Renal Cell Tumors Research Articles

V01-07 A RARE CASE OF PT3A CLEAR CELL RENAL CELL CARCINOMA IN A BIFID KIDNEY TREATED WITH ROBOTIC HEMINEPHRECTOMY

INTRODUCTION AND OBJECTIVE: Bifid, or divided-shaped kidney is relatively rare, with a reported incidence of 4%, of which 42% also demonstrate collecting system duplication. Malignant neoplasm accompanied by ureteral duplication is extremely rare with 24 cases reported in the literature. The majority of these reports were of urothelial carcinoma, and one case reported in the literature of a bifid kidney with papillary carcinoma. Here we present a case of a 42 year-old Hispanic female with the finding of a renal cell carcinoma involving only the upper pole of a bifid kidney with a completely duplicated collecting system. METHODS: The patient underwent a robotic-assisted laparoscopic left hemi-nephrectomy of the upper pole moiety of a bifid left kidney, with pathologic analysis demonstrating a 7.2 x 6.3 x 5.1cm clear cell renal cell carcinoma with invasion into a segmental branch of the renal vein. Intraoperative ultrasound was critical in the identification of the inferior border of the lesion to ensure complete excision along the isthmus dividing the upper and lower pole moieties. Indocyanine green was used to demonstrate re-perfusion and drainage of the remaining lower moiety of the bifid kidney at the completion of the procedure. RESULTS: There were no intraoperative or postoperative complications. Total robotic console time was 162 minutes. The intraoperative estimated blood loss was 400ml. Warm ischemia time was under 30 minutes. The patient was discharged home on postoperative day 2. Pre and post-operative eGFR were identical. Final pathologic analysis demonstrated a pT3a Fuhrman Grade 1 clear cell renal cell carcinoma with negative margins. CONCLUSIONS: Renal cell carcinoma of a bifid kidney with a duplicated collecting system is extremely rare. Here we demonstrate that a minimally invasive nephron sparing approach may be safely utilized in these cases. Pre-operative CT angiogram may be used in these cases delineate aberrant anatomy to minimize ischemia further. Further follow up to ensure oncologic outcome similar to partial nephrectomy in pT3a renal cell tumors will be necessary.Source of Funding: none

RENAL CELL CARCINOMA WITH ONCOCYTIC CELL TUMOR IN ASEMPTOMATIC DIALYSIS PATIENT

Kronik böbrek yetmezlikli ve renal replasman tedavisi gören hastalarda kardiyovasküler hastalıklar (%56), infeksiyonlar (%11.2) ve maligniteye (%8) bağlı artmış mortalite oranları söz konusudur. Diyaliz süresi uzadıkça malignite görülme oranı da artar. Diyaliz hastalarında renal hücreli karsinom (RCC) prevalansının genel popülasyona göre daha yüksek olduğu bilinmektedir. Edinilmiş kistik böbrek hastalığı (ACKD) sıklığı diyaliz süresi ile artar; CKD ile ilişkili RCC erkeklerde daha sık görülür; sıklıkla bilateral ve multisentriktir. Renal hücreli tümörlerden olan onkositom varyant bir tümör olarak kabul edilmesine rağmen histopatolojik olarak malign tümör özellikleri gösterebilir. Bu yazıda uzun süreden beri hemodiyaliz tedavisi gören ve yakınması olmayan hastada rastlantısal olarak saptanan renal kitleler anlatılmaktadır.

A rare case of Mucinous, tubular and spindle cell carcinoma of kidney and Histomorphological study of renal cell tumours

A rare case of Mucinous, tubular and spindle cell carcinoma of kidney and Histomorphological study of renal cell tumours - IJPO- Print ISSN No: - 2394-6784 Online ISSN No:- 2394-6792 Article DOI No:- 10.18231/j.ijpo.2020.033, Indian Journal of Pathology and Oncology-Indian J Pathol Oncol

Eosinophilic Renal Cell Tumors With a TSC and MTOR Gene Mutations Are Morphologically and Immunohistochemically Heterogenous

