Renal Metastasis Research Articles

Cardiac Leiomyosarcoma in a Cat Presenting for Bilateral Renal Neoplasia

A 10-year-old neutered female domestic longhair cat was presented to a tertiary care veterinary hospital for evaluation of a right renal mass that was identified incidentally on abdominal radiographs and classified further as a sarcoma based on fine needle aspiration cytology. Further diagnostic workup, including ultrasound and cytology, identified a sarcoma in the left kidney. After approximately 1 month of conservative medical management, the clinical condition deteriorated and the cat was humanely destroyed. Post-mortem examination confirmed bilateral renal masses with multifocal infarction and extensive necrosis, and further identified a large mass at the apex of the heart as well as multiple pulmonary nodules. Microscopical examination of the masses identified a population of poorly-differentiated neoplastic spindle cells, consistent with sarcoma. Immunohistochemically, the neoplastic cells expressed smooth muscle actin and muscle-specific actin, but were negative for myoglobin and factor VIII. Phosphotungstic acid-haematoxylin staining was unable to identify cross-striations in the neoplastic cells. Based on these results and the pattern of lesion distribution, the cat was diagnosed with cardiac leiomyosarcoma with pulmonary and bilateral renal metastasis.

Rare presentation of renal cell cancer as dysphagia: a case report

BackgroundMetastasis from distal solid organs to the esophagus is very rare. Renal cell cancer with esophageal metastasis is extremely rare. We present the first case report of undiagnosed renal cell cancer presenting as dysphagia.Case presentationA 56-year-old Caucasian man presented for dysphagia evaluation. An esophagogastroduodenoscopy examination revealed a 6 mm nodule located at gastroesophageal junction. Pathology and immunohistopathology were suggestive of metastatic renal cell cancer. Abdominal imaging revealed a large renal mass consistent with renal cell cancer. He underwent left nephrectomy and is clinically asymptomatic, while being monitored by Oncology and Urology.ConclusionsUndiagnosed renal cell cancer metastasis presenting as dysphagia is very rare. Careful upper endoscopy examination contributed to the diagnosis of this rare entity. A multidisciplinary team approach is key for management of these clinical dilemmas.

Local recurrence of renal cell carcinoma presented with massive gastrointestinal bleeding: management with renal artery embolization

BackgroundGastrointestinal bleeding from renal cell carcinoma metastasis is an uncommon manifestation of tumor recurrence and is usually difficult to control. Palliative trans-catheter embolization to control the bleeding has been used and described in the literature.Case presentationThe present report describes a 62- years-old male with local recurrence of RCC who presented with upper GI bleeding as the primary manifestation 10 years after right-sided partial nephrectomy. A pseudoaneurysm of renal artery with erosion into the duodenal lumen was responsible for the massive bleeding and was controlled with coil embolization.ConclusionThis case report highlights the importance of high index suspicion in post-nephrectomy patients for RCC, presenting with new symptoms. Aggressive gastrointestinal workup and adequate awareness of available minimally-invasive endovascular options for controlling GIB in these patients, are of paramount importance.

In Situ Cranioplasty for Renal Cell Skull Metastasis: Technical Note.

Treatment of a large, symptomatic skull metastasis requires surgical excision and in many cases postoperative radiation therapy. Immediate reconstruction of the skull for cerebral protection usually involves cranioplasty with titanium mesh and/or methyl methacrylate. Preoperative synthetic cranioplasty technology is yet to evolve sufficiently to allow computer-generated prostheses to precisely fit a defined craniectomy defect created at the time of tumor removal. We document the techniques used for simultaneous craniectomy and composite cranioplasty in the setting of a large occipital renal cell skull metastasis. Preoperative computed tomography (CT) and magnetic resonance (MR) imaging identified the pathological anatomy of an occipital skull metastasis presenting as an exophytic scalp mass. Preoperative angiography and embolization was performed followed by craniectomy in the semi-sitting position and composite cranioplasty using titanium mesh and methyl methacrylate. A series of steps in the surgical procedure are outlined to assist with safely and accurately performing the craniectomy and cranioplasty to guarantee the best surgical and cosmetic outcome. Postoperative CT imaging confirmed excellent contours of the cranioplasty. The method described herein allows for a single-step surgical procedure to excise a large skull metastasis and create a structurally sound and cosmetically acceptable composite cranioplasty. This method can also be used for the excision and repair of other skull tumors or anomalies requiring excision.

