Diagnóstico de cáncer renal metastásico en gestante a través de lesiones cutáneas: descripción de un caso clínico

Introduction

Gestational cancer affects approximately 1 in 1,000 pregnant women, with renal cell carcinoma (RCC) being the most common in the urinary tract. RCC dissemination can include cutaneous metastases in 2.8-6.8% of cases. A multidisciplinary approach to RCC during pregnancy is crucial due to diagnostic and therapeutic challenges that can impact maternal and neonatal outcomes.

Symptoms and Clinical Findings

A 15-week pregnant woman presents with asymptomatic cutaneous lesions for 4 months. Physical examination reveals two erythematous-violaceous nodules in the right hypochondrium and two in the right thigh, all adherent to deep planes and without palpable lymphadenopathy.

Diagnosis, Therapeutic Intervention, and Results

Excisional skin biopsy with immunohistochemical and molecular studies suggests cutaneous metastasis of papillary-pattern renal carcinoma. Nuclear magnetic resonance reveals multiple metastatic implants and lymphadenopathies. Despite recommendations to terminate pregnancy for targeted therapy, the patient chooses to continue. At week 31, a cesarean section is performed due to maternal clinical deterioration from disease progression. Oncologic treatment with Cabozantinib begins postpartum. Six months later, the patient remains stable with significant lesion improvement.

Conclusion

Diagnosing cancer during pregnancy presents a complex challenge, balancing maternal prognosis with fetal health is critical. Emphasizing a multidisciplinary approach and early consultation optimizes both clinical and emotional management.