Eosinophilic renal neoplasms have a wide spectrum of histologic presentations, and several studies have demonstrated a subtype of renal cell carcinomas (RCCs) associated with the tuberous sclerosis complex (TSC)/mammalian target of rapamycin pathway. A review of our institutional archives led to the identification of 18 cases of renal eosinophilic tumors with unusual morphology. Immunohistochemical analysis demonstrated that these could be separated into 3 groups: group 1 had solid architecture and morphology similar to chromophobe RCC but was negative for CK20 and vimentin, and had weak focal staining for CK7 and P504S; group 2 had solid architecture and morphology similar to either renal oncocytoma or chromophobe RCC, eosinophilic variant and had diffuse staining of CK7 and P504S, absent to weak staining of CK20, and negative staining for vimentin; and group 3 had solid, cystic and papillary architecture and was negative for CK7, except for 1 case, along with moderate to strong staining of CK20, P504S, and vimentin. The cases were then sent for next-generation sequencing to determine whether molecular pathogenic variants were present. In group 1, all 3 cases had mutations in TSC2. In group 2, pathogenic variants were identified in 3 genes: TSC1, TSC2, and MTOR. In group 3, genetic alterations and pathogenic variants were identified in TSC1 and TSC2. Our results support TSC/MTOR-associated neoplasms as a distinct group that exhibits heterogenous morphology and immunohistochemical staining.

Pre-operative risk factors predicting missed diagnosis of renal vein tumor thrombus in renal cell carcinoma: a retrospective cohort study

Purpose: Previous reports showed that some patients with renal cell carcinoma (RCC) and renal vein tumor thrombus (RVTT) were misdiagnosed pre-operatively. To improve the accuracy of this diagnosis, the clinical characteristics of RCC with missed RVTT diagnosis were analyzed.Methods: We retrospectively reviewed RCC patients with RVTT between January 2000 and December 2015. The survival analysis was estimated using the Kaplan–Meier method. The Cox proportional hazard models were applied to identify risk factors.Results: The missed diagnosis rate of RVTT in RCC was 30.5%. In multivariate analysis, maximal tumor diameter, tumor located in the middle part, renal vein contrast agents filling insufficiently and tumor with collateral vessels (odds ratio = 1.22, 1.35, 1.25, 1.22; and p = .034, .003, .015 and .037, respectively) were independent predictors of missed RVTT diagnosis. A missed-diagnosis score was presented as area under curve of 0.852 (p < .001). Moreover, the missed diagnosis group had favorable prognosis, and tumor with collateral vessels was an independent prognostic indicator of poor overall survival time (hazard ratio = 1.15, p = .025).Conclusions: This was the first study exploring clinical features as predictors of missed RVTT diagnosis. The possibility of complicating tumor thrombus should be considered when there is pre-operative presence of tumor with large diameter, renal tumor in the middle part, renal tumor with collateral vessels and renal vein contrast agents filling insufficiently. Patients with three points in missed-diagnosis scoring suggested a high possibility of missed RVTT diagnosis, and tumor with collateral vessels indicated poor prognosis.

Osteopontin is differentially expressed in renal cell tumors

ABSTRACT Osteopontin (OPN) has been shown to play a significant role in regulating the aggressiveness of cancer cells and promote tumor growth. Evaluation of this phosphorylated extracellular glycoprotein expression may help estimate its use as a potential prognostic marker in tumorigenesis of different renal tumors. The objective of the present study was to characterize for the first time the expression pattern of OPN in primary renal tumors and correlate its association to tumor progression and survival. A total of 68 primary renal tumors (clear cell renal cell carcinoma, oncocytoma, renal cell carcinoma, invasive urothelial carcinoma, papillary renal cell carcinoma, chromophobe renal cell carcinoma, papillary urothelial carcinoma) were analyzed by immunohistochemical staining and Western blot methods. Expression of OPN in relation to grading, histologic type of tumor, and survival was statistically assessed. Study data demonstrated that OPN is differentially expressed in various renal tumor cells types. It was shown that OPN is predominantly expressed at the protein level in clear cell renal cell carcinoma when compared to other types of renal tumors. In conclusion, osteopontin may be involved in the pathogenesis of renal tumors. However, the role of OPN expression in predicting the biological response requires further evaluation.

ESC, ALK, HOT and LOT: Three Letter Acronyms of Emerging Renal Entities Knocking on the Door of the WHO Classification.

