Asymptomatic Renal Cell Carcinoma Research Articles

Asymptomatic Renal Cell Carcinoma Presenting as Clavicle Fracture

Abstract Renal cell carcinoma (RCC) accounts for 3% of all cancer cases. The classical triad of hematuria, loin pain, and mass per abdomen is rarely seen. RCC commonly metastasizes to the lungs, bones, and liver. Clavicle metastasis as the sole presentation of RCC is extremely rare. A 61-year-old man presented with pain and swelling over the left clavicle. Imaging revealed a lytic lesion with pathological fracture of the left clavicle, with a histopathological diagnosis of metastasis from clear cell RCC. Subsequent imaging of the abdomen revealed a right kidney mass. He underwent right partial nephrectomy and total left cleidectomy. At 30-month follow-up, he is free of disease with good limb function. Solitary skeletal metastasis from RCC is rare, of which clavicle metastasis as the initial presentation is extremely rare. The overall prognosis of metastatic RCC is poor, emphasizing the importance of identification of the pathological nature of the fracture, for early detection and prompt treatment of the primary tumor in its early stage, thereby improving the chances of overall survival.

Role of F-18 FDG PET/CT in the follow-up of asymptomatic renal cell carcinoma patients for postoperative surveillance: based on conditional survival analysis.

This study investigated the clinical usefulness of F-18 fluorodeoxylucose (FDG) positron emission tomography/computed tomography (PET/CT) for postoperative surveillance in the RCC patients in terms of detectability of recurrence and radiation exposure. Three-hundred-and-forty- three RCC patients who underwent surgery and postoperative surveillance were retrospectively included. Conditional recurrent free survival (CRFS) was investigated and diagnostic performance of conventional imaging (CI) which include abdominopelvic CT or/and chest CT was compared to the FDG PET/CT. At a median follow-up of 4.3years (0.5-13.0years), thirty-nine patients (11.4%) developed recurrence. CRFS of the patients increased over time with greater increment in advanced stage. The sensitivity, specificity, positive-predictive value, negative-predictive value, and accuracy of FDG PET/CT were 92.3%, 97%, 80%, 99.0%, and 96.5% in detecting recurrence, while those values for CI were 89.7%, 97.7%, 83.3%, 98.7%, and 96.8%, respectively. There were no significant differences in these values between FDG PET/CT and CI (McNemar test, p = 0.581). The average radiation dose from FDG PET/CT was around 16.9 ± 3.08mSv at each follow-up time point. For early stage patients, the average radiation dose from CI was around 26.5 ± 8.57mSv at each follow-up time point, while this was about 33.0 ± 9.76mSv for advanced stage patients. FDG PET/CT exhibited good diagnostic performance in asymptomatic RCC patients after surgery, of a level comparable to that of CI, but with a lower radiation dose.

Clinical features and outcomes in kidney transplant recipients with renal cell carcinoma: a single-center study.

BackgroundPrevious studies have recommended a 2- to 5-year waiting time prior to kidney transplantation (KT) in patients with end-stage renal disease (ESRD) and symptomatic renal cell carcinoma (RCC) and no delay for incidental early-stage RCC. Data on Asian KT recipients are unavailable.MethodsThis is a Korean single-center retrospective study on 35 KT recipients with ESRD and RCC. Patients were classified into two groups: early KT (KT performed within 1 year after nephrectomy for RCC, including KT with simultaneous nephrectomy) and delayed KT (KT performed over than 1 year after nephrectomy for RCC). Patient survival, graft survival, and cancer recurrence were compared between both groups.ResultsThere were no statistically significant differences in patient survival (P = 0.388), graft survival (P = 0.317), or graft rejection rate (P = 0.207) between the early and delayed KT groups. Additionally, there were no differences in pathological characteristics or RCC stage other than cancer histology: acquired cystic disease-associated RCC (47.4%) was the most common RCC type in the early KT group, whereas clear cell type (62.5%) was the most common RCC type in the delayed KT group. No RCC recurrence was observed.ConclusionPatients with early-stage and asymptomatic RCC do not require a mandatory observational period prior to KT after curative nephrectomy.

