Malignant Renal Tumors Research Articles

Paediatric Renal Mass: A Case Report

More than 90% of malignant renal tumors encountered in children are Nephroblastoma. Renal Cell Carcinoma is extremely rare in children but in children older than 5 years with renal masses it is very important to suspect diagnosis. We present a 6 years old child primarily presented with abdominal mass and haematuria. The mass was described by ultrasonography & computer tomography as Wilms’ Tumour which is commonest before 5 years of age with peak age of presentation is 3 years of life. Surgery is the best treatment and prognosis is favorable when tumour is localized and completely eradicated. In our case no adjuvant therapy was given nephrectomy Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.102-104

Squamous Cell Carcinoma in Non-Functioning Kidney Associated with Staghorn Calculi: Uncommon Presentation of Common Malignancy

Cancers of the kidney account for 2% of all the total human cancer. Squamous cell carcinoma (SCC) of renal pelvis is a rare neoplasm, accounting for only 0.5 to 0.8% of malignant renal tumors. In most cases, renal SCC is associated with chronic infections, chronic renal calculi, radiotherapy or any factor that can irritate the urothelium. We report a female patient aged 60 years diagnosed with Right Non-functioning Kidney with Nephrolithiasis with Suspicious Mass. Histopathological diagnosis with Squamous Cell Carcinoma in Stage III with Staghorn Calculi. In long standing urolithiasis, possibility of concomitant harboring of malignancy needs to be taken into consideration.

Giant Wilms tumor in a child: Safe radical nephrectomy

Abstract Wilms tumor is the second most common intraabdominal malignancy, and the most common malignant renal tumor in the pediatric age group, accounting for more than 95% of all renal tumors in children. In the last few decades, a significant improvement has been reported in the prognosis of patients with Wilms tumors due to adopting a multidisciplinary treatment approach consisting of surgery, chemotherapy and radiotherapy based on results of sequential trials. Regardless the kind of protocol followed to treat children with Wilms tumor, surgery remains an essential and fundamental step in the overall management. Well performed surgeries following rules of safe tumor excision, evaluation of disease extension and lymph nodes sampling will determine the accurate stage of the disease and decide future therapy. Although Wilms tumors can often grow to very large sizes at time of detection, most are resectable and radical nephrectomy should almost be the initial therapeutic option unless there are indications of delayed resection. We present a giant right sided Wilms tumor that developed in a 16 months old female, where surgical excision was attempted as the initial therapeutic option and discuss the preoperative evaluation, intraoperative details and immediate postoperative outcome.

Identification of miRNA signatures for kidney renal clear cell carcinoma using the tensor-decomposition method

Cancer is a highly complex disease caused by multiple genetic factors. MicroRNA (miRNA) and mRNA expression profiles are useful for identifying prognostic biomarkers for cancer. Kidney renal clear cell carcinoma (KIRC), which accounts for more than 70% of all renal malignant tumour cases, was selected for our analysis. Traditional methods of identifying cancer prognostic markers may not be accurate. Tensor decomposition (TD) is a useful method uncovering the underlying low-dimensional structures in the tensor. The TD-based unsupervised feature extraction method was applied to analyse mRNA and miRNA expression profiles. Biological annotations of the prognostic miRNAs and mRNAs were examined utilizing the pathway and oncogenic signature databases DIANA-miRPath and MSigDB. TD identified the miRNA signatures and the associated genes. These genes were found to be involved in cancer-related pathways, and 23 genes were significantly correlated with the survival of KIRC patients. We demonstrated that the results are robust and not highly dependent upon the databases we selected. Compared with traditional supervised methods tested, TD achieves much better performance in selecting prognostic miRNAs and mRNAs. These results suggest that integrated analysis using the TD-based unsupervised feature extraction technique is an effective strategy for identifying prognostic signatures in cancer studies.