Kidney neoplasms are among the most heterogeneous and diverse tumors. Continuous advancement of this field is reflected in the emergence of new tumour entities and an increased recognition of the expanding morphologic, immunohistochemical, molecular, epidemiologic and clinical spectrum of renal tumors. Most recent advances after the 2016 World Health Organization (WHO) classification of renal cell tumors have provided new evidence on some emerging entities, such as anaplastic lymphoma kinase rearrangement-associated RCC (ALK-RCC), which has already been included in the WHO 2016 classification as a provisional entity. Additionally, several previously unrecognized entities, not currently included in the WHO classification, have also been introduced, such as eosinophilic solid and cystic renal cell carcinoma (ESC RCC), low-grade oncocytic renal tumor (LOT) and high-grade oncocytic renal tumor (HOT) of kidney. Although pathologists play a crucial role in the recognition and classification of these new tumor entities and are at the forefront of the efforts to characterize them, the awareness and the acceptance of these entities among clinicians will ultimately translate into more nuanced management and improved prognostication for individual patients. In this review, we summarise the current knowledge and the novel data on these emerging renal entities, with an aim to promote their increased diagnostic recognition and better characterization, and to facilitate further studies that will hopefully lead to their formal recognition and consideration in the future classifications of kidney tumors.

Diagnosis of Kidney Renal Cell Tumor through Clinical data mining and CT scan image processing: A Survey

This study deals with the systematic study of the mining of data and medical image-based CAD to classify or predict Kidney Renal (KRCC) tumors. Kidney tumors are of different types having different characteristics and have different methodologies to classify or predict tumor and its stages. KRCC is the most common type of cancer of the kidney, but there are others. Several factors may increase the risk of a person developing KRCC disease like smoking, obesity, High blood pressure, and many more. In almost all cases, only a single kidney is affected, but in rare cases, both can be affected by KRCC. As cancer grows, it may invade structures near the kidney, such as surrounding fatty tissue, veins, renal gland, or the liver. It might also spread to other parts of the body, such as the lungs or bones. It becomes essential to detect the KRCC tumor and classify it at the early stage to assist the pathologist in identifying the cause and severity of the tumor and in monitoring treatment. The pathologist examines the kidney diseases by using two different modes of data (Medical images and clinical databases). In this study, we reviewed different CAD tools to classify or predict KRCC tumor and its stages. For this study, two groups of methods that are data mining and medical image processing methods are selected. These methods allow the accurate quantification and classification of KRCC tumors from the clinical tools. Computer-assisted medical image and clinical database analysis show excellent potential for tumor diagnosis and monitoring.

Differentiation of renal cell tumors with morphological cocktails using a minimal panel of immunohistochemical markers.

Context:Morphological cocktails in renal cell carcinoma (RCC).Aims:Minimal immunohistochemistry (IHC) panel to resolve the diagnosis of renal cell cacinoma (RCC) with morphological overlaps.Settings and Design:RCC is the most common malignancy in kidney accounting for 90% of all kidney cancers. Clear cell RCC is the most common histological type followed by papillary RCC. However, many of the RCCs show morphological cocktails which may pose diagnostic difficulties in small biopsies and even in the resection specimens. Accurate diagnosis has both prognostic and therapeutic implications; hence, correct differentiation is necessary.Subjects and Methods:This retrospective study includes all renal cell tumors diagnosed on core biopsies, radical and partial nephrectomies between January 2015 and September 2017 were studied. The demographic, clinical, and gross findings were noted. The cases that had morphological overlap among the subtypes were subjected to a panel of IHC markers, including CD10, CK7, alpha-methyl acyl-coenzymeA racemase (AMACR), and CD117.Results:There were 128 RCC in the study period, and morphological overlap was seen in 36 (27.9%) specimens including 13 core biopsies, 16 radical, and 7 partial nephrectomies. IHC resolved 35/36 (97.2%) cases rendering a diagnosis of clear cell (11), papillary (15), chromophobe (4), and oncocytoma (5). However, in one case where the provisional diagnosis was oncocytic tumor, all IHC markers were negative rendering IHC noncontributory.Conclusions:Difficulty in diagnosis was encountered in many core biopsies, resection specimens which when subjected to IHC panel of CD10, CK7, AMACR, and CD117 helped in resolving the diagnosis of subtypes of RCC.

