Pelvic Carcinoma Research Articles

Laparoscopic Heminephrectomy in Horseshoe kidney: single-center experience of four cases

BackgroundHorseshoe kidney (HSK) is the most common congenital fusion anomaly and found in 1 in 400 of the general population (Grainger et al. in Ir Med J 76:315–317, 1983 Jul). Impaired drainage due to anomalous anatomy leads to ureteric obstruction resulting in hydronephrosis and nonfunctioning kidney.Conventionally heminephrectomy is done by open technique; however, in the era of minimally invasive surgery, laparoscopic heminephrectomy in HSK has been described. Kidney location, aberrant vasculature and isthmus division are the most common obstacle encountered by the operating surgeon. Here we report our single-center experience in laparoscopic heminephrectomy in four patients with HSK.MethodsRetrospective data were analyzed for four cases of laparoscopic heminephrectomy for nonfunctioning moiety in HSK operated between 2012 and 2020. Of these four patients, one case was converted to open approach in view of intra-operative bleeding. Computed tomography urogram (CTU) was done pre-operatively in all patients. Laparoscopic surgery was performed via transperitoneal approach.ResultsThe mean age of the patients was 37 ± 5.38 years. Flank pain was noted in all cases while dysuria seen in two patients and one patient had fever. Mean operative time was 145 ± 26.92 min and estimated blood loss was 85 ± 55 ml. Various techniques for isthmectomy and lower pole resection were used including use of monopolar hook in laparoscopic suite, Ligasure and bipolar scissor in minimal invasive milieu and monopolar cautery in laparoscopic conversion to open procedure. Histopathological examination revealed chronic pyelonephritis in three cases and squamous cell carcinoma of renal pelvis in one case which was converted to open.ConclusionsLaparoscopic heminephrectomy in HSK is doable. Preoperative CT urography along with CT angiography may provide important anatomical and vascular information which reduces intra-operative risks of vascular injury or calyceal entry. Vascular control of isthmus and transection of dilated and thinned out lower pole with cauterization of pelvicalyceal mucosa will provide uneventful surgical course.

Incidence, management and treatment outcomes of renal malignancy in a post-transplant recipient at a tertiary care centre: A 16-year experience

Introduction and Objective: Although the incidence of malignancy in renal transplant recipients is on the rise owing to boom in the post-transplant immunosuppressive therapy, there is paucity of literature regarding their reporting and management. In this study, we report the incidence of de novo renal malignancies, post-renal transplantation at our centre over a 16-year period and discuss their management. Methods: All patients who underwent renal transplantation at our department between March 2004 and February 2020 were included and retrospectively reviewed. We analysed the incidence of renal malignancy both in the native kidney and the graft, histological subtype, time to and type of treatment. Results: A total of 376 patients underwent renal transplantation. Mean age of recipients was 48.2 and 52.15 years among those who developed cancer. 13 (2.93%) of 376 recipients developed urogenital malignancy, of whom 8 had renal cell carcinoma (RCC) in their native kidneys and 1 in the allograft. Transitional cell carcinoma (TCC) of renal pelvis was noted in three patients with one concomitant TCC of bladder. No treatment-related graft losses occurred in the native kidney malignancy. Patients with RCC underwent nephrectomy while TCC of renal pelvis underwent nephroureterectomy with bladder cuff excision. Transurethral resection was done for bladder tumour. All patients were followed up as per standard protocol. Conclusion: A rise in urological post-transplant malignancies mandates regular surveillance after renal transplantation to ensure early detection of de novo malignancies and early initiation of treatment. Goal should be to minimise adverse graft outcomes with no compromise on oncological outcomes. Level of evidence: Not applicable

Reclassifying pT3 renal pelvic urothelial carcinoma with renal parenchyma invasion to pT2 improves correlation with overall survival

The American Joint Cancer Committee pT categorization in renal pelvic carcinoma defines pT3 as invasion of renal parenchyma, invasion of peripelvic fat, or both. However, survival heterogeneity within the pT3 category has been demonstrated. This investigation sought to compare survival between pT categories of renal pelvic urothelial carcinoma and identify modifications to improve correlation with survival. Pathology reports from nephroureterectomies performed at our institution from 2010 to 2019 were analyzed to identify primary renal pelvic urothelial carcinoma (n=146). Tumors were stratified based on pT, pN, and invasion of renal parenchyma vs invasion of peripelvic fat with or without renal parenchyma invasion. Kaplan-Meier survival curves and Cox regression multivariate analysis were used to compare overall survival between groups. Similar survival curves were observed for pT2 and pT3 tumors. Multivariate analysis confirmed overlapping hazard ratios (HRs) for pT2 (HR=2.64, 95% confidence interval [CI] = 0.69, 10.06)and pT3 (HR=4.42, 95% CI = 2.08, 9.37). pT3 tumors with peripelvic fat invasion, regardless of renal parenchyma involvement, had a 3.3-fold worse overall survival than pT3 tumors with only renal parenchyma involvement. Additionally, pT3 tumors with only renal parenchyma invasion had similar survival compared to pT2, while pT3 tumors with peripelvic fat invasion had worse overall survival (p=0.00091). Reclassifying renal parenchyma invasion as pT2 yielded greater survival curve separation and greater difference in HRs. For renal pelvic urothelial carcinoma, modifying the pT3 category to only include tumors with peripelvic fat invasion and expanding the pT2 category to include renal parenchyma invasion may improve pT correlation with overall survival.

