Suspicion Of Renal Cell Carcinoma Research Articles

Abstract 18215: The Silent Intruder Unveiled: A Case of Renal Malignancy Presenting as Cardiac Mass

Background: Cardiac mass is a space-occupying lesion within the cardiac cavity. Its differential diagnosis includes thrombus, vegetation or tumor. Diagnosis is on imaging. Primary cardiac tumors are benign, solitary masses attached by a stalk in the atria. Carcinomas are metastatic from direct invasion or hematogenous spread. Right-sided cardiac masses present with shortness of breath, fatigue, syncope, and night sweats. We discuss a patient with a right atrial (RA) mass as the presenting sign of renal malignancy. Case: A middle-aged female with no prior cardiac history presented to the hospital with complaints of shortness of breath. On presentation, the patient was hemodynamically stable. Echocardiogram showed a 4.9 x 2.9cm mobile RA mass heterogeneous in texture and attached to the interatrial septum with a narrow stalk. Further views showed that the RA mass continued into the inferior vena cava (IVC) and filled it entirely. A CT scan abdomen demonstrated a heterogeneous mass involving the left kidney extending from the left renal vein into the IVC and ultimately extending up to the RA. Given the high suspicion of renal cell carcinoma (RCC), a biopsy was offered however the patient declined further workup. Discussion: RCC can invade through the renal vein into the IVC and involve the right heart. Cavoatrial tumor thrombus extension is seen in 1% of RCC. In this case, the RA mass was the first step in the diagnosis of renal malignancy. It is imperative to assess for the extension of a RA mass into the IVC as it has diagnostic implications. Treatment is resection performed on cardiopulmonary bypass for intracardiac exploration and preventing embolization.

Granulomatosis with polyangiitis presenting as a solitary renal mass: a case report

BackgroundGranulomatosis with polyangiitis (GPA) is characterized by necrotizing granulomatous vasculitis involving small-sized vessels in the upper airways, lower airways, and kidneys. Renal pathology is usually characterized by focal segmental necrotizing glomerulonephritis, which often leads to rapidly progressive renal failure. This type of renal involvement is usually unapparent on radiography. The presence of a renal mass in a patient with GPA, although extremely rare, is recognizable. Herein, we report a rare case of GPA presenting as a solitary renal mass and present a review of the literature.Case presentationA 75-year-old woman presented with a solitary right kidney mass measuring 4 × 3.5 cm detected by enhanced computed tomography. There was no history of sinusitis, rhinitis, cough, or pneumonia suggestive of systemic GPA. Nephrectomy was performed based on the suspicion of renal cell carcinoma or malignant lymphoma. Three months later, she was admitted because her serum creatinine levels increased from 54.81 μmol/L to 405.76 μmol/L accompanied by a high C-reactive protein level of 159 mg/L. Anti-neutrophil cytoplasmic antibodies against myeloperoxidase and anti-proteinase 3 were negative. Histological examinations of the solitary renal mass revealed necrotizing granulomatous arteritis in the cortex and medullary vasa recta, surrounded by interstitial fibrosis, and focal segmental necrotizing glomerulonephritis in the localized lesion; however, signs of vasculitis were not observed in areas other than the solitary mass. Therefore, the patient was diagnosed with granulomatosis with polyangiitis (GPA). Despite treatment with prednisolone (30 mg/day), the patient developed oliguria with an elevation of her serum creatinine level to 583.44 μmol/L, which required hemodialysis within one month after the initiation of steroid therapy. The patient could successfully discontinue hemodialysis 21 months later, following a decrease in her serum creatinine level to 251.06 μmol/L.ConclusionsGPA should be considered as one of the differential diagnoses of a solitary renal mass. Furthermore, patients with solitary renal masses associated with GPA may exhibit a favorable response to steroid or immunosuppressive treatment.