Auger radiopharmaceutical therapy targeting prostate-specific membrane antigen in a micrometastatic model of prostate cancer

Auger radiopharmaceutical therapy is a promising strategy for micrometastatic disease given high linear energy transfer and short range in tissues, potentially limiting normal tissue toxicities. We previously demonstrated anti-tumor efficacy of a small-molecule Auger electron emitter targeting the prostate-specific membrane antigen (PSMA), 2-[3-[1-carboxy-5-(4-[125I]iodo-benzoylamino)-pentyl]-ureido]-pentanedioic acid), or 125I-DCIBzL, in a mouse xenograft model. Here, we investigated the therapeutic efficacy, long-term toxicity, and biodistribution of 125I-DCIBzL in a micrometastatic model of prostate cancer (PC).Methods: To test the therapeutic efficacy of 125I-DCIBzL in micrometastatic PC, we used a murine model of human metastatic PC in which PSMA+ PC3-ML cells expressing firefly luciferase were injected intravenously in NSG mice to form micrometastatic deposits. One week later, 0, 0.37, 1.85, 3.7, 18.5, 37, or 111 MBq of 125I-DCIBzL was administered (intravenously). Metastatic tumor burden was assessed using bioluminescence imaging (BLI). Long-term toxicity was evaluated via serial weights and urinalysis of non-tumor-bearing mice over a 12-month period, as well as final necropsy.Results: In the micrometastatic PC model, activities of 18.5 MBq 125I-DCIBzL and above significantly delayed development of detectable metastatic disease by BLI and prolonged survival in mice. Gross metastases were detectable in control mice and those treated with 0.37-3.7 MBq 125I-DCIBzL at a median of 2 weeks post-treatment, versus 4 weeks for those treated with 18.5-111 MBq 125I-DCIBzL (P<0.0001 by log-rank test). Similarly, treatment with ≥18.5 MBq 125I-DCIBzL yielded a median survival of 11 weeks, compared with 6 weeks for control mice (P<0.0001). At 12 months, there was no appreciable toxicity via weight, urinalysis, or necropsy evaluation in mice treated with any activity of 125I-DCIBzL, which represents markedly less toxicity than the analogous PSMA-targeted α-particle emitter. Macro-to-microscale dosimetry modeling demonstrated lower absorbed dose in renal cell nuclei versus tumor cell nuclei due to lower levels of drug uptake and cellular internalization in combination with the short range of Auger emissions.Conclusion: PSMA-targeted radiopharmaceutical therapy with the Auger emitter 125I-DCIBzL significantly delayed development of detectable metastatic disease and improved survival in a micrometastatic model of PC, with no long-term toxicities noted at 12 months, suggesting a favorable therapeutic ratio for treatment of micrometastatic PC.

Prognostic effect of renal collecting system invasion on survival of patients with renal cell carcinoma and tumor thrombus.

IntroductionUrinary collecting system invasion (UCSI) has been found to have significant prognostic value for patients with renal cell carcinoma (RCC). However, for RCC patients with venous tumor thrombus (VTT), only contradictory data exist regarding the prognostic efficacy of UCSI. Therefore, the aim of this study is to assess the prognostic relevance of UCSI in survival of patients with RCC and VTT.Material and methodsMedical records in a prospectively maintained institutional database were analyzed for RCC-VTT patients who had undergone nephrectomy with thrombectomy. Then, the effect of UCSI on overall survival was analyzed.ResultsThe study examined data for 114 patients, including patients with VTT present in the renal vein (35 patients, 31%), infrahepatic inferior vena cava (28 patients, 24%), and suprahepatic inferior vena cava (51 patients, 45%). Nineteen percent of patients had UCSI. The median overall survival of patients with UCSI was 9 months, whereas median overall survival was 10 months for patients without collecting system invasion. Survival and regression analyses rejected UCSI as a prognostic marker for overall survival.ConclusionsUCSI has no effect on survival in our cohort of RCC-VTT patients. Therefore, it should not be considered in risk stratification models or in treatment decision-making for this patient group.