The Prognostic Impact of Tumor Location in pT3N0M0 Upper Urinary Tract Urothelial Carcinoma: A Retrospective Cohort Study.

BackgroundWe aimed to evaluate the impact of tumor location on cancer outcomes in patients with pT3N0M0 upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU) with bladder cuff excision.Materials and MethodsWe retrospectively reviewed 302 patients with pT3N0M0 UTUC who underwent RNU with bladder cuff excision at our institution between 2005 and 2019, including 191 renal pelvis tumors and 111 ureteral tumors. Clinicopathologic characteristics were compared between renal pelvis and ureter urothelial carcinomas. Multivariate Cox proportional hazard regression was used to assess the association between outcomes and clinical factors. Outcomes of interest included intravesical recurrence-free survival (IVRFS), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and cancer-specific survival (CSS), which were measured using the Kaplan–Meier curve with a log-rank test.ResultsA total of 302 patients underwent RNU with bladder cuff excision. During the median follow-up of 42.7 months, 70 (23.2%), 95 (31.5%), and 99 (32.8%) patients experienced intravesical recurrence, local recurrence, and distant metastasis, respectively. Seventy (23.2%) patients died from UTUC. Multivariate Cox regression analysis showed that tumor location was an independent predictor of local recurrence (HR = 2.05, p = 0.001), with borderline independent significance in intravesical recurrence (HR = 1.54, p = 0.074) and distant metastasis (HR = 1.45, p = 0.08). Kaplan–Meier analysis showed that ureter tumors had a worse 5-year local recurrence (log-rank p < 0.001) and borderline worse 5-year intravesical recurrence (log-rank p = 0.055) and 5-year distant metastasis (log-rank p = 0.073).ConclusionUreter tumors seem to be associated with worse oncological outcomes, especially with local recurrence in UTUC. Further large and long-term studies are warranted for investigating biological differences based on tumor location.

Identification of Recurrent Insertions and Deletions in Exon 18 and 19 of Human Epidermal Growth Factor Receptor 2 as Potential Drivers in Non-Small-Cell Lung Cancer and Other Cancer Types.

PURPOSEHuman epidermal growth factor receptor 2 (HER2) belongs to the same family as epidermal growth factor receptor (EGFR) and is known as an important cancer driver gene. Insertions and deletions (indels) are frequent driver mutations in both EGFR and HER2. The most common HER2 indels are the exon 20 insertions within the kinase domain, while others are rarely reported. Our study aimed to investigate other indels of HER2 that may act as driver mutations in Chinese patients with different cancer types.METHODSIn this retrospective study, patient samples were subjected to targeted sequencing covering HER2 and other cancer-related genes. Mutation profiles of patients harboring HER2 exon 18/19 indels were described. Identified HER2 exon 18/19 indels in our study were compared with external data from COSMIC. In silico and in vitro analyses were performed on selected indels of HER2 exon 18 and 19, respectively.RESULTSA total of 25 indels in HER2 exon 18/19, 17 of which being recurrent, were identified in 20 of 53,591 patients with lung cancer (0.037%), two of 5,888 patients with colorectal cancer (0.034%), two of 3,774 patients with breast cancer (0.053%), and one of 14 patients with urothelial carcinoma of the renal pelvis (7.1%). Most patients harboring HER2 exon 18/19 indels were absent of known driver mutations. In lung cancer, mutation profiles were comparable between patients carrying HER2 exon 18/19 indels and the two established HER2 drivers (exon 20 insertions and S310 mutations). The in silico and in vitro analyses suggested an activated state conferred by HER2 exon 18/19 indels, which could be targeted by different tyrosine kinase inhibitors.CONCLUSIONOur study revealed a class of rare but unique indels in HER2 exon 18/19, which may act as driver mutations in several cancer types.

