Renal Tumors In Patients Research Articles

Renal artery embolization in a case of renal cell carcinoma with intractable hematuria with acute myocardial infarction

Introduction: Renal artery embolization is a valuable treatment option for various renal tumors, both malignant and benign. The indications for this procedure include preoperative arterial embolization of large and vascular renal cell carcinoma to reduce intraoperative hemorrhagic complications, management of malignant renal tumors in patients who are not suitable candidates for surgery, treatment of symptomatic hematuria and palliative care for metastatic renal cancer. Case Report: In this case report, we present the case of a 56-year-old female with a known history of hypertension and cerebrovascular accident, who presented with complaints of hematuria and urinary retention. A diagnosis of left renal mass suggestive of renal cell carcinoma was made. The patient was planned for left radical nephrectomy and advised to discontinue aspirin for a week. However, on the morning of surgery, she experienced acute myocardial infarction and had to be hospitalized in intensive cardiac care. Aspirin was restarted, leading to recurrent severe hematuria. The patient underwent renal artery embolization, which successfully controlled the hematuria. Following cardiac stabilization, radical nephrectomy was performed three months later. The surgery and post-operative period were uneventful. Conclusion: This case study demonstrates the use of renal artery embolization as an effective modality for controlling hematuria, and temporizing management in a case of renal cell carcinoma where surgery was not immediately feasible due to a medical emergency.

Non-Invasive Tumor Grade Evaluation in Von Hippel-Lindau-Associated Clear Cell Renal Cell Carcinoma: A Magnetic Resonance Imaging-Based Study.

Pathology grading is an essential step for the treatment and evaluation of the prognosis in patients with clear cell renal cell carcinoma (ccRCC). To investigate the utility of texture analysis in evaluating Fuhrman grades of renal tumors in patients with Von Hippel-Lindau (VHL)-associated ccRCC, aiming to improve non-invasive diagnosis and personalized treatment. Retrospective analysis of a prospectively maintained cohort. One hundred and thirty-six patients, 84 (61%) males and 52 (39%) females with pathology-proven ccRCC with a mean age of 52.8 ± 12.7 from 2010 to 2023. 1.5 and 3 T MRIs. Segmentations were performed on the T1-weighted 3-minute delayed sequence and then registered on pre-contrast, T1-weighted arterial and venous sequences. A total of 404 lesions, 345 low-grade tumors, and 59 high-grade tumors were segmented using ITK-SNAP on a T1-weighted 3-minute delayed sequence of MRI. Radiomics features were extracted from pre-contrast, T1-weighted arterial, venous, and delayed post-contrast sequences. Preprocessing techniques were employed to address class imbalances. Features were then rescaled to normalize the numeric values. We developed a stacked model combining random forest and XGBoost to assess tumor grades using radiomics signatures. The model's performance was evaluated using positive predictive value (PPV), sensitivity, F1 score, area under the curve of receiver operating characteristic curve, and Matthews correlation coefficient. Using Monte Carlo technique, the average performance of 100 benchmarks of 85% train and 15% test was reported. The best model displayed an accuracy of 0.79. For low-grade tumor detection, a sensitivity of 0.79, a PPV of 0.95, and an F1 score of 0.86 were obtained. For high-grade tumor detection, a sensitivity of 0.78, PPV of 0.39, and F1 score of 0.52 were reported. Radiomics analysis shows promise in classifying pathology grades non-invasively for patients with VHL-associated ccRCC, potentially leading to better diagnosis and personalized treatment. 1 TECHNICAL EFFICACY: Stage 2.

Renal Function After CT-Guided Cryoablation of Small Renal Tumours in Patients with Solitary Kidney: An Analysis of European Multinational Prospective EuRECA Registry

PurposeTreatment of renal cell carcinoma (RCC) in patients with solitary kidneys remains challenging. The purpose of this multicentre cohort study was to explore how renal function is affected by percutaneous image-guided cryoablation in patients with solitary kidneys.Material and MethodsData from the European Registry for Renal Cryoablation database were extracted on patients with RCC in solitary kidneys treated with image-guided, percutaneous cryoablation. Patients were excluded if they had multiple tumours, had received previous treatment of the tumour, or were treated with more than one cryoablation procedure. Pre- and post-treatment eGFR (within 3 months of the procedure) were compared.ResultsOf 222 patients with solitary kidneys entered into the database, a total of 70 patients met inclusion criteria. The mean baseline eGFR was 55.8 ± 16.8 mL/min/1.73 m2, and the mean 3-month post-operative eGFR was 49.6 ± 16.5 mL/min/1.73 m2. Mean eGFR reduction was − 6.2 mL/min/1.73 m2 corresponding to 11.1% (p = 0.01). No patients changed chronic kidney disease group to severe or end-stage chronic kidney disease (stage IV or V). No patients required post-procedure dialysis.ConclusionImage-guided renal cryoablation appears to be safe and effective for renal function preservation in patients with RCC in a solitary kidney. Following cryoablation, all patients had preservation of renal function without the need for dialysis or progression in chronic kidney disease stage despite the statistically significant reduction in eGFR.Level of Evidence 3Observational study.Graphical