Physiological and pathological levels of prostaglandin E2 in renal parenchyma and neoplastic renal tissue

Prostaglandin (PG)E2 seems to promote tumor proliferation by regulating cell growth, inhibiting apoptosis, promoting angiogenesis, and suppressing host immune surveillance of cancer cells. The suppression of prostaglandins biosynthesis is thought to be the main molecular mechanism for non-steroidal anti-inflammatory drugs antineoplastic effect. Yet the relationship between PGE2 and human renal cell carcinoma remains unclear. The aim of our study is to evaluate the PGE2 content in human renal parenchyma and Renal Cell Carcinoma. The study was conducted on 20 consecutive patients undergoing radical nephrectomy for Renal Cell Carcinoma. In the normal renal parenchyma and in the neoplastic renal tissue the PGE2 level was 83.43 ± 5.89 pg/mg and 289.67 ± 22.2 pg/mg, respectively (P < 0.0001). There was no relationship between PGE2 content and Renal Cell Carcinoma dimension, Fuhrman grade, pathological-Tumor-Node and Metastasis (pTNM) stage and histological subtype. The PGE2 over-content in neoplastic renal tissue suggests a role of PGE2 in development and progression of renal carcinoma.

Clear cell renal cell carcinoma bone metastasis: What should be considered in prognostic evaluation

IntroductionKnowledge of clear cell renal cell carcinoma bone metastasis (ccRCC-BM) remains scarce. This study depicts clinical, pathological and outcome features of the disease and provides suggestions to establish prognosis prediction system more appropriate for ccRCC-BM. Materials and methodsPatients with ccRCC-BM had clinical, pathological data collected. Kaplan-Meier survival analysis was used for outcome profiles. Prognostic risks were evaluated using MSKCC/Motzer score. Univariate and multivariate logistic regression were performed to investigate association between clinical, pathological features and prognosis. ResultsIn the series containing 106 ccRCC-BM patients with 4:1 male predominance, 44.3% of them had synchronous bone metastasis and 28.3% had multi-organ metastasis. Axial bone was prone to bone metastasis and the incidence of severe skeletal-related events was 54.7%. Curative bone lesion resection was performed in 70.7% patients. The median overall survival (mOS) time was 45 months for all and 32 months for those in unfavorable risk stratification. Shorter time to bone metastasis (TTBM) [OR 1.019, 95% CI (1.007, 1.031)], elderly age [OR 1.040, 95% CI (1.001, 1.080)], concomitant multi-organ metastasis [OR 3.883, 95% CI (1.375, 10.967)] and carbonic anhydrase (CA)-IX expression loss [OR 58.824, 95% CI (2.653, 1000)] were associated with poor prognosis. ConclusionThe outcome of ccRCC-BM remained poor in unfavorable risk stratification. Bone lesion resection accompanied by systematic therapy for selected patient could improve prognosis. Shorter TTBM, elderly age, concomitant multi-organ metastasis and the expression loss of CA-IX along with gender-bias, feasibility for surgical treatment are suggested to be incorporated in modified ccRCC-BM-specific prognosis prediction system.