Immunotherapy Combined with Chemotherapy in Neoadjuvant Therapy for Locally Advanced Renal Pelvis Carcinoma: A Case Report and Literature Review

ABSTRACT Introduction and importance: Upper tract urothelial carcinoma (UTUC), including renal pelvis cancer and ureteral cancer, is highly prevalent in people aged 70 ˜ 90 years. Immune checkpoint inhibitor therapy is a major breakthrough in the field of oncology and is an emerging anti-tumor treatment modality after chemotherapy, targeted therapy and anti-angiogenic therapy. Here we presented a UTUC case who benefited from treatment of immunotherapy combined with chemotherapy in neoadjuvant therapy. Case presentation: A 66-year-old male patient presented on July 2, 2021, with a 3-month history of left-sided abdominal pain and a 2-month history of gross hematuria. To confirm the diagnosis, the treatment of left ureteroscopy was performed under general anesthesia on July 7, 2021. Biopsy pathology revealed urothelial carcinoma, clinical stage cT3-4N1M0, high-risk. Four cycles of neoadjuvant therapy were preoperatively administered with immunotherapy combined with chemotherapy every 21 days. Partial response (PR) was confirmed via imaging after the 4th cycle. The patient underwent radical surgery on November 11, 2021. Postoperative diagnosis: left renal pelvis cancer, pT3N0M0, high risk. Adjuvant therapy was continued after surgery with 4 cycles of GC chemotherapy. After chemotherapy, CTU reexamination and cystoscopy was performed and show no signs of the carcinoma returning. Discussion: Immune checkpoint inhibitors have become first-line therapy for patients with metastatic UC who are not candidates for cisplatin chemotherapy. However, the current literature is inconclusive on the efficacy of neoadjuvant therapy with preoperative immunotherapy combined with chemotherapy. We discuss clinical outcomes and literature reviews for these patients. Conclusion: It’s feasible and safe in PD-L1-positive locally advanced UTUC patients that preoperative neoadjuvant PD-1 inhibitor immunotherapy combined with GC chemotherapy was selected for 4 cycles, after neoadjuvant therapy, further radical surgery was performed, and adjuvant chemotherapy was performed after surgery. Highlight

Compilation of Developmental and Neoplastic Entities in Kidney with Histomorphology and Immunohistochemistry as an Eye Opener in Troubleshooting the Diagnostic Errors

Introduction: Renal cell tumours are common neoplasms with varying incidence and mortality rates across the globe. There are many histological types forming not merely the basis of classification but being associated with unique immunological and molecular profiles governing the biological behaviour. Apart from these, there are separate spectrum of neoplasms restricted particularly to paediatric age group. The overall prognosis is conferred by an array of factors including the histological grade, stage, necrosis and lympho-vascular invasion. Case Reports: This discussion aims to outline the renal mass encountered in our setting with special reference to age group and the light microscopic picture. However, we encountered diagnostic dilemmas while dealing with the cases and these were further resolved employing relevant immunohistochemical markers. A particular mention of protocols for staging, grading and relevance of special stains has also been outlined. Conclusion: To conclude, 1 case each of chromophobic renal cell carcinoma and infiltrating urothelial carcinoma of pelvis in middle aged adults have been discussed. 2 cases in paediatric age group have been highlighted namely triphasic nephroblastoma and multicystic dysplastic kidney (MCDK).

Opportunities and Limitations of Pelvic Exenteration Surgery.

Simple SummaryPelvic exenteration is often the only curative treatment option for selected locally advanced tumours, and especially for recurrent cancers. Because of the heterogeneous patient population with different clinical pictures, it is not possible to standardize the indication, treatment strategy and surgical technique for this procedure. For the same reason, as well as a rather low annual number of total cases, clinical trials are notably difficult to design. However, it is important to underline the often-underestimated possibilities of surgical treatment when a R0 resection is achievable, with a low mortality and acceptable postoperative quality of life.Purpose: The practice of exenterative surgery is sometimes controversial and has garnered a certain scepticism. Surgical studies are difficult to conduct due to insufficient data. The aim of this review is to present the current standing of pelvic exenteration from a surgical, gynaecological and urological point of view. Methods: This review is based upon a literature review (MEDLINE (PubMed), CENTRAL (Cochrane) and EMBASE (Elsevier)) of retrospective studies on exenterative surgery from 1993–2020. Using MeSH (Medical Subject Headings) search terms, 1572 publications were found. These were evaluated and screened with respect to their eligibility using algorithms and well-defined inclusion and exclusion criteria. Therefore, the guidelines for systematic reviews (PRISMA) were used. Results: A complete tumour resection (R0) often represents the only curative option for advanced pelvic carcinomas and their recurrences. A recent systematic review showed significant symptom relief in 80% of palliative patients after pelvic exenteration. Surgical limitations (distant metastases, involvement of the pelvic wall, etc.) are diminished by adequate surgical expertise and close interdisciplinary cooperation. While the mortality rate is low (2–5%), the still relatively high morbidity rate (32–84%) can be minimized by optimizing the perioperative setting. Following exenterations, roughly 79–82% of patients report satisfying results according to PROs (patient-reported outcomes). Conclusion: Due to multimodality treatment strategies combined with extended surgical expertise and patients’ preferences, pelvic exenteration can be offered nowadays with low mortality and acceptable postoperative quality of life. The possibilities of surgical treatment are often underestimated. A multi-centre database (PelvEx Collaborative) was established to collect data and experiences to optimize the research in this field.