The kidney imaging surveillance scoring system (KISSS): using qualitative MRI features to predict growth rate of renal tumors in patients with von-Hippel Lindau (VHL) syndrome.

To determine the reliability of an MRI-based qualitative kidney imaging surveillance scoring system (KISSS) and assess which imaging features predict growth rate (GR) of renal tumors in patients with VHL. We identified 55 patients with VHL with 128 renal tumors who underwent intervention from 2015 to 2020 at the National Cancer Institute. All patients had 2 preoperative MRIs at least 3 months apart. Two fellowship-trained radiologists scored each tumor on location and MR-sequence-specific imaging parameters from the earlier MRI. Weighted kappa was used to determine the degree of agreement between radiologists for each parameter. GR was calculated as the difference in maximum tumor dimension over time (cm/year). Differences in mean growth rate (MGR) within categories of each imaging variable were assessed by ANOVA. Apart from tumor margin and renal sinus, reliability was at least moderate (K>0.40) for imaging parameters. Median initial tumor size was 2.1 cm, with average follow-up of 1.2 years. Tumor MGR was 0.42 cm/year. T2 hypointense, mixed/predominantly solid, and high restricted diffusion tumors grew faster. When comparing different combinations of these variables, the model with the lowest mean error among both radiologists utilized only solid/cystic and restricted diffusion features. We demonstrate a novel MR-based scoring system (KISSS) that has good precision with minimal training and can be applied to other qualitative radiology studies. A subset of imaging variables (T2 intensity; restricted diffusion; and solid/cystic) were independently associated with growth rate in VHL renal tumors, with the combination of the latter two most optimal. Additional validation, including in sporadic RCC population, is warranted.

Renal Neoplasia Occurring in Patients With PTEN Hamartoma Tumor Syndrome : Clinicopathologic Study of 12 Renal Cell Carcinomas From 9 Patients and Association With Intrarenal "Lipomas".

The aim of this study was to assess the histopathologic spectrum of renal tumors in patients with PTEN hamartoma tumor syndrome (PHTS), with a specific focus on potential features predictive of the underlying syndrome. A multi-institutional study was conducted to obtain clinical and pathologic data on renal tumors arising in patients with PHTS, either diagnosed by germline mutational analysis or clinical criteria for Cowden syndrome. Histologic sections of the renal tumors were re-reviewed for classification. Twelve renal epithelial tumors from 9 patients were identified (4 males and 5 females, with a mean age of 41.8y), 7 of whom carried germline PTEN mutations. All 12 renal epithelial tumors were renal cell carcinomas (RCCs): 5 were chromophobe RCCs, 4 papillary RCCs, and 3 RCC not otherwise specified. Pathologic stage distribution was: 7 (59%) pT1a, 2 (17%) pT1b, 1 (8%) pT2a, 1 (8%) pT2b, and 1 (8%) pT3a. World Health Organization/International Society of Urological Pathology (WHO/ISUP) histologic grade was applicable in 7 (54%) nonchromophobe tumors: 4 (57%) G2, 2 (29%) G3, and 1 (14%) G4. An unexpected histologic finding was the presence of 2 patients with incidental microscopic collections of intrarenal adipocytes that had no features of angiomyolipoma (and were negative with 2 sensitive PEComa markers: cathepsin-K and GPNMB); both were classified as lipoma/"lipomatous hamartomas." The average follow-up interval was 67.8 months (13 to 172mo): 5 patients had no evidence of disease, 2 were lost to follow-up, 1 died of other (non-PHTS) causes (ie, prostate cancer), and 1 was alive with metastatic RCC to the lung (RCC not otherwise specified with rhabdoid differentiation). All tumors showed loss of nuclear PTEN staining by immunohistochemistry. Fumarate hydratase was retained and 2SC was negative in all papillary RCCs. CK7 was moderate-strong/diffuse positive in 4 of 5 chromophobe RCCs and in 3 of 4 papillary RCCs. Renal epithelial tumors associated with PHTS represent a heterogeneous group of RCCs, but classic chromophobe and papillary RCC are most common. The majority have a favorable clinical behavior as would be predicted by subtype. In contrast to other hereditary renal neoplasia syndromes, morphologic features of the RCCs do not allow identification of PHTS-associated neoplasia with any degree of specificity in the absence of clinical setting and/or prior history, but the presence of microscopic "lipomas" within the kidney may provide a clue in rare cases. Therefore, clinical suspicion and genetic counseling with germline testing remain necessary for identifying PHTS-associated RCC.

