Malignant Renal Tumors Research Articles

Contrast-enhanced ultrasound (CEUS) of benign and malignant renal tumors: Distinguishing CEUS features differ with tumor size.

Contrast-enhanced ultrasound (CEUS) is now a guideline-recommended strategy for diagnosing renal lesions. Tumor size is related to the risk of the treatment and prognosis in renal tumors. Thus, we aim to analyze the CEUS features of solid renal tumors in relation to tumor size. The CEUS appearance of 156 pathologically diagnosed solid renal tumors were retrospectively analyzed. Three groups were stratified according to the tumor size (≤2cm [group I], 2.1-4cm [group II] and 4.1-7cm [group III]). For each group, the features of wash-in type, enhancement degree, enhancement homogeneity, and the presence of a pseudocapsule sign were compared between benign and malignant tumors. All 156 included lesions were detected by CEUS. The proportion of benign tumors in three size groups was 37.1%, 19.4%, and 20.4%, respectively. The proportion of malignant tumors was highest (80.6%) in group II, followed by group III (79.6%) and group I (62.9%). In group I, malignant and benign tumors differed significantly in the presence of a pseudocapsule sign (p=0.015) and homogeneity (p=0.007). In group II, the degree of enhancement differed (p=0.02) between tumor types. In group III, the two tumor types differed in both the wash-in pattern (p=0.015) and enhancement degree (p=0.024). The weighted and Cohen's kappa values for the concordance between inter-observer agreement ranged from 0.31 (95% CI: 0.36-0.57) to 0.90 (95% CI: 0.77-1.00). CEUS features of malignant and benign renal tumors change along with the tumor size. The use of CEUS features in the diagnosis of benign and malignant tumors requires consideration of tumor size.

Comparison of perinephric fat measurements between malignant and benign renal tumours.

ObjectiveTo investigate different parameters derived from the quantity and quality of perinephric fat, and to compare their effectiveness in predicting the malignant pathology of renal tumours.MethodsData from patients diagnosed with renal tumour between April 2014 and December 2020 were retrospectively reviewed, and patients were categorized into malignant or benign tumour groups. Fat parameters, including perinephric fat volume (PFV), perinephric fat area (PFA), perinephric fat thickness (PFT), and Mayo adhesive probability (MAP) score were measured using abdominal computed tomography scans. Between-group differences were assessed by analysis of variance and χ2-test. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the performance of perinephric fat parameters in diagnosing malignancy.ResultsA total of 109 patients were included. MAP score, PFV, PFA, and PFT were significantly increased in the malignant versus benign tumour group, and after correction for body mass index (BMI), the indexed PFV/BMI, PFA/BMI, and PFT/BMI values remained significantly higher in the malignant tumour group. All parameters showed fair predictivity of malignancy, with comparable area under the curve values in the ROC curve.ConclusionAn increased amount of perinephric fat is predictive of malignant pathology for renal tumours. The predictive accuracy for each perinephric fat parameter remained fair after correcting for BMI.

1471P Plasma KIM-1 for preoperative identification and risk stratification of renal cell carcinoma

Deciding between active surveillance and treatment for patients with small renal masses remains a challenge. Kidney injury molecule-1 (KIM-1) is a candidate circulating biomarker for renal cell carcinoma detection and risk stratification. We sought to determine whether plasma KIM-1 can assist in the risk stratification of patients with suspicious kidney masses. The WHO/IARC K2 study prospectively enrolled adults undergoing nephrectomy for kidney masses between 2007-2012 in Eastern Europe. We performed a nested case-control study using pre-nephrectomy banked plasma. We identified 162 patients who were subsequently found to have ccRCC (cases) and 162 patients who were subsequently found to have benign renal masses (controls). Plasma KIM-1 was measured in banked pre-nephrectomy plasma. Patients had prospective follow-up to determine clinical outcomes. Area under the receiver operating curve (AUC-ROC) was used to assess the relationship between pre-nephrectomy plasma KIM-1 and the likelihood of detecting ccRCC at time of surgery. Multivariable Cox models were used to assess the relationship between pre-nephrectomy plasma KIM-1 and subsequent metastasis-free survival and overall survival. Among 324 patients, plasma KIM-1 distinguished ccRCC versus benign masses with AUC-ROC 0.81 (95% CI: 0.76-0.86). Among patients with ccRCC, higher pre-nephrectomy KIM-1 was associated with shorter metastasis free survival (multivariable MFS HR 1.29 per unit increase in log KIM-1, 95% CI 1.10-1.53) and shorter overall survival (multivariable OS HR 1.31 per unit increase in log KIM-1, 95% CI 1.10-1.54).Table: 1471PPerformance of plasma KIM-1 for distinguishing benign versus malignant renal tumors, by sizeTumor sizeNAUR-ROC (95% CI)0-4cm1270.73 (0.64-0.82)4-7cm890.72 (0.61-0.83)7-10cm490.88 (0.73-1.00)>10cm510.89 (0.76-1.00)All tumors3240.81 (0.76-0.86) Open table in a new tab In patients with renal masses, pre-nephrectomy plasma KIM-1 helped distinguish between clear cell renal cell carcinoma versus benign tumors. Among patients with ccRCC, higher pre-nephrectomy KIM-1 was associated with worse MFS and OS. Plasma KIM-1 may be a useful risk stratification tool for patients with suspicious kidney masses.

