Renal cell carcinoma (RCC) with sarcomatoid differentiation belongs to most aggressive clinicopathologic type of RCC. It is associated with poor prognosis and therapeutic outcome. We report a case of clear cell renal cell carcinoma with sarcomatoid differentiation involving left kidney in a 51 year old female. Immunohistochemistry was performed for exact characterization. The importance of this case report is identification and reporting of sarcomatoid component in renal cell carcinoma as it confers more propensity of metastasis and hence less chances of survival.

Keywords: renal cell carcinoma (RCC), sarcomatoid differentiation, poor prognosis.

1. Renate Pichler, Eva Compérat, [...], and Manuela Schmidinger. Renal Cell Carcinoma with Sarcomatoid Features: Finally New Therapeutic Hope?. Cancers (BaseI).2019 Mar; 11(3): 422.
2. Jones TD, Eble JN, Wang M, Macclenny GT, Jain S, Cheng L. Clonal divergence and genetic heterogeneity in clear cell renal cell carcinomas with sarcomatoid transformation. Cancer. 2005;104:1195-1203. Cancer. 2005; 104:1195–1203.
3. Cheville J.C., Lohse C.M., Zincke H., Weaver A.L., Leibovich B.C., Frank I., Blute M.L. Sarcomatoid renal cell carcinoma: An examination of underlying histologic subtype and an analysis of associations with patient outcome. Am. J. Surg. Pathol. 2004;28:435–441. 
4. Mikami S., Katsube K., Oya M., Ishida M., Kosaka T., Mizuno R., Mukai M., Okada Y. Expression of Snail and Slug in renal cell carcinoma: E-cadherin repressor Snail is associated with cancer invasion and prognosis. Lab Investig. 2011; 91: 1443–1458.
5. Delahunt B., Cheville J.C., Martignoni G., Humphrey P.A., Magi-Galluzzi C., McKenney J., Egevad L., Algaba F., Moch H., Grignon D.J., et al. The International Society of Urological Pathology (ISUP) grading system for renal cell carcinoma and other prognostic parameters. Am. J. Surg. Pathol. 2013;37:1490–1504. 
6. De Peralta-Venturina M., Moch H., Amin M., Tamboli P., Hailemariam S., Mihatsch M., Javidan J., Stricker H., Ro J.Y., Amin M.B. Sarcomatoid differentiation in renal cell carcinoma: A study of 101 cases. Am. J. Surg. Pathol. 2001;25:275–284.
7. DALL'OGLIO, Marcos F. et al. Sarcomatoid differentiation in renal cell carcinoma: prognostic implications. braz j urol.[online]. 2005, vol.31, n.1 [cited  2020-07-16], pp.10-16.
8. Bertoni F, Ferri C, Benati A, Bacchini P, Corrado F: Sarcomatoid carcinoma of the kidney. J Urol. 1987; 137: 25-8.    
9. Brian Shuch, Gennady Bratslavsky, [...], and Ramaprasad Srinivasan. Sarcomatoid renal cell carcinoma: A comprehensive review of the biology and current treatment strategies. Oncologist. Jan 2012;17(1):46-54.
10. Shuch B, Said J, La Rochelle JC et al. Cytoreductive nephrectomy for kidney cancer with sarcomatoid histology –is upfront resection indicated and,if not, is it avoidable? J Urol.2009;182:2164-2171.
11. Akhtar M, Tulbah A, Kardar AH et al. Sarcomatoid renal cell carcinoma: The chromophobe connection. Am J Surg Pathol.1997;21:1188-1195.
12. Vogelzang NJ, Fremgen AM, Guinan PD et al. Primary renal sarcoma in adults. A natural history and management study by the American Cancer Society, Illinois Division. Cancer. 1993;71:804-810.
13. Bonsib SM, Fischer J, Plattner S et al. Sarcomatoid renal tumors. Clinicopathologic correlation of three cases. Cancer. 1987;59:527-532.
14. DeLong W, Grignon DJ, Eberwein P et al. Sarcomatoid renal cell carcinoma. An immunohistochemical study of 18 cases. Arch Pathol Lab Med. 1993;117:636-640.
15. Kanamaru H, Li B, Miwa Y et al. Immunohistochemical expression of p53 and bcl-2 proteins is not associated with sarcomatoid change in renal cell carcinoma. Urol Res. 1999;27:169-173.
16. Mian BM, Bhadkamkar N, Slaton JW et al. Prognostic factors and survival of patients with sarcomatoid renal cell carcinoma. J Urol. 2002;167:65-70.
17. Cangiano T, Liao J, Nitoh J et al. Sarcomatoid renal cell carcinoma: Biologic behaviour, prognosis, and response to combined surgical resection and immunotherapy. J Clin Oncol. 1999; 17:5523-528.
18. Cleveland P, Tang V. Sarcomatoid renal cell carcinoma. Uro Onco.2017;21(6).

Dr Sarita Asotra

Associate Professor, Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh- 171001, India