V05-09 ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR NEW OR RECURRENT TUMOR IN PATIENT WITH PRIOR PARTIAL NEPHRECTOMY OR TUMOR ABLATION

You have accessJournal of UrologyCME1 Apr 2023V05-09 ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR NEW OR RECURRENT TUMOR IN PATIENT WITH PRIOR PARTIAL NEPHRECTOMY OR TUMOR ABLATION Sumit Saini, Timothy O'Rourke, Parth Thakker, and Ashok Hemal Sumit SainiSumit Saini More articles by this author , Timothy O'RourkeTimothy O'Rourke More articles by this author , Parth ThakkerParth Thakker More articles by this author , and Ashok HemalAshok Hemal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003263.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Salvage robot-assisted partial nephrectomy (sRAPN) for new or recurrent renal tumor is a technically challenging procedure secondary to varying degree of peri & paranephric fibrosis and intrarenal changes in parenchymal architecture. Here in, we demonstrate surgical technique in such complex cases. METHODS: Between January 2013 and July 2022, we queried our prospectively maintained institutional database. We identified 20 renal lesions in 18 patients who underwent robot-assisted salvage partial nephrectomy for local recurrences after prior partial nephrectomy or tumor ablation. Meticulous dissection through the adhesions while ensuring a rim of normal renal parenchyma is the key to achieve negative surgical margins in these challenging cases. Intraoperative ultrasound and indocyanine green-near infrared fluorescence imaging (ICG-NIRF) also play an indispensable role in these cases. RESULTS: Majority of our patients either had prior cryoablation or prior partial nephrectomy (Table 1). A second/new renal lesion was noted in 2 patients in the same kidney following initial cryoablation which were also excised simultaneously. Median time to recurrence from primary procedure was 2 years (1-7) and mean age at salvage surgery was 65±10.2 years. Mean operative time was 161.4 minutes (66-348) and mean warm ischemia time was 23.3±4.6 minutes. All the surgical margins were negative and none of the patients developed any major complications post-operatively. At median follow up of 15 months (3-62), all patients are alive and none of the patients developed any recurrence. CONCLUSIONS: sRAPN for new or recurrent renal tumor in patients with prior partial nephrectomy or tumor ablation is technically feasible with excellent peri-operative and oncological outcomes. However, it requires prudent cross-sectional imaging to understand spatial anatomy and technical tools such as intraoperative ultrasound/near infrared fluorescence imaging with ICG. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e426 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sumit Saini More articles by this author Timothy O'Rourke More articles by this author Parth Thakker More articles by this author Ashok Hemal More articles by this author Expand All Advertisement PDF downloadLoading ...

EP024 - Our experiences in clinical T2 renal tumor in patients with nephron-saving surgery single center

EP024 - Our experiences in clinical T2 renal tumor in patients with nephron-saving surgery single center

Experience With Normal Breathhold Planning Scans for Radiosurgery of Moving Targets With Live Tracking.

Utilization of breathhold scans with live tracking has a long track record of good published outcomes for stereotactic body radiation therapy (SBRT)and is recommended by the manufacturer of the Synchrony tracking system. However, the popularity of four-dimensional computed tomography (4DCT) scans challenges the validity of the breathhold scan with live tracking technique. Although this study is not intended to prove the superiority of either method, we demonstrate the feasibility of using the breathhold scans with a phantom test and clinical examples. A 4DCT of a perfect sphere was scanned at 20 breaths per minuteand compared to a 4DCT of a small lung tumor in one patient and a 4DCT of a larger renal tumor in another patient, as well as to fiducial matching in a patient with pancreatic cancer.Normal exhale and normal inhale breathhold CT scans were performed for the pancreatic cancer patient, combined with Synchrony tracking on CyberKnife (Sunnyvale, CA: Accuray) for treatment. The 4DCT scan of the phantom exhibited considerable apparent deformation, which must be entirely due to imaging artifact since the perfect sphere in the phantom is known to be completely rigid.The 4DCT of the lung and renal tumors in patients had similar apparent deformation.Usually in patients, from 4DCT alone, it is difficult to determine how much was due to deformation and how much was due to artifact.Fiducial positions in the final normal exhale and normal inhale breathhold scans for Synchrony matched each other within 1mm for the pancreatic cancer patient. We demonstrated the feasibility of breathhold scans with Synchrony live tracking, as recommended by the manufacturer.More studies will be needed to determine whether this method is better than using a 4DCT.