Tim3scFv-Transforming Lactobacillus Inhibits Transplanted Tumor of Renal-Cell Carcinoma

Introduction: T-cell immunoglobulin-3 (Tim-3) antibody drugs can treat malignant renal tumors but are expensive. To overcome this limitation, Lactococcus lactis host bacteria were used to express Tim-3 single-chain antibodies. Methods: The pLAN-CTB-Tim3scFv plasmid was constructed using molecular cloning technology and transformed into Lactococcus lactis. Expression and immune activity of proteins in the transformed bacteria were analyzed using Western blotting and enzyme-linked immunosorbent assay in vitro. A mouse subcutaneously transplanted tumor model of renal adenocarcinoma was constructed. The promoting effect of transformed bacteria on mouse spleen lymphocyte activation and their inhibitory effect on transplanted tumors were analyzed. Results: Transformed L. lactis NZ-CTB-Tim3scFv and NZ-Tim3scFv were successfully constructed. CTB-Tim3scFv secreted by NZ-CTB-Tim3scFv showed immunological activity. Compared with the NZ-Tim3scFv and NZ-Vector groups, the subgroups of splenic lymphocytes in the NZ-CTB-Tim3scFv group had a higher proportion of CD3⁺CD4⁺, CD3⁺CD8a⁺, and CD3⁺CD69⁺ cells. Ki67 and CD31 expression in the NZ-CTB-Tim3scFv group was significantly reduced. Tumor volume in the NZ-CTB-Tim3scFv group increased the least. Discussion/Conclusion: Secretion of CTB-Tim3scFv promoted the proliferation and activation of spleen lymphocytes and inhibited growth, cell proliferation, and angiogenesis of tumors. The proposed method is low cost and convenient with potential to become a new immunotherapy approach for renal-cell carcinoma.

Perirenal cystic lymphangioma mimicking a renal cyst in an elderly patient: Case report.

Cystic lymphangioma is a congenital benign lymphatic tumor commonly diagnosed in childhood. Cervical and axillary locations are the most usual, while retroperitoneal involvement is exceptional. Perirenal cystic lymphangioma may be revealed by urological signs or by incidental findings. Imaging plays an essential role in characterizing the tumor, however differential diagnosis with benign or malignant renal tumors is not always possible, thus requiring histological evidence. We report the case of a 50-year-old man who presented with a cystic lymphangioma of the left kidney revealed by lumbar pain with imaging features mimicking an exocortical developing renal cyst. The work has been reported in line with the SCARE criteria.

Diagnostic Accuracy of 99mTc-Sestamibi SPECT/CT for Characterization of Solid Renal Masses.

