Benign Renal Tumors Research Articles

High signal renal tumors on DWI: the diagnostic value of morphological characteristics.

To assess the usefulness of morphological characteristics of diffusion-weighted imaging (DWI) for differentiating malignant renal tumors from benign renal tumors, and clear cell renal cell carcinoma (RCC) from non-clear cell RCC at 3.0T. The study included 249 patients with 251 histopathologically confirmed renal tumors that showed high signal on DWI. For each tumor, two radiologists independently evaluated apparent diffusion coefficient (ADC) values and morphological characteristics of DWI. The differences in the quantitative and qualitative magnetic resonance imaging (MRI) features determined by the readers were assessed. The ADC values between malignant and benign renal tumors and between clear cell and non-clear cell RCC were compared using Mann-Whitney tests. The proportional differences of morphological characteristics of DWI between malignant and benign renal tumors and between clear cell and non-clear cell RCC were compared using Chi-square tests. There were no significant differences in the quantitative and qualitative MRI features determined by the readers. The ADC values for malignant renal tumors were statistically significantly higher than those for benign renal tumors (p < 0.05), and the ADC values for clear cell RCC were statistically significantly higher than those for non-clear cell RCC (p < 0.05). The proportion of morphological characteristics of DWI between malignant and benign renal tumors was statistically significantly different at ring, nodular, flaky high signal. The proportion of morphological characteristics of DWI between clear cell and non-clear cell RCC was statistically significantly different at uniform high signal. The morphological characteristics of DWI are useful in differentiating renal tumors.

Novel clinicopathological and molecular characterization of metanephric adenoma: a study of 28 cases

BackgroundMetanephric adenoma is a rare, benign renal neoplasm with occasional misdiagnosis. However, its molecular characterization is not fully understood.MethodsIn this study, we use the hybrid capture-based Next-Generation Sequencing to sequence a panel of 295 well-established oncogene or tumor suppressor genes in 28 cases of MA patients in China. Novel clinicopathological markers associated with the mitogen-activated protein kinase (MAPK) pathway in metanephric adenoma were detected by immunohistochemistry.ResultsIt was found that except for BRAF (22/28) mutations (c.1799 T > A, p.V600E), NF1 (6/28), NOTCH1 (5/28), SPEN (5/28), AKT2 (4/28), APC (4/28), ATRX (3/28), and ETV4 (3/28) mutations could also be detected. Meanwhile, a novel and rare gene fusion of STARD9-BRAF, CUX1-BRAF, and LOC100507389-BRAF was detected in one MA patient. In addition, although MEK phosphorylation was normally activated, the phosphorylation level of ERK was low in metanephric adenoma cases. Highly expressed p16 and DUSP6 may have contributed to these results, which maintained MA as a benign renal tumor.ConclusionsThis study provides novel molecular and pathological markers for metanephric adenoma, which could improve its diagnosis and increase the understanding of its pathologic mechanism.

Noninvasive phenotyping of renal tumors-current state of the art

Due to often overlapping imaging features, solid renal tumors pose adiagnostic challenge. In addition, personalized therapies require exact tumor subtyping. To reduce complications, this should ideally be performed noninvasively. The aim of this work was to provide an overview on the current state of the art and new developments in the field of noninvasive radiological phenotyping of the most common types of adult renal tumors. Multimodal and multiparametric imaging already enables an exact, noninvasive differentiation between many types of benign and malignant renal tumors. Concerning problematic cases, as well as for amore detailed characterization of renal tumors (tumor grade, genetic factors), promising new techniques, or techniques that have not previously been used for this purpose, such as texture analysis, computer-based "deep feature classifications", iodine quantification or MR spectroscopy, are being investigated.