Percutaneous Thermal Ablation for Renal Tumors in Patients with Birt-Hogg-Dubé Syndrome.

Simple SummaryPercutaneous thermal ablation (TA) could be a safe and efficient nephron-sparing treatment for treating renal cell carcinoma (RCCs) associated with Birt–Hogg–Dubé (BHD) syndrome, a rare hereditary condition at greater risk of repeated treatments, even in the case of advanced chronic kidney disease, and should be systematically discussed as a treatment option. Indications for nephron-sparing management of these tumors in BHD patients depends on many factors, including size, number, and location of the tumor(s) in each kidney, patient surgical history, and renal function. The role of the tumor board including radiologists, interventional radiologists, urologists, and oncologists is essential.BHD syndrome is characterized by an increased risk of bilateral and multifocal renal cell carcinoma (RCCs), but is rarely metastatic. Our report aims to analyze the outcome of patients with BHD syndrome who underwent percutaneous thermal ablation (TA). The present report included six BHD syndrome patients (five men) with a mean age of 66 ± 11 (SD) years who had a proven germline FLCN gene mutation and underwent TA for a renal tumor. Nineteen renal tumors (median two tumors per patient; range: 1–3), including seven chromophobe RCCs, five clear-cell RCCs, four papillary RCCs, two clear-cell papillary RCC, and one hybrid oncocytic/chromophobe tumor were treated in 14 ablation sessions. The mean size of the tumors was 21 ± 11 (SD) mm (median: 20 mm; interquartile range (IQR): 14–25 mm) for a mean volume of 7 ± 11 (SD) mL (median: 3; IQR: 1–5 mL). Technical success was achieved in all ablation sessions (primary success rate, 100%). The procedure was well tolerated under conscious sedation with no significant Clavien–Dindo complication (grade 2, 3, 4). All patients were alive with no distant metastasis during a median follow-up period of 74 months (range: 33–83 months). No local tumor progression was observed. The mean decrease in estimated glomerular filtration rate was 8 mL/min/1.73 m2. No patients required dialysis or renal transplantation. In this case series, percutaneous TA appeared as a safe and efficient nephron-sparing treatment for treating RCCs associated with BHD syndrome, even in the case of advanced chronic kidney disease.

Combined transarterial embolization and percutaneous image-guided ablation for the treatment of T1B and central renal tumors in patients with high surgical risk

Objectives: The objectives of the study were to assess the technical success, efficacy, and complications of the combination of transarterial embolization (TAE) followed by percutaneous ablation in treating stage cT1b and central renal tumors. Material and Methods: An institutional registry was reviewed for patients who underwent TAE followed by percutaneous computed tomography (CT)-guided renal ablation from 2007 to 2018. Twenty-eight consecutive patients (median age 69 years; range 45–89 years) with tumor size ranging from 25 to 58 mm (average 45 mm), including 24 patients with T1b tumors and four with central T1a tumors, were identified. Nineteen patients had TAE followed by cryoablation (CA), and nine patients had TAE followed by radiofrequency ablation (RFA). Technical success, local tumor control, and post-procedure complications were retrospectively reviewed. Results: All procedures were technically successful. Local tumor control was achieved in 26 of 28 patients (92.9%) at a median follow-up of 26 months. Local tumor recurrence was found in two of 28 patients, with a median time to local recurrence of 15 months. The recurrences occurred in one patient who had TAE plus CA and in one patient who had TAE plus RFA. Self-limited hematoma and hematuria were minor complications observed in 3 patients (10.7%). Only one patient had a major complication. This patient developed ureteral obstruction and perirenal abscess requiring ureteral stent and percutaneous drainage without long-term sequela. Conclusion: In this cohort of patients, a combination of TAE and percutaneous CT-guided ablation was an effective, well-tolerated, and safe treatment for patients with T1b and central renal tumors.

