib therapy till progression.

Conclusions: The present case shows a rare metastasis to the ovary and early onset of rare adverse event of alopecia on starting sunitinib therapy. In the presence of confounding factors like hypothyroidism and dandruff, establishing this as an adverse reaction of sunitinib is difficult. This case had a unique metastatic spread with involvement of the bowel, ovary and peritoneal carcinomatosis. Use of adjuvant TKI's after resection of primary tumour in nonmetastatic setting may reduce metastatic rates and increase progression-free survival.

Fig. 1

Computed tomogram showing large mass replacing almost whole of the right kidney with a functioning left kidney

Fig. 2

MR image showing mass in the right kidney

Fig. 3

T2-weighted MR image showing a mass replacing whole of the kidney with no extracapsular invasion

Fig. 4

Photomicrograph showing clear cell carcinoma of the kidney (haematoxylin and eosin × 40)

Fig. 5

Computed tomography image showing mass at the ileocolic junction; no recurrence is seen in the renal bed

Fig. 6

Computed tomography image showing collection in the uterine cavity with lesion in the left adnexa

Fig. 7

Photomicrograph of the recurrent tumour. a Low power view showing nests of clear cells (H&E × 40). b High power view showing clear cell deposits (H&E × 400). c Clear cell deposits in the mesentry with smooth muscle wall on top right and tumour on bottom left (H&E × 40). d Low power view showing necrosis on the left and tumour on the right (H&E × 40)