ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2023 and some content may be unavailable. To unlock all content for 2023, please visit the archives.

Abstract: SA-PO244

Elevated 1,25-Dihydroxy-Vitamin D Level: A Perplexing Case of Renal Sarcoma with Osteoclast-Like Giant Cells

Session Information

Category: Onconephrology

  • 1700 Onconephrology


  • Poulton, Gregory, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
  • Batool, Aisha, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
  • Rao, Veitla, Advocate Aurora Health Inc, Milwaukee, Wisconsin, United States
  • Gallan, Alexander James, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
  • Veitla, Vineet, Medical College of Wisconsin, Milwaukee, Wisconsin, United States

Elevated 1,25 Dihydroxy vitamin D(DHVD) level is commonly attributed to increased macrophage activity in chronic granulomatous conditions such as sarcoidosis. There are no reports yet of DHVD elevation in renal tumors. Renal sarcoma is very rare accounting for 0.8–2.7% of malignant kidney tumors and coexistence with Extra-skeletal Osteoclast-like giant cell tumors (OGCT) is not yet reported.

Case Description

Our patient is 74 years old Caucasian female with history of HTN. She came to ER with complaints of right sided abdominal pain, also reported 18 lb weight loss and poor appetite. CT abdomen with contrast revealed Interval enlargement of the very large, heterogeneous right renal mass compatible with renal cell carcinoma now measuring up to 15.2 x 16.1 x 17.9 cm which directly invades the right hepatic lobe (hepatic invasion has increased) and possibly the posterior abdominal/chest wall. Laboratory data significant for total serum calcium level 15.0 mg/dl, 25 Hydroxy vitamin D level 33.6ng/ml,1,25 hydroxyvitamin D level 133 pg/ml, iPTH level 6.4 pg/ml and PTH related peptide level 1.7 pmol/L. She underwent radical nephrectomy with histopathology showing High grade dedifferentiated sarcoma, with multinucleated giant cells involving kidney and extending into liver segment 6 and 7 (19.2 cm), with lympho-vascular and perinephric adipose tissue involvement. Cytogenetics significant for CD 10 positive, RCC markers negative, MDM2 focally positive, High positive for PD-L1. One week postoperative, laboratory data significant for normalization of 1,25 DHVD level 9.6pg/ml, and serum calcium 8.7 mg/dl.


Resolution of hypercalcemia and normalization of DHVD levels after Sarcoma resection in our patient is very unique. The most effective therapy for renal and retroperitoneal sarcomas is the gross total resection of the tumor. Increased rates of necrosis, poor differentiation, mitotic activity and increased histological grade are associated with a poor prognosis.