Our objective was to assess the diagnostic accuracy of 99mTc-sestamibi SPECT/CT for characterizing solid renal masses. Methods: Imaging and clinical records of patients who underwent 99mTc-sestamibi SPECT/CT for clinical work-up of their solid renal masses from September 2018 to October 2021 were retrospectively reviewed. Histopathology formed the reference standard, and the diagnoses were categorized as malignant/concerning (renal cell carcinomas [RCCs] other than chromophobe histology) and benign/nonconcerning (oncocytic tumors including chromophobe RCC, other benign diagnoses) to calculate the sensitivity and specificity of 99mTc-sestamibi SPECT/CT and contrast-enhanced CT (ceCT). The clinical reads of the SPECT/CT images were used for visual classification of the lesions. Additionally, the SPECT images were manually segmented to obtain the maximum and mean counts of the lesion and adjacent renal cortex and maximum and mean lesion Hounsfield units. Results: 99mTc-sestamibi SPECT/CT was performed on 42 patients with 62 renal masses. A histopathologic diagnosis was available for 27 patients (18 male, 9 female) with 36 solid renal masses. ceCT findings were available for 20 of these patients. The most commonly identified single histologic type was clear cell RCC (13/36; 36.1%). Oncocytic tumors were the most common group of nonconcerning lesions (15/36), with oncocytoma as the predominant histologic type (n = 6). The sensitivity and specificity of SPECT/CT for diagnosing a nonconcerning lesion were 66.7% and 89.5%, respectively, compared with 10% and 75%, respectively, for ceCT. The lesion-to-kidney ratios for maximum and mean counts and maximum lesion Hounsfield units showed significant differences between the 2 groups (P < 0.05). The lesion-to-kidney mean count ratio at a cutoff of 0.46 showed a sensitivity and specificity of 87.5% and 86.67%, respectively, for detecting nonconcerning lesions, which was significantly higher than that of ceCT. Conclusion: The current literature on the utility of 99mTc-sestamibi SPECT/CT for characterization of solid renal masses is limited. We offer additional evidence of the incremental value of 99mTc-sestamibi SPECT/CT over ceCT for differentiating malignant or aggressive renal tumors from benign or indolent ones, thereby potentially avoiding overtreatment and its associated complications. Quantitative assessment can further increase the diagnostic accuracy of SPECT/CT and may be used in conjunction with visual interpretation.

Clinical Benefits of Indocyanine Green Fluorescence in Robot-Assisted Partial Nephrectomy.

Simple SummaryIndocyanine green (ICG) administration in robot-assisted partial nephrectomy (RAPN) can minimize warm ischemia time and preserve more parenchyma resulting in exceptional preservation of renal function and reduced incidence of postoperative complications. However, previous studies have seldom compared how ICG-RAPN use differs when used to treat benign versus malignant renal tumors because the baseline patient and tumor characteristics as well as treatment goals are completely different. The aim of our retrospective study was to compare the intraoperative and postoperative outcomes and the differences in the results of ICG administration between patients with benign and malignant tumors. We have demonstrated that ICG-RAPN yielded superior preservation of short-term renal function. Of the patients with malignant renal tumors, it had less operative blood loss without a more positive margin rate than standard RAPN.Background: To compare the intraoperative and postoperative outcomes of indocyanine green (ICG) administration in robot-assisted partial nephrectomy (RAPN) and report the differences in the results between patients with benign and malignant renal tumors. Methods: From 2017 to 2020, 132 patients underwent RAPN at our institution, including 21 patients with ICG administration. Clinical data obtained from our institution’s RAPN database were retrospectively reviewed. Intraoperative, postoperative, pathological, and functional outcomes of RAPN were assessed. Results: The pathological results indicated that among the 127 patients, 38 and 89 had received diagnoses of benign and malignant tumors, respectively. A longer operative time (311 vs. 271 min; p = 0.006) but superior preservation of estimated glomerular filtration rate (eGFR) at 3-month follow-up (90% vs. 85%; p = 0.031) were observed in the ICG-RAPN group. Less estimated blood loss, shorter warm ischemia time, and superior preservation of eGFR at postoperative day 1 and 6-month follow-up were also noted, despite no significant differences. Among the patients with malignant tumors, less estimated blood loss (30 vs. 100 mL; p < 0.001) was reported in the ICG-RAPN subgroup. Conclusions: Patients with ICG-RAPN exhibited superior short-term renal function outcomes compared with the standard RAPN group. Of the patients with malignant tumors, ICG-RAPN was associated with less blood loss than standard RAPN without a more positive margin rate. Further studies with larger cohorts and prospective designs are necessary to verify the intraoperative and functional advantages of the green dye.

Differentiation of Benign Solid Renal Lesions from Malignant Lesions Using Dual-Energy CT

