Heterogeneous response to target therapy in metastatic papillary renal cell carcinoma evaluated by morphologic and metabolic multimodality imaging: A case report

Emanuele Naglieri, Artor Niccoli Asabella, Anna Giulia Nappi, Claudia Carella, Cristina Ferrari, Giuseppe Rubini

Research output: Contribution to journalArticlepeer-review


Rationale:Papillary renal cell carcinoma (PRCC) accounts for about 15% to 20% of renal cell carcinoma and is histologically distinguished in type I and type II. The last one is associated with poorer prognosis.Treatment options for PRCC patients are surgery, immunotherapy, revolutionized by Nivolumab, and other target-therapy with an improvement in overall survival. Heterogenous response and a pseudo-progression may be observed in the initial phase of biological treatment that could induce premature discontinuation.Patient concerns:We present the case of a 44-year-old woman with left cervical palpable mass increased in size and without concomitant disease or previous surgery.Diagnosis:Neck ultrasonography, contrast-enhanced Computed Tomography, and 18F-FDG PET/CT were performed with the detection of lymph nodes involvement and a left renal lesion.Interventions:The patients underwent left radical nephrectomy and homolateral cervical and para-aortic lymphadenectomy, with histological diagnosis of PRCC, type II. After disease relapse, the inter-aortocaval lymph node was laparoscopically removed. Following the detection of further disease relapse in several lymph nodes and the lung, several lines of target-therapy were started; then disease progression and worsening of clinical and hematological status led us to start Nivolumab as last-line therapy.Outcomes:A heterogeneous response to therapies was documented with morphological and nuclear medicine imaging, however the concomitant deterioration of performance status and liver function led to discontinuation of Nivolumab; then the patient died, 30 months after diagnosis.Lessons:Here we describe the clinical case and radiological and nuclear medicine imaging investigations performed by our patient, highlighting that 18F-FDG PET/CT shows greater adequacy in assessing the response to therapy, avoiding premature drug discontinuation, and ensuring better management of a patient with advanced PRCC.

Original languageEnglish
Article numbere18093
JournalMedicine (United States)
Issue number50
Publication statusPublished - Jan 1 2019


  • 18F-FDG PET/CT
  • heterogeneous response
  • multimodality imaging
  • papillary renal cell carcinoma
  • target therapy

ASJC Scopus subject areas

  • Medicine(all)


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