Von Meyenburg complexes in a patient with chronic gastritis - a case report

Introduction: Bile ducts hamartoma (von Meyenburg complexes) is a common but unknown pathology of the liver. It can lead to the widening of the bile ducts. It is usually detected incidentally in asymptomatic patients. There are indications of transformation into bile duct cancer or hepatocellular carcinoma.Aim of the study: The aim of the study is to draw attention to a little known, but common pathology - von Meyenburg complexes and to sensitize medical professionals to the implications it may cause during the diagnostic process.Material and methods: We conducted a case study. The research material was the patient's medical history.Case report: A 60-year-old man came to the Gastrology Clinic due to chronic epigastric pain and tenderness in the navel area. Colonoscopy ruled out pathology in the large intestine. After six months, the pain worsened. The result of the gastroscopy allowed the diagnosis of chronic gastritis, which was probably the cause of the problem. The abdominal ultrasound showed a suspicion of renal cell carcinoma of the right kidney, but the neoplastic process was excluded on the basis of the abdominal computed tomography. In the same study, for the first time, numerous minor hypodense lesions in the liver were detected. The final diagnosis was made on the basis of magnetic resonance cholangiography, where the disseminated, T2 hyperintense cystic areas were described. This suggested a biliary scythe.Conclusions: Despite the asymptomatic occurrence of biliary hamartoma, it is important to remember about the possible transformation into a malignant neoplasm. It should be considered in the differential diagnosis of disseminated liver lesions. Patients should be treated symptomatically.

Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†.

Renal cell carcinoma (RCC) accounts for 2%–3% of all adultmalignancies, representing the seventh most common cancer inmen and the ninth most common cancer in women [1].Worldwide, there are ∼209000 new cases and 102000 deathsper year. The incidence of all stages of RCC has increased overthe past several years, contributing to a steadily increasing mor-tality rate per unit population. Active and passive cigarettesmoking is an established risk factor for RCC as well as hyper-tension. However, anti-hypertensive medications such as diure-tics are not independently associated with RCC development.RCC also appears to be more common in patients with obesity,end-stage renal failure, acquired renal cystic disease and tuber-ous sclerosis.Approximately 2%–3% of RCC are hereditary and severalautosomal dominant syndromes are described, each with a dis-tinct genetic basis and phenotype, the most common one beingVon Hippel Lindau disease.In recent years, many new genes associated with RCC havebeen reported (such as PBRM1, SETD2, BAP1). Their roles inpathogenesis and as prognostic biomarkers are currently underinvestigation.

Port site recurrence after laparoscopic radical nephrectomy: a case report

BackgroundDue to the recent development of laparoscopic devices, laparoscopic radical nephrectomy is the standard procedure for localized renal cell carcinoma. However, some studies have reported postoperative port site metastasis in several cancers.Case presentationA 68-year-old Asian-Japanese man was referred to our hospital for a further examination of his right renal tumor in 2009. Due to a clinical suspicion of renal cell carcinoma, laparoscopic nephrectomy was performed. The histopathological diagnosis was clear cell renal cell carcinoma. Follow-up computed tomography revealed a mass between the internal oblique muscle of his abdomen and the transverse muscle of his abdomen in 2014. The tumor size gradually increased, and positron emission tomography-computed tomography revealed the accumulation of fludeoxyglucose in that tumor with maximum standardized uptake value of 2.7. Based on these findings, port site recurrence was suspected, and tumor resection was performed in 2017. The pathological diagnosis was metastatic clear cell renal cell carcinoma.ConclusionsHere we report a rare case of port site metastasis that was successfully treated 7 years after laparoscopic nephrectomy.

Nondestructive Diagnosis of Kidney Cancer on 18-gauge Core Needle Renal Biopsy Using Dual-color Fluorescence Structured Illumination Microscopy

To present a novel imaging technique used for rapid, nondestructive histological assessment of renal neoplasias using a dual-component fluorescence stain and structured illumination microscopy (SIM). After Institutional Review Board approval, 65 total biopsies were obtained from 19 patients undergoing partial or radical nephrectomy. Biopsies were stained with a dual-component fluorescent, and optically sectioned SIM images were obtained from the surface of the intact biopsies. Specimens were subsequently fixed and analyzed using hematoxylin and eosin (H&E) histopathologic methods and compared with SIM images. A single, board-certified pathologist blinded to specimens reviewed all SIM images and H&E slides, and determined the presence or absence of neoplasias. Results of blinded diagnosis of SIM were validated against traditional pathology. Of the 19 patients, 15 underwent robotic partial nephrectomies and 4 underwent laparoscopic nephrectomies. Indications included clinical suspicion of renal cell carcinoma. In total, 65 biopsy specimens were available for review. Twenty-one specimens were determined to be neoplastic on H&E, whereas 41 represented benign renal tissue. The final sensitivity and specificity of our study were 79.2% and 95.1%, respectively. SIM is a promising technology for rapid, near-patient, ex vivo renal biopsy assessment. By improving the ability to rapidly assess sufficiency of biopsy specimens and enabling immediate diagnostic capability, SIM aids in more effective biopsy performance, tissue triage, and patient counseling regarding management options. Additionally, because tissue is preserved, effective utilization of downstream diagnostic tests and molecular assessments are possible.