Squamous cell carcinoma of the renal pelvis in a patient with long-term spinal cord injury—a case report

For individuals with spinal cord injury/disease (SCI/D) the risk of developing a stone in the upper urinary tract is up to six times higher than in the able-bodied population. Upper urinary tract carcinomas, in general, are rare and account for only 5-10% of all urinary tract carcinomas. It is believed that chronic upper urinary tract irritation caused by e.g., kidney stones or recurrent upper urinary tract infections may be associated with an increased risk of renal squamous cell carcinoma (RSCC). We report on a 64-year-old male who suffered a spinal cord injury in 1981 resulting in a complete sensory and motor impairment below T6, AIS A. Recurrent left-sided kidney stone disease had to be treated repeatedly from 1984 onwards. Despite repeated surgical attempts, it was ultimately not possible to achieve stone clearance in the long term. Within the concept of life-long surveillance of SCI/D, the patient was examined regularly, including ultrasound examinations of the kidneys. Six months after the last control examination, the patient was admitted to our hospital with a locally advanced tumor of the left kidney, so that only the option of palliative treatment remained. Histologically an RSCC was found. As people with SCI/D have a higher risk of developing kidney stones, it is of utmost importance to check regularly for stone disease and, if necessary, treat with the aim of long-term stone clearance in order to protect renal function and to avert potentially malignant changes at an early stage.

Pelvicalyceal Squamous Cell Carcinoma: Incidental Diagnosis With Liver Metastasis on Follow Up

Primary squamous cell carcinoma (SCC) of the renal pelvis is a rare malignancy. We report a case of a 43-year-old male presenting with stones and a non-functioning kidney. Incidental SCC was diagnosed histopathologically on nephrectomy. The patient then returned with metastasis to the liver after one year. Nephrolithiasis is the most important risk factor implicated in renal SCC; hence, awareness of this rare entity in a patient of long-standing nephrolithiasis is important.

Primary squamous cell carcinoma of renal pelvis and kidney- Sole diagnosis by histopathology

Primary Squamous cell carcinoma of the renal pelvis is rare and accounts to only 0.5- 0.8 % of malignant renal tumours having poor prognosis. Chronic irritation, inflammation and infection induce the pathogenesis of this malignancy. A 53 year old male patient, presented with left flank pain since one month. On radiological investigation, his CT revealed atrophic shrunken left kidney measuring 7.9x5.2cms showing significant parenchymal thinning and complete loss of corticomedullary differentiation. A left upper ureteric calculus is seen measuring 7.5 mm with significant left renal hydronephrosis.Clinically, it was diagnosed as Xanthogranulomatous Pyelonephritis. Grossly the radical nephrectomy specimen measures 10.5x5.5x3.5cm. External surface is irregular &amp; bosselated. On Cut surface renal architecture is effaced by necrotic mass measuring 9.5x5.0x3.0 cm involving pelvic ureter and most of renal parenchyma.Hematoxylin and eosin stained tissue revealed characteristic feature such as keratin pearls and intracellular bridges seen, rendering the diagnosis of well-differentiated keratinising squmaous cell carcinoma seen with 40% tumour necrosis associated with Keratinizing Squamous Dysplasia. In the present case, obstructive uropathy has triggered the event of malignancy. The radiologic differential diagnosis includes primary and secondary renal neoplasms and xanthogranulomatous pyelonephritis associated with renal calculi. XGP is commonly associated with lithiasis however, rarely causes keratinizing squamous metaplasia and its manifestations closely mimic renal neoplasm, leading to misdiagnosis of malignancy.The prognosis is dismal with a 5-year survival rate of &amp;#60;10%. CT and MRI play a crucial role in diagnosis and staging of these tumors, though histology always remains confirmatory and diagnostic.

V11-10 ROBOTIC RETROPERITONEAL NEPHROURETECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA

You have accessJournal of UrologyRenal Oncology II (V11)1 Sep 2021V11-10 ROBOTIC RETROPERITONEAL NEPHROURETECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA Zachary McDowell, and James Porter Zachary McDowellZachary McDowell More articles by this author , and James PorterJames Porter More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002073.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nephroureterectomy is the standard of care for high grade upper tract urothelial carcinoma (UTUC) or low grade UTUC when nephron-sparing surgery is not possible, and a retroperitoneal approach can be advantageous in the setting of previous abdominal surgeries. The patient in this case is a 67 year old female that was found to have high grade urothelial carcinoma of the left renal pelvis. She underwent 3 cycles of gemcitabine and cisplatin chemotherapy, and subsequent nephroureterectomy. A retroperitoneal approach was chosen for this patient because she had a history of multiple abdominal surgeries including exploratory laparotomy. This video will demonstrate the retroperitoneal approach for robotic nephroureterectomy as definitive surgical management of this patient's high grade UTUC. METHODS: The surgery was performed using the daVinci Xi robot. The patient was placed in full flank position and 4 robotic ports were placed in a line midway between the iliac crest and the 12th rib. A 12mm high-flow insufflator assistant port was placed near the anterior superior iliac spine. The retroperitoneal space was developed using balloon dilation. The initial step was mobilization of the ureter. Once the ureteral dissection was carried distally to the point of decreased range of motion for the robotic arms, the arms were undocked, the boom rotated 180 degrees, and the direction of dissection was into the pelvis. An additional 5mm assistant port was placed cephalad to the robotic ports near the 11th rib. After completion of the ureteral and bladder cuff dissection the robot was redocked and returned to the initial arm configuration. We then proceed to adrenal sparing radical nephrectomy with retroperitoneal lymph node dissection. RESULTS: We have experience with 3 robotic retroperitoneal nephroureterectomies. All patients had high grade transitional cell carcinoma of the kidney as the indication for surgery, and all had history of significant abdominal surgery. The mean age was 70 years, mean operative time was 251 mins, mean estimated blood loss was 42 cc, mean lymph nodes removed was 13, and mean length of stay of 2 days. There were no complications, readmissions, and recurrences. CONCLUSIONS: The retroperitoneal approach is a safe and effective technique for robotic assisted nephroureterectomy. This approach allows complete access to the kidney, ureter and bladder cuff and avoids adhesions in patients with prior abdominal surgery. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e860-e861 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zachary McDowell More articles by this author James Porter More articles by this author Expand All Advertisement Loading ...