Impairment of gamma-glutamyl transferase 1 activity in the metabolic pathogenesis of chromophobe renal cell carcinoma

Chromophobe renal cell carcinoma (ChRCC) accounts for 5% of all sporadic renal cancers and can also occur in genetic syndromes including Birt-Hogg-Dube (BHD) and tuberous sclerosis complex (TSC). ChRCC has a distinct accumulation of abnormal mitochondria, accompanied by characteristic chromosomal imbalances and relatively few "driver" mutations. Metabolomic profiling of ChRCC and oncocytomas (benign renal tumors that share pathological features with ChRCC) revealed both similarities and differences between these tumor types, with principal component analysis (PCA) showing a distinct separation. ChRCC have a striking decrease in intermediates of the glutathione salvage pathway (also known as the gamma-glutamyl cycle) compared with adjacent normal kidney, as well as significant changes in glycolytic and pentose phosphate pathway intermediates. We also found that gamma glutamyl transferase 1 (GGT1), the key enzyme of the gamma-glutamyl cycle, is expressed at ∼100-fold lower levels in ChRCC compared with normal kidney, while no change in GGT1 expression was found in clear cell RCC (ccRCC). Significant differences in specific metabolite abundance were found in ChRCC vs. ccRCC, including the oxidative stress marker ophthalmate. Down-regulation of GGT1 enhanced the sensitivity to oxidative stress and treatment with buthionine sulfoximine (BSO), which was associated with changes in glutathione-pathway metabolites. These data indicate that impairment of the glutathione salvage pathway, associated with enhanced oxidative stress, may have key therapeutic implications for this rare tumor type for which there are currently no specific targeted therapies.

A back-to-back tumor composed of papillary renal cell carcinoma and oncocytoma treated by laparoscopic partial nephrectomy: a case report

BackgroundRenal oncocytoma is the most common benign renal tumor, and papillary renal cell carcinoma is the second most common histologic subtype of renal cell carcinoma. Renal tumors containing different components such as papillary renal cell carcinoma and oncocytoma are extremely rare.Case presentationA renal mass was incidentally detected in a 52-year-old Korean woman, and a computed tomographic scan showed a 32-mm multicystic mass with some calcifications in the lower pole of the right kidney. She underwent laparoscopic partial nephrectomy without any perioperative complications. We found a papillary renal cell carcinoma and an oncocytoma in a tumor mass.ConclusionsThe possibility of a mixed malignant tumor should be considered while treating benign tumors such as oncocytoma.

CT and MRI of small renal masses.

Small renal masses are increasingly detected incidentally at imaging. They vary widely in histology and aggressiveness, and include benign renal tumors and renal cell carcinomas that can be either indolent or aggressive. Imaging plays a key role in the characterization of these small renal masses. While a confident diagnosis can be made in many cases, some renal masses are indeterminate at imaging and can present as diagnostic dilemmas for both the radiologists and the referring clinicians. This article will summarize the current evidence of imaging features that correlate with the biology of small solid renal masses, and discuss key approaches in imaging characterization of these masses using CT and MRI.

Survival outcomes in patients with large (≥7cm) clear cell renal cell carcinomas treated with nephron-sparing surgery versus radical nephrectomy: Results of a multicenter cohort with long-term follow-up.

BackgroundDoes the dogma of nephron sparing surgery (NSS) still stand for large renal masses? Available studies dealing with that issue are considerably biased often mixing imperative with elective indications for NSS and also including less malignant variants or even benign renal tumors. Here, we analyzed the oncological long-term outcomes of patients undergoing elective NSS or radical tumor nephrectomy (RN) for non-endophytic, large (≥7cm) clear cell renal carcinoma (ccRCC).MethodsProspectively acquired, clinical databases from two academic high-volume centers were screened for patients from 1980 to 2010. The query was strictly limited to patients with elective indications. Surgical complications were retrospectively assessed and classified using the Clavien-Dindo-classification system (CDS). Overall survival (OS) and cancer specific survival (CSS) were analyzed using the Kaplan-Meier-method and the log-rank test.ResultsOut of in total 8664 patients in the databases, 123 patients were identified (elective NSS (n = 18) or elective RN (n = 105)) for ≥7cm ccRCC. The median follow-up over all was 102 months (range 3–367 months). Compared to the RN group, the NSS group had a significantly longer median OS (p = 0.014) and median CSS (p = 0.04).ConclusionsIn large renal masses, NSS can be performed safely with acceptable complication rates. In terms of long-term OS and CSS, NSS was at least not inferior to RN. Our findings suggest that NSS should also be performed in patients presenting with renal tumors ≥7cm whenever technically feasible. Limitations include its retrospective nature and the limited availability of data concerning long-term development of renal function in the two groups.