Biomarkers of renal cell carcinoma

Renal cell carcinoma (RCC) ranks first in mortality among urogenital tumors and is the most common disease after prostate and bladder cancer. Early detection of RCC allows immediately undertaking appropriate treatment, which significantly increases the survival of patients. In the case of the asymptomatic RCC, timely diagnosis in the early stages is usually difficult. To date, the problem of searching for molecular markers of clear cell RCC, which allows to determine the stage, metastatic potential and prognosis of disease, or select a treatment regimen remains topical. Of particular interest are early-stage biomarkers of RCC and its metastatic potential, as well as markers that can be obtained by non-invasive or minimally invasive methods. This review presents modern methods for diagnosing RCC using biomarkers.

Exsanguinating Hemorrhage from an Anterior Abdominal Wall Metastasis of an Asymptomatic Renal Cell Carcinoma.

Renal cell carcinoma is the most frequently encountered urological malignancy and accounts for 3% of all adult malignancies. The classically described triad of hematuria, palpable mass, and flank pain is rarely encountered, and most patients are diagnosed by screening done for other reasons. It is notorious for unusual sites of metastatic spread. We present a case of an asymptomatic renal cell carcinoma that presented as an anterior abdominal wall swelling and its neglect led to ulceration, and torrential and exsanguinating hemorrhage to which the patient succumbed.

Meta-analysis of the prevalence of renal cancer detected by abdominal ultrasonography.

The potential for an ultrasound-based screening programme for renal cell carcinoma (RCC) to improve survival through early detection has been the subject of much debate. The prevalence of ultrasound-detected asymptomatic RCC is an important first step to establishing whether a screening programme may be feasible. A systematic search of MEDLINE and Embase was performed up to March 2016 to identify studies reporting the prevalence of renal masses and RCC. Two populations of patients were chosen: asymptomatic individuals undergoing screening ultrasonography and patients undergoing ultrasonography for abdominal symptoms not related to RCC. A random-effects meta-analysis was performed. Study quality was evaluated using a validated eight-point checklist. Sixteen studies (413 551 patients) were included in the final analysis. The pooled prevalence of renal mass was 0·36 (95 per cent c.i. 0·23 to 0·52) per cent and the prevalence of histologically proven RCC was 0·10 (0·06 to 0·15) per cent. The prevalence of RCC was more than double in studies from Europe and North America than in those from Asia: 0·17 (0·09 to 0·27) versus 0·06 (0·03 to 0·09) per cent respectively. Data on 205 screen-detected RCCs showed that 84·4 per cent of tumours were stage T1-T2 N0, 13·7 per cent were T3-T4 N0, and only 2·0 per cent had positive nodes or metastases at diagnosis. At least one RCC would be detected per 1000 individuals screened. The majority of tumours identified are early stage (T1-T2).

PD10-07 ASYMPTOMATIC BRAIN METASTASIS FROM RENAL CELL CARCINOMA - ARE WE MISSING OUR WINDOW TO CURE?