V10-07 NEAR-INFRARED FLUORESCENCE IMAGING TECHNOLOGY APPLICATIONS IN UROLOGIC SURGERY

You have accessJournal of UrologyCME1 May 2022V10-07 NEAR-INFRARED FLUORESCENCE IMAGING TECHNOLOGY APPLICATIONS IN UROLOGIC SURGERY Riccardo Mastroianni, Gabriele Tuderti, Umberto Anceschi, Alfredo Maria Bove, Aldo Brassetti, Mariaconsiglia Ferriero, Leonardo Misuraca, and Giuseppe Simone Riccardo MastroianniRiccardo Mastroianni More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Alfredo Maria BoveAlfredo Maria Bove More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002623.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clinical applications of near-infrared fluorescence (NIRF) with Indocyanine green (ICG) technology are rapidly growing. Potential improvements especially for functional outcomes have been described in different urologic procedures. In this video we highlights our experience with multiple clinical applications of NIRF-ICG technology in distinct urologic procedures. METHODS: In this video we collected multiple clinical applications of NIRF technology: ICG-marking of totally endophytic renal tumors selected for partial nephrectomy, assessment of thrombus extent during level III IVC tumor thrombectomy, identification of functioning adenomas during adrenal surgery, assessment of ureteral vascularization during robot assisted radical cystectomy and during ureteral reimplantation, identification of urethra and ejaculatory ducts during Madigan prostatectomy. RESULTS: First, NIRF-ICG technique was demonstrated useful to mark endophytic renal tumors in patients selected for purely off-clamp robotic partial nephrectomy. Lipiodol indocyanine green mixture was selectively delivered in the tertiary ordered arteries feeding the tumor. In this way, the use of NIRF imaging allow to easily recognize endophytic renal tumor. Therefore, parenchyma incision, margins scoring and deep part of enucleation were performed under NIRF imaging. Secondly, intravenous injection of ICG was used during robot-assisted radical nephrectomy with level III IVC tumor thrombectomy in order to better define thrombus boundaries, to control cranial IVC thrombus edge, to expect IVC lumen and to confirm proper restoration of IVC flow. Then, NIRF-ICG technology was used to easily identify hypervascularized adrenal mass during robotic partial adrenalectomy and to evaluate proper perfusion of distal ureters both during RARC and robot-assisted ureteral reimplantation. Finally, NIRF-ICG technology was reported as an essential tool during robot-assisted Madigan prostatectomy when ejaculation preservation is planned. A retrograde injection of ICG throw the urethral catheter placed on navicular fossa allowed to easily recognize proximal prostatic urethra, and therefore to preserve ejaculatory function avoiding unintended violation of the urinary tract. CONCLUSIONS: NIRF-ICG technology sounds a safe and feasible procedure. This technique allows to easy identify key anatomical landmarks, providing information about tissue vasculature and perfusion. NIRF-ICG technique demonstrated to potentially improve functional outcomes of robotic procedures even if larger series with longer follow-up are needed. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e850 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Riccardo Mastroianni More articles by this author Gabriele Tuderti More articles by this author Umberto Anceschi More articles by this author Alfredo Maria Bove More articles by this author Aldo Brassetti More articles by this author Mariaconsiglia Ferriero More articles by this author Leonardo Misuraca More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF DownloadLoading ...

Folliculin impairs breast tumor growth by repressing TFE3-dependent induction of the Warburg effect and angiogenesis.

Growing tumors exist in metabolically compromised environments that require activation of multiple pathways to scavenge nutrients to support accelerated rates of growth. The folliculin (FLCN) tumor suppressor complex (FLCN, FNIP1, FNIP2) is implicated in the regulation of energy homeostasis via 2 metabolic master kinases: AMPK and mTORC1. Loss-of-function mutations of the FLCN tumor suppressor complex have only been reported in renal tumors in patients with the rare Birt-Hogg-Dube syndrome. Here, we revealed that FLCN, FNIP1, and FNIP2 are downregulated in many human cancers, including poor-prognosis invasive basal-like breast carcinomas where AMPK and TFE3 targets are activated compared with the luminal, less aggressive subtypes. FLCN loss in luminal breast cancer promoted tumor growth through TFE3 activation and subsequent induction of several pathways, including autophagy, lysosomal biogenesis, aerobic glycolysis, and angiogenesis. Strikingly, induction of aerobic glycolysis and angiogenesis in FLCN-deficient cells was dictated by the activation of the PGC-1α/HIF-1α pathway, which we showed to be TFE3 dependent, directly linking TFE3 to Warburg metabolic reprogramming and angiogenesis. Conversely, FLCN overexpression in invasive basal-like breast cancer models attenuated TFE3 nuclear localization, TFE3-dependent transcriptional activity, and tumor growth. These findings support a general role of a deregulated FLCN/TFE3 tumor suppressor pathway in human cancers.

