PMC7083626_01
During crizotinib treatment multilocular cysts appear in both kidneys.
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After 3 months, a CT scan showed a partial response of the disease in the chest and brain metastases were stable. After 8 months of the crizotinib therapy, a CT scan confirmed the stable disease for all lesions but it showed the appearance of multilocular cysts in both kidneys, the biggest of 3 cm, and a multilocular cyst starting from the right kidney to the perirenal adipose tissue and the posterior renal fascia (Figure 1).
By continuing the crizotinib treatment the confluent cystic formations extend from the kidneys to the diaphragm, to perirenal spaces, to the left iliopsoas muscle; two hepatic cysts appear.
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In September 2018 a CT scan confirmed that the disease was stable, but it documented confluent cystic formations bounded by solid walls, extended posteriorly and bilaterally from the kidneys along the perirenal and pararenal spaces: a cyst of 8 cm infiltrated the diaphragm and another one of 12 cm invaded the left iliopsoas muscle; two cystic hepatic lesions with thick walls also appeared, the biggest of 3 cm (Figure 2).
The cysts decreased in size and number by switching therapy to alectinib.
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In December 2018, after 3 months of the alectinib therapy, a CT scan confirmed that the disease was stable for the metastases affecting the brain, the chest and the abdomen and it showed the regression of cystic lesions in the kidneys, in the perirenal space and in the liver with a relevant reduction in size of the cystic lesion of the left iliopsoas muscle (2.8 cm versus 12 cm) (Figure 3).