Clinicopathologic spectrum of adult nephrectomy specimens – A two year study

Nephrectomy is indicated in patients with a wide range of conditions such as irreversibly damaged kidney resulting from symptomatic chronic infections, obstruction, calculi, severe traumatic injury, treatment of renovascular hypertension from non correctable renal artery disease or renal cell carcinoma. To review the clinicopathological spectrum of renal lesions in total or partial nephrectomy specimens in a tertiary care hospital in Mangalore and to study the non neoplastic renal parenchyma in tumor nephrectomy specimens. Materials and MethodsThe present study was done on 52 nephrectomy specimens received at the Department of Pathology, A.J Institute of Medical Sciences & Research Centre, Mangalore during a period of 2 years (May 2014 - May 2016). A total of 52 cases over a period of 2 years were studied out of which 35(67.3%) were neoplastic.34/35 were malignant out of which, 29 were Clear cell Renal Cell Carcinoma (RCC) followed by 2 cases of papillary RCC, 2 cases of sarcomatoid RCC and 1 case of chromophobe RCC. A single case of angiomyolipoma were found. The most common finding in nonneoplastic renal parenchyma immediately adjacent to the tumor was chronic pyelonephritis 57.1% and one case showed caseating tuberculous nephritis. Out of 17 non-neoplastic conditions, 52.9% were hydronephrosis in association with chronic pyelonephritis. Two cases each of adult polycystic kidney disease and caseating tuberculous pyelonephritis were found. Malignant renal tumors are the major indication for nephrectomy and adequate examination of the adjacent non-neoplastic renal parenchyma is an important tool in recognising patients at risk for early patient care. A detailed histological study of benign nephrectomies could be a clinical predictor for further clinical course, as well as a management strategy for slowing down the progression or decline of renal function.

Shape and texture-based radiomics signature on CT effectively discriminates benign from malignant renal masses.

Using a radiomics framework to quantitatively analyze tumor shape and texture features in three dimensions, we tested its ability to objectively and robustly distinguish between benign and malignant renal masses. We assessed the relative contributions of shape and texture metrics separately and together in the prediction model. Computed tomography (CT) images of 735 patients with 539 malignant and 196 benign masses were segmented in this retrospective study. Thirty-three shape and 760 texture metrics were calculated per tumor. Tumor classification models using shape, texture, and both metrics were built using random forest and AdaBoost with tenfold cross-validation. Sensitivity analyses on five sub-cohorts with respect to the acquisition phase were conducted. Additional sensitivity analyses after multiple imputation were also conducted. Model performance was assessed using AUC. Random forest classifier showed shape metrics featuring within the top 10% performing metrics regardless of phase, attaining the highest variable importance in the corticomedullary phase. Convex hull perimeter ratio is a consistently high-performing shape feature. Shape metrics alone achieved an AUC ranging 0.64-0.68 across multiple classifiers, compared with 0.67-0.75 and 0.68-0.75 achieved by texture-only and combined models, respectively. Shape metrics alone attain high prediction performance and high variable importance in the combined model, while being independent of the acquisition phase (unlike texture). Shape analysis therefore should not be overlooked in its potential to distinguish benign from malignant tumors, and future radiomics platforms powered by machine learning should harness both shape and texture metrics. • Current radiomics research is heavily weighted towards texture analysis, but quantitative shape metrics should not be ignored in their potential to distinguish benign from malignant renal tumors. • Shape metrics alone can attain high prediction performance and demonstrate high variable importance in the combined shape and texture radiomics model. • Any future radiomics platform powered by machine learning should harness both shape and texture metrics, especially since tumor shape (unlike texture) is independent of the acquisition phase and more robust from the imaging variations.

Essential Elements as Biomarkers of Metastatic Renal Cell Carcinoma

Renal cell carcinoma (RCC) represents 3% of human malignant tumors and approximately 90% of malignant renal neoplasms. Despite great therapeutic advances in the last decade, metastatic RCC (mRCC) is still considered an incurable disease. In this study, we examined the potential of essential elements as biomarkers of mRCC using an orthotropic metastatic mouse model. Frozen lung and plasma samples from healthy and mRCC-induced mice were lyophilized, digested, and analyzed using inductively coupled plasma mass spectrometry. In metastatic lungs, a significant increase in Ca concentration (268%) was observed, whereas a significant decrease in Cu (23.2%), Fe (17.4%), Mn (38.8%), and Na (11.7%) was observed. The plasma of mRCC-induced mice showed decreased concentrations of Mn (53%), Na (19.7%) and Zn (49,50%) and increased levels of Ca (53%), Cu (39.5%), Our findings revealed marked differences in the concentrations of essential elements in the lung and plasma of the metastatic mouse model. The circulating levels of Ca, Cu, Mn, Na, and Zn could be utilized as diagnostic and therapeutic response biomarkers.