Wunderlich syndrome as the first manifestation of an extraskeletal Ewing sarcoma.

We recently encountered an extremely rare case of spontaneous perirenal hemorrhage in a 34-year-old man. He initially had undergone radical nephrectomy owing to suspicion of renal cell carcinoma. The final diagnosis was extraskeletal Ewing sarcoma.

Renal leiomyoma: a contemporary multi-institution study of an infrequent and frequently misclassified neoplasm.

Renal leiomyoma is an exceptionally rare benign mesenchymal tumor of the kidney predominantly arising in proximity of the renal capsule or pelvis. Its rarity and nonspecific clinical and imaging features may lead to radical or partial nephrectomy on the basis of preoperative suspicion of renal cell carcinoma. The diagnosis of renal leiomyoma is challenging because of the histologic overlap with lipid-poor angiomyolipoma (AML). We conducted a multi-institution study to characterize renal leiomyoma in greater detail. We collected and reviewed 24 cases diagnosed initially as renal leiomyoma in 10 institutions from North America, Canada, and Europe. Immunohistochemical expression of desmin, HMB-45, estrogen receptor (ER), progesterone receptor (PR), and cathepsin K was evaluated. Upon central review, 9 tumors were classified as renal leiomyoma, whereas the remaining were reclassified as AML (n=13), myolipoma (n=1), and medullary fibroma (n=1). All renal leiomyomas were solitary and occurred in female patients (mean age 63 y; range, 44 to 74 y). Tumor size ranged from 0.6 to 7.0 cm (mean 2.9 cm); 7 originated from the renal capsule or the subcapsular area and 1 from a large vessel in the renal sinus. All leiomyomas were diffusely positive for desmin and negative for HMB-45 and cathepsin K; 6/9 (67%) showed diffuse ER and PR expression, and 1 case showed focal ER positivity only. Renal leiomyoma should be included in the histologic differential diagnosis of solid renal masses, particularly in perimenopausal women. The main differential diagnosis is with lipid-poor AML, and cathepsin K plays a key role in distinguishing these 2 lesions.

Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Usefulness of resistive index on spectral Doppler ultrasonography in the detection of renal cell carcinoma in patients with end-stage renal disease.

Purpose:The aim of this study was to explore the usefulness of the resistive index (RI) on spectral Doppler ultrasonography (US) in the detection of renal cell carcinoma (RCC) in patients with end-stage renal disease (ESRD).Methods:Seventeen ESRD patients with kidneys in which renal masses were suspected in routine US were subjected. They underwent computed tomography scans and additional Doppler US for the characterization of the detected lesions. All underwent radical nephrectomy with the suspicion of RCC. Fourteen patients finally were included. RI measurements were conducted in the region of the suspected renal mass and the background renal parenchyma. The intraclass correlation coefficient was used to assess the reproducibility of the RI measurement. A paired t-test was used to compare the RI values between the renal mass and the background renal parenchyma (P<0.05).Results:The RI values measured at the RCCs were significantly lower than those measured at the background renal parenchyma (0.41-0.65 vs. 0.75-0.89; P<0.001). The intrareader reproducibility proved to be excellent and good for the renal masses and the parenchyma, respectively (P<0.001).Conclusion:RI on spectral Doppler US is useful in detecting RCC in patients with ESRD. The RI values measured at the RCCs were significantly lower than those measured at the background renal parenchyma.

CT perfusion in the characterisation of renal lesions: an added value to multiphasic CT.

Objective. To prospectively evaluate if computed tomography perfusion (CTp) could be a useful tool in addition to multiphasic CT in renal lesion characterisation. Materials and Methods. Fifty-eight patients that were scheduled for surgical resection of a renal mass with a suspicion of renal cell carcinoma (RCC) were enrolled. Forty-one out of 58 patients underwent total or partial nephrectomy after CTp examination, and a pathological analysis was obtained for a total of 49 renal lesions. Perfusion parameters and attenuation values at multiphasic CT for both lesion and normal cortex were analysed. All the results were compared with the histological data obtained following surgery. Results. PS and MTT values were significantly lower in malignant lesions than in the normal cortex (P < 0.001 and P = 0.011, resp.); PS, MTT, and BF values were also statistically different between oncocytomas and malignant lesions. According to ROC analysis, the accuracy, sensitivity, and specificity to predict RCC were 95.92%, 100%, and 66.7%, respectively, for CTp whereas they were 89.80%, 93.35%, and 50%, respectively, for multiphasic CT. Conclusion. A significant difference between renal cortex and tumour CTp parameter values may suggest a malignant renal lesion. CTp could represent an added value to multiphasic CT in differentiating renal cells carcinoma from oncocytoma.

