Pole Of Kidney Research Articles

Renal infarction caused by fibromuscular dysplasia

Introduction: Fibromuscular dysplasia (FMD) is an atherosclerotic/non-inflammatory disease, usually involving the renal and internal carotid arteries. Renal infarction is a rare condition that can present with flank pain and can be caused by FMD. Case Report: A 49-year-old female patient was admitted to the emergency department with complaints of flank pain, fever, nausea, vomiting, and chills. Her blood pressure was normal. Abdominal examination showed right costovertebral tenderness. Laboratory assessment showed hematuria, leukocytosis, increased C-reactive protein (CRP), and increased lactate dehydrogenase (LDH). Nephrolithiasis was strongly considered a cause of pain because of the nature of the pain and the presence of hematuria. The urinary system ultrasound was normal. On the computed tomography (CT), in contrastenhanced sections, an infarct area was detected in the lower pole of the right kidney. In renal angiography, severe focal stenosis was seen in the polar renal artery, and angioplasty was made. Conclusion: Renal infarction can be caused by FMD and may be misdiagnosed as renal colic.

Primary renal leiomyosarcoma: A rare case report

Primary leiomyosarcoma of kidney is rare with aggressive behavior. A 61 year female presented with complaint of right flank pain since 2 months. Radiological investigation show mass in mid and lower pole of right kidney for which she underwent radical nephrectomy. Microscopy reveal malignant mesenchymal tumor and IHC confirmed the diagnosis of renal leiomyosarcoma with Caldesmon, smooth muscle actin [SMA] positive and Ki67% - 25%. Complete resection done and on follow up patient is doing well.

Percutaneous Nephrolithotomy Removal of Eroded Hem-o-lok Clip Post-Partial Nephrectomy

Clinical History: This video is a demonstration of the removal of an eroded Hem-o-lok clip post-partial nephrectomy through percutaneous nephrolithotomy (PCNL). The index patient is a 69-year-old gentleman, who received robotic partial nephrectomy 10 years ago for a right kidney lower pole renal cell carcinoma. Later he was presented with hematuria. Physical Examination: Physical examination was unremarkable. Diagnosis: A computer tomography scan discovered an eroded Hem-o-lok clip into the system at lower pole of the right kidney. There were associated stones. Otherwise, there was no other lesion in the urinary system explaining his symptoms. Intervention: Retrograde intrarenal surgery (RIRS) was performed but failed to access the lower pole Hem-o-lok and the associated stones. PCNL was attempted with modified prone position. Antegrade access with ultrasound-guided upper pole puncture was performed. Upper pole was punctured as it allows access to all calixes, including the lower pole, and also because of the distorted anatomy after partial nephrectomy observed in fluoroscopy in the previous RIRS. Holmium laser was employed for disengagement of the clip from surrounding mucosa. Stones were fragmented with Lithoclast lithotripter. Clip and the related stones were removed with forceps. Follow-Up/Outcomes: Patient was discharged one day postoperation and the pelvicaliceal system was clear of stones on a later computed tomography scan. Removal of eroded surgical clips endourologically with PCNL is a safe and possible method. No competing financial interests exist. Runtime of video: 4 mins 34 secs Patient Consent Statement: The authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.

Evaluation of the results and feasibility of vibration, diuresis and inversion therapy in the treatment of upper urinary tract stones

To evaluate the feasibility, efficiency, and predictive factors of therapeutic success of Vibration, Diuresis and Inversion (VDI) therapy for the removal of upper urinary tract stones. It is a retrospective, single-center study at the CHU - La Conception, Marseille, France including all patients treated with VDI from 2013to 2018. VDI was indicated for stones <6mm in first-line treatment or for residual fragments <6mm after ureteroscopy, PCNL, microPCNL. The protocol included 4sessions in outpatient care from 2013to 2015then 6sessions from 2015to 2018and a final radiological evaluation. In total, 109patients or 489sessions are reported: median age was 55years [14-84], median BMI 25kg/m2 [15-37], average cumulative size of kidney stones 3mm ±4. VDI was performed after flexible ureteroscopy (62%), SWL (20%), percutaneous treatment (9%) or as a first-line treatment (9%). Compliance was 87%. The median VAS during the session was 0[0-8]. The incidence of post-session renal colic was 4% (all Clavien I). The postoperative fragment-free and microfragment rates were respectively 39% and 21%, i.e. an overall success of 60% for kidney stones, and 43% and 21%, i.e. an overall success of 64% for lower pole kidney stones. VDI is a simple, non invasive and well tolerated technique for the elimination of small renal lithiasis after SWL, ureteroscopy, PCNL or as a first-line treatment.