Inflammatory pseudotumor of Castleman disease and IgG4-related disease masquerading as kidney malignancy

BackgroundWith widespread clinical application of imaging techniques, renal space-occupying lesions have been identified at an increasing frequency. Here, we report two rare cases, Castleman disease (CD) and IgG4-related disease (IgG4-RD), presenting primarily with the symptoms and imaging findings of kidney malignancy.Case presentationIn case 1, an occupying lesion located in the right renal pelvis was detected using magnetic resonance imaging in a 32-year-old female who presented with hematuria and lumbago. First misdiagnosed as carcinoma of the renal pelvis, the patient underwent right radical nephroureterectomy. However, postoperative pathological and immunohistochemistry studies finally confirmed the diagnosis of CD. In case 2, a 45-year-old male presented with the chief complaint of anuria. Nephrostomy and renal biopsy indicated lymphoma, following which, antegrade urography and computed tomography urography were performed, which revealed bilateral hydronephrosis and mass lesions around the renal pelvis. Partial resection of the masses and frozen section examination indicated the diagnosis of CD. However, the results of postoperative histopathology and immunohistochemistry combined with serum IgG4 were consistent with IgG4-RD. Both the patients recovered well after drug treatment without recurrence of the diseases.ConclusionsInflammatory pseudotumor of CD and IgG4-RD with kidney involvement are primarily diagnosed by postoperative histopathology and can pose a preoperative diagnostic challenge because these lesions can masquerade as kidney malignancy. Therefore, we recommend core biopsy as a nonnegligible procedure to evaluate renal masses and potentially prevent unnecessary surgical treatment.

Urothelial carcinoma of the renal pelvis with renal vein and inferior vena cava tumor thrombus: case series and literature review

BackgroundUrothelial carcinoma (UC) of the renal pelvis with renal vein and inferior vena cava (IVC) tumor thrombus (TT) was extremely rare. We aimed to explore the clinical and pathological characteristics, diagnosis and treatment of renal pelvis UC with renal vein and IVC TT.MethodsFrom March 2016 to January 2019, eight patients of renal pelvis UC with renal vein and IVC TT were diagnosed and underwent operation in our hospital. Clinical features, operative details, pathological outcomes, and prognosis data were reviewed and collected.ResultsThere were five males and three females (52–84 years old). Their main symptoms were flank pain and hematuria. According to the Mayo classification, the TT was 4 level-0 (1 left and 3 right), 2 level-I (right), and 2 level-II (right). Half the patients underwent retroperitoneal laparoscopic radical nephroureterectomy with thrombectomy, and the other underwent open procedures. The mean operative time was 298.9 minutes. Pathological outcomes revealed high-grade UC, with positive lymph nodes in 6 cases. Four patients received adjuvant chemotherapy, one target therapy and one adjuvant chemotherapy combined with immunotherapy after surgery. The mean follow-up time was 11.1 months. Three patients are alive, and two of them developed recurrence and lung metastasis.ConclusionsPreoperative differentiation between renal pelvis UC and renal cell carcinoma with venous TT was very important for the management. Radical nephroureterectomy with thrombectomy might be a reasonable method for renal pelvis UC with venous TT. The prognosis of such cases was poor even if adjuvant therapy was scheduled.