You have accessJournal of UrologyKidney Cancer: Evaluation/Staging I1 Apr 2014PD10-07 ASYMPTOMATIC BRAIN METASTASIS FROM RENAL CELL CARCINOMA - ARE WE MISSING OUR WINDOW TO CURE? Michael Hanzly, Ahmed Aboumohamed, Terry Creighton, Christopher Foote, Diana Mehedint, Kristopher Attwood, Eric Kauffman, and Thomas Schwaab Michael HanzlyMichael Hanzly More articles by this author , Ahmed AboumohamedAhmed Aboumohamed More articles by this author , Terry CreightonTerry Creighton More articles by this author , Christopher FooteChristopher Foote More articles by this author , Diana MehedintDiana Mehedint More articles by this author , Kristopher AttwoodKristopher Attwood More articles by this author , Eric KauffmanEric Kauffman More articles by this author , and Thomas SchwaabThomas Schwaab More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.483AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Follow up guidelines for renal cell carcinoma (RCC) recommend brain imaging only in patients with central nervous system (CNS) symptoms. We hypothesized that using symptomatology as an indicator for brain imaging in patients with localized RCC would miss a substantial proportion of patients with asymptomatic brain metastases. METHODS The IRB-approved, prospectively-maintained kidney cancer data base at Roswell Park Cancer Institute was queried for all RCC patients between 1995 and 2011 who developed brain metastases on imaging (CT or MRI). Patients were divided into a cohort of patients with CNS leading CNS imaging and a cohort of patients without CNS symptoms at the time of brain metastases diagnosis. CNS symptoms were defined as any change in the patient’s baseline neurologic exam. Patient demographics, primary treatment for RCC, elapsed time between primary diagnosis and brain metastasis, presence or absence of associated CNS symptomatology, treatment of metastatic site and overall survival following diagnosis of brain metastasis were examined. Student T-Test was used for statistical analysis. RESULTS Out of 898 patients, 52 patients met these criteria. CNS symptoms were absent in 37% of patients with brain metastases. The mean number of metastases was 1.8 per patient with a mean size of 1.0 cm in the asymptomatic group, and 2.7 metastases with a mean size of 1.9 cm in patients with CNS symptoms (p<0.05). One-year overall survival (OS) of patients with CNS symptoms was 81% and 69% at three years, while the asymptomatic group had an OS of 81% 31%, respectively. Interestingly, two patients in the CNS symptom group and one in the asymptomatic group presented with no other metastatic sites. Among both groups, pulmonary metastases were present in 75% of patients at the time of brain metastasis diagnosis (p<0.005). Clinical trial enrolment was the most common reason for brain imaging in asymptomatic patients. CONCLUSIONS This is the largest series examining the presence or absence of CNS symptoms at the time of diagnosis of brain metastases following treatment for RCC. Our findings suggest that patients without CNS symptoms had smaller brain metastases and a worse overall survival. The current urologic guidelines recommending CNS imaging only in patients with symptoms may be missing a subset of the metastatic RCC population with small, potentially treatable brain metastases. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e284 Peer Review Report Advertisement Copyright & Permissions© 2014MetricsAuthor Information Michael Hanzly More articles by this author Ahmed Aboumohamed More articles by this author Terry Creighton More articles by this author Christopher Foote More articles by this author Diana Mehedint More articles by this author Kristopher Attwood More articles by this author Eric Kauffman More articles by this author Thomas Schwaab More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Bilateral diffuse uveal melanocytic proliferation associated with renal cell carcinoma.

To report a case of bilateral diffuse uveal melanocytic proliferation associated with an asymptomatic renal cell carcinoma. Clinical case report. A 70-year-old man presented with a 7-month history of bilateral visual loss. Ophthalmoscopic examination, fluorescein angiography, ocular coherence tomography, and a search for underlying systemic malignancy were performed. Examination revealed multiple melanocytic uveal proliferations in both eyes. Fluorescein angiography revealed a pattern of multiple areas of early hyperfluorescence, and ocular coherence tomography showed serous detachment of the central retina. Abdominal computerized tomography scans showed a large tumor in the left kidney and nodular involvement in the right kidney. Pathologic examination revealed a clear cell carcinoma of the kidney. A literature review revealed a total of 40 cases of bilateral diffuse uveal melanocytic proliferation. To our knowledge, this is the first case to be associated with renal cell carcinoma.