Outcomes in Lower Pole Kidney Stone Management Using Mini-Percutaneous Nephrolithotomy Compared With Retrograde Intra Renal Surgery: A Randomized Controlled Trial.

Background Because of the anatomical properties of the inferior calyx, lower pole stones are difficult to remove through the ureter, even if the stones are fragmented. Retrograde intra-renal surgery (RIRS) is typically employed to treat the smaller lower pole stones (1.0-2.0 cm) while percutaneous nephrolithotomy (PCNL) is primarily used to treat the larger diameter stones or when RIRS has failed to clear the stones. This study was conducted to compare mini-PCNL and RIRS for the management of lower pole kidney stones in terms of stone clearance. Material and methods This randomized control trial was conducted in the Department of Urology, Shaikh Zayed Hospital, Lahore from October 2020 to December 2022. A total of 150 patients between the ages of 18 and 80 years with a kidney stone size of 10-20 mm at the lower pole were included. Patients with positive urine culture, anatomical abnormalities, uncontrolled diabetes (hemoglobin{Hb}A1c >9%), and undergone previous renal surgery were excluded. Group A patients were treated with mini-PCNL, while group B patients were managed with RIRS. Follow-up visits were planned four weeks postoperatively with CT KUB (computed tomography of kidneys, ureters, and bladder) plain to assess stone clearance. Results The mean age in group A was 43.27 ± 13.86 years, while in group B was 45.32 ± 14.14 years. Out of 150 patients, 102 (68.0%) were males and 48 (32.0%) were females. Mean size of the stone was 15.30 ± 2.21 mm. Stone clearance after mini-PCNL was found in 69 (92.0%) patients and after RIRS in 59 (78.67%) patients (p-value = 0.021). Mean hospital stay after RIRS was 1.1 ± 0.09 days, while it was 2.3 ± 0.64 days after mini-PCNL (p-value < 0.001). Two (2.67%) patients in the mini-PCNL group developed bleeding postoperatively. The stone clearance rate in older patients (51 to 80 years) was significantly higher in the mini-PCNL group than RIRS group. Similarly, the stone clearance rate in female patients and in patients with larger stones (16 to 20 mm) was found to be higher in mini-PCNL group as compared to the RIRS group. Conclusion This study concluded that both mini-PCNL and RIRS are safe and efficient techniques for treating lower pole kidney stones with a size of 11-15 mm. However, mini-PCNL has a higher stone clearance rate compared to RIRS in the treatment of stones larger than 15 mm in size. This study further suggested that patients treated with mini-PCNL had a longer hospital stay compared to patients treated with RIRS.

Prospective comparison of extracorporeal shock wave lithotripsy versus flexible ureterorenoscopy in patients with non-lower pole kidney stones under the COVID-19 pandemic.

Both shock wave lithotripsy (SWL) and flexible ureterorenoscopy (F-URS) are recommended as the first choice for non-lower pole kidney stones. Therefore, we conducted a prospective study to evaluate the efficacy, safety, and cost of SWL versus F-URS in patients with solitary non-lower pole kidney stones ≤ 20mm under the COVID-19 pandemic.This prospective study was conducted in a tertiary hospital from June 2020 to April 2022. Patients who underwent lithotripsy (SWL or F-URS) for non-lower pole kidney stones were enrolled in this study. The stone-free rate (SFR), retreatment rate, complications, and cost were recorded. Propensity score-matched (PSM) analysis was performed. A total of 699 patients were finally included, of which 81.3% (568) were treated with SWL and 18.7% (131) underwent F-URS. After PSM, SWL showed equivalent SFR (87.9% vs. 91.1%,P = 0.323), retreatment rate (8.6% vs. 4.8%,P = 0.169), and adjunctive procedure (2.6% vs. 4.9%,P = 0.385) compared with F-URS. Complications were scarce and also comparable between SWL and F-URS (6.0% vs 7.7%,P > 0.05), while the incidence of ureteral perforation was higher in the F-URS group compared with the SWL group (1.5% vs 0%,P = 0.008). The hospital stay was significantly shorter (1day vs 2days,P < 0.001), and the cost was considerably less (1200 vs 30,083,P < 0.001) in the SWL group compared with the F-URS group. This prospective cohort demonstrated that SWL had equivalent efficacy with more safety and cost benefits than F-URS in treating patients with solitary non-lower pole kidney stones ≤ 20mm. During the COVID-19 pandemic, SWL may have benefits in preserving hospital resources and limiting opportunity for virus transmission, compared to URS. These findings may guide clinical practice.