Optical spectroscopy techniques can accurately distinguish benign and malignant renal tumours

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: There is little known about optical spectroscopy techniques ability to evaluate renal tumours. This study shows for the first time the ability of Raman and optical reflectance spectroscopy to distinguish benign and malignant renal tumours in an ex vivo environment. We plan to develop this optical assistance in the operating room in the near future. To evaluate the ability of Raman spectroscopy (RS) and optical reflectance spectroscopy (ORS) to distinguish benign and malignant renal tumours at surgery. Between March and October 2011, RS and ORS spectra were prospectively acquired on surgical renal specimens removed for suspicion of renal cell carcinoma (RCC). Optical measurements were done immediately after surgery. Optical signals were normalised to ensure comparison between spectra. Initial and final portions of each spectrum were removed to avoid artefacts. A support vector machine (SVM) was built and tested using a leave-one-out cross-validation. Classification scores, including accuracy, sensitivity and specificity were calculated on the entire population and in patients with tumours of <4 cm. In all, 60 nephrectomies were performed for 53 malignant tumours (41 clear-cell, eight papillary and four chromophobe carcinomas) and seven benign tumours (four oncocytomas, two angiomyolipomas and a haemorrhagic cyst). In all, >700 optical spectra were obtained and submitted to SVM classification. The SVM could recognise benign and malignant renal tumours with an accuracy of 96% (RS) and 88% (ORS) in the whole population and with an accuracy of 93% (RS) and 95% (ORS) in the present subset of small renal tumours (<4 cm). Histological subtype could be determined in 80% and 88% of the cases with RS and ORS, respectively. The SVM was able to differentiate chromophobe carcinomas and benign lesions with an accuracy of 96% in RS and 98% in ORS. Benign and malignant renal tumours can be accurately discriminated by a combination of RS and ORS. In vivo experiments are needed to further assess the value of optical spectroscopy techniques.

Melorheostosis with renal arterio-venous malformation: A case report with review of literature

Melorheostosis, also known as Leri′s disease and flowing periosteal hyperostosis, is a rare cause of pain and stiffness in a limb. The appearance is of "candle greasing" down one side of one or several bones of the body. We describe a case referred to tertiary care center with suspicion of renal cell carcinoma with diffuse bone metastasis. After reassessment, the patient was diagnosed melorheostosis with renal AV malformation. He was reassured about the benign nature of the disease and is asymptomatic.

Nephron-Sparing Surgery and Percutaneous Biopsies in Renal-Cell Carcinoma: A Global Impression among Endourologists

On the one hand, nephron-sparing surgery (NSS) in small renal tumors is a safe and effective alternative to radical nephrectomy. On the other hand, the role of preoperative percutaneous needle biopsies (PNB) remains controversial. The purpose of this study was to evaluate the global current use of NSS in the treatment of renal-cell carcinoma (RCC) and the use of PNB among endourologists. One thousand questionnaires were distributed during the 23rd World Congress of Endourology and SWL. Six questions regarding NSS and two questions regarding PNB were presented. Two hundred twenty-two questionnaires were returned. Of the respondents, 86.6% perform NSS for small renal tumors, whereas 13.4% perform only radical nephrectomies; 7.5% will consider NSS only in patients with a solitary kidney, and 0.5% will never consider NSS. The techniques for NSS, in descending order of preference, are partial nephrectomy, enucleation, cryoablation, radiofrequency ablation, and high-intensity focused ultrasound. The mean and maximum diameter of the tumor in patients with a normal contralateral kidney for which the urologists perform NSS is 4.0 cm. For a centrally located tumor, NSS is an option for 27.2% of the respondents. Regarding PNB in patients with suspicion of RCC, 55.9% of respondents never obtain renal biopsies in the preoperative assessment and 41.8% obtain them only in rare cases. The majority (90%) prefer histologic over cytologic biopsies. Nephron-sparing surgery is evolving to a global worldwide standard treatment for small renal tumors. Percutaneous needle biopsy remains a highly debated procedure.