Urothelial Carcinoma Of Renal Pelvis Research Articles

The effect of tumor location on overall survival for pT2-4 bladder and upper tract urothelial carcinoma following radical surgery.

Historically, staging and treatment for upper tract urothelial carcinoma were extrapolated from bladder urothelial carcinoma literature. However, embryological, genetic, and anatomical differences exist between them. We sought to explore the relationship between location of urothelial cancer and overall survival (OS). Data was culled from the National Cancer Database from 2004-2015. Patients with pT2-pT4 treated with definitive surgery were included; those with metastatic disease or who received neoadjuvant or adjuvant treatment were excluded. Patients were stratified by tumor location and pathological stage. The primary outcome was OS. Secondary outcomes were predictors of mortality in each pT stage stratum. A total of 11 330 patients with bladder, 954 patients with ureteral, and 1943 patients with renal pelvis urothelial carcinoma were analyzed. Mean followup was 43.3, 39.4, and 41.4 months for bladder, ureteral, and renal pelvis, respectively. On univariable analysis, ureteral pT2 was associated with worse OS compared to both bladder (61.3 vs. 80.4 months, p=0.007) and renal pelvis (61.3 vs. 80.5 months, p=0.014). Renal pelvis pT3 was associated with improved OS compared to both bladder (42.5 vs. 28.6 months, p=0.003) and ureteral (42.5 vs. 25.7 months, p<0.001). Renal pelvis pT4 had decreased survival compared to bladder (11.4 vs. 17.7 months, p<0.001). On multivariable Cox regression, only renal pelvis pT3 was associated with a 20% decreased risk of mortality compared to bladder pT3 (hazard ratio 0.80, 95% confidence interval 0.72-0.88, p<0.001). Renal pelvis pT3 is associated with lower mortality. Mutational and embryological differences may play a role in this disparity.

Plasmacytoid urothelial carcinoma of renal pelvis with positive zinc finger E\u2013box\u2013binding homeobox 1: a case report

BackgroundThe tumor transformation mechanism of a plasmacytoid urothelial carcinoma remains unexplained. We describe the case of a plasmacytoid urothelial carcinoma of the renal pelvis in which the expression of zinc finger E–box–binding homeobox 1 (ZEB1), a key nuclear transcription factor in an epithelial–mesenchymal transition, is involved in tumor transformation.Case presentationThe patient had a left nephrectomy with the clinical diagnosis of left pelvic renal cancer. The resected specimen showed that the tumor surface comprised a noninvasive papillary urothelial carcinoma with the carcinoma in situ, and the invasive area comprised a plasmacytoid urothelial carcinoma characterized by the presence of single dyscohesive malignant cells that resembled plasma cells in a loose myxoid stroma. The noninvasive urothelial carcinoma was positive for cytokeratin and E–cadherin, and negative for vimentin and ZEB1. In contrast, the invasive plasmacytoid urothelial carcinoma was positive for cytokeratin and also vimentin and ZEB1, and negative for E–cadherin. Additionally, this component was immunoreactive for CD138 and CD38 that are immunohistochemical markers for plasma cells.ConclusionWe suggest that ZEB1 is involved in the plasmacytoid transformation by repressing the E–cadherin in a plasmacytoid urothelial carcinoma.

Humoral hypercalcemia of malignancy caused by renal pelvic urothelial carcinoma with broad squamous differentiation: An autopsy case

Humoral hypercalcemia of malignancy caused by renal pelvic urothelial carcinoma with broad squamous differentiation: An autopsy case