A rare occurrence of an incidental primary intra-abdominal Cystic Lymphangioma in a Middle Eastern adult female: A case report.

The authors hereby demonstrate the case of a 46-year-old lady who presented to the outpatient general surgery clinic at our university hospital complaining of chronic right hypochondriac abdominal pain. Investigative radiological imaging marked a cystic formation with well-defined borders and homogenous content extending from the lower pole of the right kidney to the lower hepatic border. Surgical intervention was performed by completely resecting the lesion in question. Directly afterward, histopathological analysis was achieved and established the diagnosis of a CL.Conclusion:CL is a rare neoplasm with ill-defined symptoms and ambiguous clinical presentations. They remain poorly studied due to their rarity and lack of sufficient data in the published literature. This magnifies the importance of clinical awareness and time-efficient surgical intervention. Documenting these cases aids in identifying their subsequent etiological origins, disease-specific risk factors, clinical course, and yields proposals of novel therapeutic approaches.

Synchronous Retroperitoneal Schwannoma and Incidental Papillary Renal Cell Carcinoma: A Case Report

Background: Retroperitoneal schwannoma is a rare tumor rising from Schwann cells in peripheral nerve sheaths. Retroperitoneal schwannoma is really infrequent and has nonspecific symptoms and imperfect radiologic features, and is often identified histologically after surgery.&#x0D; Case Report: We report the case of a 73-year-old man presented with flank mass. Imaging shows a hypoechoic macro lobulated solid cystic mass in retroperitoneum. Intraoperatively, after complete resection of retroperitoneal mass, a suspected lesion in upper pole of right kidney was observed. Histopathology evaluation after surgery shows coexistence of a large retroperitoneal schwannoma and papillary renal cell carcinoma, type 1.&#x0D; Conclusion: Schwannoma should be considered in the differential diagnosis of retroperitoneal spindle cell tumor. Schwannoma coexisted with renal cell carcinoma in a patient is an unusual event. Thus, it can show the importance of appropriate evaluation before any surgery.

Case of the Month from the Peter MacCallum Cancer Centre, Melbourne, Australia: combination of stereotactic ablative body radiotherapy and radical nephrectomy for synchronous bilateral primary renal cell carcinoma.

Case of the Month from the Peter MacCallum Cancer Centre, Melbourne, Australia: combination of stereotactic ablative body radiotherapy and radical nephrectomy for synchronous bilateral primary renal cell carcinoma.

Endovascular embolization of idiopathic renal arteriovenous fistula – A case report and literature review

Idiopathic renal arteriovenous fistulas (RAVFs) are rare vascular anomalies with no identifiable etiology. We present a case of 65-year-female who was being evaluated for complaints of the right flank pain and dysuria with no past history of trauma or surgery. Computed tomography showed arteriovenous fistula in lower pole of the right kidney with dilated branch of the right renal artery and dilated venous sacs. The patient was planned for endovascular embolization. Right renal angiogram showed dilated lower polar artery with a single-hole arteriovenous fistula. Selective coil embolization of the arterial channel was done. Post-deployment angiogram showed complete occlusion of the fistula and normal opacification of remaining segmental branches. On follow-up 1-month later, the patient was in good general condition. With advancements in endovascular techniques, transcatheter embolization has become initial treatment of choice for managing RAVF due to its less incidence for complications and preservation of renal function.