Dual-Phase 99mTc-MIBI SPECT/CT in the Characterization of Enhancing Solid Renal Tumors: A Single-Institution Study of 147 Cases.

The aim of this study was to investigate the value of dual-phase Tc-MIBI SPECT/CT in the differential diagnosis between benign and malignant enhancing solid renal tumors. Totally, 180 patients were imaged with dual-phase Tc-MIBI SPECT/CT, which was performed 30 minutes and 90 minutes after Tc-MIBI administration. Among them, 147 patients with 148 histologically proved solid renal tumors met the selection criteria and were included for the final analysis. Relative quantification was performed by measuring the radioactive uptake ratio of tumor to the normal renal parenchymal background for both early and delayed images. Benign renal tumors (4 renal oncocytomas and 8 lipid-poor angiomyolipomas) demonstrated a significantly higher early relative uptake value (ERUV) and delayed relative uptake value (DRUV) than malignant renal tumors (n = 136; both P < 0.0001). The ERUV cutoff value of 0.53 helped to differentiate benign from malignant renal tumors, with sensitivity of 100%, specificity of 94.8%, and accuracy of 95.3% for the diagnosis of benign renal tumors. The DRUV cutoff value of 0.50 helped to differentiate benign from malignant renal tumors, with sensitivity of 100%, specificity of 96.3%, and accuracy of 96.6% for the diagnosis of benign renal tumors. There was no statistically significant difference between the efficacy of ERUV and DRUV in the differential diagnosis between benign and malignant renal tumors (P = 0.5). The efficacies of ERUV and DRUV were all significantly higher than the retention index (both P < 0.0001). Both early and delayed phase Tc-MIBI SPECT/CT are helpful for distinguishing benign renal oncocytoma and lipid-poor angiomyolipoma from malignant renal tumors, and the delayed phase imaging tends to show higher diagnostic accuracy.

Incidence of childhood renal tumours: An international population-based study.

Malignant renal tumours represent 5% of childhood cancers and include types with likely different aetiology: Wilms tumour (WT), rhabdoid renal tumour, kidney sarcomas and renal carcinomas. WT is the most common renal tumour in children, previously shown to vary internationally and with ethnicity. Using the comprehensive database of the International Incidence of Childhood Cancer study (IICC), we analysed global variations and time trends in incidence of renal tumour types in children (age 0‐14 years) and adolescents (age 15‐19 years). The results were presented by 14 world regions, and five ethnic groups in the US. We included 15 320 renal tumours in children and 800 in adolescents reported to the 163 contributing registries during 2001‐2010. In children, age‐standardised incidence rate (ASR) of renal tumours was 8.3 per million (95% confidence interval, CI = 8.1, 8.4); it was the highest in North America and Europe (9‐10 per million) and the lowest in most Asian regions (4‐5 per million). In the US, Blacks had the highest ASR (10.9 per million, 95% CI = 10.2, 11.6) and Asian and Pacific Islanders the lowest (4.4 per million, 95% CI = 3.6, 5.1). In adolescents, age‐specific incidence rate of renal tumours was 1.4 per million (95% CI = 1.3, 1.5). WT accounted for over 90% of all renal tumours in each age from 1 to 7 years and the proportion of renal carcinomas increased gradually with age. From 1996 to 2010, incidence remained mostly stable for WT (average annual percent change, AAPC = 0.1) and increased for renal carcinomas in children (AAPC = 3.7) and adolescents (AAPC = 3.2). Our findings warrant further monitoring.

Does renal tumor biopsies for small renal carcinoma increase the risk of upstaging on final surgery pathology report and the risk of recurrence?