A rare pediatric renal tumor: classic congenital mesoblastic nephroma: two cases and review of literature

Background Mesoblastic nephroma (Boland’s tumor) is the most common benign renal tumor occurring in infants and neonates. The most common presentation is abdominal mass, but it can have varied presentations because of associated paraneoplastic syndromes. Majority of these tumors can be cured with surgical excision alone; however, long-term follow-up is required for recurrence or metastasis. Histopathologically, it is divided into two subtypes: classic and cellular. The less common cellular congenital mesoblastic nephromas have cellular elements in them and tend to have a more malignant potential.Patients and methods Two patients were studied over a period of 2 years from June 2010 to June 2012.Results By reporting two patients presenting in the infantile period with classic congenital mesoblastic nephromas, an attempt is made in this paper to characterize the clinical behavior of this variety of renal tumors. Hypertension and paraneoplastic syndromes can be associated with this tumor. Herein we compare our experience with other similar cases reported in the literature.Conclusion When renal tumors occur in infancy or at neonatal age, mesoblastic nephroma should be kept in mind. Association of hypertension and paraneoplastic syndromes should be looked for. Surgery is usually curative and postoperative follow-up for recurrence is required, more so in cellular variety.

Renal Angiomyolipoma: The Good, the Bad, and the Ugly.

Angiomyolipomas (AMLs) are the most common benign renal tumours. Most of these neoplasms are found incidentally on imaging. However, symptomatic presentation does exist.Renal AMLs are typically composed of smooth muscle, blood vessels, and adipose tissue. Because of the abundant fat tissue, they give a characteristic appearance on imaging and are therefore easily diagnosed. However, sometimes they contain too little fat to be detected. This increases the difficulty in differentiating them from renal cell carcinoma (RCC).Management of AML is based on clinical presentation and should be individualized for every patient. Treatment modalities range from active surveillance to more invasive approaches.

Local lymphatic metastasis for chromophobe renal cell carcinoma in a child after nephron-sparing surgery: a case report and literature review

Objective To discuss the lymph node metastasis of chromophobe renal cell carcinoma (chRCC)in children. Methods One case of chRCC was reported. A eleven-year-old boy was admitted to our hospital on November 2, 2017 and presented gross hematuria 4 weeks. No mass was palpable in the abdomen and he felt tenderness in the left back. The ultrasound showed a solid mass in the lower pole of the left kidney. There were a lot of tortuous blood vessels in the tumor. Contrast enhanced CT suggested a mass of 4.5 cm×6.3 cm×4.9 cm. The left renal artery and vein were thickened. There was no enlarged lymph nodes were seen in both examinassions. During the operation, the tumor was located in the lower pole of the kidney. The frozen section diagnosis was benign renal tumor. Nephron-sparing surgery was performed. Results The pathology showed that the tumor cells had well-defined cell borders and characteristic peri-nuclear halos surrounded by eosinophilic cytoplasm that was positive for Hale's colloidal iron stain. Immunohistochemical studies were positive for EMA(+ ), Ki-67(5%+ ), CK19(+ ), CK(+ ), CD10(+ ), CD117(+ ), CD56(+ ). Fluorescence in situ hybridization showed absence of TFE3 protein, a strong immune marker of Xp11.2/TFE renal cell carcinoma. 1 year after the operation, contrast-enhancement magnetic resonance showed long T1 signal near the left renal hilum and the mass showed slight enhancement. ChRCC with regional lymph node metastasis hereby was considered. Intraoperatively, an approximately 2.5 cm×2.0 cm×2.0 cm mass was seen near the the left renal hilum. The tumor did not involve left kidney, abdominal aorta and inferior vena cava. The mass was completely removed and intro-operative fast-frozen pathology revealed chRCC. Nephron-sparing surgery was performed. Postoperative pathology report chRCC local lymph node metastasis . Follow-up at six months after resection, there was no recurrence or metastatic disease identified. Conclusions chRCC is rare in children and clinical stage is low with a good prognosis. Local recurrence and distant metastasis is rare. Key words: Chromophobe renal cell carcinoma; Children; Metastasis; Prognosis

