Long Term Survival in Pediatric Renal Cell Carcinoma despite multiple relapses: A Case Study

Background Although common in adults, renal cell carcinoma (RCC) is extremely rare in pediatric populations, comprising of less than 5% of malignant renal tumors. Literature on the topic is scarce, and there currently is no protocol for the treatment of pediatric RCC. This study focuses on a pediatric RCC patient who experienced multiple relapses of the disease, and aims to highlight the multifocal approach taken to care for the patient. Case History A 6 year old male presented in 2006 with a chief complaint of 1 week of painless hematuria, and was found to have a renal mass by abdominal examination. He was diagnosed with type II papillary RCC based on pathological examination of tissue following radical nephroureterectomy and regional lymph node excision. Over the next 7 years the patient had several regional and distal metastases of the disease, which required different approaches including a right pneumonectomy, stereotactic spinal radiosurgery, external beam radiotherapy, and chemotherapy with Sunitinib. In addition, patient developed posterolateral right sided rotation of his heart (iatrogenic retrodextrocardia) after the pneumonectomy. Despite several relapses, the patient has done well with treatment, and has not shown any evidence of metastasis or active disease in the last five years, with the most recent follow up being in 2018. Conclusion Renal cell carcinoma is an extremely rare malignancy in pediatric populations, and research on it is sparse. Studies for the development of appropriate treatment protocols are being explored currently, however, nothing concrete exists currently. The patient in our case study portrays the success of an individualized approach, and calls for attention to the need for further research in treatment options, and the development of a standardized protocol. We hope that this case report serves as a source of optimism, and increases clinicians’ knowledge of treatment approaches that have shown positive results for this rare pediatric neoplasm.