Comparison of Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy for Patients with Completely Lower Pole Renal Tumors.

(1) Background: For completely lower pole renal tumors, we compared the perioperative outcomes of robotic partial nephrectomy via transperitoneal and retroperitoneal approaches. (2) Methods: Complete lower pole renal tumors were defined as tumors that received 1 point for the “L” element of the R.E.N.A.L. and located at the lower pole of kidney. After confirming consistency in baseline characteristics, oncological and functional benefits were compared. Pentafecta achievement was used to represent the perioperative optimal outcome, followed by multivariate analysis of factors associated with the lack of pentafecta achievement. (3) Results: Among 151 patients identified, 116 (77%) underwent robotic partial nephrectomy via a transperitoneal approach and 35 (23%) via a retroperitoneal approach. Patients undergoing transperitoneal robotic partial nephrectomy experienced more blood loss than those undergoing retroperitoneal robotic partial nephrectomy (50 mL vs. 40 mL, p = 0.015). No significant differences were identified for operative time (120 min vs. 120 min), ischemia time (19 min vs. 20 min), positive surgical margins (0.0% vs. 2.86%), postoperative rate of complication (12.07% vs. 5.71%). No significant differences were identified in pathologic variables, eGFR decline in postoperative 12-month (3.9% vs. 5.4%) functional follow-up. Multivariate cox analysis showed that tumor size (OR: 0.523; 95% CI: 0.371−0.736; p < 0.001) alone was independently correlated to the achievement of pentafecta. (4) Conclusions: For completely lower pole renal tumors, transperitoneal and retroperitoneal robotic partial nephrectomy provide similar outcomes. These two surgical approaches remain feasible options for these cases.

Mucinous tubular and spindle cell carcinoma of the kidney.

Mucinous tubular and spindle cell carcinoma (MTSCC) is a unique neoplasm attributing to less than 1% of all renal cell carcinoma (RCC). The median age is 6th decade with a significant female preponderance.1 These tumors classically consist of tightly packed, elongated, and anastomosing tubules which merge with bland spindle cells in a myxoid stroma in variable proportions. Tubules with tufting or small papillae and foci of foamy macrophages may occur. The tumor cells are low-grade and may show clear cytoplasm or oncocytic changes with rare mitosis. Immunohistochemically, PAX8, CK7, AMACR, and CD10 are positive in this tumor.1,2 Though it is a morphological diagnosis, it can be challenging to differentiate from a solid variant of papillary RCC, sarcomatoid RCC, or myoid-predominant angiomyolipoma. Immunohistochemistry may be of little help due to overlapping profiles.3 Copy number analyses can help establish a diagnosis in challenging cases or core biopsies since these are associated with multiple chromosomal losses involving chromosomes 1, 4, 6, 8, 9, 13, 14, 15, and 22. Novel biomarkers like VSTM2A overexpression are also emerging, which can be detected by RNA in-situ hybridization. Recurrent Hippo pathway aberrations have been defined as the molecular signature of MTSCC with increased nuclear YAP1 protein expression.4 Adverse features such as necrosis, solid growth, single file infiltration, sarcomatoid transformation, lymphovascular invasion, and increased mitoses are indicators of metastatic disease. Although it has indolent behavior, rare cases with classic morphology have been seen to develop metastases.5-6 We describe gross and histopathological findings of mucinous tubular and spindle cell carcinoma in a 65-year-old male patient. He presented with right abdominal pain for one month. The pain was dull and mild to moderate in intensity. On contrast-enhanced ultrasound, a well-defined, smoothly marginated heterogeneous hyperechoic lesion measuring 5.5x6cm was noted at the upper pole of the right kidney. The lesion was hyper enhancing compared to the rest of the renal parenchyma. Based on the radiological findings, possibilities of chromophobe RCC and oncocytoma were considered. The abdominal computed tomography (CT) revealed a hyperdense lesion in the upper pole of the right kidney with a relatively well-defined margin measuring 63x65x69mm with no evidence of significant post-contrast enhancement in the either arterial, venous or delayed phase. The patient underwent a right radical nephrectomy. On gross examination, a well-encapsulated mass was seen wholly occupying the upper pole of the kidney measuring 6.9x6.5x5.5cm. The cut surface was variegated with grey-white, firm areas admixed with mucinous and hemorrhagic foci (Figure 1A). No capsular breach or perinephric fat extension was noted. The renal pelvis, sinus, and renal vessels were free of tumor. Figure 1 A - gross nephrectomy specimen showing a large, well-demarcated tumor involving the upper pole of the kidney measuring 6.9x6.5x5.5cm. The cut surface is variegated and appears grey-white and firm, along with intervening mucinous and hemorrhagic areas (scale bar = 5 cm); B - microscopically, the tumor is well-circumscribed with sharp demarcation from adjacent normal renal parenchyma (H&E; 40x); C - the dominant epithelial component is seen against the background stroma containing significant extracellular mucin (H&E; 100x); D - higher magnification showing tightly packed anastomosing tubules lined by low-grade cuboidal cells with cytoplasmic vacuoles against mucinous background (H&E; 400x).: Microscopically, the tumor was well-demarcated from the adjacent native renal parenchyma (Figure 1B). It was composed of the dominant epithelial element against the background of extracellular mucinous stroma (Figure 1C). The epithelial component contained tightly packed, elongated, tufted, and anastomosing tubules lined by low-grade cuboidal cells and are seen merging with bland spindle cells (Figure 1D). The nuclei display fine vesicular chromatin, inconspicuous nucleoli, and moderate cytoplasm with vacuolations. Mitotic figures are infrequent (<1/10HPF). No necrosis, lymphovascular invasion, or high-grade transformation was found. However, foamy macrophage collections and lymphoid aggregates are admixed. Cholesterol clefts with focal foreign body giant cell response indicated the long-standing nature of the tumor. Based on the gross and microscopy findings, the diagnosis of mucinous tubular and spindle cell carcinoma [(pT1bpNx; American Joint Committee on Cancer (AJCC) staging manual; 8th edition)] was rendered.