Radiofrequency ablation for renal tumours: A retrospective study from a tertiary centre

ObjectiveThis study aimed to evaluate the safety and efficacy outcomes of percutaneous radiofrequency ablation (RFA) for localised renal cell carcinoma (RCC) in a tertiary hospital patient who remained unfit for surgical intervention. MethodsWe retrospectively analysed survival outcomes for patients with biopsy proven RCC treated by RFA at Royal Perth Hospital between September 2009 and May 2018. Complication data were gathered for all patients that underwent renal RFA along with 2- and 5-year recurrence-free survival (RFS) rate and compared the outcomes with data from previous studies. ResultsA total of 69 patients (73 procedures) were eligible for the study, and those patients had biopsy-proven RCC with a minimum of 2-year follow-up. The complication rate was 8.2% (6/73) and local recurrence rate 9.6% (7/73). Two-year RFS is 95.7% and 5-year RFS is 78.8% on a median 3.82-year follow-up (interquartile range 1.90–5.75 years). ConclusionRFA performed at our centre was found to be safe and effective with low complication rates and durable RFS in line with expectations from existing research. Our study demonstrated that RFA is an alternative modality of treatment for small renal tumours in patients unfit for surgical approach.

Metastases to the Kidney: An Analysis of 35 Cases and a Review of Literature.

IntroductionIn addition to being rare, metastases to the kidney present clinicians with issues regarding their treatment.Materials and MethodsWe retrospectively analyzed 35 cases of diagnosed renal metastases. The clinical characteristics, imaging features, pathological features, diagnosis, and treatment were analyzed, and Kaplan-Meier methods and Cox regression analysis were used to calculate overall survival (OS) and influencing factors.ResultsThe average age of the patients was 62 years, and 40% presented with symptoms. The most common primary tumor was lung cancer (60%), and two patients had renal metastases coexisting with renal cell carcinoma. The average interval from primary tumor to renal metastasis was 29.4 months. Only 45.5% of the patients who underwent enhanced computerized tomography were diagnosed with renal metastases. Renal biopsy was performed in 16 patients (45.7%), leading to a diagnosis in 15 (93.8%). Twenty-one patients (60%) received surgical treatment, and median recurrence free survival of these patients was 7 months (95% CI, 5 to 12). Overall, the median OS was 44 months for patients who underwent renal surgery, and 52 months for patients who did not (P = 0.672). However, for patients without metastases at other sites, surgery could significantly prolong OS (P = 0.001).ConclusionAlthough rare, the possibility of renal metastasis should be considered after finding renal tumors in patients with primary tumors in other organs, and can be diagnosed by imaging examination and puncture biopsy. For patients without other metastases, surgical intervention can be considered for the renal lesions.

Laparoendoscopic single-site simultaneous bilateral nephrectomy: first reported case series.

Bilateral renal tumors in patients on dialysis are usually managed with bilateral nephrectomy. With traditional laparoscopy, this procedure requires the insertion of multiple trocars. Laparoendoscopic single-site surgery (LESS) uses a single umbilical incision to insert multiple instruments and is also employed for extraction of specimens. This technique appears especially useful for bilateral nephrectomy, since many access ports can be spared. We describe 5 cases of simultaneous bilateral radical nephrectomies performed at a single academic institution. We had no intraoperative complications and a mean operating time of 155 minutes. Four patients could be resected using this approach; one case was converted to a traditional laparoscopy. One case had a postoperative complication. We believe this technique is feasible, and can be accomplished with acceptable morbidity and ade-quate operative time.

IPSILATERAL SYNCHRONOUS MUCINOUS TUBULAR AND SPINDLE CELL CARCINOMA AND CLEAR CELL PAPILLARY RENAL CELL CARCINOMA: A CASE REPORT AND REVIEW OF THE LITERATURE