Objective: To evaluate the quantitative measurement of effective atomic number (Zeff) and iodine density reconstructed from dual-energy computed tomography (CT) in the discrimination of malignant renal lesions from benign renal lesions. Materials and Methods: The present study was a retrospective study that included patients with renal lesions who underwent dual-energy CT between January 2017 and June 2020. All subjects had a pathological diagnosis or follow-up imaging of at least 24 months. Two observers independently measured the Zeff, iodine density, and conventional CT attenuation of the renal lesions. Associations between the different tumor types and the quantitative CT measurements reconstructed from dual-energy CT were assessed, and interobserver agreement was evaluated. Results: Sixty-one renal lesions from 48 patients were included in the present study. No statistical differences were found in mean Zeff, iodine density, or CT attenuation between the benign renal lesions and the malignant renal lesions. However, significant differences were observed in Zeff, iodine density, and CT attenuation between the renal cell carcinoma (RCC) and the other malignant tumors, and between the clear cell RCC and the papillary RCC. The optimal thresholds for Zeff, iodine density, and CT attenuation for distinguishing RCC from other malignant tumors were 8.22, 1.71 mg/mL, and 79.50 HU, respectively, which provided sensitivity of 76%, 76%, and 80%, respectively. Conclusion: Benign solid renal lesions cannot be differentiated from malignant renal tumors by Zeff and iodine density measurements alone. However, dual-energy Zeff and iodine density have potential for the non-invasive differentiation of RCC from the other malignant renal tumors, and for the differentiation of RCC subtypes. Keywords: Dual-energy CT; Spectral CT; Renal cell carcinoma; Renal mass; Iodine density; Effective atomic number

Review of Perioperative Care Pathway for Children With Renal Tumors.

IntroductionWilms tumor is the most common (90%) renal tumor in children. With the recent advances survival rate approaches 90%. This study was designed to identify factors associated with early recovery and hospital discharge, a step forward in the future development of early recovery after surgery (ERAS) protocol in children. MethodsA retrospective cohort study was conducted from May 2020 to February 2022 among children up to the age of 18-years with a diagnosis of primary malignant renal tumors who underwent radical nephrectomy. Baseline parameters (preoperative), intraoperative, and postoperative components were analyzed. A univariable and multivariable logistic regression model was used to identify the factors leading to early discharge. The data were entered into SPSS version 20 (IBM Inc., Armonk, USA), and a p-value ≤0.05 was statistically significant.ResultsA total of 44 patients with malignant renal tumors were managed with a mean age at diagnosis of 4.06±3.00 years. Twenty-six (59.1%) were male and 18 (40.9%) were female. All the patients received neoadjuvant chemotherapy. Wilms tumor was the most common pathology found in 41 (93.1%) patients; 19 (43.0 %) had stage I, 21 (47.7%) stage II, and four (9.1%) stage III disease. Thirty-four (77.3%) patients had a nasogastric tube placed postoperatively. Median blood loss (BL) was 40 ml (range: 5-250), and the median operative time was two hours (range: 1-4). The median postoperative day to mobilization was one day (range: 1-3), to clear liquids was two days (range: 1-3), and advanced to regular diet was three days (range: 2-5). The median postoperative day of discharge (from surgery to discharge) was four days (range: 2-7), with 31 (70.5%) patients discharged early.ConclusionOur findings indicate that early removal of tube, mobilization, and re-feedings were significantly associated with the early hospital discharge, while the other analyzed factors were not statistically significant. Furthermore, our findings are important in the future development and implementation of ERAS protocol in pediatric oncological resections.

CD34 and FSHR Expression to Differentiate Multiple Subtypes of Benign and Malignant Renal Neoplasms

BackgroundCurrently, no markers accurately differentiate benign from malignant renal masses. CD34 and FSHR are transmembrane proteins involved in neo-angiogenetic pathways and are differently expressed in several normal and cancerous tissues. However, little evidence exists on their distribution in different renal tumors. We aimed to evaluate their expressions in various renal tumors and adjacent normal tissue.MethodsWe retrieved 810 histological samples from 26 patients who underwent surgery for suspected RCa. In each case a core of 10 × 1 mm was selected perpendicular to the tumor capsule between normal kidney and tumor. Within this core 30 regions of interest (ROI), each measuring 669 μm × 500 μm, were acquired at 20× magnification (n = 2 adjacent normal tissue; n = 2 tumor capsule; n = 26 tumor). The surface area of FSHR and CD34 immunostaining was quantified in each ROI using number of stained pixels. The results were compared between RCa and normal kidney.ResultsImmunostaining was significantly different in normal, tumor capsular, and tumor tissues (both CD34 and FSHR P &lt; 0.0001), with overall highest expression in normal and lowest in tumor tissues, where CD34 and FSHR were differently expressed amongst different tumor subtypes (both P &lt; 0.0001). CD34 and FSHR were more expressed in benign versus malignant (both P &lt; 0.0001) and in chromophobe carcinoma versus oncocytoma tumor tissues (CD34 P = 0.0003; FSHR P &lt; 0.0001). The discriminating ability of FSHR alone for benign versus malignant (AUC 0.805; 95% CI 0.771 to 0.837) and chromophobe carcinoma versus oncocytoma (AUC 0.973; 95% CI 0.939 to 0.991) was high. In both cases FSHR AUC was significantly higher than CD34 (both P &lt; 0.0001) and equivalent to the combination of CD34 and FSHR (both P &gt; 0.9). The correlation amongst levels of staining in tumor tissues and distance from the capsule were overall weak (Spearman coefficient CD34 to 0.0644; FSHR-0.16322).ConclusionCD34 and FSHR are differentially expressed across renal tumor subtypes and between tumor and surrounding tissues. FSHR expression alone may be a useful tool to differentiate benign from malignant tumors and chromophobe carcinoma from oncocytoma.