Comprehensive Genomic Profiling of Upper-tract and Bladder Urothelial Carcinoma

BackgroundCharacterization of the different genomic alterations (GAs) in urothelial carcinoma (UC), by site of origin, may identify contrasting therapeutic opportunities and inform distinct putative pathogenetic mechanisms. ObjectiveTo describe the genomic landscape of UC based on the anatomic site of the primary tumor. Design, setting, and participantsIn total, 479 upper tract UC (UTUC) and 1984 bladder UC (BUC) patients underwent comprehensive genomic profiling (CGP) to evaluate all classes of GAs, tumor mutational burden (TMB), and microsatellite instability (MSI) status. Targetable GAs and signatures were assessed according to the European Society for Medical Oncology Scale for Clinical Actionability of molecular Targets (ESCAT). InterventionHybrid-capture–based CGP. Outcome measurements and statistical analysisDescriptive analyses and differences between anatomic subgroups were reported. Results and limitationsIn total, 39% of patients with UC harbored one or more tier 1–2 GAs, suggesting potential benefit from approved or investigational therapies. UTUC cases were enriched in FGFR3 short variant (SV) GA (20% vs 13%) and HRAS SV GA (7.3% vs 3%), the latter attributed specifically to enrichment in renal pelvis UC (9.5%) versus ureteral UC (1.8%, p=0.002). RB1 GAs were more frequent in BUC than in UTUC (21% vs 7.8% p<0.001). Non-FGFR3 kinase fusions were observed in 1% of patients, including BRAF/RAF1 fusions in 0.5%. BRAF mutations/fusions were observed in 2% of cases and were mutually exclusive with FGFR3 GA (p=0.002). There were no differences of TMB high/MSI high for primary tumor and metastatic sites, but UTUC was enriched for MSI high (3.4%) relative to BUC (0.8%, p<0.001). ConclusionsDifferences in the genomic landscapes of UTUC and BUC were modest; however, patients with UTUC were enriched for FGFR3 and HRAS SV relative to BUC. Further investigation on UC, stratified by the site of origin, is warranted. In addition, these results suggest an opportunity for the routine incorporation of CGP prior to systemic therapy initiation in metastatic UC. Patient summaryGenomic profiling of advanced urothelial carcinoma can inform several therapeutic opportunities for patients, particularly those with upper tract urothelial carcinoma, an infrequent and generally aggressive tumor entity with nonoverlapping clinical features compared with its bladder counterpart, which is often treated based on the data extrapolated from bladder cancer.

The effectiveness of chemotherapy for patients with pT3N0M0 renal pelvic urothelial carcinomas: An inverse probability of treatment weighting comparison using Surveillance, Epidemiology, and End Results data.

IntroductionUnlike the established evidence to use chemotherapy for urothelial carcinoma of the bladder, presently there are insufficient data to inform a recommendation on upper urinary tract urothelial carcinoma treatment. The prognosis for patients with stage T4 and positive lymph nodes is poor; however, primary tumors in the renal pelvis are associated with favorable prognoses compared to those located in the ureter. Our study aimed at investigating the effectiveness of chemotherapy in patients with pT3N0M0 renal pelvic urothelial carcinomas (RPUC) who have relative favorable prognosis.MethodsPatients with pT3N0M0 tumors who underwent radical nephroureterectomy combined with bladder cuff excision between 2005 and 2014 and registered in the Surveillance, Epidemiology, and End Results database were eligible for inclusion (n = 939). Baseline characteristics between the chemotherapy and observation groups were controlled for with inverse probability of treatment weighting (IPTW)‐adjusted analysis.ResultsAfter the IPTW‐adjusted analysis, the 5‐year IPTW‐adjusted rates of overall survival (OS) for the chemotherapy and observation groups were 53.1% and 44.9%, respectively. The IPTW‐adjusted Kaplan‐Meier curves suggested that chemotherapy was associated with increased OS compared with observation (P = .028). In the IPTW‐adjusted Cox proportional hazards regression model, chemotherapy was associated with favorable survival benefits compared with observation (hazard ratio [HR] 0.71, 95% CI 0.52‐0.92, P = .031), and this was maintained after bootstrapping (HR 0.72, 95% CI 0.49‐0.93). Chemotherapy had a protective effect on OS benefits, which were found in a majority of the results of the subgroup analysis and were consistent with the main results (all P‐interactions > 0.05).ConclusionChemotherapy may provide significant OS benefits for patients with pT3N0M0 RPUC. The results of our study could strengthen the evidence for using adjuvant chemotherapy in this rare group of patients.