Megaprosthetic replacement of the distal humerus: still a challenge in limb salvage

The distal humerus is a rare location of bone tumors. Because of the complexity of the elbow joint, poor soft-tissue coverage, and proximity of nerves and vessels, resection and endoprosthetic reconstruction are demanding. This retrospective study evaluated the clinical results after distal humeral resection and megaprosthetic reconstruction in 12 patients with an average age of 46 years. All patient files were reviewed for clinical information, and postoperative function and patients' contentment were assessed using the Musculoskeletal Tumor Society score. The predominant diagnoses were bone and soft-tissue sarcoma (n = 6), giant cell tumor (n = 2), and renal cell carcinoma metastasis (n = 2). Local recurrence was the reason for secondary amputation in all cases (n = 3). The prosthetic survival rate after surgery was 82% at 2 years and 64% at 5 years. Reconstruction failure was mainly caused by aseptic loosening of the humeral stem, occurring in 27% (n = 3), followed by aseptic loosening of the ulnar stem in 9% (n = 1) and periprosthetic infection in 9% (n = 1). The mean Musculoskeletal Tumor Society score was 24 points (range, 20-30 points). An extension lag of more than 10° was noted in 6 patients (55%). Our results suggest that limb salvage with a distal humeral replacement can achieve good functional results in most patients, although the complication rate with special emphasis on the loosening rate of the humeral stem is high. However, limb salvage was not achieved in 27% of patients because of local recurrence.

Recurrent epistaxis as manifestation of renal cell carcinoma sinonasal metastasis

Introduction. Renal cell carcinoma is the most frequent infraclavicular primary tumor metastasizing in the sinonasal region, although these metastases are not common. We present an unusual case of recurrent epistaxis as the initial sign of renal carcinoma sinonasal metastasis and discuss the diagnostic and treatment options. Case outline. A 66-year-old patient was admitted to the hospital due to recurrent and severe epistaxis. The patient underwent nephrectomy due to renal cell carcinoma, with no signs of relapse during a three-year follow-up. Nasal endoscopy and computed tomography revealed a large mass in nasal cavity, spreading to the anterior and posterior ethmoid cells, sphenoid sinus, orbit, and anterior cranial fossa. Definite diagnosis of renal cell carcinoma metastasis in sinonasal region was made by a pathologist after biopsy and further radiological examination showed no signs of malignant disease in the abdomen, thorax, or pelvis. Although the patient had received 50 Gy of radiation therapy, the malignant disease was evaluated as progressive with further extension in anterior cranial fossa and maxilla, and the patient died five months after the occurrence of epistaxis. Conclusion. In patients with recurrent epistaxis who also had a history of renal carcinoma, endoscopic finding of tumefaction in the nasal cavity should raise a suspicion of sinonasal metastasis. In such cases, biopsy is mandatory to differentiate a metastasis from primary sinonasal tumors. Histological confirmation should be followed by radiological examination of the abdomen, thorax, and pelvis to evaluate the possibility of renal cell carcinoma recurrence or metastatic dissemination elsewhere.

Gallbladder Cancer with Recurrence of Renal Metastasis—A Case Report—

症例は80歳，女性．7年前，胆嚢癌に対して拡大右葉尾状葉合併切除，肝外胆管切除を施行．病理診断はtub1＞2，CGnB，結節浸潤型，3.0×2.5×2.5cm，ss，pHinf0，pPV0，pA0，pN1，pDm2，pHm1，pEm1，fStage IIIb．術後，TS-1による補助療法を1年間行った．初回手術から5年後，造影CTで膵頭部に境界不明瞭な腫瘤を認め，内視鏡的逆行性胆管造影にて膵内胆管に占拠性病変を認めたため，膵内胆管再発と診断して亜全胃温存膵頭十二指腸切除を施行．腫瘍は2.5×2.0×1.8cm大で，前回と類似した組織型であった．2年後，右腎に2.5cm大の乏血性，辺縁不整な腫瘤性病変が出現した．DUPAN2高値のため転移再発を疑い，経腰的右腎摘を施行して病理組織学的に胆嚢癌腎転移と診断した．胆嚢癌の腎転移再発は稀であるため，文献的考察を加えて報告する．

Thyroid-like Follicular Carcinoma of the Right Kidney: A Case Report

Renal cell carcinoma is responsible for approximately 80% of malignant tumors of the kidney. Clear cell, papillary, and chromophobe forms comprise the most frequent histological subtypes of renal cell carcinoma. Thyroid-like follicular renal cell carcinoma is an extremely rare subtype of renal cell carcinoma that resembles thyroid follicular neoplasms. Histologic findings should not be confused with chronic pyelonephritis with thyroidization or renal metastasis of thyroid cell carcinoma. There are few reports of thyroid-like follicular renal cell carcinoma. Here, we report a new case of thyroid -like follicular carcinoma of the kidney diagnosed in a partial nephrectomy specimen in a 62-year-old man.

