Synchronous Bilateral Renal Cell Research Articles

Case of the Month from the Peter MacCallum Cancer Centre, Melbourne, Australia: combination of stereotactic ablative body radiotherapy and radical nephrectomy for synchronous bilateral primary renal cell carcinoma.

Case of the Month from the Peter MacCallum Cancer Centre, Melbourne, Australia: combination of stereotactic ablative body radiotherapy and radical nephrectomy for synchronous bilateral primary renal cell carcinoma.

Bilateral Single-Stage Nephrectomy for Synchronous Bilateral Renal Cell Carcinoma.

Bilateral synchronous renal cell carcinoma (RCC) is uncommonly encountered. Debate exists among urologists in managing these cases in a single surgery versus staged surgeries. We aim to report our experience in managing encountered cases using single-stage surgeries. Retrospective collection of cases with pathologically confirmed RCC that had single-stage bilateral renal surgery over the past 2 years. Three cases were identified. Patients were managed using bilateral transverse lateral lumbotomy. All patients did not have intraoperative or postoperative complications. Kidney function stayed stable after surgery. Single-stage bilateral renal surgery is a safe procedure. Bilateral transverse lateral lumbotomy allows for a fast and safe surgery with minimal complications. There is a possible histological dis-concordance in bilateral synchronous RCC.

Synchronous sporadic bilateral multiple chromophobe renal cell carcinoma accompanied by a clear cell carcinoma and a cyst: A case report

BACKGROUNDRenal cell carcinomas are usually unilateral. However, they are bilateral in 2% to 4% of sporadic cases and is considerably more common in familial cases. Synchronous sporadic bilateral multiple chromophobe renal cell carcinoma (CHRCC) with different subtypes is rare.CASE SUMMARYIn this case report, we describe a case of synchronous bilateral CHRCC with two histological variants, accompanied by a clear cell carcinoma and a cyst in a 50-year-old male. The patient underwent retroperitoneal laparoscopic bilateral nephron-sparing surgery and there was no serious postoperative renal dysfunction.CONCLUSIONWe report a rare case of synchronous bilateral CHRCC with two histological variants associated with a clear cell carcinoma and a cyst.

Bilateral chromophobe renal cell carcinoma in an end-stage renal disease patient on haemodialysis

There is a well-known association between end-stage renal disease (ESRD) and the development of kidney cancer in the native kidney of patients requiring renal replacement therapy. There is now emerging evidence that lesser degrees of renal insufficiency (chronic kidney disease [CKD]) are also associated with an increased likelihood of cancer in general and kidney cancer in particular. Bilateral renal involvement by primary malignant processes is uncommon, although known to occur with Wilms tumours and in von Hippel–Lindau disease. Our patient is a 65-year-old female CKD, on haemodialysis for 8 years with bilateral renal tumours, underwent laparoscopic bilateral radical nephrectomy with histopathology reported as synchronous chromophobe bilateral renal cell carcinoma (RCC), which is the first case reported in the literature. In a study for 10 years on patients with CKD on haemodialysis, who developed acquired renal cystic disease (ARCD), there was an increase in the prevalence and severity of the ARCD as the dialysis continues over the years. Twenty per cent of patients dialysed for 1–3 years have ARCD, compared with >90% of patients dialysed for 5–10 years. In another study held at the Massachusetts General Hospital. They found that the occurrence of bilateral RCC is rare and found in only 1.8% of 329 patients who were treated RCC in 30 years. In a study published in the European Urology 2011. They also found that there are many favourable clinical, pathological and outcome features in the RCC accompanied with ESRD patients on dialysis which arising in the native kidneys compared with the RCC diagnosed in general population patients.