TGR5 expression in normal kidney and renal neoplasms

BackgroundThe G protein-coupled bile acid receptor (TGR5) is a cell surface receptor which induces the production of intracellular cAMP and promotes epithelial-mesenchymal transition in gastric cancer cell lines. TGR5 is found in a wide variety of tissues including the kidney. However, the patterns of TGR5 expression have not been well characterized in physiologic kidney or renal neoplasms. We explore the expression of TGR5 in benign renal tissue and renal neoplasms and assess its utility as a diagnostic marker.MethodsSixty-one renal cortical neoplasms from 2000 to 2014 were retrieved. TGR5 protein expression was examined by immunohistochemistry. TGR5 mRNA was also measured by real-time PCR.ResultsIn normal renal tissue, TGR5 was strongly positive in collecting ducts, distal convoluted tubules and thin loop of Henle. Proximal convoluted tubules showed absent or focal weak staining. In clear cell renal cell carcinomas (RCCs), 25 of 27 cases (92%) were negative for TGR5 (p < 0.001). TGR5 mRNA was also significantly decreased in clear cell RCCs, suggesting that decreased TGR5 protein expression may be attributable to the downregulation of TGR5 mRNA in these tumors. All 11 papillary RCCs expressed TGR5 with 45% (5/11) exhibiting moderate to strong staining. All chromophobe RCCs and oncocytomas were positive for TGR5 with weak to moderate staining. TGR5 mRNA expression in these tumors was similar to normal kidney. All urothelial carcinomas of the renal pelvis strongly expressed TGR5 including a poorly differentiated urothelial carcinoma with sarcomatoid features.ConclusionTGR5 is strongly expressed in collecting ducts, distal convoluted tubules and thin loop of Henle. TGR5 protein and mRNA expression were notably decreased in clear cell RCCs and may be helpful in differentiating these tumors from other RCCs.

MP28-13 DIAGNOSTIC YIELD AND ACCURACY OF OPTICAL COHERENCE TOMOGRAPHY (OCT) AND RENAL MASS BIOPSY FOR RENAL MASS DIFFERENTIATION

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging I1 Apr 2018MP28-13 DIAGNOSTIC YIELD AND ACCURACY OF OPTICAL COHERENCE TOMOGRAPHY (OCT) AND RENAL MASS BIOPSY FOR RENAL MASS DIFFERENTIATION Mara Buijs, Peter G Wagstaff, Patricia J Zondervan, C Dilara Savci-Heijink, Otto M van Delden, Ton G van Leeuwen, R Jeroen van Moorselaar, Jean JMCH de la Rosette, M. Pilar Laguna Pes, and Daniel M. de Bruin Mara BuijsMara Buijs More articles by this author , Peter G WagstaffPeter G Wagstaff More articles by this author , Patricia J ZondervanPatricia J Zondervan More articles by this author , C Dilara Savci-HeijinkC Dilara Savci-Heijink More articles by this author , Otto M van DeldenOtto M van Delden More articles by this author , Ton G van LeeuwenTon G van Leeuwen More articles by this author , R Jeroen van MoorselaarR Jeroen van Moorselaar More articles by this author , Jean JMCH de la RosetteJean JMCH de la Rosette More articles by this author , M. Pilar Laguna PesM. Pilar Laguna Pes More articles by this author , and Daniel M. de BruinDaniel M. de Bruin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.913AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cross-sectional imaging lacks specificity in distinguishing benign or indolent small renal masses (SRMs) from renal cell carcinoma, leading to overtreatment. Additionally, renal mass biopsy (RMB) is hampered by high non-diagnostic rates. Optical coherence tomography (OCT) is a high resolution, real-time imaging modality, using backscattered near-infrared light for tissue differentiation. Percutaneous, needle-based OCT imaging and differentiation between benign and malignant RMs by quantitative parameters (attenuation-coefficient;μOCT) has proven to be safe and feasible. We prospectively assessed the diagnostic yield and accuracy of OCT and RMB and compared this to each other for the differentiation of RMs. METHODS Percutaneous, needle-based OCT was performed in consecutive patients with a solid enhancing renal mass. Final treatment pathology was used for correlation to μOCT and RMB. μOCT values for benign masses and oncocytoma vs RCC were compared using a Mann-Whitney test. Accuracy calculations were performed using ROC-curve and 2*2 tables for μOCT and RMB respectively. RESULTS Since October 2013, OCT was performed in 95 patients. The diagnostic yield of RMB and OCT was 79% and 99% respectively. The median μOCT of benign tumours (3.2mm-1, IQR 2.65-4.35) and oncocytoma (3.38mm-1, IQR 2.68-3.95) were significantly lower (P=0.0171, and P=0.0031 respectively) than the median μOCT of RCC (4.3mm-1, IQR 3.70-5.00) (Fig. 1A,C). In differentiating malignant from benign tumours, OCT shows a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 91%, 56%, 91%, and 56%, and respectively. The accuracy of OCT increases for the differentiation between RCC and oncocytoma, with a sensitivity, specificity, PPV and NPV of 92%, 67%, 95% and 55% respectively. RMB has a sensitivity, specificity, PPV and NPV of 100%, 89%, 99% and 100% respectively. CONCLUSIONS OCT accurately distinguishes malignant from benign renal tumours. Additionally, OCT has a higher diagnostic yield than RMBs, balanced by a lower specificity and NPV. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e361 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Mara Buijs More articles by this author Peter G Wagstaff More articles by this author Patricia J Zondervan More articles by this author C Dilara Savci-Heijink More articles by this author Otto M van Delden More articles by this author Ton G van Leeuwen More articles by this author R Jeroen van Moorselaar More articles by this author Jean JMCH de la Rosette More articles by this author M. Pilar Laguna Pes More articles by this author Daniel M. de Bruin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Clinicopathological significance of galectin-1 expression and percentage of galectin-1-expressing T cells in clear-cell renal cell carcinoma.