Successful management of renal abscess secondary to diabetes mellitus with surgical treatment and hyperbaric oxygen therapy

Renal abscess (RA) is a collection of infective fluid in or around the renal parenchyma. It typically occurs in immunocompromised patients including those with diabetes mellitus (DM), poor nutritional status, or steroid administration. We herein report a case of RA associated with DM in which hyperbaric oxygen (HBO2) therapy greatly contributed to the resolution of this disease. The patient was an 85-year-old man with poorly controlled type 2 DM. Contrast-enhanced computed tomography for postoperative follow-up of appendiceal cancer showed a mass lesion with poor contrast enhancement extending from the upper pole of the left kidney to the dorsal side. Therefore, a diagnosis of RA was established. The lesion was percutaneously punctured and a drainage tube was placed. Antibiotics following sensitivity testing was administered. The catheter was removed six days after its placement. However, pus discharge continued from the catheter removal site, with persistent redness around the wound. Therefore, lumbotomy incision for abscess drainage was performed on the 49th day. However, the pus discharge persisted, and we decided to perform HBO2 therapy, expecting decreases in bacterial proliferation, reduction in local edema, and improvement of host defense. HBO2 therapy for 90 minutes at two atmosphere absolute was performed 10 times. The amount of pus discharge decreased and redness improved from the fifth day after HBO2 therapy. One month after starting HBO2 therapy, the wound was closed and pus discharge resolved completely. Four years have passed since the HBO2 therapy, and there have been no symptomatic or imaging relapses of RA.

PS-BPR03-9: A CASE OF RENAL JUXTAGLOMERULAR CELL TUMOR THAT WAS PREOPERATIVELY DIAGNOSED BY SELECTIVE RENAL VENOUS SAMPLING

