Renal Carcinoma Presenting Research Articles

Metástasis tiroidea como forma de presentación de carcinoma renal de células claras

Resumen El carcinoma renal de células claras es el subtipo histológico más frecuente de los tumores renales, con gran capacidad de provocar metástasis a distancia, siendo el origen más frecuente de metástasis en la glándula tiroidea. Normalmente, las metástasis a este nivel se diagnostican de forma tardía, puesto que la mayoría son de pequeño tamaño y no provocan síntomas, pudiendo ser confundidas al inicio por nódulos benignos. El diagnóstico definitivo se realiza mediante estudio histológico. En cuanto al tratamiento, la cirugía suele ser de elección, salvo en casos diseminados. Se presenta el caso de una paciente mujer de 61 años intervenida de nefrectomía y suprarrenalectomía izquierda por carcinoma renal de células claras tras hallazgo incidental posthemitiroidectomia izquierda por nódulo Bethesda III con AP definitiva de metástasis tiroidea de origen renal.

Undifferentiated metastatic renal cell carcinoma presenting as a cutaneous nodular lesion.

Cutaneous metastases may be the first sign of clinically silent visceral cancer. Approximately 30% of patients with primary renal cell carcinoma present with metastatic disease, and only 8% of them have skin metastases. We present the case of a 59-year-old male patient with a subcutaneous nodular on the upper chest extending to the jugular region. The lesion appeared skin colored and was not painful and 5 cm × 3.5 cm in diameter. The histological examination of the cutaneous biopsy showed an infiltration of undifferentiated epithelial cells positive to cytokeratins AE1/AE3, whereas they were negative to CK-20, CK5/6, cluster of differentiation 10, vimentin, thyroid transcription factor-1, S-100, human melanoma black-45, hepatocyte-specific antigen, carcinoembryonic antigen, and chromogranin A. A total-body computed tomography (CT) showed the presence of a tumoral lesion in the left kidney with multiple metastases in the lung, brain, and bones. According to the cutaneous biopsy and total-body CT, a final diagnosis of an undifferentiated renal carcinoma presenting as a subcutaneous metastasis was made. A chemotherapeutic treatment with gemcitabine and cisplatin resulted in the stabilization of the renal and metastatic lesions with an improvement in the quality of life of the patient. Considering that the prognosis of patients with cutaneous metastases is very poor, it is necessary to obtain an appropriate diagnosis in order to identify patients with treatable disease with the purpose of starting a therapeutic protocol.

A Multidisciplinary Evaluation of Inter-Reviewer Agreement of the Nephrometry Score and the Prediction of Long-Term Outcomes

The nephrometry score was introduced in 2009 as a way to quantify renal tumor complexity in a systematic way. However, the reproducibility of scoring has not been rigorously validated across specialty or level of training, nor has it been evaluated with regard to meaningful clinical outcomes. We identified 95 consecutive patients with a solid renal mass treated surgically. Each renal tumor was separately scored by 6 reviewers, including 2 staff urologists, 1 staff radiologist, 2 trainees (1 urology, 1 radiology) and 1 medical student. Inter-reviewer agreement for nephrometry score was evaluated using Lin's concordance correlation coefficient. We evaluated the ability of the nephrometry score to predict surgery type, pathological features and clinical outcomes. Agreement in nephrometry score was substantial among the 3 staff physicians (0.72, 95% CI 0.64-0.80). Nephrometry score agreement continued to be substantial when including the trainees and medical student in the analysis (0.75, 95% CI 0.69-0.81). The median nephrometry score of patients treated with radical nephrectomy was 9.0 vs 7.2 for those treated with a nephron sparing approach (p <0.001). Increasing nephrometry score was associated with increased risk of distant metastasis (HR 3.27, p <0.001), death from renal cell carcinoma (HR 2.83, p <0.001) and death from any cause (HR 1.24, p = 0.017). Nephrometry scoring with minimal initial instruction was robust across specialties and levels of training. The additional anatomical information that nephrometry score adds to size alone may be associated with other important clinical outcomes such as tumor aggressiveness and survival, and warrants further study.