Surgical strategy of bilateral synchronous sporadic renal cell carcinoma\u2014experience of a Chinese university hospital

BackgroundThe objective of this study is to investigate the optimal therapeutic protocol for BSSRCC.MethodsA total of 32 BSSRCC patients, including 28 males and 4 females, were enrolled the study from January 2004 to May 2016. The diagnoses were defined by the measurements of CT, ultrasound, and MRI. Patients with hereditary syndrome were excluded. The management of surgical manner, operation staging, and sequence were scheduled in accordance with the tumor’s location and size (based on Zhongshan score, ZS score), as well as the performance status of the patients. Among them, 8 cases were conducted with bilateral surgical procedure simultaneously and 24 cases were implemented with staged operations. NSS on the one side with contralateral RN, and NSS on both sides were performed in 17 and 15 patients separately.ResultsThirty cases were conducted 56 operations in total. The average operation time was 260 ± 52 min in simultaneous operations and 162 ± 40 min in staged operations. The length of hospital stay in average was 11.5 ± 1.8 and 7.5 ± 1.4 days, respectively. Twenty-eight cases were followed up by 6–138 months. The level of creatinine was elevated in 5 cases without hemodialysis conducted.ConclusionsThe location and size of the carcinomas, and the performance status of patients should be considered in determination of an appropriate surgical approach. Both renal function preservation and tumor eradication were similarly critical, whereas the latter is of more importance. ZS score may be helpful in the dilemma. Longer follow-up period and more patient enrolment are required.

Independent Tumor Origin in Two Cases of Synchronous Bilateral Clear Cell Renal Cell Carcinoma.

Bilateral renal cell carcinomas (RCCs) pose a challenge for clinical treatment and management. Most bilateral RCCs are sporadic, and do not show a hereditary pattern indicative of VHL syndrome or other inherited cancers. The origin and evolution of these sporadic bilateral RCCs remains elusive. We obtained normal and tumor samples from two male patients suffering from early stage synchronous bilateral clear cell RCC (ccRCC), and analyzed genomic DNA using whole exome sequencing and bisulfite pyrosequencing. We detected distinct 3p loss of heterozygosity (LOH) in both tumors in each patient. Two tumors within the same patient harbored distinct driver mutations and different CpG hypermethylation sites in the VHL promoter. Moreover, tumors exhibit independent evolutionary trajectories. Therefore, distinct 3p LOH, combined with contingent driver gene mutations and independent VHL hypermethylation, led to independent tumor origin and parallel evolution of bilateral ccRCC in these two patients. Our results indicate that tumors in these two cases were not due to common germline oncogenic mutations. They were results of multiple de novo mutations in each kidney, rather than primary ccRCC with contralateral renal metastasis. Therefore, histopathologic and genetic profiling from single tumor specimen may underestimate the mutational burden and somatic heterogeneity of bilateral ccRCCs.

Surgical strategy in treating synchronous sporadic bilateral renal cell carcinoma

Objective To evaluate the impact of different surgical approach on postoperative renal function in patients with synchronous sporadic bilateral renal cell carcinoma (SSBRCC). Methods The medical records of 28 patients with SSBRCC were reviewed. Of all these cases, 21 patients were male and 7 were female, and the mean age was 51 (25-63) years. None of these cases had family history of renal carcinoma. The treatment and other clinical data were analyzed retrospectively. Results All of the 28 patients underwent bilateral surgeries. Single procedures were performed on 16 patients, of which, one underwent bilateral radical nephrectomy (RN), 8 bilateral nephron-sparing surgery (NSS) and 7 unilateral NSS combined with contralateral RN. Staged procedures were performed on 12 patients, of which bilateral NSS was on 5 patients (NSS-NSS group), NSS followed by RN (NSS-RN group) on 3 patients and RN followed by NSS (RN-NSS group) on 4 patients. In term of postoperative renal function preservation for SSBRCC patients, the standard NSS was better than RN. Between different staged procedures, NSS-NSS was the preferred choice, and the NSS-RN was superior to the RN-NSS. Conclusions In term of preservation of postoperative renal function, the staged procedures were recommended, and NSS was preferred in the first stage. In deciding the second stage surgical approaches, the surgeons should take the renal function preservation and the tumor size into consideration. Key words: Carcinoma, renal cell; Bilateral surgery; Strategy; Renal function

Synchronous bilateral renal cell carcinoma and prostate cancer: A bad luck case with a good outcome

Synchronous bilateral renal cell carcinoma and prostate cancer: A bad luck case with a good outcome