BackgroundRenal tumor biopsies (RTB) have been proposed as a means to diminish overtreatment of small renal masses. A potential concern of RTB is tumor seeding along the biopsy tract leading to worse clinical outcomes. ObjectivesTo evaluate whether RTB was associated with greater upstaging to pT3a compared to patients without a biopsy and to determine if pathologic upstaging affects the risk of recurrence. Design, setting and participantsThe Canadian Kidney Cancer information system was used to identify patients who underwent radical or partial nephrectomy for malignant renal tumors ≤ 4cm (cT1a) between January 1, 2011 and July 2, 2019. InterventionRTB prior to nephrectomy or nephrectomy without biopsy. Outcomes measurements and statistical analysisUpstaging to pT3a and cancer recurrence were compared between subjects that had a RTB compared to those who did not. A multivariable analysis was used to evaluate factors associated with disease upstaging and recurrence. Results and limitationsThe cohort consisted of 1993 cT1a patients, followed for a median of 17.5 months. Of these patients, 502 (25%) had a preoperative RTB. There was no difference in the proportion with tumor upstaging to pT3a between patients that had RTB compared to those who did not (7.2% vs. 6.3%; P = 0.5). On multivariable analysis, RTB was not associated with pathological upstaging (Odds Ratio 0.90; 95% Confidence Interval 0.61–1.34) or recurrence (Odds Ratio 1.04; 95% Confidence Interval 0.57–1.89). The main limitation is that the study is underpowered to detect small differences between groups. ConclusionsIn this large, multi-institution cohort, RTB was not associated with increased risk of tumor upstaging or recurrence. Hence, tumor tract seeding, although possible, should not be a clinical deterrent to using RTBs as a means of personalizing renal masses management and diminishing overtreatment. Patient summaryRecent evidence suggests that tumor seeding following RTB may be more common than initially perceived. Our results have demonstrated that RTB was not associated with an increased risk of tumor upstaging or disease recurrence.

MicroRNA Profiling in Wilms Tumor: Identification of Potential Biomarkers

Wilms tumor (WT) is the most frequently diagnosed malignant renal tumor in children. With current treatments, ~90% of children diagnosed with WT survive and generally present with tumors characterized by favorable histology (FHWT), whereas prognosis is poor for the remaining 10% of cases where the tumors are characterized by cellular diffuse anaplasia (DAWT). Relatively few studies have investigated microRNA-related epigenetic regulation and its relationship with altered gene expression in WT. Here, we aim to identify microRNAs differentially expressed in WT and describe their expression in terms of cellular anaplasia, metastasis, and association with the main genetic alterations in WT to identify potential prognostic biomarkers. Expression profiling using TaqMan low-density array was performed in a discovery cohort consisting of four DAWT and eight FHWT samples. Relative quantification resulted in the identification of 109 (48.7%) microRNAs differentially expressed in both WT types. Of these, miR-10a-5p, miR-29a-3p, miR-181a-5p, miR-200b-3p, and miR-218-5p were selected and tested by RT-qPCR on a validation cohort of 53 patient samples. MiR-29a and miR-218 showed significant differences in FHWT with low (P = 0.0018) and high (P = 0.0131) expression, respectively. To discriminate between miRNA expression FHWTs and healthy controls, the receiver operating characteristic (ROC) curves were obtained; miR-29a AUC was 0.7843. Furthermore, low expression levels of miR-29a and miR-200b (P = 0.0027 and P = 0.0248) were observed in metastatic tumors. ROC curves for miR-29a discriminated metastatic patients (AUC = 0.8529) and miR-200b (AUC = 0.7757). To confirm the differences between cases with poor prognosis, we performed in situ hybridization for three microRNAs in five DAWT and 17 FHWT samples, and only significant differences between adjacent tissues and FHWT tumors were found for miR-181a, miR-200b, and miR-218, in both total pixels and nuclear analyses. Analysis of copy number variation in genes showed that the most prevalent alterations were WTX (47%), IGF2 (21%), 1q (36%) gain, 1p36 (16%), and WTX deletion/1q duplicate (26%). The five microRNAs evaluated are involved in the Hippo signaling pathway and participate in Wilms tumor development through their effects on differentiation, proliferation, angiogenesis, and metastasis.