&lt;p&gt;The Roles of Ubiquitination Factor E4B (UBE4B) in the Postoperative Prognosis of Patients with Renal Cell Carcinoma and in Renal Tumor Cells Growth and Metastasis&lt;/p&gt;

ObjectThis study aimed at investigating the clinical significance and biological function of ubiquitination factor E4B (UBE4B) in human renal cell carcinoma (RCC).Methods19 paired clear cell renal cell carcinoma (ccRCC) tumor samples and the matched neighboring non-tumor samples were used to detect the expression of UBE4B in RCC tumor by Western blotting and RT-qPCR. UBE4B expression was also detected in 151 ccRCC paraffin-embedded tumor samples by using immunohistochemistry. Overall survival (OS) in different UBE4B expression groups were compared with Log rank test. The prognostic value of UBE4B expression in OS was evaluated with the univariate and multivariate Cox regression models. UBE4B was knocked down by small interfering RNA (siRNA) technology, and the effect of UBE4B on cell proliferation, colony formation, metastasis, apoptosis and cell cycle of RCC cells were examined in vitro.ResultsBoth protein and mRNA levels of UBE4B were up-regulated in ccRCC tumor tissues in contrast to the corresponding adjacent nontumor ones. UBE4B expression was positively associated with tumor-node-metastasis (TNM) stage and distant metastasis in ccRCC patients. Survival analyses indicated that low expression of UBE4B was associated with increased OS in ccRCC patients. Functional analyses demonstrated that siRNA silencing of UBE4B expression in SKRC39 and ACHN cells further reduced the growth, motility and invasiveness of RCC cells. Moreover, siRNA silencing of UBE4B in the RCC cell lines did not induce apoptosis, and an increase in the cell population was observed during the G0/G1 phase of the cell cycle.ConclusionUBE4B might act as an oncogene in regulating RCC development. Therefore it could be served as an effective indicator to predict OS and a potential biomarker for targeted therapy of RCC patients.

Caso Clínico: Metástasis Tumoral a Tumor. Un Raro Fenómeno.

Introducción: La metástasis tumor a tumor es muy rara con menos de 50 casos descritos en la literatura. Este artículo informa de un caso de metástasis de cáncer de mama en un tumor renal de células claras.&#x0D; Caso clínico: El caso corresponde a una mujer de 61 años de edad con antecedente de cáncer de mama, libre de enfermedad por 23 años. Por control, se solicita Tomografía computarizada (TC) simple y contrastada observándose a nivel de pelvis renal izquierda imagen nodular hipercaptante heterogénea de 2.4 cm, de bordes definidos, no infiltrante a tejidos adyacentes, por localización de lesión es sometida a nefrectomía radical izquierda. El examen patológico demostró un carcinoma de mama metastásico de 3 mm, mal definido, dentro de un carcinoma de células renales claras de 2,5x2x2cm. Este caso pone de relieve la importancia de los antecedentes previos de neoplasia maligna de un paciente, así como del muestreo adecuado de las neoplasias renales.

Molecular Genetics of Renal Cell Tumors: A Practical Diagnostic Approach.

Renal epithelial cell tumors are composed of a heterogeneous group of tumors with variable morphologic, immunohistochemical, and molecular features. A “histo-molecular” approach is now an integral part of defining renal tumors, aiming to be clinically and therapeutically pertinent. Most renal epithelial tumors including the new and emerging entities have distinct molecular and genetic features which can be detected using various methods. Most renal epithelial tumors can be diagnosed easily based on pure histologic findings with or without immunohistochemical examination. Furthermore, molecular-genetic testing can be utilized to assist in arriving at an accurate diagnosis. In this review, we presented the most current knowledge concerning molecular-genetic aspects of renal epithelial neoplasms, which potentially can be used in daily diagnostic practice.

8p deletions in renal cell carcinoma are associated with unfavorable tumor features and poor overall survival