A case of treatment in a patient with synchronous bilateral renal cell carcinoma and simultaneous metastatic involvement of both adrenal glands: Clinical observation

A case of treatment in a patient with synchronous bilateral renal cell carcinoma and simultaneous metastatic involvement of both adrenal glands: Clinical observation

BILATERAL SYNCHRONOUS MULTIFOCAL RENAL CLEAR-CELL CARCINOMA

A 56-year-old man with a history of hypertension, alcoholism and active smoking, was admitted because of progressive dyspnoea and leg oedema. He also mentioned an increase of his abdominal perimeter and a weight loss of 20 kg during the last two months. On admission, blood pressure was 130/80 mmHg, body temperature was 35.6° C and pulse rate 75 per minute. Physical examination revealed bibasal thoracic dullness, bilateral massive kidney enlargement and ascites. Relevant laboratory data were: C-reactive protein 0.9 mg/dl, white blood cell count 6940/μl, serum urea 78 mg/ dl, serum creatinine 1.65 mg/dl, GammaGT 184 UI/l, total serum bilirubin 1.8 mg/dl and serum albumin 4.2 g/dl. Urinalysis was unremarkable. Abdominal ultrasonography showed non-cystic polylobulated kidney enlargement (20 cm of major axis), with irregular contours. Abdominal MRI demonstrated large and numerous bilateral renal masses, with enlarged left adrenal gland (Figure A and B). Bilateral pleural effusion and ascites were also noted. A differential diagnosis of bilateral oncocytomatosis – benign kidney involvement by oncocytoma – and malignancy was then made. Percutaneous biopsy of the left kidney revealed malignant infiltration in keeping with the diagnosis of clear cell carcinoma. Bilateral nephrectomy with left adrenalectomy was performed with subsequent hemodialysis treatment. Macroscopic peroperative inspection also demonstrated liver cirrhosis. Final anatomopathological findings confirmed bilateral multifocal clear cell carcinoma invading the left adrenal gland, without evidence of oncocytoma. Brain MRI, fundoscopy and genetics studies ruled out a Von Hippel Lindau syndrome (VHL). Renal cell carcinoma (RCC) is the most common kidney cancer and accounts for about 2% of adult malignancies. Bilateral synchronous multifocal renal cell carcinoma occurs in approximately 4% of all patients with RCC. Bilateral RCC of the same subtype can exist in a hereditary form (VHL, hereditary papillary RCC) or a sporadic form. Hereditary forms are more common than the sporadic forms, and occur at an earlier age. Sporadic bilateral synchronous RCC can be of either the clear cell as in our case, or of the papillary subtype. Tumour multifocality is demonstrated in preoperative imaging in only one-third of patients.