Outbreak of myelocytomatosis caused by mutational avian leukosis virus subgroup J in China, 2018.

Avian leukosis virus subgroup J (ALV-J) was isolated in meat-type breeder chickens for the first time in 1988 in the United Kingdom. Due to the application of an eradication program, there were fewer reports related to myelocytomatosis or ALV-J in China after 2013. However, there was another breakout almost simultaneously in six provinces of China in February 2018. On-site, 15- to 20-week-old broiler breeder chickens showed depression, paralysis and weight loss. Mortality for certain flocks reached 15%. Sick chickens showed numerous yellow-white neoplasms growing in the sternum, rib and lumbar vertebra and had hepatic and renal metastasis. Histopathological observation showed all neoplasms were myelocytomas, and there were massive myelocyte-like tumour cells in the liver, kidney and bone marrow. To explore the aetiology of this re-outbreak of myelocytomatosis in China, we collected tumour-bearing chickens and isolated six strains of ALV-J (GM0209-1 to -6). Phylogenetic analysis of gp85 and gp37 showed GM0209 strains were clearly distinct from the prototype strain of ADOL-7501, HPRS-103 and NX0101, and there was a mutation, R176G, in the conserved region between hr1 and hr2 regions of gp85, which was not found in other 44 ALV-J strains. The 3'UTR nucleotide sequences of GM0209 isolates showed there was a signature deletion of 11 nt that was also present in 3'UTR sequences of SCDY1 and NHH, two isolates that have a reported association with haemangioma, indicating this deletion could not determine the tumour type induced by ALV-J. Although the eradication program of ALV-J has been successfully applied in China, the outbreak of ALV-J still occurred, and the virus strain spread quickly. Thus, the biocharacteristics and pathogenesis of mutational ALV-J should be further studied.

Minimally Invasive Lateral Access Corpectomy for a Solitary Renal Cell Carcinoma Spinal Metastasis: A Case Report

Minimally Invasive Lateral Access Corpectomy for a Solitary Renal Cell Carcinoma Spinal Metastasis: A Case Report

Solitary Renal Metastasis of Esophageal Squamous Cell Carcinoma

Esophageal cancer is the sixth leading cause of death from cancer worldwide. Most patients with esophageal cancer die from relapses or metastases, with a 5-year survival rate ranging from 15% to 25%. The most common places of metastasis are the liver, lungs, bones and adrenal glands. Metastases in the kidney are extremely rare.&#x0D; We present the clinical case of a 61-year-old patient who was surgically radically treated at the A.V. Vishnevsky Surgery Center about esophageal cancer. The lesion was localized in the middle third of the esophagus along the posterior one, with spreading to the right wall, protruding into the lumen, slightly narrowing it. The situation was complicated by the fact that preoperatively the patient was diagnosed with coronary artery stenosis: the middle third of the anterior interventricular branch (AIB) of 80%, the proximal third of the envelope of the left coronary artery to 70%, the right coronary artery in the middle third to 50%. In this connection, the first stage of treatment was performed by stenting of AIB and the envelope of the left coronary artery. With the dynamic observation of the patient's condition, metastasis to the kidney was revealed in two years, and the patient was also operated on.&#x0D; This clinical case demonstrates the possibility of using a complex radiology (including X-ray, ultrasound, MSCT and angiography) at the stages of examination and treatment of such category of patients, allowing timely detection and correction of both the manifestations of the underlying pathology and concomitant diseases.

Dissecting LncRNA Roles in Renal Cell Carcinoma Metastasis and Characterizing Genomic Heterogeneity by Single-Cell RNA-seq.