Renal cell carcinoma (RCC), the most common solid lesion of the kidney, accounts for approximately 2%-3% of all malignancies among adults. Clear cell carcinoma and papillary cell carcinoma are the most common types of renal tumors. Some case reports have described synchronous benign and malignant tumors in the same kidney. In particular, angiomyolipoma and RCC in patients with tuberous sclerosis (TSC) and non-TSC have been reported many times in the literature. However, unilateral concordance of malignant renal tumors is very rare; thus, only few cases have been reported in the literature.Here we report the case of a 58-year-old male who had ipsilateral synchronous mucinous tubular and spindle cell carcinoma (MTSCC) and clear cell papillary renal cell carcinoma (CCPRCC). Both cancers are rare and relatively recently defined subtypes of RCC. Additionally, both were successfully treated using partial nephrectomy. MTSCC has been a distinct entity in the World Health Organization classification of kidney tumors since 2004. The classic type of MTSCC is characterized by small elongated tubules lined with clear cuboidal or spindle cells with mucinous stroma. Neoplastic cells always exhibit low-grade histological features. However, unclassified variants of MTSCC, such as mucin-poor, papillary, high-grade, and sarcomatoid variants, have also been reported. MTSCC is considered to have a relatively good prognosis, but some patients with poor prognoses have recently been reported. CCPRCC is a recently recognized entity and represents the fourth most common variant of RCC. It has unique morphological and immunohistochemical features and shows indolent clinical behavior. Microscopically, CCPRCC may mimic other RCCs with clear cell features, such as clear cell RCC, translocation RCC, and papillary RCC, with clear cell changes. In 2006, CCPRCC was described as a subtype of renal tumors in patients with end-stage renal disease. However, currently, CCPRCC has also been shown to occur in kidneys with normal function.To the best of our knowledge, this is the first report of ipsilateral synchronous MTSCC and CCPRCC, which we present with a review of the pertinent literature.

Repeat ablative therapy in hereditary or multifocal renal cancer: Functional and oncological outcomes

ObjectivesTo report managing renal tumors in patients at greater risk of repeated interventions (genetic predisposition, multifocal tumors) with thermoablative treatments (AT). A known significant challenge in these patients is the balance between nephron preservation and oncologic outcome. Material and methodsThis retrospective, single-center study was based on data from patients treated with one or more AT for hereditary or multifocal renal tumors between 2007 and 2017. All medical records were systematically reviewed, and 10 patients meeting inclusion criteria were selected. Six patients had confirmed von Hippel-Lindau disease, 1 Bird-Hogg-Dubé syndrome, 1 chromosome 3 translocation, and 2 had a presumed genetic predisposition. ResultsMedian age at cancer diagnosis was 39.5 years (±8.9). Fifty-seven tumors, including 41 de novo tumors that appeared during follow-up, were treated with 32 AT sessions (cryotherapy or radiofrequency) with an average tumor size of 13.5 mm (±9) and a median RENAL score of 6 [5; 7]. One patient underwent concomitant partial nephrectomy for a 55 mm lesion which was close to the bowel. Treatment was unsuccessful in 2 cases, subsequently managed successfully by retreatment with AT. Median delay of appearance of de novo tumor after the first AT was 18 months [6 ; 24]. One patient had metastatic progression. Overall and cancer specific survival was 90% and 100%, respectively, with a mean follow-up of 7.5 years (±4.9). The mean decrease in Chronic Kidney Disease – Epidemiological Collaboration equation-estimated glomerular filtration rate at the end of follow-up was 5.5 ml/min/1.73 m2 (±24). ConclusionThis study suggests that AT allows to meet the oncological objectives whilst preserving renal function in patients with renal cancer at greater risk of repeated treatments.

The surgical and oncological rational of partial nephrectomy for the treatment of localized renal cell carcinoma

Background and objectives:The more frequent use of partial nephrectomy (nephron sparing surgery) in renal cancer treatment derives from a spectacular rise in the incidental diagnosis of renal tumors in patients undergoing abdominal ultrasound or computed tomography for abdominal diseases. This has markedly increased the detection of small, asymptomatic tumors. The aim of this study is to analyze the current evidence of efficacy and safety of open partial nephrectomy in patients with renal cell carcinoma and to speculate its indications and complications. Methods: Hos- pital based case-prospective & retrospective study. A Total of 36 patients with renal cell carcinoma who underwent nephron sparing surgery between september 2017 and March 2019 at Rizgary Teaching Hospital and Zheen Interna- tional Hospital were investigated, Tumor related characteristics, indication for nephron sparing surgery, postoperative complications, full histopathological data, and follow up results were reviewed. Results: Open partial nephrectomy was done successfully to treat patients with renal cell carcinoma; during the follow-up period one patient developed bleeding at day of surgery, three patients suffered from haematuria at 4th day, two weeks & one month postoperative- ly & one patient complicated by urine leakage & fistula formation, all complications were managed successfully. No patients were experienced disease progression (local recurrence and distant metastasis), there were no deaths from surgery, there was no acute renal failure, no postoperative dialysis & the disease specific survival rate was 100 %. Conclusions: artial Nephrectomy appears to be safe and effective procedure to control cases of renal tumors with relative and absolute indications for NSS.