IJU this issue

This issue contains three Review Articles, five Original Articles, two Short Communications and two Letters to the Editor. I focus on the clinical studies, which reported and discussed the common, but important, matters in daily practice. Takayanagi et al. (Sapporo, Japan) retrospectively evaluated the incidence of and the risk factors for upper urinary tract recurrence (UUTR) in 362 patients undergoing a radical cystectomy for bladder cancer. Among them, 11 patients (3.0%) developed UUTR. The presence of carcinoma in situ and cancer invading the urethra are the risk factors. The authors concluded that close follow up is required for early detection of UUTR for patients at high risk. The other risk factors for UUTR reported previously are ureteral involvement and multifocal/recurrent tumors. The study further reported that periodical computed tomography (CT) could detect UUTR before the symptoms of UUTR occurred. Although the authors did not describe detailed CT findings that made a diagnosis of UUTR, non-invasive diagnostic modalities should be used to detect UUTR in the early stages. Zhang et al. (Nanjing, China) reported radiofrequency ablation (RFA) on 12 patients with synchronous bilateral renal cell carcinoma. The patients were treated with bilateral RFA or unilateral RFA accompanied with contralateral radical nephrectomy. The local tumor control rate was 93%. No death or renal failure after the procedure was reported. In patients who underwent bilateral RFA, the latest mean glomerular filtration rate (GFR) had not significantly declined compared with preoperative levels. Although the long-term outcome of GFR remains under investigation, RFA might be a promising alternative to nephron-sparing surgery for patients with bilateral renal cancer. Takazawa et al. (Tokyo, Japan) reported an outcome of flexible-ureteroscopic lithotripsy (FUL) for renal stones 2 cm or greater. Although percutaneous nephrolithotomy has been recommended as the first-line treatment for renal stones larger than 2 cm, its invasive nature might not be negligible. The recent advances in endoscopic technology might make it possible to adopt FUL as an alternative treatment. FUL is an endoscopic surgery through “the natural orifice” with less renal parenchymal damage compared with percutaneous nephrolithotomy. Although the patient selection is crucial, the potential of FUL is worth further evaluating in well-designed prospective trials. Sato et al. (Sapporo, Japan) investigated the potential use of silodosin for treating premature ejaculation. The study is an interesting trial utilizing an adverse effect of the drug as a therapeutic tool. Silodosin is a new highly selective α1A-adrenoceptor antagonist showing significant clinical efficacy for lower urinary tract symptoms. However, recent studies have reported abnormal or lack of ejaculation in a significant percentage of the patients treated with silodosin. Our recent study also found that half of the cases treated with silodosin experienced a loss of ejaculation, and in contrast, over 90% of the cases treated with naftopidil, an α1D-adrenoceptor antagonist, maintained their ejaculation (unpubl. data). The authors treated eight patients suffering from premature ejaculation with 4 mg of silodosin 2 h before sexual intercourse. Intravaginal ejaculatory latency time was significantly prolonged. Premature ejaculation profile significantly improved. However, the majority of the patients experienced decreased ejaculatory volume and discomfort during orgasm. Our unpublished data also identified decreased average scores of orgasm and satisfaction at the ejaculation in the patients treated with silodosin. Further studies with a larger number of cases are warranted to evaluate the impact of silodosin on overall sexual function and the related quality of life in patients with premature ejaculation. None declared.

Radiofrequency ablation of synchronous bilateral renal cell carcinoma

The treatment of synchronous bilateral renal cell carcinoma is challenging. Radiofrequency ablation has been increasingly applied in the management of renal tumors. Herein, we report our experience of radiofrequency ablation on 12 patients with synchronous bilateral renal cell carcinoma. From March 2006 to September 2010, 12 patients with bilateral synchronous sporadic renal cell carcinoma (29 lesions overall) were identified from our kidney database. The mean age was 62.3 years (range 35-81). The mean tumor diameter was 4.5 cm (range 0.9-9.0). Three patients received unilateral radiofrequency ablation and contralateral radical nephrectomy, whereas nine patients received bilateral radiofrequency ablation. The oncological and functional outcomes were analyzed. Contrast-enhanced computed tomography examinations were carried out at day 7, and at 3 and 6 months after the procedure, and every 6 months thereafter. The mean follow-up period was 33 months (range 10-64). The local tumor control rate was 93.1% (27/29). Cancer-specific survival and the overall survival rates were 100%. No death or renal failure after the procedure was found. In patients who underwent bilateral radiofrequency ablation, the latest mean glomerular filtration rate had not significantly declined compared with preoperative levels (93.7 ± 13.0 mL/min/1.73 m(2) vs 96.9 ± 13.3 mL/min/1.73 m(2), respectively; P > 0.05). Radiofrequency ablation shows encouraging outcomes in the treatment of bilateral renal cell carcinoma. It can provide adequate local tumor control and cancer-specific survival compared with nephron-sparing surgery while not affecting the renal function.