Surgical aspects, violations and outcomes of Wilms tumor\u2014a multicenter study in a resource-limited country

BackgroundWilms tumor is the commonest malignant renal neoplasm in children. Surgery plays a pivotal role in the management, and evidence-based guidelines for surgical resection have been established by the major international groups. Any deviation from the protocol is considered as a violation. The goal of this study was to evaluate outcomes of the patients with unilateral Wilms tumor treated at a developing country and to analyze surgical violations (SV) and their impact on the prognosis. A retrospective review was conducted for 37 patients who were presented to our hospitals and underwent nephrectomy for WT from January 2016 to December 2018. All participating centers adopt Children’s Oncology Group protocol. The SV were analyzed by logistic regression. Overall survival (OS) and event-free survival (EFS) were estimated by the Kaplan-Meier method.ResultsThere were 12 (32.4%), 11 (29.7%), 10 (27%), and 4 (10.8%) stages I, II, III, and IV, respectively. Their median age at time of diagnosis was 3.1 years. Upfront nephrectomy was performed for 30 cases. Six patients had tumor relapse (2 lungs and 4 local recurrences) at a median follow-up of 15.7 months. Out of the relapsed patients, two had unfavorable histology, and regarding their staging, four were stage III, one was stage II, and one was stage IV. Thirty-month OS and EFS were 84.3% and 81.1%, respectively. Twenty-seven SV occurred within 25 patients. Lack or inadequate lymph node sampling represented 74.07% (20/27), intraoperative tumor rupture and spillage accounted for 18.52% (5/27), and unwarranted preoperative biopsy happened in 7.41% (2/27). The SV were not correlated with mortality (p value = 0.381); however, they had a significant impact on the relapse (p value = 0.001). On further analysis; tumor rupture and spillage was a predictor for recurrence reaching a statistical significance (p value = 0.003), whereas the other violations were not.ConclusionsFavorable outcomes could be achieved by compliance with evidence-based guidelines even in a resource-limited country like ours. Violations were correlated with relapse; however, only tumor rupture and spillage was of statistical significance in multivariate analysis. Failure of lymph node documentation was the main problem encountered, and it should be avoidable in future practice.

P0626THE RISK FACTORS OF ACUTE KIDNEY INJURY CAUSED BY HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS

Abstract Background and Aims Hemophagocytic lymphohistiocytosis (HLH) is a syndrome caused by uncontrolled natural killer (NK) cell and cytotoxic T cell activation, resulting in the overproduction of proinflammatory cytokines and hemophagocytosis. Acute kidney injury (AKI) characterized by rapid loss of renal excretion function is the most common complication of HLH in the kidney. In this retrospective study, we aimed to find the risk factors of AKI in patients with HLH. Method This study included adult patients with HLH admitted in West China Hospital of Sichuan University from January 2009 to June 2019. Patients with HLH were excluded from the study if they had a functioning kidney transplant, received renal replacement therapy (RRT) in the past month, suffered from end-stage renal disease (ESRD) or had the renal malignant tumor. The diagnosis of HLH was based on the HLH diagnostic criteria revised by the Histocyte Society in 2004 and AKI was defined according to the 2012 KDIGO (Kidney Disease: Improving Global Outcomes) guideline. We collected basic information, clinical manifestations and laboratory data of patients from electronic medical records. Results We analyzed 294 patients this time, of whom 95 (32.3%) developed AKI. The patients were divided into two groups according to the occurrence of AKI. The mortality rate in the AKI group was significantly higher than that in the non-AKI group (40.0% VS 12.6%; p&amp;lt;0.001). The risk factors of AKI in patients with HLH were hyperphosphatemia [Odds Ratio (OR) 3.825; 95% Confidence Interval (CI) 1.647-8.886; p=0.002] ,heart failure (OR 2.972; 95% CI 1.029-8.584; p=0.044), increased heart rate (OR 1.025; 95% CI 1.008-1.043; p=0.004), prolonged prothrombin time (OR 1.025; 95% CI 1.001-1.049; p=0.041), elevated total bilirubin level (OR 1.003; 95% CI 1.000-1.007; p=0.030), and hypoproteinemia (OR 0.915; 95% CI 0.842-0.994; p=0.035). Conclusion The incidence of AKI in HLH patients is frequent, and the risk of death in HLH patients with AKI is significantly higher. The occurrence of AKI in patients with HLH is related to hyperphosphatemia, heart failure, increased heart rate, prolonged prothrombin time, elevated total bilirubin level, and hypoproteinemia.