Long noncoding RNAs (lncRNA) have recently emerged as important regulators in cancer cell proliferation and metastasis. However, the role of lncRNAs in metastatic clear cell renal cell carcinoma (ccRCC) remains unclear. Here, single-cell RNA sequencing data were analyzed from primary renal cell carcinoma and paired metastatic renal cell carcinoma specimens, and characterized the expression profiles of over 10,000 genes, including 1,874 lncRNAs. Further analysis revealed that lncRNAs exhibit cancer type- and tissue-specific expression across ccRCC cells. Interestingly, a number of lncRNAs (n = 173) associated with ccRCC metastasis, termed ccRCC metastasis-associated lncRNAs (CMAL). Moreover, functional analysis based on a CMAL-PCG coexpression network revealed that CMALs contribute to cell adhesion, immune response, and cell proliferation. In combination with survival analysis, 12 CMALs were identified that participate in TNF and hypoxia-inducible factor 1 signaling to promote ccRCC metastasis. Further investigation on intratumoral heterogeneity showed that some CMALs are selectively expressed in different subpopulations. IMPLICATIONS: To explore ccRCC metastasis, the current study performed a global dissection of lncRNAs and a complex genomic analysis of ccRCC tumor heterogeneity. The data shed light on the discovery of potential lncRNA biomarkers and lncRNA therapeutic targets.

Isolated adrenocorticotropic hormone deficiency potentially induced by nivolumab following pseudo-progression in clear cell renal cell carcinoma: A case report.

Nivolumab is a monoclonal immunoglobulin G antibody blocking programmed death receptor-1 (PD-1) that promotes the restoration of the natural T-cell-mediated immune response against cancer cells; however, it also causes a number of autoimmune-related adverse events (irAEs) that often involve the endocrine system. The present report describes a 71-year-old man with clear cell renal cell carcinoma metastasis in the lung. Following the 14th course of nivolumab therapy, the patient complained of general malaise, loss of appetite and mild consciousness disturbance. Laboratory tests revealed a severely elevated eosinophil ratio (26.2%) and low sodium value (122 mmol/l). Endocrine system tests revealed that the patient's adrenocorticotropic hormone (ACTH; 4.5 pg/ml) and cortisol (0.1 µg/dl) levels were lower than normal, while those of other pituitary hormones were higher than normal. This case was therefore diagnosed as isolated ACTH deficiency induced by nivolumab. Magnetic resonance imaging (MRI) showed normal pituitary glands. Hydrocortisone replacement therapy improved the clinical symptoms early and enabled the patient to restart nivolumab therapy. Isolated ACTH deficiency due to nivolumab, a PD-1 immune checkpoint inhibitor antibody, is a rare occurrence. This report may be useful for avoiding delays in the diagnosis and treatment of this life-threatening irAE even if no pituitary abnormalities are identified via MRI.

Astrocyte Elevated Gene 1 (AEG-1) Acts as a Promoter Gene in Clear Cell Renal Cell Carcinoma Cell Growth and Metastasis.

BackgroundClear cell renal cell carcinoma (ccRCC) is usually incurable once it progresses to metastatic stage. Hence, in-depth investigations to reveal the precise molecular mechanisms behind the metastasis of ccRCC are required to improve the therapeutic outcome of ccRCC.Material/MethodsThe level of astrocyte elevated gene 1 (AEG-1) in ccRCC tissues and cell lines was determined by quantitative real-time PCR (qRT-PCR) assay. The MTS, colony formation, wound-healing, and Transwell invasion assays were used to assess the role of AEG-1 in ccRCC cells growth, migration, and invasion in vitro, respectively. Xenograft model and lung metastasis models were constructed to analyze the functions of AEG-1 in ccRCC cells growth and metastasis in vivo.ResultWe found that AEG-1 was overexpressed in ccRCC and was associated with the progression of ccRCC. Knocked-down AEG-1 impaired the migration and invasion of ccRCC cells in vitro. Furthermore, under-expression of AEG-1 caused complete inhibition of ccRCC cells growth and metastasis in vivo. In contrast, overexpression of AEG-1 significantly increased the migration and invasion ability of ccRCC cells in vitro. Finally, we revealed that AEG-1 boosted the metastatic ability of ccRCC cells via regulating Notch homolog 1 (Notch1).ConclusionsThe AEG-1/Notch1 signaling axis plays a vital role in ccRCC cell growth and metastasis.