Diffusion-Weighted MRI in the Genitourinary System.

Diffusion weighted imaging (DWI) constitutes a major functional parameter performed in Magnetic Resonance Imaging (MRI). The DW sequence is performed by acquiring a set of native images described by their b-values, each b-value representing the strength of the diffusion MR gradients specific to that sequence. By fitting the data with models describing the motion of water in tissue, an apparent diffusion coefficient (ADC) map is built and allows the assessment of water mobility inside the tissue. The high cellularity of tumors restricts the water diffusion and decreases the value of ADC within tumors, which makes them appear hypointense on ADC maps. The role of this sequence now largely exceeds its first clinical apparitions in neuroimaging, whereby the method helped diagnose the early phases of cerebral ischemic stroke. The applications extend to whole-body imaging for both neoplastic and non-neoplastic diseases. This review emphasizes the integration of DWI in the genitourinary system imaging by outlining the sequence’s usage in female pelvis, prostate, bladder, penis, testis and kidney MRI. In gynecologic imaging, DWI is an essential sequence for the characterization of cervix tumors and endometrial carcinomas, as well as to differentiate between leiomyosarcoma and benign leiomyoma of the uterus. In ovarian epithelial neoplasms, DWI provides key information for the characterization of solid components in heterogeneous complex ovarian masses. In prostate imaging, DWI became an essential part of multi-parametric Magnetic Resonance Imaging (mpMRI) to detect prostate cancer. The Prostate Imaging–Reporting and Data System (PI-RADS) scoring the probability of significant prostate tumors has significantly contributed to this success. Its contribution has established mpMRI as a mandatory examination for the planning of prostate biopsies and radical prostatectomy. Following a similar approach, DWI was included in multiparametric protocols for the bladder and the testis. In renal imaging, DWI is not able to robustly differentiate between malignant and benign renal tumors but may be helpful to characterize tumor subtypes, including clear-cell and non-clear-cell renal carcinomas or low-fat angiomyolipomas. One of the most promising developments of renal DWI is the estimation of renal fibrosis in chronic kidney disease (CKD) patients. In conclusion, DWI constitutes a major advancement in genitourinary imaging with a central role in decision algorithms in the female pelvis and prostate cancer, now allowing promising applications in renal imaging or in the bladder and testicular mpMRI.

Comparative study of conventional ROI-based and volumetric histogram analysis derived from CT enhancement in differentiating malignant and benign renal tumors.

To quantitatively compare the diagnostic values of conventional region of interest (ROI)-based and volumetric histogram analysis derived from CT enhancement in differentiating malignant and benign renal tumors. A total of 230 patients with pathologically confirmed renal tumors who had undergone CT enhancement were classified into clear cell renal cell carcinoma (ccRCC) (n = 133), non-ccRCC (n = 56), and benign renal tumor(n = 41) group. Parametric CT enhancement of each tumor from volumetric histogram were obtained using in-house software, including 10th percentile, 25th percentile, median, 75th percentile, 90th percentile, mean, standard deviation, as well as skewness, kurtosis and entropy, and histogram metrics among these groups were analyzed. ROI-based enhancement density was also analyzed. The entropy and SD values of ccRCCs were higher than those of non-ccRCCs and benign renal tumors (p < 0.05). The 10th percentile, 25th percentile, median, 75th percentile, 90th percentile and mean values of ccRCCs were lower than those of benign renal tumors, however, higher than those of non-ccRCCs (p < 0.05). The ROI-based enhancement density of non-ccRCCs were lower than those of ccRCCs and benign renal tumors(p < 0.05). Receiver operating characteristic (ROC) curve analyses showed that entropy and mean values had the highest diagnostic efficacy in differentiating ccRCCs/non-ccRCCs and benign renal tumors. ROC curve analyses showed that mean values had the highest diagnostic efficacy in differentiating ccRCCs and non-ccRCCs. In terms of pairwise comparisons of ROC curves and diagnostic efficacy, ROI-based CT enhancement density was worse than volumetric histogram analysis (p < 0.05). Volumetric histogram analysis parameters can effectively distinguish malignant and benign renal tumors. 1. Entropy and mean values had the highest diagnostic efficacy in differentiating ccRCCs/ non-ccRCCs and benign renal tumors.2. Mean values had the highest diagnostic efficacy in differentiating ccRCCs and non-ccRCCs.3.Volumetric histogram analysis had better performance than ROI-based enhancement density.