A 26-year-old woman without a family history of hypertension was referred to our hospital for a further examination of juvenile hypertension. At 25 years of age, she had headaches, and hypertension (210/120 mmHg) was first noted. A diagnostic examination to assess the hypertension was performed and she was hypokalemic with serum K 2.9 mEq/L. Moreover, the plasma renin activity (PRA) and plasma renin concentration (PRC) was markedly elevated (18.7 ng/mL/h and 196.3 pg/mL), and plasma aldosterone concentration (PAC) was also elevated (291 pg/mL). A captopril challenge test showed a mildly increased PRA response (15.5 ng/mL/h to 20.3 ng/mL/h), but MR angiography and renogram showed no findings suggestive of renal vascular hypertension. On the other hand, dynamic contrast-enhanced CT showed a small neoplastic lesion (10 mm in diameter) without enhancement in the early phase, but with slight enhancement in the late phase, on the left renal upper pole. We performed renal vein sampling, but no obvious lateralization in PRA was found at the main trunk level of the left and right renal veins (14.0 vs. 14.3 ng/mL/h). Therefore, we performed more selective sampling of the branches of the left renal vein and found that PRA in the upper pole branch of the left renal vein was approximately 3.7 times higher than in the inferior pole branch, the main trunk of the left and right renal veins, and the inferior vena cava (51.5 ng/mL/h vs. 14.0–15.1 ng/mL/h). Based on these results, we made a preoperative diagnosis that the tumor in the upper pole of the left kidney was a juxtaglomerular cell tumor producing renin excessively and decided to perform partial left nephrectomy. Juxtaglomerular cell tumors (JCT) are very rare diseases that primarily occur in adolescents and young adults. Excessive renin secretion from the tumor causes secondary hypertension, and hypokalemia. It has been reported that renal vein sampling, in addition to CT and MRI scans, is useful for preoperative localization of JCT. However, the usual method of sampling only the main trunk of the renal vein fails to detect lateralization of the PRAs in many cases. In the present case, we were able to identify the localization of the tumor by performing sampling of the branches of the renal vein. We herein report on the usefulness of selective renal vein sampling for the preoperative diagnosis of JCT.

Renal leiomyoma - case report and literature review

Introduction. Leiomyoma is a mesenchymal benign tumor that seldom manifests in the kidney. Typically, these tumors are small, asymptomatic, and often detected accidentally. Differentiating leiomyomas radiologically from other renal neoplasms, particularly renal cell carcinomas, poses a considerable challenge before surgical intervention. Moreover, the conclusive diagnosis of leiomyomas can only be established through histopathological and immunohistochemical evaluation following surgical intervention. Case Report. We present a case of a 44-year-old woman who was diagnosed with right kidney leiomyoma accidentally during a computed tomography examination following exploratory curettage by a gynecologist. An enhanced computed tomography scan revealed a 10 mm tumor located on the upper pole of the right kidney, extending beyond its boundaries. The imaging differential diagnosis was renal cell carcinoma of the right kidney. A laparoscopic partial nephrectomy was performed. Macroscopically, the tumor appeared subcapsular, well-defined, with a firm consistency and a tan-white whorled cut surface. The histological characteristics and the supporting immunohistochemical profile confirmed the diagnosis of renal leiomyoma. The postoperative course was uneventful, and the patient was discharged on the 3rd postoperative day. Conclusion. Leiomyomas are rare kidney tumors. A conclusive diagnosis is established through histopathological findings. The pre-operative differentiation of leiomyomas radiologically from other renal neoplasms, particularly renal cell carcinomas, poses a considerable challenge in radiological assessment.

Does displacement of lower pole stones during retrograde intrarenal surgery improves stone-free status? A systematic review and meta-analysis.

Kidney stones are one of the most common urological diseases worldwide. The size and location of the stone are the most important factors in determining the most suitable treatment options. The aim of this review was to evaluate the displacement of lower pole stones. Three studies assessing the efficacy of translocating kidney stones from the lower pole of the kidney to other locations during retrograde intrarenal surgery published in the last 20 years were included. A systematic search was conducted in the PubMed, Embase, Latin American and Caribbean Health Sciences Literature (LILACS), and Web of Science databases using the following search terms: "Lower pole," "Lithotripsy." Meta-analysis was performed using Review Manager version 5.4. Stone-free rates were improved through displacement (odds ratio - OR = -0.15; 95% confidence interval-95%CI -0.24--0.05; p = 0.002; I2 = 21%), but at the cost of increased surgical duration (mean difference = -12.50; 95%CI -24.06--0.95; p = 0.03; I2 = 94%). Although this represents a potentially negative outcome, the improvement in clearance rates justifies the additional investment of time and effort. Displacement of lower pole kidney stones for subsequent lithotripsy brings significant benefits in terms of stone-free rate, with no difference in laser energy usage. However, it results in increased surgical time. Despite these factors, the benefits to patients undergoing the procedure are substantial.