Abstract 605: Evidence that a wide variety of cancers may use the progesterone induced blocking factor protein to escape immune surveillance as evidenced by significant palliation following treatment with progesterone receptor antagonists in advanced metastatic treatment resistant cancers

Abstract A search of the literature and abstracts from national oncology meetings was conducted to determine what types of human cancers have been reported to show some type of palliative benefit from treatment with progesterone (P) receptor antagonists. Though the original concept was to try P receptor antagonists for cancers known to be associated with the classic nuclear P receptor, recent data suggest that the real beneficial target is a membrane P receptor that helps produce a unique immunomodulatory protein called the progesterone induced blocking factor (PIBF) that inhibits natural killer (NK) cells and cytotoxic T cells in the tumor microenvironment and thus may allow cancer cells to metastasize. The following human cancers known to be associated with the classic nuclear receptor that have responded to either the P receptor modulator mifepristone or onapristone, include breast, uterine, ovarian, and prostate cancer. Human cancers not associated with the classic nuclear P receptor that have demonstrated significant palliative benefits and/or increased longevity following P receptor modulator therapy include colon, thymic cell epithelial cancer, transitional cell carcinoma of the renal pelvis, leiomyosarcoma, pancreatic carcinoma, malignant fibrous histiocytoma, glioblastoma multiforme grade IV, renal cell carcinoma, fibrous osteosarcoma, small cell lung cancer, non-small cell lung cancer (including those negative for tumor markers, or those positive for PD-1, or positive for the EGFR mutation). The wide variety of very advanced cancers that have responded to the P receptor modulators as evidenced by extension of a better quality of life despite the fact that they had progressed despite standard chemo or immunotherapy, is consistent with the concept that PIBF may be a protein needed by a large variety of cancers to advance or metastasize, and thus may provide a unique target to treat with P receptor modulators, and thus provide significant palliative benefit. In contrast to most anti-cancer agents, P receptor antagonists are extremely well tolerated, and are without serious risk of complications. Larger series are needed to determine the true beneficial effect of this type of therapy. Positive beneficial effects in case reports, at least provide the basis for selection of which cancers to evaluate in a larger series. Citation Format: Jerome H. Check, Diane Check, Carrie Wilson. Evidence that a wide variety of cancers may use the progesterone induced blocking factor protein to escape immune surveillance as evidenced by significant palliation following treatment with progesterone receptor antagonists in advanced metastatic treatment resistant cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 605.

Study on setup errors for different body carcinoma radiotherapy with image guidance in TOMO-HD

Objective The literature study the setup errors of head and neck, thoracic, abdominal and pelvic tumors by megavoltage fan-beam CT based image guidance in TOMO-HD to provide the margin enlarging from clinic target volume (CTV) to planning target volume (PTV) in treatment planning system of TOMO-HD. Methods 103 patients with head and neck (30 patients), thoracic (42 patients), abdominal and pelvic (31 patients) carcinoma were enrolled. Megavoltage fan-beam CT based image guidance in tomotherapy-HD was used to acquire CT scan before every treatment. The left-right (X), superior-inferior (Y), anterior-posterior (Z) and rotation (Fy) setup errors of patients can be obtained from the tomography image automatically restructured by the system. Calculating the systematic error and the random error in the three dimensions and check whether the setup data accord with the normal distribution or not, then acquire the data expand in the three directions. Results According to 2 593 fan-beam CT scans, the shift errors (µ ± s) in X, Y, Z and Fy (rotation) of three study group were [(−0.31 ± 2.16) mm, (1.09 ± 3.56) mm, (2.36 ± 2.27) mm, (0.29 ± 0.96)°] (head and neck tumor), [(−0.98 ± 2.95) mm, (0.45 ± 6.86) mm, (3.79 ± 2.47) mm, (0.18 ± 0.60)°] (thoracic cancer) and [(−0.86 ± 2.85) mm, (−1.59 ± 6.91) mm, (5.77 ± 2.40) mm, (0.20 ± 0.68)°] (abdominal and pelvic carcinoma). The systematic errors (Σ) and random errors (σ) in X, Y, Z dimensions of patients with head and neck, thoracic, abdominal and pelvic tumors were (1.06 mm and 1.84 mm), (1.93 mm and 3.43 mm), (2.41 mm and 2.71 mm), (1.10 mm and 2.56 mm), (3.79 mm and 5.46 mm), (1.38 mm and 1.99 mm) and (1.39 mm and 0.87 mm), (4.98 mm and 5.69 mm), (1.19 mm and 2.05 mm), respectively. Conclusion It is recommended as a reference for image guidance in TOMO-HD according to the frequency distribution of setup errors, for patients with head and neck, chest and abdominal and pelvic tumors, the maximum range of motion in three dimensions are (5.00, 5.00, 5.00) mm, (6,63, 17.25, 16.00) mm and (6.49, 16.24, 13.60) mm. 摘要： 目的 利用 TOMO-HD 螺旋加速器的 MV 级扇形束 CT 研宄头颈部、胸部、腹盆部肿瘤在放疗中的摆位误差, 为 PTV 边界的外扩提供数据支持。 方法 采用 TOMO-HD 螺旋断层系统分别对 30 例头颈部、42 例胸部和 31 例腹盆 部肿瘤患者每次放疗前行 MV 级扇形束 CT 扫描, 系统自动重建图像并与治疗计划 CT 图像进行配准, 获得患者左右 (X 轴)、头脚 (Y 轴)、腹背 (Z 轴)、沿Y轴方向的旋转 (Fy) 方向的摆位误差。计算出X、Y、Z方向的系统误差(Σ) 和随 机误差(σ)并对摆位误差进行正态性检验, 计算出 PTV 的各方向外扩边界。 结果 共行 2 593 次扫描, 头颈部、胸部、腹盆部患者在 X 轴、Y 轴、Z轴、Fy 方向 (沿 Y 轴方向的旋转) 的摆位误差 (µ ± s) 分别为 [(−0.31 ± 2.16)mm、(1.09 ± 3.56)mm、(2.36 ± 2.27)mm、(0.29 ± 0.96)°], [(−0.98 ± 2.95)mm、(−0.45 ± 6.86)mm、(3.79 ± 2.47)mm、(0.18 ± 0.60)°] 和 [(−0.86 ± 2.85)mm、(−1.59 ± 6.91)mm、(5.77 ± 2.40)mm、(0.20 ± 0.68)°]。头颈部、胸部、腹盆部患者在 X 轴、Y 轴、Z轴方向的系统误差(Σ)和随机误差(σ)分别为 (1.06 mm 和 1.84 mm)、(1.93 mm 和 3.43 mm)、(2.41 mm 和 2.71 mm)、(1.10 mm 和 2.56 mm)、(3.79 mm 和 5.46 mm)、(1.38 mm 和 1.99 mm) 和 (1.39 mm 和 0.87 mm)、(4.98 mm 和 5.69 mm)、(1.19 mm 和 2.05 mm)。 结论 根据不同部位的摆位误差频数分布, 头颈部、胸部、腹盆部不同 部位肿瘤患者的靶区在三维方向上最大运动范围参考值为 (5.00, 5.00, 5.00)mm, (6.63, 17.25, 16.00)mm 和 (6.49, 16.24,13.60)mm, 推荐以此作为图像引导参考。