An Ultrasonic-Based Radiomics Nomogram for Distinguishing Between Benign and Malignant Solid Renal Masses.

ObjectivesThis study was conducted in order to develop and validate an ultrasonic-based radiomics nomogram for diagnosing solid renal masses.MethodsSix hundred renal solid masses with benign renal lesions (n = 204) and malignant renal tumors (n = 396) were divided into a training set (n = 480) and a validation set (n = 120). Radiomics features were extracted from ultrasound (US) images preoperatively and then a radiomics score (RadScore) was calculated. By integrating the RadScore and independent clinical factors, a radiomics nomogram was constructed. The diagnostic performance of junior physician, senior physician, RadScore, and radiomics nomogram in identifying benign from malignant solid renal masses was evaluated based on the area under the receiver operating characteristic curve (ROC) in both the training and validation sets. The clinical usefulness of the nomogram was assessed using decision curve analysis (DCA).ResultsThe radiomics signature model showed satisfactory discrimination in the training set [area under the ROC (AUC), 0.887; 95% confidence interval (CI), 0.860–0.915] and the validation set (AUC, 0.874; 95% CI, 0.816–0.932). The radiomics nomogram also demonstrated good calibration and discrimination in the training set (AUC, 0.911; 95% CI, 0.886–0.936) and the validation set (AUC, 0.861; 95% CI, 0.802–0.921). In addition, the radiomics nomogram model showed higher accuracy in discriminating benign and malignant renal masses compared with the evaluations by junior physician (DeLong p = 0.004), and the model also showed significantly higher specificity than the senior and junior physicians (0.93 vs. 0.57 vs. 0.46).ConclusionsThe ultrasonic-based radiomics nomogram shows favorable predictive efficacy in differentiating solid renal masses.

Knockdown of lncRNA HAGLROS inhibits metastasis and promotes apoptosis in nephroblastoma cells by inhibition of autophagy

ABSTRACT Nephroblastoma, or Wilms tumor, is a primary renal malignant tumor that easily occurs in children. Previous studies have revealed the regulatory functions of LncRNA in nephroblastoma. LncRNA HAGLROS functions as a tumor promotor in various cancers including hepatocellular carcinoma, ovarian cancer and colorectal cancer. In this study, the HAGLROS expression in nephroblastoma cells was assayed through qRT-PCR. Cell proliferation assessment employed CCK-8. Moreover, the migration and invasion of cells were examined separately through wound healing and transwell assay. Moreover, flow cytometric analysis and Western blot assay were applied to evaluate cell apoptosis. Rapamycin and 3-methyladenine were used to serve as autophagy activator or inhibitor, respectively. In addition, autophagy was identified by immunofluorescence staining and Western blot analysis. Experiment results showed that HAGLROS expressed highly in nephroblastoma cell lines. HAGLROS knockdown prevented cells from proliferating, and also showed suppressive impact on migration and invasion in HFWT cells. In addition, knockdown of HAGLROS showed a facilitative effect on apoptosis and an inhibitory effect on autophagy. Stimulation of autophagy alleviated HAGLROS silencing-induced apoptosis, while inhibition of autophagy reversed the effect in nephroblastoma cells. In summary, our results revealed that HAGLROS executed an oncogenic role in the progress of nephroblastoma, offering a new perspective on the strategy for nephroblastoma therapy.

The value of sestamibi single-photon emission computed tomography/computed tomography in differentiating and staging renal cell carcinomas: A systematic review.