Differentiating Radiological Features of Rapid- and Slow-Growing Renal Cell Carcinoma Using Multidetector Computed Tomography

This study aimed to retrospectively evaluate the radiological features between rapid- and slow-growing renal cell carcinoma (RCC). Twenty-five pathologically proven RCCs were reviewed with computed tomography (CT). Each tumor underwent at least 2 CT sessions. Growth rate was evaluated in terms of its maximal diameter and volume change with the serial CT scan. We reviewed 8 reports from 8 single-institution series in the world literature regarding growth rate of RCCs and determined mean growth rate. Slow- and rapid-growing RCCs were compared in relation to several radiological factors (tumor shape, initial size, initial volume, initial location, enhancement pattern, and cystic change). In addition, we evaluated differences in growth rate between asymptomatic and symptomatic RCCs. The mean diameter growth rate of RCC was determined as 0.49 cm/y (8 studies, 126 cases). There were 14 cases of rapid-growing RCCs (mean growth rate, 1.3 cm/y) and 11 cases of slow-growing RCCs (mean growth rate, 0.1 cm/y). The slow-growing tumors showed round shape, small initial size, small initial volume, and outer location of the kidney compared with the rapid-growing tumors. Sixteen patients (64%) were treated for incidental and 9 patients (36%) were treated for symptomatic RCCs. The asymptomatic RCCs grew at a slow rate both diametrically (P = 0.007) and volumetrically (P = 0.003). Rapid- and slow-growing RCCs tend to show some different radiological features with respect to tumor shape, initial size, initial volume, and location. Radiological features may be helpful to predict growth rate.

Clinico-radio-pathologic features of a solitary solid renal mass at MDCT examination

incidental detection of solid renal masses has been increasing since the multidetector computed tomography (MDCT) scanner was introduced. to evaluate the clinico-radio-pathologic features of a solitary solid renal mass at MDCT examination. a total of 466 non-fatty solid renal masses in 466 patients undergoing nephrectomy were evaluated by MDCT examination. MDCT was performed before and after intravenous injection of contrast material. We obtained the incidences of benign tumors versus malignant tumors, renal cell carcinoma (RCC) versus non-RCC, and asymptomatic RCCs versus symptomatic RCCs. MDCT accuracy for detection of RCC was obtained with a threshold of more than 20 HU tumor attenuation difference between unenhanced and contrast-enhanced CT images. Nuclear grade was also compared between small RCCs (≤4 cm) and large RCCs (>4 cm). of 466 tumors, 443 (95%) were malignant and 23 (5%) were benign. Of 443 malignant tumors, 437 (99%) were RCC and 6 (1%) were non-RCC. Of 437 RCCs, 324 (74%) were asymptomatic and 113 (26%) were symptomatic. Asymptomatic RCCs (n=183, 56%) were more frequently pT1a than symptomatic RCCs (n=28, 25%) (P<0.05). MDCT accuracy for detection of RCC was 94% (437/466). Of 220 RCCs ≤4 cm, low grade RCC (53%) was more common than high grade RCC (47%). most solitary solid renal masses are early stage RCCs and can be diagnosed preoperatively at MDCT examination.

Contemporary Clinical Epidemiology of Renal Cell Carcinoma: Insight From a Population Based Case-Control Study

To clarify the contemporary clinical epidemiology of renal cell carcinoma we present trends in clinical presentation and treatment in patients enrolled in a population based case-control study. The National Cancer Institute performed a population based case-control study in metropolitan Detroit and Chicago from 2002 through 2007. In 1,136 patients with renal cell carcinoma who consented to an epidemiological interview and medical record review we ascertained detailed information on social and medical history, methods of renal cell carcinoma detection and diagnosis, cancer severity and treatment(s) received. From these data we assessed the demographic and cancer specific characteristics of study cases, and trends in clinical presentation, diagnosis and treatment. Most patients with renal cell carcinoma had localized or regional tumors, including 52% with tumors 4 cm or less. The proportion of asymptomatic cases increased from 35% in 2002 to 50% in 2007 (p<0.001). Hypertension and diabetes were common in patients (58% and 17%, respectively) and 24% had at least 2 significant comorbid conditions at cancer diagnosis. While the use of laparoscopic surgery increased with time (p<0.001), fewer than 1/5 patients underwent nephron sparing surgery. The proportion of patients presenting with small, asymptomatic renal cell carcinoma continues to increase. Most of these cases are still treated with radical nephrectomy, although increasingly via a laparoscopic approach. Since most patients with small renal cell carcinomas have 1 or more renal function relevant comorbidities, there is an imperative to increase the use of nephron sparing surgery.