Spontaneous regression of adrenal metastasis from renal cell carcinoma after sunitinib withdrawal: case report and literature review

BackgroundThe spontaneous regression of metastatic renal cell carcinoma is a rare phenomenon, with an estimated incidence of < 1%. We report a case of post-nephrectomy renal cell carcinoma adrenal metastasis, followed by the spontaneous regression of the metastasis after withdrawal of sunitinib.Case presentationThe patient was a 55-year-old male with clear cell type renal cell carcinoma who previously underwent a left laparoscopic radical nephrectomy. After 51 months of follow up, a recurrence in the left renal fossa was observed and subsequently excised. Four months after excision, an abdominal Computerized tomography (CT) identified an adrenal metastasis of 1.6 cm. The patient was treated with sunitinib. However, the treatment was discontinued because of gastrointestinal side effects and fatigue. Eleven months after the discontinuation of sunitinib treatment, a progression in the adrenal metastasis growth (5.7 cm) was observed, whereas 16 months after the discontinuation, a regression of the adrenal metastasis growth (3.4 cm) was observed. During subsequent follow-ups, a gradual reduction in the size of the adrenal metastasis (1.8 cm) was observed. After 44 months from the discontinuation of sunitinib treatment, the patient was still alive and followed up in the outpatient department.ConclusionsSunitinib is a multi-targeted inhibitor of vascular endothelial growth factor (VEGF) receptors. This compound reduces tumor angiogenesis and has been approved worldwide for the treatment of advanced renal cell carcinoma. To our knowledge, this is the fourth case of the spontaneous regression of metastatic renal cell carcinoma after the discontinuation of sunitinib treatment.

Sunitinib-suppressed miR-452-5p facilitates renal cancer cell invasion and metastasis through modulating SMAD4/SMAD7 signals

PurposeAlthough microRNAs (miRNAs) were revealed as crucial modulators in tumor metastasis and target therapy, our understanding of their roles in metastatic renal cell carcinoma (mRCC) and Sunitinib treatment was limited. Here we sought to identify human miRNAs that acted as key regulators in renal cancer metastasis and Sunitinib treatment.Experimental designWe focused on 2 published microarray data to select out our anchored miRNA and then explored the roles of miR-452-5p both in vitro and in vivo, which was downregulated after Sunitinib treatment while upregulated in metastasis renal cell carcinoma (RCC) tissues.ResultsHere, we discovered that treating with Sunitinib, the targeted receptor tyrosine kinase inhibitor (TKI), inhibited renal cancer cell migration and invasion via attenuating the expression of miR-452-5p. The novel identified miR-452-5p was upregulated and associated with poor prognosis in RCC. Preclinical studies using multiple RCC cells and xenografts model illustrated that miR-452-5p could promote RCC cell migration and invasion in vitro and in vivo. Mechanistically, P65 could directly bind to the miR-452-5p promoter and thus transcriptionally induce miR-452-5p expression, which led to post-transcriptionally abrogate SMAD4 expression, thus inhibition of its downstream gene SMAD7.ConclusionOur study presented a road map for targeting this newly identified miR-452-5p and its SMAD4/SMAD7 signals pathway, which imparted a new potential therapeutic strategy for mRCC treatment.

75] Renal metastasis of a primary ovarian carcinoma: A historical case report

ObjectiveTo report on a rare case of renal recurrence of ovarian malignancy. The frequency of secondary tumours of the kidney is underestimated, especially as their diagnosis is often delayed, after nephrectomy or autopsy. Unusual sites for recurrent ovarian metastases include extrahepatic solid organs (except the spleen), bone and the abdominal wall.

Renal metastasis from a high grade serous ovarian carcinoma: a case report and literature review

Renal metastasis from a high grade serous ovarian carcinoma: a case report and literature review