Misdiagnosis of benign renal neoplasms can lead to unnecessary surgical resections, which increases the risk of other morbidities and mortality. Therefore, it is crucial to find a diagnostic modality for differentiation between benign and malignant renal masses. In the current study, we summarized published pieces of evidence concerning the use of technetium-99m (99mTc)-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) as a promising diagnostic nuclear imaging modality for the differentiation of renal neoplasms. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for Systematic Reviews and Meta-Analyses. We conducted a systematic electronic database search for suitable studies from inception till February 20, 2020 in 9 databases. The risk of bias was assessed for the included studies using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. We identified 9373 records after exclusion of 8978 duplicates using EndNote software. Title and abstract screening resulted in 761 records for further full-text screening. Finally, four studies were included with total sample size of 80 patients. The overall risk of bias was low to moderate. The results of all the included studies supported using 99mTc-sestamibi SPECT/CT for the differentiation between benign and malignant renal neoplasms. The use of 99mTc-sestamibi SPECT/CT could be a rapid, less invasive, promising diagnostic modality for histological diagnosis and staging of renal neoplasm, as well as monitoring post-therapy tumor's response. However, more studies with large sample sizes are essential to confirm the reliability and accuracy of this modality for usage.

The association between comorbidities and disease activity in patients with rheumatoid arthritis: a multicenter, cross-sectional cohort study in Japan with the highest proportion of elderly individuals

BackgroundThis study aimed to assess the association of disease activity with the presence of comorbidities in patients with rheumatoid arthritis, using the Akita Orthopedic Group on Rheumatoid Arthritis (AORA) registry, a multicenter, cross-sectional registry in Japan with the highest proportion of elderly people. We included 1838 patients (mean age: 66.4 years old) who visited our affiliated institutions between April 2018 and March 2019. The patients were divided into two groups based on the disease activity in 28 joints based on the erythrocyte sedimentation rate (DAS28-ESR) into the remission or low disease activity group (L group) and the moderate or high disease activity group (H group). Patient demographics and comorbidities in the two groups were compared.ResultsThe most common comorbidity was hypertension (33.7%), followed by renal disease (25.2%), respiratory disease (12.2%), diabetes mellitus (8.1%), cardiovascular disease (8.0%), malignancies (5.7%), and cerebrovascular disease (4.7%). The H group was older (p<0.0001); had a higher prevalence of hypertension (p<0.0001), diabetes (p=0.0011), respiratory disease (p<0.0001), cerebrovascular disease (p<0.0001), and cardiovascular disease (p=0.0030); and was less likely to use anti-rheumatic drugs. The prevalence of comorbidities other than renal disease and malignant tumor was higher in the H group. Multivariate logistic regression analysis showed that female sex (p=0.0054), advanced Steinbrocker class (p<0.0001), high anti-citrullinated protein antibody levels (p=0.0211), high prednisolone dose (p<0.0001), and absence of biologics’ or JAK inhibitors’ use (p<0.0001) were risk factors for high disease activity, and shorter treatment period was a low-risk factor for high disease activity (p=0.0041). Among comorbidities, the presence of cerebrovascular disease (p=0.0334) was the only independent risk factor for high disease activity.ConclusionsIn our registry study with a high proportion of elderly RA patients, cerebrovascular disease was associated with high disease activity in patients with RA. Therefore, when treating elderly patients with RA, we need to pay careful attention to cerebrovascular disease, and treatment should be aimed at achieving adequate control of RA.

Analysis of 87 Nephrectomies in a Tertiary Healthcare Center in Nigeria.

Nephrectomy is one of the most frequently performed operations on the kidney. It is necessary for treatment of malignant as well as some benign renal conditions. This was a five-year retrospective review of all adult patients who had open nephrectomy in Lagos University Teaching Hospital, Lagos, Nigeria between January 2014, and December 2019. The cases were traced using clinic, ward, and theatre records. The clinical and operative details of these patients were retrieved and analysed. Clinical information extracted included patients' demography, clinical presentations, diagnosis, procedures performed, complications and the immediate treatment outcome. Data were analysed using SPSS for Mac Version 25.0. Results were displayed in simple proportions using tables and charts. A total of 87 patients' records were available for review. Age range was15-76years with a mean and median age of 49.415 and 52 years, respectively. Majority, 73(83.9%) of the patients presented with at least one symptom, whereas14(17.7%) were asymptomatic. Loin pain was the commonest presentation in 72(82.8%). Indication for nephrectomy were benign in 28(32.2%) and malignant in 59(67.8%) patients. Overall, renal cell carcinoma was the most common indication for nephrectomy accounting for 59.8% of all nephrectomies. A total of thirty-one morbidities occurred in sixteen patients with a complication rate of 18.4% while transfusion rate was 40.2%. Reoperation and mortality rates were 2.3 and 3.4%, respectively. Malignant renal tumors are predominant indications for nephrectomy in our institution. Though associated with a high transfusion rate, open nephrectomy remains a safe procedure with a good short-term outcome.