Mixed epithelial and stromal tumor of the kidney: A retrospective clinicopathological evaluation

ObjectiveMixed epithelial and stromal tumor of the kidney (MESTK) is a rare renal tumor for which there is limited clinical case experience. The aim of this study was to investigate the clinicopathological features, imaging manifestations, immunohistochemical phenotype, diagnosis, and differential diagnosis of MESTK. MethodsWe systematically evaluated the clinicopathological characteristics of 13 patients diagnosed with MESTK from 2016 to 2022. ResultsThere were 12 female cases and 1 male case, and their age ranged from 24 to 62 (mean age 47 years). The tumor was located in the left kidney in 11 patients. Seven of these patients were located in the upper pole of the left kidney. The mean diameter of the tumor was 4.6 cm (range 1.3–8.6 cm), and the main body of the tumor was mainly located in the medulla or medulla. In 7 cases, the tumors were clearly outlined, 4 cases had clear but irregular borders, and in 3 cases, the masses broke through the renal capsule but did not invade the surrounding organs. All tumors had varying proportions of cystic and solid components. In most tumors, the epithelial cell component was predominant. Among the epithelial components, we observed a predominance of large cysts. Small cysts and tubular structures were also seen; the least common were papillary structures. The most common types of lining epithelium were flat and cuboidal. The cell cytoplasm was predominantly eosinophilic with hyaline degeneration. The tumor cells were composed of different proportions of sparse hypocellular areas and dense hypercellular areas between these cells. In most cases, the cellular stroma had an ovarian-like appearance. It is characterized histologically by mature adipocytes, thick-walled blood vessels, and chronic inflammatory cells. Calcification and collagenization were seen in a few cases. In all female patients, estrogen and progesterone receptors in the interstitial component were almost always positively expressed. In male patients, all interstitial components showed locally positive expression of androgens. ConclusionMESTK had unique characteristics with complex and variable lesion shapes. There was a high degree of overlap with cystic kidney cancer, and the rate of missed and misdiagnosis was extremely high. The diagnosis could not be confirmed by preoperative imaging. The final diagnosis depended on pathomorphology.

A nomogram for evaluation and analysis of difficulty in retroperitoneal laparoscopic adrenalectomy: A single-center study with prospective validation using LASSO-logistic regression.

While it is known that inaccurate evaluation for retroperitoneal laparoscopic adrenalectomy (RPLA) can affect the surgical results of patients, no stable and effective prediction model for the procedure exists. In this study, we aimed to develop a computed tomography (CT) -based radiological-clinical prediction model for evaluating the surgical difficulty of RPLA. Data from 398 patients with adrenal tumors treated by RPLA in a single center from August 2014 to December 2020 were retrospectively analyzed and divided into sets. The influencing factors were selected by least absolute shrinkage and selection operator regression model (LASSO). Additionally, the nomogram was constructed. A receiver operating characteristic curve was used to analyze the prediction efficiency of the nomogram. The C-index and bootstrap self-sampling methods were used to verify the discrimination and consistency of the nomogram. The following 11 independent influencing factors were selected by LASSO: body mass index, diabetes mellitus, scoliosis, hyperlipidemia, history of operation, tumor diameter, distance from adrenal tumor to upper pole of kidney, retro renal fat area, hyperaldosteronism, pheochromocytoma and paraganglioma, and myelolipoma. The area under the curve (AUC) of the training set was 0.787, and 0.844 in the internal validation set. Decision curve analyses indicated the model to be useful. An additional 117 patients were recruited for prospective validation, and AUC was 0.848. This study developed a radiological-clinical prediction model proposed for predicting the difficulty of RPLA procedures. This model was suitable, accessible, and helpful for individualized surgical preparation and reduced operational risk. Thus, this model could contribute to more patients' benefit in circumventing surgical difficulties because of accurate predictive abilities.