Risk of Bilateral Renal Cell Cancer

The risk of developing bilateral kidney cancer has not been adequately defined in any large, population-based study with long-term follow-up to our knowledge. We estimated the risk of metachronous bilateral renal cell cancer in patients diagnosed with unilateral kidney cancer, as recorded in the nationwide cancer registries of Norway and Sweden. Altogether 28,642 patients were followed for an average of 4.4 years. The standardized incidence ratio--the ratio of the observed number of bilateral cancers to the number expected on the basis of the incidence in the Norwegian and Swedish population at large--was used as a measure of relative risk. We used multivariate Poisson regression to separate the effects of the explanatory variables. A synchronous bilateral renal cell cancer was reported in 86 patients. A total of 112 metachronous bilateral cancers were recorded during 126,493 person-years of follow-up compared with 35.8 expected, yielding an overall relative risk (RR) of 3.1 (95% CI, 2.6 to 3.8) and a cumulative incidence of 0.8% after 20 or more years of follow-up. In the multivariate analyses, risk increased monotonically with younger age at first diagnosis (P for trend < .001); compared with patients who were 60 years or older, those younger than 40 years were at a 17-fold higher risk (RR = 17.4; 95% CI, 10.1 to 29.8). We also found a modest but statistically significant decreasing trend with increasing duration of follow-up. The risk of metachronous bilateral renal cell cancer is drastically higher among patients first affected at a young age, suggesting a subset of early onset renal cell cancer with a strong genetic component.

Bilateral synchronous occurrence of three different histological types of renal tumor: a case report

IntroductionRenal cell carcinomas account for 85% of all renal neoplasms. With the introduction of modern imaging modalities, there has been an increased diagnosis of renal tumors. Recent studies have shown that partial nephrectomy can be as safe as radical nephrectomy for smaller renal tumors. Renal cell carcinomas are usually unilateral, however, they can be bilateral in 2% to 4% of sporadic cases and considerably more common in familial cases.Case presentationIn this case report, we describe an unusual case of two bilateral synchronous chromophobe renal cell carcinomas accompanied by an oncocytoma and an angiomyolipoma, that were all treated by open partial nephrectomy.ConclusionsTo the best of our knowledge, this is the first case report on the synchronous occurrence of bilateral chromophobe renal cell carcinomas associated with an oncocytoma and an angiomyolipoma.

Editorial Comment

No AccessJournal of UrologyAdult urology1 Feb 2008Editorial Comment Lee Richstone and Louis R. Kavoussi Lee RichstoneLee Richstone More articles by this author and Louis R. KavoussiLouis R. Kavoussi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2007.09.139AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 179(2), pp. 472–473 References 1 : Prognostic value of histologic subtypes in renal cell carcinoma: a multicenter experience. J Clin Oncol2005; 23: 2763. Google Scholar 2 : Clinicopathological features and prognosis of synchronous bilateral renal cell carcinoma: an international multicentre experience. BJU Int2007; 100: 21. Google Scholar 3 : Clinicopathologic and molecular correlations of necrosis in the primary tumor of patients with renal cell carcinoma. Cancer2005; 103: 2517. Google Scholar Smith Institute For Urology, North Shore Long Island-Jewish Health System, New Hyde Park, New York© 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 2February 2008Page: 472-473 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Lee Richstone More articles by this author Louis R. Kavoussi More articles by this author Expand All Advertisement PDF downloadLoading ...

Clinicopathological features and prognosis of synchronous bilateral renal cell carcinoma: an international multicentre experience

To present a multicentre experience and the largest cohort to date of nonmetastatic (N0M0) synchronous bilateral renal cell carcinoma (RCC), as because it is rare the single-institutional experience is limited. We retrospectively studied 10 337 patients from 12 urological centres to identify patients with N0M0 synchronous bilateral RCC; the clinicopathological features and cancer-specific survival were compared to a cohort treated for N0M0 unilateral RCC. In all, 153 patients had synchronous bilateral solid renal tumours, of whom 135 (88%) had synchronous bilateral RCC, 118 with nonmetastatic disease; 91% had nonfamilial bilateral RCC. Bilateral clear cell RCC was the major histological subtype (76%), and papillary RCC was the next most frequent (19%). Multifocality was found in 54% of bilateral RCCs. Compared with unilateral RCC, patients did not differ in Eastern Cooperative Oncology Group performance status (ECOG PS) and T classification, but bilateral RCCs were more frequently multifocal (54% vs 16%, P < 0.001) and of the papillary subtype (19% vs 12%), and less frequently clear cell RCC (76% vs 83%, P = 0.005). For the outcome, patients with nonmetastatic synchronous bilateral RCC and unilateral RCC had a similar prognosis (P = 0.63); multifocality did not affect survival (P = 0.60). Multivariate analysis identified ECOG PS, T classification, and Fuhrman grade, but not laterality, as independent prognostic factors for cancer-specific survival. Patients with N0M0 synchronous bilateral RCC and N0M0 unilateral RCC have a similar prognosis. The frequency of a familial history for RCC (von Hippel-Lindau disease or familial RCC) was significantly greater in bilateral synchronous than in unilateral RCC. The significant pathological findings in synchronous bilateral RCC are papillary subtype and multifocality.