Characteristics of the coexistence of melanoma and renal cell carcinoma

Patients with melanoma (MM) have an increased risk of kidney cancer, and there is an excess risk of MM among patients with renal cell carcinoma (RCC). The objective of the current study was to analyze a series of 42 patients with both MM and RCC to identify clinical and pathologic features as well as risk factors of this association. Clinical and pathologic characteristics of 42 patients who developed both MM and RCC (the MM + RCC series) were compared with 2 published series in each cancer alone: a series of 293 patients with MM (MM series) and a series of 1527 patients with RCC (RCC series). RCC was diagnosed concomitantly or after MM in 83% of patients in the MM + RCC series. Those patients displayed a high proportion of asymptomatic RCC at diagnosis (70%) and a higher frequency of stage I tumors (61%) than patients in the RCC series. Compared with the MM series, patients in the MM + RCC series more often were men, had a higher frequency of blond/red hair, had poor tanning ability, and had a higher number of nevi. In addition, patients in the MM + RCC series had a high aggregation of other malignancies (mainly skin cancers) and a significantly higher frequency of family history of MM (P = .005). Only 2 cyclin-dependent kinase 2A gene (CDKN2A) germline mutations were identified among patients in the MM + RCC series who also were members of MM-prone families. The high aggregation of cancers among patients in the MM + RCC series and the familial clustering of MM argued for a genetic predisposition that may be partly independent of CDKN2A.

Features and outcomes of renal cell carcinoma of native kidneys in renal transplant recipients

To outline the features and outcomes of renal cell carcinoma (RCC) in native kidneys of renal transplant recipients, who are at increased risk of developing this disease. We retrospectively studied the clinicopathological features and survival of 28 surgically treated RCCs, which developed in 24 renal transplant recipients. Features and outcomes were compared with 671 patients with RCC who had no renal transplant. The median interval between renal transplantation and the occurrence of RCC was 5.6 years. Acquired cystic kidney disease was present in 83% of the transplanted patients. Compared with the patients with RCC and no renal transplant, RCCs of native kidneys in transplant recipients were more frequently incidental findings (92% vs 77%, P = 0.092), multifocal (39% vs 15%, P < 0.001), bilateral (17% vs 4%, P = 0.006), had lower T stages (P = 0.040), were smaller (P = 0.027), of lower grades (P = 0.010), were more frequently papillary (43% vs 19%, P = 0.019) and occurred at a significantly younger age (P = 0.022). After a median follow-up of 6.7 years, eight renal transplant recipients had died (33%), but only two deaths were due to RCC. Survival with metastatic RCC was only 4 months, if a full resection of all metastatic sites was not achieved. In multivariate analysis the presence of a renal transplant had no effect on survival. Most RCCs in renal transplant recipients are incidental low-stage, low-grade tumours with a favourable prognosis. The outstanding pathological findings are bilateral occurrence, papillary subtype and multifocality. Prognosis of metastatic RCC is poor but might be favourable if all metastases are resected. Screening for early detection of asymptomatic RCC is advocated.

The haphazard approach to the early detection of asymptomatic renal cancer: results from a contemporary executive health programme