This study investigates the clinical significance of galectin-1 expression in carcinoma tissues, plasma, and lymphocytes of patients with clear-cell renal cell carcinoma (RCC). Galectin-1 expression was investigated, using immunohistochemistry, in 91 clear-cell RCC tissue sections, five angioleiolipomas tissue sections, and three oncocytomas tissue sections. As controls, normal tissue sections adjacent to each tumour and six benign renal tumour sections were examined. Plasma galectin-1 levels as measured by ELISA were compared in 39 patients. Proportions of galectin-1 expressing CD4+ and galectin-1 expressing CD8+ T lymphocytes in peripheral blood of these patients were detected by flow cytometry. The positive expression rate of galetin-1 in 91 clear-cell RCC tissues sections by immunohistochemistry was 87 (95.6%), with weak expression rate of 35.2 (32/91), moderate expression rate of 51.6% (47/91), and strong expression rate of 13.2% (12/91); whereas 25% (2/8) of renal benign tumour sections showed weak galectin-1 expression, 91.2% (83/91) of non-tumor tissues adjacent to carcinomas had negative expression of galectin-1, and another six (75%) renal benign tumour sections had negative galectin-1 expression. Plasma galectin-1 levels between patients with clear-cell RCC and with benign tumours were not significantly difference (p>0.05). In patients with clear-cell RCC, we found a significantly higher proportion of galectin-1-expressing CD4+ lymphocytes (p<0.05) and galectin-1-expressing CD8+ lymphocytes (p<0.05) than in patients with benign tumours. Moreover, the level of galectin-1 expression was positively associated with stage and Fuhrman grade of clear-cell RCC. Our results suggest that high level of galectin-1 expression in clear-cell RCC tissues may be a useful marker for clear-cell RCC. Our findings also reveal a new clinical significance of galectin-1 - that high proportions of galectin-1-expressing CD4+ and CD8+ lymphocytes were positively associated with poor clinicopathological features.

MicroRNA-15a expression measured in urine samples as a potential biomarker of renal cell carcinoma.

Currently, there is no accurate diagnostic molecular biomarker for renal cell carcinoma (RCC). The aim of this study was to assess the expression of microRNA-15a (miR-15a) in urine of patients with RCC and to evaluate its potential as a diagnostic molecular biomarker. In total, 67 patients with solid renal tumors were enrolled: clear-cell RCC (ccRCC, n = 22), papillary RCC (pRCC, n = 16), chromophobe RCC (chRCC, n = 14), oncocytoma (n = 8), papillary adenoma (n = 2) and angiomyolipoma (n = 5). MiRNA-15a expression levels measurement in urine were performed using qPCR. Urine of 15 healthy volunteers without kidney pathology was used as control. We observed a difference in mean miR-15a expression values in groups of pre-operative patients with RCC, benign renal tumors and healthy persons (2.50E-01 ± 2.72E-01 vs 1.32E-03 ± 3.90E-03 vs 3.36E-07 ± 1.04E-07 RFU, respectively, p < 0.01). There was no difference in miR-15a expression between ccRCC, pRCC and chRCC (p > 0.05). Direct association between RCC size and miR-15a expression values was obtained (Pearson correlation coefficient-0.873). On the 8th day after nephrectomy, mean expression value in patients with RCC decreased by 99.53% (p < 0.01). MiR-15a expression differentiated RCC from benign renal tumors with 98.1% specificity, 100% sensitivity at a cut-off value of 5.00E-06 RFU, with AUC-0.955. MiR-15a expression measured in urine may be used as diagnostic molecular biomarker for RCC.