Hypertension in Young Adults: Think Juxtaglomerular Cell Tumor!

Abstract Introduction/Objective Juxtaglomerular cell tumor is a benign, renin-secreting neoplasm. The tumor arises from the juxtaglomerular apparatus cells of the kidney. Because the tumor is hormonally active, patients usually suffer from hypokalemia, hyperaldosteronism, and hypertension. The typical patient population is adolescents and young adults with slight female predominance. Herein, we describe a case of a 19-year-old Asian female with a somewhat atypical presentation. Methods/Case Report A 19-year-old Asian female presented with upper extremity weakness, numbness, and tingling. On physical examination, the only notable finding was hypertension. Extensive work up reveled an aldosterone level of 71 nanograms per deciliter and plasma renin activity of 6.25 nanograms per milliliter per hour. A CT scan of the abdomen revealed a 2.4cm mass in the lower pole of the left kidney. The mass was resected by partial nephrectomy. Sectioning of the specimen revealed a 2.4cm well-circumscribed, encapsulated tumor. On microscopic evaluation, the tumor had glomoid appearance with sheets of uniform, round to polygonal cells with clear to eosinophilic cytoplasm. The stroma was scanty, mitoses were rare, and necrosis was not identified. Immunohistochemical stains showed the tumor cells to be positive for CD117, CD34, Cathepsin K, Synaptophysin, and CD10 and negative for ER, PR, CK7, PAX-8, pancytokeratin, EMA, S100, Melan-A, HMB45, SMA and CAIX. Diagnosis of Juxtaglomerular cell tumor was rendered. The patient was alive and well and without signs of recurrence 14 months after surgery. Results (if a Case Study enter NA) NA. Conclusion This case highlights the importance of a regular physical exam and having a high index of suspicion in patients presenting with unusual complaints.

Papillary Renal Cell Carcinoma with Massive Hemorrhage: An Autopsy Case Report

Abstract Introduction/Objective Spontaneous renal hemorrhage is a rare complication of various kidney pathologies. It can be due to renal artery aneurysms, arteriovenous malformations, cystic renal diseases, renal calculus, coagulation disorders, as well as neoplastic lesions like angiomyolipoma and renal cell carcinoma (RCC). Individuals present with sudden flank or scapular pain, hypovolemic shock, termed as Wunderlich syndrome (WS). 30-35% cases of WS are from spontaneously ruptured RCC, commonly clear cell variant (70%) followed by papillary (10-15%) and chromophobe variant (4-6%). We present an autopsy case of a papillary variant RCC identified as a small kidney mass with a pathogenetic correlation behind the intractable bleeding. Methods/Case Report An 81-year-old Caucasian man with a history of atrial fibrillation, on long-term Xarelto treatment, was found to have a 1.2 cm incidental mass in the right kidney. He started experiencing right-sided scapular pain, then rapidly became hypotensive, drowsy. CT scan revealed a large right-sided perinephric and retroperitoneal hematoma (17.5 x 5.7 x 8.9 cm) extending in the pelvis. Despite receiving blood products, other supportive treatment, and successful angio-embolization, his condition worsened to acute kidney injury, bowel ischemia, and persistent lactic acidosis leading to death. On autopsy, bloody ascites, clots on mesenteric root insertion, and bulging in retroperitoneal spaces were seen. The perinephric spaces had organized clots. The bleeding originated from a 2.0 x 2.0 cm brown mass in the middle pole of the right kidney. There was a slit-like vessel at the interface of the kidney and the mass. Microscopic examination of the mass shows trabecula of abnormal cells with abundant eosinophilic cytoplasm in the hemorrhagic and necrotic background. These cells are positive for PAX8, CK7, CD10, dim positive for CAIX, and negative for CD117, which is consistent with renal cell carcinoma, papillary variant. Results (if a Case Study enter NA) NA. Conclusion Papillary RCC is much less vascular and less aggressive than clear cell RCC. However, necrosis or bleeding into renal vessels may occur. In this case, blood-leaks and accumulation in enclosed space followed by necrosis, fibrosis, and hyalinization cause neovascularization forming a negative spiral for re-bleeding. Anticoagulants can lead to profuse sustained bleeding from even very small size RCC.