Microwave Thermal Ablation versus Open Partial Nephrectomy for the Treatment of Small Renal Tumors in Patients Over 70 Years Old.

Background and objectives: Microwave thermal ablation (MWT) is one of the treatment options for kidney cancer. However, for patients over 70 years old the safety and oncological efficacy of this treatment is still controversial. The goal of this study was to compare MWT with open partial nephrectomy (OPN) and to find out whether MWT is preferable in maintaining patient renal function and reducing the risk of postoperative complications. Materials and Methods: Depending on the treatment choice, all patients were divided into two groups: an MWT group and an open kidney resection (OPN) group. Data have been retrospectively collected for 7 years, starting with January 2012 up to January 2019. A total number of 33 patients with exophytic, single small renal masses were treated with either OPN (n = 18) or MWT (n = 15). All patients had histologically proven T1 kidney cancer. MWT was performed for patients who refused to have OPN or in those cases where the collecting system, renal calyx, and great vessels were free from tumor margins of more than 1 cm. Results: In the MWT group a median (IQR) patients’ age was 75 years (71–79) years, in the OPN group—71.5 (70–75) years, p = 0.005. A median (IQR) Charleston comorbidity index in the MWT group was 7.5 (5–10) and in the same way in the OPN group it was 5.22 (5–6), p = 0.005. A median (IQR) estimated glomerular filtration rate (eGFR) before surgery was higher in the MWT group 59.9 (49.5–73.8) mL/min/1.73 m2 vs. 46.2 (42.7–65.8) mL/min/1.73 m2 in the OPN group, p = 0.12. Three days following the surgery a median (IQR) eGFR was 56.45 (46.6–71.9) in MWT group mL/min/1.73 m2 vs. 43.45 (38.3–65) mL/min/1.73 m2) in the OPN group, p = 0.30. A median (IQR) of primary hemoglobin level was lower in the MWT group compared with the OPN group (134.5 (124–140) g/L vs. 125 (108–138) g/L), p = 0.41. However, after the surgery a median (IQR) lower hemoglobin level was detected in the OPN group (123.5 (111–134) g/L vs. 126 (112–135)), p = 0.53. The median (IQR) duration of the procedure in MWT group was shorter compared with the OPN group (26 (25–30) min vs. 67.5 (55–90) min), p < 0.0001. A median (IQR) hospitalization time was shorter in MWT group (3 (2–3) days vs. 89 (7–11.5) days), p < 0.0001. Pain by the visual analogue scale (VAS) scale the first day after surgery was significantly lower—median (IQR) in the MWT group was 2 (1–3) vs. 4 (3–6)), p = 0.008. Treatment failure rate was numerically higher in MWT (1/15 vs. 0/18, p = 0.56). Conclusions: Pain level on the next day after surgery, mean number of hospitalization and operation time were significantly lower in the MWT group than in the OPN group. The blood loss estimated glomerular filtration rate and oncologic data between the two groups was not statistically significant.

A radiomic approach to differential diagnosis of renal cell carcinoma in patients with hydronephrosis and renal calculi

ObjectiveTo explore the application of radiomic analysis in differential diagnosis of renal cell carcinoma in patients with hydronephrosis and renal calculi using supervised machine learning methods.MethodThe abdominal CT scan data were retrospectively analyzed for 66 patients with pathologically confirmed hydronephrosis and renal calculi, among whom 35 patients had renal cell carcinoma. In each case 18 non-texture features and 344 texture features were extracted from the region of interest (ROI). Infinite feature selection (InfFS)-based forward feature selection method coupled with support vector machine (SVM) classifier was used to select the optimal feature subset. SVM was trained and performed the prediction using the selected feature subset to classify whether hydronephrosis with renal calculi was associated with renal cell carcinoma.ResultsA total of 12 texture features were selected as the optimal features. The area under curve (AUC), accuracy, sensitivity, specificity, false positive rate and false negative rate of the SVM- InfFS model for predicting accompanying renal tumors in patients with hydronephrosis and calculi were 0.907, 81.0%, 70.0%, 90.9%, 9.1%, and 30.0%, respectively. The diagnostic accuracy, sensitivity, specificity, false positive and false negative rates by the clinicians provided with these classification results were 90.5%, 80.0%, 100%, 0.00%, and 20.0%, respectively.ConclusionThe computer-aided classification model based on supervised machine learning can effectively extract the diagnostic information and improve the diagnostic rate of renal cell carcinoma associated with hydronephrosis and renal calculi.