Background and methods8p deletions are common in renal cell carcinoma. To study their prognostic impact and association with kidney cancer phenotype, a tissue microarray with 1,809 cancers was analyzed by fluorescence in situ hybridization for 8p21 copy numbers. ResultsOne thousand four hundred and seventy four interpretable tumors showed substantial differences between renal cancer subtypes. That 8p deletion was only seen in 1 (0.5%) of 216 papillary carcinomas underscores the biologic uniqueness of papillary kidney cancer, which is also defined by a highly distinct morphology. 8p deletions were found in 13.2% of 976 clear cell carcinomas, 7.8% of 77 chromophobe carcinomas, 0.8% of 119 oncocytomas, but also in several rare tumor entities including 1 of 4 collecting duct cancers, 1 of 3 multilocular cystic clear cell renal cell neoplasm of low malignancy, 2 of 10 Xp11.2 translocation cancers, 3 of 18 not otherwise specified carcinomas, and 1 analyzed medullary carcinoma. In clear cell carcinomas, 8p deletions were significantly associated with higher International Society of Urologic Pathologists (ISUP) grading (P = 0.0014), Fuhrman (P = 0.0003) and Thoenes grade (P = 0.0033), advanced tumor stage (P = 0.0002), large tumor diameter (P = 0.0019), distant metastases (P = 0.0183), overall survival (P = 0.0394), and recurrence free survival (P < 0.0001). In multivariate analysis, the prognostic role of 8p deletions was not independent of established clinic-pathological parameters. In conclusion, 8p deletions are strongly linked to tumor aggressiveness in clear cell kidney cancer. ConclusionsBecause 8p deletions are easy to measure by fluorescence in situ hybridization, 8p deletion assessment, most likely in combination with other parameters, may have a role in future prognosis assessment in clear cell kidney cancer.

Lessons learned from the developmental origins of childhood renal cancer.

Despite the rarity of renal tumors in children, many different types of malignant and nonmalignant renal neoplasms have been described. Therefore, the correct diagnosis and clinical management of these patients can represent a challenge. Here we provide a comprehensive review of the commonly diagnosed pediatric renal malignancies, including nephroblastoma (commonly known as Wilms tumor), clear cell sarcoma of the kidney, rhabdoid tumor of the kidney, several subtypes of renal cell tumors (often collectively termed renal cell carcinoma), and congenital mesoblastic nephroma. The epidemiology, pathology, treatments, underlying genetic and molecular mechanisms, and proposed developmental origins are discussed in detail, highlighting differential features and potential improved therapeutic strategies for affected individuals.

PRMT1 expression in renal cell tumors- application in differential diagnosis and prognostic relevance

BackgroundProtein arginine methyltransferase-1 (PRMT1) is associated with the progression of various tumor types and the process of epithelial to mesenchymal transition (EMT). However, the expression of PRMT1 in renal cell tumors (RCT) is unknown.MethodsWe evaluated PRMT1 immunohistochemical (IHC) expression on tissue microarray (TMA) of 208 specimens of RCT, including clear cell renal cell carcinomas (ccRCC), papillary RCC type I and II (pRCC I and II), chromophobe RCC (chRCC), renal oncocytomas (RO), collecting duct carcinomas - Bellini (CDC) and multilocular cystic renal cell neoplasms of low malignant potential (MLCRN-LMP). Moreover, a subset of ccRCC, pRCC, chRCC, RO were also studied using conventional sections. PRMT1 expression in tumor tissue was compared to the IHC expression of EMT-related transcription factors (ZEB1, RUNX1, and TWIST1) and cell surface markers (ß-catenin, N- and E-cadherin). Additionally, qRT-PCR expression of PRMT1 in ccRCC, pRCC, and chRCC was evaluated and the results were compared to the mRNA PRMT1 transcript profiling data in The Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression (GTEx) cohort.ResultsPRMT1 immunoreactivity was observed in the majority of ccRCC, RO, all MLCRN-LMP, but in a minority of chRCC (p = 0.044), and it was associated with low grade and low stage ccRCC (p = 0.014; p = 0.044, respectively). ZEB1 immunoreactivity was noted in all RO, in minority of chRCC and neither of MLCRN-LMP (p < 0.001). The majority of PRMT1-negative ccRCC was negative to ZEB1 and showed cytoplasmic expression of TWIST1 (p = 0.028; p < 0.001, respectively). PRMT1 positive ccRCC mostly expressed RUNX1 (p = 0.019). PRMT1 and ZEB1 expression were associated with better cancer-specific survival in patients with ccRCC (p = 0.029; p = 0.009, respectively). In multivariate analysis, ZEB1 expression was an independent prognostic factor for cancer-specific survival (hazard ratio [HR], 0.367; p = 0.026). Significant IHC heterogeneity was observed in PRMT1, ZEB1 and TWIST1 expression (p < 0.001). Homogenous loss of PRMT1 was associated with high grade and high stage ccRCC, while the homogenous loss of PRMT1 and ZEB1 was more frequent in patients who died of ccRCC (p = 0.017; p = 0.040; p = 0.044; p = 0.009, respectively). Relative mRNA-PRMT1 expression in both cohorts was down-regulated in tumor tissue compared to non-tumor parenchyma (p = 0.009). Unlike in our samples, mRNA-PRMT1 expression in the TCGA cohort was not correlated to ccRCC tumor stage or grade. PRMT1, ZEB1, and TWIST1 expression were not associated with EMT related aberrant ß-catenin expression, a gain of N-cadherin or loss of E-cadherin expression. Only RUNX1 was associated with a gain of N-cadherin (p = 0.003).ConclusionsIHC expression of PRMT1 may be characteristic for low grade and low stage ccRCC, while the homogenous loss of PRMT1 may be significant for high grade and high stage ccRCC. Both, PRMT1 and/or ZEB1 expression, could be associated with better survival of the patients with ccRCC.