2269-PUB: Correlation between Serum Uric Acid Level in Adult Males and Their Fasting Blood Glucose Level in the Time of 1.5 Years

Objective: Investigating the correlation between serum uric acid (SUA) level in adult males and their fasting blood glucose (FBG) level in the time of 1.5 years. Methods: Retrospective analysis based on two physical examinations including laboratory tests held at the Beijing Hospital during the period from 2014 to 2018, on 2337 adult males who work on non-physical jobs. Mean age was 61.6±13.3 at the first exam and 63.1±13.3 at the second exam. The two exams were held in the same season with an interval of 1-2 years (average 1.5). Results were collected from questionnaire, physical exams, and laboratory tests including levels of SUA, FBG, Hemoglobin Subunit Alpha 1, total cholesterol, triglycerides, LDL-c, HDL-c, creatinine, etc. During the first exam, no diabetes mellitus, gout, hepatic and renal insufficiency or malignant tumor was found, and all participants showed FBG &amp;lt; 7.0 mmol/L. Data were divided into 4 groups based on SUA levels obtained from the two exams. Group 1 (296 participants, 12.7%): SUA ≥ 420umol/L in both exams. Group 2 (458 participants, 19.6%): SUA ≥ 420umol/L in one exam while 240 ≤ SUA &amp;lt; 420umol/L in the other one. Group 3 (1479 participants, 63.3%): 240 ≤ SUA &amp;lt; 420umol/L in both exams. Group 4 (104 participants, 4.4%): SUA&amp;lt;240umol/L. Results:1. A total of 136 participants (5.8%) showed FBG ≥ 7.0 mmol/L at the second exam, among which 29 (9.8%) belong to group 1, 40 (8.7%) belong to group 2, 65 (4.4%) belong to group 3, and 2 (1.9%) belong to group 4 (X2 24.000,P 0.000). 2. Risk analysis: Compared to group 4, the risk of individuals having FBG≥7.0mmol/L was 5.539 (95%CI 1.298-23.637) for group 1, 4.880 (95%CI 1.160-20.527) for group 2, and 2.344 (95%CI 0.566-9.712) for group 3. Conclusions: The Hyperuricemia in adult males, especially those with Chronic Hyperuricemia, is correlated to the increase of FBG in the time of 1.5 years. Hyperuricemia is potentially a predictor of FBG increase in adult males, and clinical diagnosis of diabetes is required for those having FBG≥7.0mmol/L. Disclosure Y. Wang: None.

Wilms’ tumor: A rare presentation

Wilms’ tumor is the most common malignant renal tumor of childhood with a majority of them diagnosed before 5 years of age. The incidence of metastases of Wilms’ tumor is approximately 10%. The primary distant site for metastasis is the lung; bone metastasis being extremely rare.Relapses after 5 years of diagnosis is uncommon in Wilms’ tumor and there are very few cases of relapse after 20 years of initial diagnosis. We present here a rare case of a patient who was diagnosed with Wilms’ tumor 17 years ago and now presented with a lung mass.

Comprehensive analysis of long non‑coding RNA using an associated competitive endogenous RNA network in Wilms tumor.