Chronic Kidney Disease Before and After Partial Nephrectomy

We performed a multi-institutional retrospective cohort study to evaluate baseline renal function of patients who underwent partial nephrectomy for renal tumors, and determined rates of progression to higher stages of chronic kidney disease. The Modification of Diet in Renal Disease study equation was used to estimate glomerular filtration rate. Preoperative and postoperative serum creatinine values were obtained from patients who underwent partial nephrectomy at 6 institutions with a normal contralateral kidney, and had baseline chronic kidney disease stage I (estimated glomerular filtration rate greater than 90 ml/minute/1.73 m(2)), II (estimated glomerular filtration rate 60 to 89 ml/minute/1.73 m(2)) or III (estimated glomerular filtration rate 30 to 59 ml/minute/1.73 m(2)). The end point was change in chronic kidney disease stage at long-term followup (3 to 18 months). Multivariate logistic and Cox regression models tested the association of newly acquired chronic kidney disease stage III or greater with pertinent demographic, tumor and surgical factors. For 1,228 patients with followup creatinine data at least 3 months after partial nephrectomy median baseline glomerular filtration rate was 74 ml/minute/1.73 m(2). At baseline 19%, 59% and 22% of patients had chronic kidney disease stage I, II and III, respectively. At long-term followup for patients with baseline chronic kidney disease stage I or II median postoperative glomerular filtration rate was 67 ml/minute/1.73 m(2) with 29% having progression to chronic kidney disease stage III or greater. Increasing age, female gender, increasing tumor size, clamping of the renal artery and vein, and lower preoperative estimated glomerular filtration rate were independently associated with newly acquired chronic kidney disease stage III or greater. The presence of comorbid conditions such as coronary artery disease, diabetes mellitus or hypertension did not independently predict an increased risk of higher chronic kidney disease stage. Chronic kidney disease stage III or greater will develop postoperatively in approximately a third of patients with an estimated glomerular filtration rate greater than 60 ml/minute/1.73 m(2), and this progression is associated with definable demographic, tumor and surgical factors.

Clear cell renal carcinoma presenting as a bleeding cyst in pregnancy: inaugural manifestation of a von Hippel-Lindau disease

Von Hippel-Lindau (VHL) disease is a dominant autosomal disorder inducing the development of many tumors, such as hemangioblastomas in the central nervous system and retina, cysts or tumors (benign or malignant) in the kidneys and/or the pancreas. We report the case of a pregnant woman who presented with a voluminous hemorrhagic cyst of the right kidney with an exophytic lesion detected in the lower median part of the cyst wall. As an anamnestic inquiry resulted in a familial history of VHL disease, a screening imaging was performed and detected three medullary hemangioblastomas. Considering the active bleeding of the renal cyst and its potential malignancy, a unilateral nephrectomy was carried out after pregnancy interruption. Histological analysis confirmed a multilocular clear cell renal carcinoma. This case underlines the importance of screening procedures such as abdominal ultrasonography and medullary magnetic resonance imaging in all pregnant women with a familial history of VHL disease.

Metástasis cutánea durante el seguimiento de carcinoma renal de células claras

To report a new case of metastatic renal carcinoma with atypical localization. Skin metastatic involvement by urological tumors is a rare clinical entity. It is usually associated with internal organ involvement, so that this finding makes prognosis poor. We review the most frequent metastatic sites, their prognostic implications and treatment. We present the case of a 60-year-old male patient with the diagnosis of inferior maxillary skin metastasis 18 months after radical nephrectomy for clear cell adenocarcinoma. The patient was treated with oral Sorafenib within a phase II clinical trial. Two years after diagnosis the patient is alive and a disease-free. The wide variability of localizations and forms of presentation of metastatic renal carcinoma obliges to be alert during followup. New antiangiogenic drugs are an efficient therapeutic option.