Robot-assisted nephroureterectomy requiring no robot redocking or patient repositioning: experience from a single center with 62 cases

Objective: To examine a new technique of robot-assisted nephroureterectomy without robot reldocking or patient repositioning. Methods: Patients diagnosed as upper tract urothelial carcinoma treated with this modality between November 2015 and January 2019 at Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were included in this analysis. Data collection including patient demographics, operative procedure and postoperative morbidities were conducted by retrospective charts review, after receiving the institutional review board's approval. There were 35 males and 27 females with a median age of 70 years (range: 30 to 91 years) underwent single docking robot-assisted nephroureterectomy without repositioning. Among the 62 cases, 37 patients had pelvic carcinoma while 25 patients had ureteral carcinoma (with proximal portion 12 cases, middle portion 5 cases and distal portion 8 cases). The patient was placed in a 60 to 80-degree, modified flank position with a 15-degree Trendelenburg tilt. The contralateral arm was positioned perpendicular to the torso on an arm board while the ipsilateral arm was taped to the patient's side with ample padding. The robot cart was then docked at a 90-degree angle, perpendicular to the patient. A "W"-shape, three robotic-arm configurations was used for port placement. Results: The surgical procedures were performed successfully in all the 62 patients. The operation time was (171.6±54.7) minutes (range: 60 to 370 minutes). The estimated blood loss during the operation was 50(50) ml (range: 20 to 400 ml) with 4 patients had transfusion. No perioperative death was encountered. Eleven patients had post-operative complications (Clavien-Dindo grade 2) including 3 cases of hemorrhage and 8 cases of chylous leakage. All cases were regularly followed up with a median time of 37 months (range: 17 to 55 months). There were 8, 30, 19, 4 and 1 case followed up for 48, 36, 24, 18 and less than 18 months, respectively. Three patients had reginal recurrences and 11 cases of distant metastasis occurred, with 5 patients died for cancer. The survival rate within 24 months was estimated as 75.4%(43/57). Conclusion: Robot-assisted nephroureterectomy without robot redocking or patient repositioning could be safely reproduced, with surgical outcomes comparable to other established techniques.

A novel DNA methylation marker for the urine-based liquid biopsies to detect bladder cancer.