OBJECTIVE To compare the detection of asymptomatic renal cell carcinoma (RCC) in an executive health programme (EHP) that uses traditional methods of screening (history, physical examination and urine analysis) to programmes that screen by renal imaging. PATIENTS AND METHODS We retrospectively reviewed case records from patients undergoing executive health examinations at Mayo Clinic between 1 January 2002 and 30 September 2007. Results Of 32 310 patients, 18 RCCs were detected; of these, 13 (72%) were detected by the EHP and five (28%) were missed by the initial EHP screening process but subsequently discovered within 4-24 months. Of the 13 detected through the EHP, eight were discovered incidentally, two because of symptoms, and three because of asymptomatic microscopic haematuria (AMH). Of the 13, 12 were classified as early-stage cancers (Stage I). By contrast, of the five cancers missed by the EHP screening process, two were diagnosed because of the development of symptoms and only one was classified as Stage I. To date, two of these patients whose cancers were undetected by the EHP developed metastasis and one of them has died. Both had been followed in the EHP for years and neither had MH in multiple specimens. CONCLUSION Our EHP follows standard policy and relies on a history, physical examination and urine analysis to decide who to evaluate for asymptomatic RCC. This practice missed >70% of the potentially diagnosable cancers. The patients with RCCs that were discovered initially by the EHP fared better than those whose diagnosis was delayed. Our detection rate of four per 10 000 was only a fraction of those reported by programmes using imaging as a screening tool. The logic behind our current approach to the early detection of asymptomatic RCC needs to be reassessed. AMH is coincidental in most cases and patients could forego imaging if they are unsuitable candidates for screening. However, AMH will miss most treatable cancers and is not an appropriate screening test for an early detection programme. In the absence of reliable biomarkers, renal imaging should be the primary screening tool for detecting asymptomatic RCC in informed, clinically suitable individuals enrolled in an early detection programme.

Correlación de los síntomas de los pacientes con cáncer de células renales con la supervivencia

To evaluate the correlation between type of presentation in patients with renal cell carcinoma and survival. Longitudinal retrospective study of 42 patients with clinical and histological diagnosis of renal cell carcinoma (RCC) between July 2002 and September 2007 at University Hospital Manuel Fajardo. The following variables were studied: Sex, age, clinical presentation: 1) asymptomatic: 2) symptomatic: 3) paraneoplastic syndrome; tumor stage (TNM 1997) and survival. There is a predominance of men over women, the age of greater incidence was between the fifth a and seventh decades. The tumors were classified as: asymptomatic 7%, 3/42; symptomatic 67%, 28/42, with flank pain 31%, 13/42; with hematuria 24%, 10/42, and tumor 10%, 4/42, the classic triad of hematuria, flank pain and mass was 2.3%, 1/42 of the patients and paraneoplastic syndrome 24%, 11/42. The patients with non-metastatic disease were 57%, 24/42 and 43%, 18/42 presented metastases. Five-year survival for patients with RCC by TNM stage was T1, 100% ( 12/12) , T2, 97% (11/12) , T3, 36% (4/11) , T4, 0% (0/7) . The survival of localized and metastatic RCC was 95%, 23/24 and 22%, 4/18 cases respectively and all stage was 64% (27/42). The asymptomatic RCCs were smaller; pain, hematuria, and mass were the most common manifestations in symptomatic RCC. The prognosis is dismal in patients with RCC showing paraneoplastic syndromes.

Asymptomatic Renal Cell Carcinoma as a Finding of Bardet Biedl Syndrome

Retinitis pigmentosa represents a class of disorders that exhibit dystrophy of the photoreceptors, pigment epithelium, and often systemic abnormalities, Bardet-Biedl syndrome is a form of retinitis pigmentosa that has characteristic non-ocular findings including polydactyly, obesity, learning difficulties, male hypogonadism, and renal anomalies. Though none of these renal anomalies are neoplastic, there is a 17 fold increased risk for renal cell carcinoma in obligate carriers of Bardet-Biedl syndrome. Herein, we describe a case of metastatic renal cell carcinoma discovered in a patient with Bardet-Biedl syndrome.