The Evolving Presentation of Renal Carcinoma in the United States: Trends From the Surveillance, Epidemiology, and End Results Program

The incidence of renal cancer is increasing, while cases series suggest that tumor size is decreasing. This has important implications for treatment planning. We evaluated national trends in renal cancer size and observed survival in patients diagnosed in the 3 periods 1988 to 1992, 1993 to 1997 and 1998 to 2002. From the Surveillance, Epidemiology, and End Results database we identified 29,053 patients diagnosed with primary renal cancer. Patients were stratified into size categories and 5-year time cohorts. Size distribution was compared across cohorts. Kaplan-Meier survival curves and Cox proportional hazards modeling were used to examine trends in overall and stage specific survival. From 1988 through 2002 renal tumor size decreased from 66.8 to 58.6 mm, while the age adjusted incidence of renal cancer increased from 8.6 to 11.2 cases per 100,000 individuals. Kaplan-Meier analysis showed steadily deteriorating survival with increased cancer size above 4 cm with a median survival of 105 months for 4 to 7 cm vs 46 months for more than 7 cm. Cox modeling demonstrated significantly improved survival in patients diagnosed in the latter cohorts. With adjustment for size the latter cohorts remained significantly improved compared to the earliest cohort, although the 1998 to 2002 cohort was no longer significantly different than the 1993 to 1997 cohort. Nationally renal tumor size at presentation has steadily and consistently decreased. Patients more recently diagnosed had improved survival, which could be attributable to decreased tumor size in the latter cohorts. Patients more recently diagnosed also demonstrated a relative survival advantage independent of size compared to the earliest patients studied.

Metástasis tiroidea de un carcinoma renal: a propósito de un caso

The thyroid metastasis of renal carcinoma is a very rare entity; in most cases, the diagnosis is obtained after necropsy. We report one clinical case of thyroid metastasis from a renal carcinoma presenting as a cold node seven years after nephrectomy. We perform a bibliographic review.

Carcinoma renal metastásico intraocular. ceguera unilateral progresiva como forma de presentación

Intraocular metastatic renal carcinoma presenting as progressive unilateral blindnessClear cell renal carcinoma is the most common histological type, representing 70-80% of all renal carcinomas1. Metastases are already present in about 25-30% of patients at the time of diagnosis of renal cell carcinoma. Ocular metastasis is extremely rare.

Les métastases intrathyroïdiennes du cancer du rein à cellules claires : présentation de sept cas et revue de la littérature

Purpose. – The aim of this study was to retrospectively report clinical manifestations, type of treatment, survival rate of thyroid metastases from renal carcinoma. Patients and methods. – Seven patients were retrospectively collected from files of different Burgundy’s hospitals. All renal and thyroid gland specimens were controlled by the anatomopathologist. Results. – Tumors occurred in four women and three men (mean age: 66 years). Symptoms were generally a solitary mass. The metastatic tumor to the thyroid gland was the initial presentation of renal carcinoma in one case. In the other cases, patients had documented previous evidence of renal carcinoma as remotely 8.1 years before the thyroid metastases. Thyroglobulin immunohistochemistry was always negative in the foci of metastatic renal carcinoma. All patients had surgical resection of there metastasis. The majority of patients died with disseminated malignancies (mean: 38.1 months after there thyroid resection). Three patients are still alive, one after a complementary pancreatic resection for a secondary pancreatic metastasis and one other with cervical and mediastinal lymph node recurrence. Conclusions. – Surgical treatment of the metastatic disease is suggested, as this may prolonged patient survival.

Renal Carcinoma Presenting with Flank Pain

Renal Carcinoma Presenting with Flank Pain

Fine‐needle aspiration cytology of metastatic clear‐cell renal carcinoma presenting as a solitary mass in the head of the pancreas

In nearly 25% of patients with primary renal-cell carcinoma, metastasis is not uncommon and usually does not give rise to difficulties in diagnosis. However, its presentation as a mass in the head of the pancreas following an elapse of several years after the initial diagnosis of renal carcinoma is not only uncommon but may be confused clinicoradiologically with a primary pancreatic adenocarcinoma. The case presented here illustrates such an example with an emphasis on the usefulness of fine-needle aspiration cytology (FNAC) in the diagnosis. Diagn. Cytopathol. 1998;19:194–197. © 1998 Wiley-Liss, Inc.