Clinical and morphological features, immune profile of renal cell tumors with clear cytoplasm

In the structure of oncological morbidity, renal cell carcinoma takes the 10th place among malignant neoplasms. The increase in incidence is observed from the age of 35–40 years and reaches a maximum at the age of 65–70 years. In terms of frequency of occurrence, clear cell renal cell carcinoma is ranked first among all kidney tumors. Meanwhile, due to the high heterogeneity of renal cell carcinomas with clear cytoplasm group, significant differential diagnostic difficulties arise in the morphological verification of these tumors. The article presents all nosological forms of kidney tumors with clear cytoplasm and provides a database of already known immunohistochemical markers for each nosological unit.

Cover Image: Volume 34 Issue 10

Front Cover Caption: The cover image is based on the Original Article Pulmonary tumor embolization as early manifestation in patients with renal cell carcinoma and tumor thrombus: Perioperative management and outcomes by Giuseppe Serena et al., https://doi.org/10.1111/jocs.14182.

1945 Isolated Gastric Varices as the Sole Manifestation of Renal Cell Carcinoma

INTRODUCTION: Isolated gastric (fundal) varices (IGV) are a consequence of left (sinistral) portal hypertension commonly caused by splenic vein thrombosis (SVT). It occurs when SVT results in a backflow into the collateral short gastric and gastroepiploic vessels. Common causes of SVT include pancreatic and splenic pathologies. Renal cell carcinoma (RCC) is an extremely rare cause, and by itself, RCC is lethal because of the vagueness of its presenting symptoms. CASE DESCRIPTION/METHODS: A 76 year-old male with a past medical history of chronic anemia is presenting with two day history of hematochezia. He denies any personal or family history of colon cancer. He is not on anticoagulation or NSAID regimen. On evaluation, patient was noted to have non-remarkable vital signs. Physical exam was fairly unremarkable. Initial CBC was remarkable for severe anemia with hemoglobin of 6.1. MCV was normal. After routine transfusion, he was evaluated by gastroenterology and underwent an EGD, colonoscopy and capsule endoscopy. EGD was remarkable for 2 cm diameter non bleeding fundic gastric lesion. Colonoscopy and capsule endoscopy were unremarkable except for findings of dark blood in the distal ileum and throughout the colon. Tagged RBC scan was negative. Endoscopic ultrasound was obtained that showed multiple tubal, anechoic structures in the cardia of the stomach consistent with varices. CT abdomen and pelvis then confirmed a giant mass filling the left renal fossa presumably primary renal cell neoplasm with displacement of the pancreas and splenomegaly. CT chest was obtained and confirmed pulmonary nodules likely suggesting metastatic lesions. He then underwent splenectomy and nephrectomy with adjuvant chemotherapy for the metastatic disease. DISCUSSION: Sinistral (left) portal hypertension (SPH) was first outlined by Greenwald and Wasch in 1939. It is a clinical syndrome in which a patient with a patent portal vein and normal hepatic (liver) function tests develops isolated gastric variceal bleeding secondary to splenic vein thrombosis. Interestingly, only two cases have documented renal cell carcinoma as a cause of SPH in the last 30 years. Patients with this condition need to be considered for a prophylactic splenectomy and removal of associated arteries and veins, as well as a total nephrectomy. In this case, with metastatic lesions to his lungs, involving hematology/oncology and general surgery and gastroenterology in the multidisciplinary decision making process would be in his best interest.