Wilms tumor (WT) is the most common malignant renal neoplasm in children; however, the underlying molecular mechanisms are not well understood. According to the competing endogenous RNA (ceRNA) theory, long non-coding RNAs (lncRNAs) can regulate the expression of target genes by adsorbing microRNAs (miRNAs/miRs). However, the role of lncRNAs in WT has not been fully elucidated. The aim of the present study was to construct a ceRNA network to identify the potential lncRNAs involved in WT. The expression profiles of lncRNAs, miRNAs and mRNAs in 120 WT and six normal tissues were obtained from the Therapeutically Applicable Research to Generate Effective Treatments database. A total of 442 lncRNAs, 214 miRNAs and 4,912 mRNAs were identified as differentially expressed in WT and were enriched in 472 Gene Ontology terms (355 biological processes, 89 cellular components and 29 molecular functions) and 18 Kyoto Encyclopedia of Genes and Genomes pathways. A lncRNA-miRNA-mRNA ceRNA network of WT consisting of with 32 lncRNAs, 14 miRNAs and 158 mRNAs was constructed, based on the bioinformatics analysis of the miR target prediction database and the miRNAcode, miRTarBase and TargetScan databases. Subsequently, three lncRNAs, three miRNAs and 17 mRNAs, which had a significant effect on the overall survival rate of patients with WT, were identified based on the survival analysis. The three lncRNAs were also differentially expressed in the late and early stages of WT and were validated using the GSE66405 dataset obtained from the Gene Expression Omnibus database. In conclusion, the present study generated a specific lncRNA-related ceRNA network of WT, which may provide a novel perspective on the molecular mechanisms underlying the progression and prognosis of the disease.

Primary Renal Mesenchymal Neoplasms in Nephrectomy Specimens: A 16-Year Survey of Primary and Incidental Cases From a Single Institution

Context. Primary renal mesenchymal neoplasms are rare but diverse. Several neoplasms of mesenchymal derivation can arise as a primary renal mass; however, incidental tumors are identified in nephrectomies performed for end-stage renal disease or other malignant epithelial renal neoplasms. In this article, we document their frequencies with demographic information in nephrectomy specimens. Design. We retrospectively searched our database for nephrectomy specimens from the year 2000 to 2016. Results. A total of 224 cases were identified with an incidence rate of 4.4% (224/5128). One hundred ninety (85%) neoplasms were benign, 27 (12%) were malignant, and 7 (3%) were of intermediate biologic behavior. The majority of cases occurred in adults (93%, 208/224), and 39% of cases represented an incidental finding. The most common neoplasms were angiomyolipoma (58%) and renomedullary interstitial cell tumor (17%). Malignant mesenchymal kidney tumors are rare (0.39% of nephrectomy specimens). The most common adults' malignant tumors in our survey were synovial sarcoma and Ewing's sarcoma. Conclusion. Primary renal mesenchymal tumors are rare and are mostly benign in nature with many incidentally identified lesions. They arise in different age groups with malignant lesions usually presenting at a younger mean age.

The prognostic value of ephrin type-A2 receptor and Ki-67 in renal cell carcinoma patients: An Immunohistochemical and Bioinformatical Approach; A STROBE - compliant article.

Patients with renal cell carcinoma (RCC), the most common malignant renal epithelial tumor, usually present with advanced disease and unpredicted clinical behavior. The receptor tyrosine kinase, ephrin type-A receptor 2 (EphA2) was found to be overexpressed in several malignancies and its expression was found to be associated with poor prognostic features.Our study is an observational study with the aim of investigating the prognostic value of EphA2 in RCC patients and its association with clinicopathological parameters as well as Ki-67 expression, which is a well-known proliferative and prognostic marker in RCC.EphA2 and Ki-67 immunohistochemical staining was performed on whole sections representative of 50 patients diagnosed with primary RCC from 2013 to 2018. In addition, the association between EphA2 mRNA expression and clinicopathological parameters as well as the patients’ outcome was also evaluated using two large publicly available databases.Our results showed a significant association between EphA2 immunohistochemical expression and tumor size, nuclear grade, tumor stage, patients’ outcome and Ki-67 expression (P < .05 for all). The same trend was also observed with EphA2 mRNA expression using larger patients’ cohorts in 2 publicly available databases. Notably, EphA2 protein expression showed higher levels of co-expression with the proliferative marker Ki-67.Our results suggested that higher expression of EphA2 and Ki-67 in tumor tissues predicts a locally aggressive behaviour and poor outcome of patients with RCC. Moreover, our results give a rationale for the potential benefits of using novel therapeutic strategies with the aim of targeting EphA2 receptor in RCC patients that might help in improving their outcome.