A prospective randomized EORTC intergroup Phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma: Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, Marechal JM, Klotz L, Skinner E, Keane T, Claessens I, Sylvester R, European Organization for Research and Treatment of Cancer (EORTC); National Cancer

This study compared the complications and the cancer control of elective nephron-sparing surgery (NSS) and radical nephrectomy (RN) in patients with a small (≤5 cm), solitary, low-stage N0 M0 tumor suspicious for renal cell carcinoma (RCC), and a normal contralateral kidney. Five hundred forty-one patients were randomized in a prospective, multicenter, Phase 3 trial to undergo NSS (n = 268) or RN (n = 273) together with a limited lymph node dissection. This publication reports only on the complications reported for both surgical methods. The rate of perioperative blood loss was slightly higher after RN (96.0% vs. 87.2%) and the rate of severe hemorrhage was slightly higher after NSS (3.1% vs. 1.2%). Ten patients (4.4%), all of whom were treated with NSS, developed urinary fistulas. Pleural damage (11.5% for NSS vs. 9.3% for RN) and spleen damage (0.4% for NSS and 0.4% for RN) were observed with similar rates in both groups. Postoperative computed tomography scanning abnormalities were seen in 5.8% of NSS and 2.0% of RN patients. Reoperation for complications was necessary in 4.4% of NSS and 2.4% of RN patients. NSS for small, easily resectable, incidentally discovered RCC in the presence of a normal contralateral kidney can be performed safely with slightly higher complication rates than after RN. The oncologic results are eagerly awaited to confirm that NSS is an acceptable approach for small asymptomatic RCC.

Renal Cell Carcinoma in a Child Presented as Bilateral Femur Neck Fractures Caused by Severe Vitamin D Deficiency

An Ethiopian girl 14 years and 11 months of age presented with bilateral transcervical hip fractures. Workup revealed severe vitamins D and C deficiencies with secondary hyperparathyroidism. Imaging studies showed bilateral radiolucent metaphyseal bands with multiple lytic lesions in long bones. A mass in the right flank was found to be renal cell carcinoma (RCC). Currently, 9 months postsurgery and supplemental therapy, the patient is fully ambulatory and free of pain. This first report of asymptomatic RCC in severely vitamin D deficient child highlights the relation of RCC to vitamin D deficiency and emphasizes the importance of careful evaluation of these children.

A Prospective Randomized EORTC Intergroup Phase 3 Study Comparing the Complications of Elective Nephron-Sparing Surgery and Radical Nephrectomy for Low-Stage Renal Cell Carcinoma

ObjectivesThis study compared the complications and the cancer control of elective nephron-sparing surgery (NSS) and radical nephrectomy (RN) in patients with a small (≤5cm), solitary, low-stage N0 M0 tumour suspicious for renal cell carcinoma (RCC) and a normal contralateral kidney. Methods541 patients were randomised in a prospective, multicentre, phase 3 trial to undergo NSS (n=268) or RN (n=273) together with a limited lymph node dissection. ResultsThis publication reports only on the complications reported for both surgical methods. The rate of perioperative blood loss <0.5l was slightly higher after RN (96.0% vs. 87.2%) and the rate of severe haemorrhage was slightly higher after NSS (3.1% vs. 1.2%). Ten patients (4.4%), all of whom were treated with NSS, developed urinary fistulas. Pleural damage (11.5% for NSS vs. 9.3% for RN) and spleen damage (0.4% for NSS and 0.4% for RN) were observed with similar rates in both groups. Postoperative computed tomography scanning abnormalities were seen in 5.8% of NSS and 2.0% of RN patients. Reoperation for complications was necessary in 4.4% of NSS and 2.4% of RN patients. ConclusionsNSS for small, easily resectable, incidentally discovered RCC in the presence of a normal contralateral kidney can be performed safely with slightly higher complication rates than after RN. The oncologic results are eagerly awaited to confirm that NSS is an acceptable approach for small asymptomatic RCC.

Metastatic Tumor of Orbit Presenting as Pulsatile Proptosis

Pulsatile proptosis is caused by vascular lesion of orbit or by herniation of brain through bony defect in orbit. Pulsatile proptosis secondary to a metastatic tumor of orbit is very uncommon. We report a 69-year-old male who presented with pulsatile proptosis owing to metastasis of an asymptomatic renal cell carcinoma.