Recurrent Metachronous Metastatic Renal Cell Carcinoma to the Breast- Think Kidney! Case report and Literature Review

Background: Metastases to the breast from non-mammary primary tumours are uncommon and account for 0.5-2.0% of all breast malignancies. Renal cell carcinomas (RCC) (historically also known as hypernephroma or Grawitz tumour) are primary malignant adenocarcinomas derived from the renal tubular epithelium and are the most common malignant renal tumour. Metastatic renal cell carcinoma to the breast is very rare, with 23 cases published in the literature. We present a patient with a history of previous RCC treated surgically who has developed three recurrences of metastatic RCC to the same breast.

Development and Validation of a Nomogram to Predict Distant Metastasis in Elderly Patients With Renal Cell Carcinoma

BackgroundRenal cell carcinoma (RCC) is the most common renal malignant tumor in elderly patients. The prognosis of renal cell carcinoma with distant metastasis is poor. We aim to construct a nomogram to predict the risk of distant metastasis in elderly patients with RCC to help doctors and patients with early intervention and improve the survival rate.MethodsThe clinicopathological information of patients was downloaded from SEER to identify all elderly patients with RCC over 65 years old from 2010 to 2018. Univariate and multivariate logistic regression analyzed the training cohort's independent risk factors for distant metastasis. A nomogram was established to predict the distant metastasis of elderly patients with RCC based on these risk factors. We used the consistency index (C-index), calibration curve, and area under the receiver operating curve (AUC) to evaluate the accuracy and discrimination of the prediction model. Decision curve analysis (DCA) was used to assess the clinical application value of the model.ResultsA total of 36,365 elderly patients with RCC were included in the study. They were randomly divided into the training cohort (N = 25,321) and the validation cohort (N = 11,044). In the training cohort, univariate and multivariate logistic regression analysis suggested that race, tumor histological type, histological grade, T stage, N stage, tumor size, surgery, radiotherapy, and chemotherapy were independent risk factors for distant metastasis elderly patients with RCC. A nomogram was constructed to predict the risk of distant metastasis in elderly patients with RCC. The training and validation cohort's C-indexes are 0.949 and 0.954, respectively, indicating that the nomogram has excellent accuracy. AUC of the training and validation cohorts indicated excellent predictive ability. DCA suggested that the nomogram had a better clinical application value than the traditional TN staging.ConclusionThis study constructed a new nomogram to predict the risk of distant metastasis in elderly patients with RCC. The nomogram has excellent accuracy and reliability, which can help doctors and patients actively monitor and follow up patients to prevent distant metastasis of tumors.

Utilisation of virtual non-contrast images and virtual mono-energetic images acquired from dual-layer spectral CT for renal cell carcinoma: image quality and radiation dose

BackgroundRenal cell carcinoma (RCC) is the most common renal malignant tumour. We evaluated the potential value and dose reduction of virtual non-contrast (VNC) images and virtual monoenergetic images (VMIs) from dual-layer spectral CT (DL-CT) in the diagnosis of RCC.ResultsSixty-two patients with pathologically confirmed RCC who underwent contrast-enhanced DL-CT were retrospectively analysed. For the comparison between true non-contrast (TNC) and VNC images of the excretory phase, the attenuation, image noise, signal-to-noise ratio (SNR) and subjective image quality of tumours and different abdominal organs and tissues were evaluated. To compare corticomedullary phase images and low keV VMIs (40 to 100 keV) from the nephrographic phase, the attenuation, image noise, SNR and subjective lesion visibility of the tumours and renal arteries were evaluated. For the tumours, significant differences were not observed in attenuation, noise or SNR between TNC and VNC images (p > 0.05). For the abdominal organs and tissues, except for fat, the difference in attenuation was 100% within 15 HU and 96.78% within 10 HU. The subjective image quality of TNC and VNC images was equivalent (p > 0.05). The attenuation of lesions in 40 keV VMIs and renal arteries in 60 keV VMIs were similar to those in the corticomedullary images (p > 0.05). The subjective lesion visibility in low keV VMIs is slightly lower than that in the corticomedullary images (p < 0.05). Using VNC and VMIs instead of TNC and corticomedullary phase images could decrease the radiation dose by 50.5%.ConclusionVNC images and VMIs acquired from DL-CT can maintain good image quality and decrease the radiation dose for diagnosis of RCC.