Ung thư biểu mô tế bào vảy của đài bể thận (rscc): thông báo 1 trường hợp và hồi cứu y văn

SQUAMOUS CELL CARCINOMA (SCC) OF THE RENAL PELVIS: A CASE REPORT AND REVIEW OF LITERATURE Background: SCC of Renal pelvis are rare in clinical practice and patholoyl. We report a case with clinicopathological correlation of SCC in Hospital C Da Nang The purpose of this case is to demonstrate on unusual and aggressive of SCC .The discusses the clinical and and radiological features. Methods :We review the clinical and pathological record of a case RSCC in retrospective of nephrectomy specimens and follow up the patient from Oct/2018 to Jan/2019 and approprivate literatures Case reportA 78 years old malepresented with history of renal stone operation ten years ago.The patient admitted with flank,abdominal pain and hematuria.Family history and physical examination were within normal limits Ultrasound examination of abdomen showed left renal calculi, KUB and UIV which reveals only calculi and hydronephrosisAbdominal CT reveals a left renal pelvis mass, calculis and large lymph nodes. The patient underwent a left radical nephrectomy without complications Histopathological examination revealed features of well – differentiated squamous cell carcinoma of renal with extensive involvement of renal parenchyma and metastasis to lymph nodes.Due to aggressive nature of these tumour patient develop locally recurrence and disseminated metastatic disease. The patients was dead four month after pathologic diagnosis. Primary SCC of renal pelvis is rare, which represents only 0.5 to 15 % of malignant renal tumor. Few such cases have been reported.Nephrolithiasis, especially formation of staghorn stone was accepted as a main carcinogenic risk factor SCC. Chronic irritation, inflammation and infection are believed to induce reactive change in the urothelium and leads to neoplasia via metaplasia and leucoplasia. Initial diagnosis of SCC is based on histopathological examination. The histopathology is the hallmark of diagnosis because of lack of characteristic clinical and imaging features. Most of these SCC are moderately or presented with advance stage. The current primary treatment of renal SCC is nephrectomy, adjuvant chemotherapy or radiotherapy indicated in metastatic disease. However, it is highly aggressive unfavorable outcome, suggesting very poor prognosis, with a median survival of 3.5 months in cases of metastatic dissemination; 7 months post operatively and a dismal 5 years survival rate 7.7% Conclusion: primary SCC of renal pelvis is a rare aggressive tumor with poor prognosis. The patient with newer imagingteachnologies for early detaction of the tumor that may lead to better outcome for the patients Histopathology is the hallmark of diagnosis which is usually made after surgical resection Keyword: Squamous cell carcinoma of renal pelvis.

Deep Learning to Distinguish Benign from Malignant Renal Lesions Based on Routine MR Imaging.

With increasing incidence of renal mass, it is important to make a pretreatment differentiation between benign renal mass and malignant tumor. We aimed to develop a deep learning model that distinguishes benign renal tumors from renal cell carcinoma (RCC) by applying a residual convolutional neural network (ResNet) on routine MR imaging. Preoperative MR images (T2-weighted and T1-postcontrast sequences) of 1,162 renal lesions definitely diagnosed on pathology or imaging in a multicenter cohort were divided into training, validation, and test sets (70:20:10 split). An ensemble model based on ResNet was built combining clinical variables and T1C and T2WI MR images using a bagging classifier to predict renal tumor pathology. Final model performance was compared with expert interpretation and the most optimized radiomics model. Among the 1,162 renal lesions, 655 were malignant and 507 were benign. Compared with a baseline zero rule algorithm, the ensemble deep learning model had a statistically significant higher test accuracy (0.70 vs. 0.56, P = 0.004). Compared with all experts averaged, the ensemble deep learning model had higher test accuracy (0.70 vs. 0.60, P = 0.053), sensitivity (0.92 vs. 0.80, P = 0.017), and specificity (0.41 vs. 0.35, P = 0.450). Compared with the radiomics model, the ensemble deep learning model had higher test accuracy (0.70 vs. 0.62, P = 0.081), sensitivity (0.92 vs. 0.79, P = 0.012), and specificity (0.41 vs. 0.39, P = 0.770). Deep learning can noninvasively distinguish benign renal tumors from RCC using conventional MR imaging in a multi-institutional dataset with good accuracy, sensitivity, and specificity comparable with experts and radiomics.