Clinical study of Raman spectroscopy in the diagnosis of renal clear cell carcinoma

Objective To investigate the availability of Raman spectroscopy for distinguishing renal clear-cell carcinoma (RCC) . Methods There were 27 RCC, 5 oncocytoma and 6 angiomyolipoma were collected in our hospital from June 2016 to October 2016, and then analyzed by Raman spectroscopy. Discriminant Analysis (DA) was applied to evaluate the accuracy of Raman to classify RCC and benign tumors. Results A total of 201 Raman spectra were eventually acquired, of which 81 cases were RCC, 15 cases were oncocytoma, 18 cases were angiomyolipoma, and 87 cases were distal rena parenchyma. Raman was able to recognize RCC and oncocytoma with an accuracy of 94.20%, and distinguish RCC with angiomyolipoma with an accuracy of 87.04%. Besides, the distal renal parenchyma could also be separated from RCC and benign renal tumors with an accuracy of 93.42% and 85.74%, respectively. Conclusions Raman can accurately distinguish RCC and may serve as a useful tool in the future for pre-operative diagnosis of renal tumor. Key words: Kidney Neoplasms; Adenocarcinoma, Clear Cell; Spectrum Analysis, Raman

Birt-Hogg-Dubé syndrome: an underdiagnosed genetic tumor syndrome.

Birt-Hogg-Dubé syndrome (BHD, also referred to as Hornstein-Knickenberg syndrome) is an autosomal dominant tumor syndrome caused by mutations in the FLCN gene located on chromosome17. Depending on their age, patients with BHD may exhibit various clinical signs and symptoms. Disease severity can vary greatly among members of the same family. Early symptoms include basal lung cysts, which can lead to recurrent spontaneous pneumothoraces. The majority of patients (>90%) develop multiple fibrofolliculomas, especially on the face and upper trunk, in the second or third decade of life. Given the 12-34% lifetime risk of developing benign or malignant renal tumors, targeted screening programs are prognostically crucial. While these renal tumors may belong to various histological subtypes, common variants include multifocal - sometimes bilateral - chromophobe and oncocytic hybrid tumors. Early diagnosis and adequate long-term care of families with BHD require interdisciplinary cooperation.

Using aorta lesion attenuation difference (ALAD) on preoperative contrast-enhanced CT scan to differentiate between malignant and benign renal tumors.

606 Background: To evaluate the ability of Aorta−Lesion−Attenuation−Difference (ALAD) to differentiate malignant renal tumors from renal oncocytomas. Methods: A retrospective review of preoperative CT scans and surgical pathology from robotic assisted partial nephrectomy specimens obtained by a single surgeon was performed. ALAD was calculated by measuring the difference in Hounsfield units (HU) between the aorta and the lesion of interest on the same image slice in the nephrographic phase on preoperative CT scan. The discriminative ability of ALAD to differentiate malignant pathology from oncocytoma was evaluated by sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under curve (AUC) using ROC analysis. Results: A total of 218 preoperative CT scans and corresponding pathology reports were reviewed. Pathology review revealed 22 oncocytomas (10.1%), 11 chromophobe RCC (5%), 37 papillary RCC (17%), and 148 clear cell RCC (67.9%). ALAD was able to differentiate malignant pathology from oncocytoma using a HU threshold of 24 with a sensitivity of 84%, specificity of 86%, PPV of 98%, and NPV of 33%. The AUC for malignant pathology versus oncocytoma was 0.86 (95% CI 0.77−0.96). Subgroup analysis showed that ALAD was able to differentiate chromophobe RCC from oncocytoma using a HU threshold of 24 with a sensitivity of 100%, specificity of 86%, PPV of 75%, and a NPV of 100%. The AUC for chromophobe RCC versus oncocytoma was 0.98 (95% CI 0.91−1.00). Conclusions: ALAD measurements based upon preoperative CT scans provide good discrimination between malignant renal tumors and oncocytomas, potentially decreasing the need for biopsy in certain patients. ALAD also discriminates well between chromophobe RCC and oncocytoma, which may aid in the management of patients with indeterminate diagnoses of oncocytic neoplasm on biopsy. Further validation of ALAD will be necessary prior to routine use in clinical practice.