Distinct patterns of chromosomal losses in clinically synchronous and asynchronous bilateral renal cell carcinoma.

Bilateral renal cell carcinoma has been reported to occur in 1% to 4% of patients with renal cancer. However, whether bilateral renal cell carcinoma involves metastatic lesions of the contralateral kidney or develops as simultaneous primary tumors remains unclear to date. Thus, we investigated chromosomal losses and von Hippel-Lindau (VHL) gene abnormalities in bilateral tumors from patients with nonfamilial bilateral renal cell carcinoma. Genomic DNA was exacted from 2 tumors in 8 patients each with nonfamilial bilateral renal cell carcinoma, including clinically asynchronous and synchronous disease in 5 and 3, respectively. The DNA was then subjected to microsatellite analysis on 13 chromosomal loci. In addition, polymerase chain reaction-single nucleotide specific conformation polymorphism analysis and direct sequencing of 3 exons of the VHL gene were performed. All 5 asynchronous cases showed loss of the same allele in bilateral tumors, indicating a common clonal origin. In contrast, 2 of the 3 synchronous cases showed different patterns of chromosomal loss in the right and left renal tumors, suggesting bilateral primary origins. The other synchronous case with loss of the same allele in each tumor involved right stage T3b and left stage T1a neoplasms. No VHL gene mutations were detected in any case. Except for a small number of cases synchronous and asynchronous bilateral renal cell carcinoma may represent the simultaneous appearance of separate primary tumors and metastatic progression from the contralateral kidney, respectively.

Distinct Patterns of Chromosomal Losses in Clinically Synchronous And Asynchronous Bilateral Renal Cell Carcinoma

Bilateral renal cell carcinoma has been reported to occur in 1% to 4% of patients with renal cancer. However, whether bilateral renal cell carcinoma involves metastatic lesions of the contralateral kidney or develops as simultaneous primary tumors remains unclear to date. Thus, we investigated chromosomal losses and von Hippel-Lindau (VHL) gene abnormalities in bilateral tumors from patients with nonfamilial bilateral renal cell carcinoma. Genomic DNA was exacted from 2 tumors in 8 patients each with nonfamilial bilateral renal cell carcinoma, including clinically asynchronous and synchronous disease in 5 and 3, respectively. The DNA was then subjected to microsatellite analysis on 13 chromosomal loci. In addition, polymerase chain reaction-single nucleotide specific conformation polymorphism analysis and direct sequencing of 3 exons of the VHL gene were performed. All 5 asynchronous cases showed loss of the same allele in bilateral tumors, indicating a common clonal origin. In contrast, 2 of the 3 synchronous cases showed different patterns of chromosomal loss in the right and left renal tumors, suggesting bilateral primary origins. The other synchronous case with loss of the same allele in each tumor involved right stage T3b and left stage T1a neoplasms. No VHL gene mutations were detected in any case. Except for a small number of cases synchronous and asynchronous bilateral renal cell carcinoma may represent the simultaneous appearance of separate primary tumors and metastatic progression from the contralateral kidney, respectively.

Distinct Patterns of Chromosomal Losses in Clinically Synchronous And Asynchronous Bilateral Renal Cell Carcinoma

Distinct Patterns of Chromosomal Losses in Clinically Synchronous And Asynchronous Bilateral Renal Cell Carcinoma

Primary osteosarcoma of the spermatic cord with synchronous bilateral renal cell carcinoma

Primary extraskeletal osteosarcoma of the spermatic cord is an extremely rare tumor with only two other cases being reported in the world literature. We describe a patient with this lesion who also had concomitant bilateral renal cell carcinoma. The management of this case and a review of this subject are presented.