BILATERAL BREAST METASTASES FROM A RENAL CARCINOMA

SUMMARY Metastatic involvement of the breast is rare. The commonest cause is spread from a contralateral breast carcinoma. However, metastatic malignant melanoma, lymphoma and lung carcinoma have all been reported sporadically in the literature. Renal carcinoma is well recognised for its protean clinical manifestations ranging from loin pain, haematuria and an abdominal mass to less obvious metastatic effects such as pathological fracture of a long bone or one of a variety of associated paraneoplastic syndromes. We present a case of a renal carcinoma presenting with bilateral breast masses with literature review, and discuss the efficacy of the standard gamut of investigations in a breast mass of non‐primary origin.

Renal carcinoma presenting as cardiac tamponade: A case report and review of literature

Pericardial involvement in an advanced malignancy is common but malignancy presenting as cardiac tamponade is rather uncommon. Review of English literature using Medline CD ROM revealed 131 cases since 1935, who have presented with this life threatening emergency. Lung is the most common primary site followed by lymphomas and leukemias. We report a case of transitional cell carcinoma of kidney presenting as cardiac tamponade. Such a presentation of transitional cell carcinoma of kidney has never been reported.

Renal Cell Carcinoma: Diagnosis Based on Metastatic Manifestations

Renal Cell Carcinoma: Diagnosis Based on Metastatic Manifestations

Gallbladder and pancreatic metastasesfrom bilateral renal carcinoma presenting with hematobilia and anemia

A case of bilateral metachronous renal cell carcinoma withgallbladder and pancreatic metastases, presenting with hematobilia and anemia is presented. The presentation of metastatic renal cell carcinoma with hematobilia and anemia is previously unreported. This case illustrates (l) the occasionally very long interval between metachronous renal carcinoma; (2) this tumor's propensity to unusual metastases and unpredictable presentation; and (3) the significant palliation which may be achieved by appropriate surgical resection of these metastases.

Renal carcinoma presenting as a primary submandibular gland tumor

An unusual case of metastatic renal cell carcinoma presenting as a submandibular salivary gland tumor is presented, and its differentiation from a primary clear cell neoplasm of salivary origin is discussed.

Metastatic renal carcinoma presenting with profuse haemorrhage at cardiac surgery

A 62-year-old man undergoing coronary artery bypass grafting sustained profuse unexplained haemorrhage during sternal diathermy before sternotomy. Histology of tissue from the sternum suggested metastatic renal carcinoma. A primary renal tumour was subsequently identified. Sternal metastases are rare, often highly vascular, and arise particularly from thyroid or renal tumours. In the absence of angiographic evidence of an eroding aortic aneurysm, sternal metastases represent the most likely cause of unexplained haemorrhage during sternotomy.

Radical surgery for renal cell carcinoma.

A modified radical nephrectomy to cope with renal carcinoma presenting at advanced stages, is evaluated. A total of 50 cases were treated in this hospital from 1962 to 1976. The poor results from treatment of renal cell carcinoma in the earlier years, have prompted the modification of the conventional radical nephrectomy to cope with this disease which is still frequently seen at advanced stages. The modification includes exclusion of distant metastasis. The adherent segment of colon is resected along with the tumour. The renal vessels are then isolated. If the IVC is involved by a right-sided tumour, it is resected along with the tumour. The ureter is then ligated and the tumour with the adrenal gland, the resected colon segment, regional lymph nodes and the IVC are removed in one block. 2 such patients who otherwise would have been considered inoperable have survived for over 3 years.

Metastatic deposit from renal carcinoma presenting as an arteriovenous aneurysm, with angiographic demonstration.

Angiography is not often performed in the investigation of bone metastases from renal carcinoma. A brief review of the literature has failed to produce reference to the vascularity of such deposits and, in particular, to any presenting as an arteriovenous aneurysm. A patient was recently encountered whose clinial features prompted the performance of angiography in the evaluation of the bone lesion. A 66-year-old female was admitted on 26.10.67 because of increasing pain in the upper end of the left tibia for a period of six months. The pain was first noticed while kneeling to do house work. Two months prior to onset of the pain, she had suffered minor trauma to the region of the left knee. Her general health was good, but she admitted some recent weight loss and excessive sweating. There was no abdominal or back pain, and no signs or symptoms referable to the renal tract. Clinical examination revealed a localised swelling in the skin overlying the upper end of the left tibia, and the skin in this area was...