Serum miR-122-5p and miR-206 expression: non-invasive prognostic biomarkers for renal cell carcinoma

BackgroundMicroRNAs (miRNA) play a relevant role in carcinogenesis, cancer progression, invasion, and metastasis. Thus, they can serve as diagnostic/prognostic biomarkers. The knowledge on circulating miRNAs for clear cell renal cell carcinomas (ccRCC) is limited. Our study was designed to identify novel biomarkers for ccRCC patients.ResultsThe serum small RNA expression profile was determined in 18 ccRCC and 8 patients with benign renal tumors (BRT) using small RNA sequencing. We detected 29 differentially expressed miRNAs (17 upregulated and 12 downregulated in ccRCC) in the expression profiling cohort. Based on the expression levels, we next validated serum miR-122-5p, miR-193a-5p, and miR-206 levels in an independent cohort (68 ccRCC, 47 BRT, and 28 healthy individuals) using quantitative real-time PCR. Serum expression levels of miR-122-5p and miR-206 were significantly decreased in ccRCC compared to healthy individuals. Both miRNAs were circulating at similar levels in ccRCC and BRT patients. miR-193a-5p expression levels were not different within the study cohort. High serum miR-122-5p and miR-206 levels were associated with adverse clinicopathological parameters: miR-122-5p levels were correlated with metastatic RCC and grade, and miR-206 with pT-stage and metastasis. Furthermore, high miR-122-5p and miR-206 serum levels were associated with a shorter period of progression-free, cancer-specific, and overall survival in patients with ccRCC.ConclusionWe identified serum miR-122-5p and miR-206 as novel non-invasive prognostic biomarkers for patients with ccRCC.

240 An Unusual Presentation of Multiple Unilateral Benign and Cancerous Renal Neoplasms in a Female Patient

240 An Unusual Presentation of Multiple Unilateral Benign and Cancerous Renal Neoplasms in a Female Patient

336 Increased Nicotinamide Phosphoribosyltransferase and Cystathionine B-Synthase in Renal Oncocytomas, Renal Transitional Cell Carcinoma, and Renal Cell Carcinoma

Renal cell carcinoma (RCC) and transitional cell carcinoma (TCC) are the two most common renal malignancies, while renal oncocytomas are common benign renal neoplasms. Nicotinamide phosphoribosyltransferase (Nampt) catalyzes the rate-limiting step in nicotinamide adenine dinucleotide synthesis, while cystathionine B-synthase (CBS) catalyzes H2S synthesis. Both Nampt and CBS show concomitant increased expression in some tumors, with their expression positively correlating with higher tumor grade. We employed tissue microarray studies to analyze Nampt and CBS protein levels in benign renal cortex, RCC, TCC, and renal oncocytoma tissue samples. For Nampt, 29 benign, 49 TCCs, 94 RCCs, and six oncocytomas were examined. For CBS, 11 benign, 53 TCCs, 101 RCCs, and six oncocytomas were examined. The expression of both proteins was increased in TCC, RCC, and oncocytomas, compared to benign renal tissue. In RCC, the expression of both enzymes increased with increasing Fuhrman grade. To our knowledge, this is the first demonstration that Nampt and CBS are increased in renal RCC, TCC, and oncocytomas, and also increased with increasing RCC grade. Both enzymes promote tumor growth, survival, and angiogenesis in several malignancies. Increased expression of either enzyme in any oncocytoma type has not been previously reported. While preliminary, our data indicate that increased in Nampt and CBS protein expression, and possibly changes in H2S metabolism may have a role in benign and malignant renal neoplasia.