e16503 Background: For bladder cancer (BC), the 5-year survival rate for patients with localized tumors can reach as high as 92%, but only 45% for those with tumors spreading to nearby regions. Cystoscopy combined with tissue biopsy can miss 10-40% of the cancer cases due to multiple factors. Meanwhile, the method is invasive, causing physical discomfort and psychological trauma for the patients. Therefore, development of a noninvasive, sensitive, and specific diagnostic alternative is needed. By analyzing TCGA data and improving analytic technology currently available, we have developed an easy-to-use, convenient, and accurate detection approach for BC relying on a single methylation marker. Methods: We searched TCGA database and selected a total of 366 candidate markers including those that have been published for subsequent examination and analyzed 446 primer pairs and probe sets. Using quantitative methylight method, we narrowed the field down to top 5 performers for subsequent urine-based testing of 270 samples. Finally, two markers were selected for validation testing in a group of 530 urine samples, consisting of 161 bladder cancers, 244 normal controls, 80 renal carcinomas, and 45 carcinomas of renal pelvis and ureter. In addition, we detected the methylation level and mRNA expression of target gene in 8 bladder cancer cell lines and 1 normal bladder epithelial cell line by MSP, qMSP and qPCR. Results: Methylation marker DMRTA2 had a sensitivity of 85.7%, an AUC value of 0.924, and an accuracy of 90.6%. The specificity, from a control group consisting of patients with lithangiuria, prostatoplasia, and prostatitis as well as healthy individuals, is 93.9% (138/161). Notably, the methylation assay had the highest sensitivities for tumors at stages of T1 (94.4%) and T2 (96.6%) compared with T3 (80.0%), T4 (71.4%), and unknown stage (90.0%). While methylation was observed in 34/45 urine samples from patients with carcinomas of renal pelvis and ureter, a good sensitivity of 75.6%, it was detected at extremely low rate of 7.5% (6/80) in those with interfering cancers of kidney and prostate. Additionally, the assay specificity was significantly affected by the age of the cancer patients and selection of healthy controls, critical aspects to be carefully considered during the design and development phase of the methylation-specific testing. Compared with SV-HUC-1, the normal bladder epithelial cell line, DMRTA2 gene was hypermethylated in 8 bladder cancer cell lines, which is consistent with the results of MSP and qMSP. The mRNA levels of DMRTA2 were low in some bladder cancer cell lines, such as T24, J82, UM-UC-3 and RT4, however were fairly high levels in 5637, SCaBER, TCCSUP and SW780. Conclusions: Our data demonstrated that a single-target DNA methylation signature could be highly effective to detect bladder cancer via urine samples.

Discrepancy between clinical and pathological Tstages in upper urinary tract urothelial carcinoma: Analysis of the Hospital-Based Cancer Registry data in Japan.

To examine the discrepancy between clinical and pathological Tstages in patients with urothelial carcinoma of the upper urinary tract treated with radical surgery, and to compare them with the corresponding discrepancy in urothelial carcinoma of the bladder. We used the Hospital-Based Cancer Registry data in Japan to extract urothelial carcinoma of the bladder cases (n=3747) and urothelial carcinoma of the upper urinary tract cases (n=6831), including urothelial carcinoma of the renal pelvis (n=3295) and urothelial carcinoma of the ureter (n=3536) with cT1-4N0M0 diagnosed in 2012-2015, histologically confirmed, and treated with radical surgery without chemotherapy or radiotherapy. We compared the T-stage discrepancy among different tumor locations. The proportions of overall T-stage discrepancy in the urothelial carcinoma of the renal pelvis (40.8%) and urothelial carcinoma of the ureter (42.9%) groups tended to be higher compared with that in the urothelial carcinoma of the bladder (38.8%) group. The upstaging rate from clinical non-muscle-invasive cancer (≤cT1) to pathological muscle-invasive cancer (≥pT2) was significantly higher in the urothelial carcinoma of the renal pelvis and urothelial carcinoma of the ureter groups compared with the urothelial carcinoma of the bladder group (P=0.002, P<0.0001, respectively). Upstaging from clinical organ-confined disease (≤cT2) to pathological non-organ-confined disease (≥pT3) was significantly more frequent in the urothelial carcinoma of the renal pelvis (27.8%, P<0.0001) and urothelial carcinoma of the ureter (22.3%, P<0.0001) groups compared with the urothelial carcinoma of the bladder (17.8%) group. Discrepancy in Tstaging is significantly higher in patients with urothelial carcinoma of the upper urinary tract compared with those with urothelial carcinoma of the bladder, especially in those with organ-confined disease. As T-stage discrepancy might lead to missed opportunities to carry out perioperative treatment, more accurate diagnostic techniques are required to identify the appropriate urothelial carcinoma candidates for preoperative treatment.

Squamous cell carcinoma of the right renal pelvis in a 46-years-old with long history of right pyelolithiasis. A case report and review of literature

Squamous cell carcinoma of the kidney is a rare malignancy of the upper urothelium usually seen at advanced stage due to delay in diagnosis and or presentation. Mostly seen in patients with history of untreated chronic urolithiasis, chronic renal infection or analgesic abuse. A 46-years-old man who presented with right recurrent loin pain that radiates to the right groin of 10 years duration which worsened 2 weeks prior to presentation, he had history of recent haematuria, right loin pain, significant weight lost with associated history of untreated right renal calculi. General examination was not remarkable, ultrasound scan revealed a huge right renal mass with calculi. Intravenous urogram showed a non-functioning right kidney. Right radical nephrectomy was done, cut surface showed replacement of the renal parenchyma with greyish white tumour with stones in some blind calyxes. Histology revealed moderately differentiated squamous cell carcinoma of the right kidney. We report a case of moderately differentiated squamous cell carcinoma of the right kidney in a patient with a long history of untreated renal calculi. High index of suspicion for malignancy should be kept when seeing patients with long history of untreated renal calculi.