V03-07 TECHNICAL CAVEATS IN ROBOT-ASSISTED RADICAL NEPHROURETERECTOMY WITH RETROPERITONEAL LYMPHADENECTOMY FOR POST CHEMOTHERAPY UPPER TRACT UROTHELIAL CARCINOMA

INTRODUCTION AND OBJECTIVE: Upper tract urothelial carcinoma (UTUC) forms 5% of all urothelial cancers.Urothelial carcinoma has been known for tumors developing lymphatic metastases at a relatively high incidence of 20–30%. Post chemotherapy UTUC with residual lymph nodes represents a distinct surgical challenge because of severe desmoplastic reactions. Radical nephroureterectomy with retroperitoneal lymphadenectomy provides a technically feasible and safe option in such patients. A robotic approach is being increasingly used to perform this complex oncologic procedure in view of its distinct advantages. We hereby present a video of robot assisted radical nephroureterectomy with retroperitoneal lymph node dissection for post chemotherapy UTUC and discuss a few points of technique related to it. METHODS: A 64 year female was incidentally found to have left renal pelvis urothelial carcinoma. CECT KUB revealed a poorly defined mildly enhancing lesion distending the left renal pelvis and left upper ureter. Multiple retrocaval lymph nodes was present. Left ureteroscopy showed upper ureteric and pelvis wall thickening with 2-3 cm sized protruding mass in the left renal pelvis. Biopsy was taken which came out as high grade urothelial carcinoma. Chemotherapy (Gemcitabine + Cisplatin) x 3 cycles was given after which FDG avidity and number of lymph nodes decreased. Transperitoneal robot assisted radical nephroureterectomy with retroperitoneal lymphadenectomy was then performed. Patient was first placed in standard left lateral position. Pneumoperitoneum created using Veress needle. Standard right kidney 7 ports made, 4 of 8 mm, 1 of 5 mm and 2 of 12 mm. Da Vinci Xi docked. Right colon reflected along the white line of Toldt, duodenum kocherized. Right gonadal vein identified, traced up, clipped and divided. IVC dissected, pre caval, para caval and inter aortic caval lymph node dissection done till proximal right common iliac vein (crossing of ureter). Right renal vein dissected gently and lymph node tissue behind renal vein removed. Large lymphatic vessels clipped before cutting.Hemostatsis confirmed. Robot undocked, ports removed and closed, keeping 2, 12 mm assitant port in situ. Patients position changed to right lateral decubitus. Standard left kidney 4 robotic ports inserted. Left ureter and gonadal vein identified and lifted. Pre and para aortic lymph node dissection done till left proximal common iliac artery (crossing of ureter) with the combination of sharp and blunt dissection. Renal vein identified and Hilar dissection done. Gonadal vein along with adjacent lymph nodes traced proximaly upto the renal vein where they were ligated and divided. Lumbar veins draining to renal vein clipped and divided. Stapling of renal hilum with endo GIA stapler was done. Ureteric clipping was done before mobilization of kidney. Kidney mobilized from all its attachements. Ureter mobilized as inferiorly as possible. Camera and right robotic arm instruments switched. Left lower ureter dissected. Left ueretrovesical junction identified. Bladder dissected distally and Stay V - loc 3.0 suture taken. Lower end of left ureter removed along with cuff of bladder wall. Bladder closed in one layer with V loc. Haemostasis ensured & drain placed. Robot undocked & Specimen retrieved through a pfannensteil incision. Abdomen closed in layers and ports removed under vision. Port site closed. RESULTS: Total console time was 425 minutes and blood loss was 50ml. Per urethral catheter and drain were removed on POD 5 and 1 respectively. Patient was discharged in stable condition on POD 2. Histopathology revealed urothelial carcinoma-pT3N0M0. CONCLUSIONS: In post chemotherapy UTUC, severe desmoplastic reaction as well as larger-volume residual disease requires more extensive retroperitoneal dissection. This increase the technical demands of the surgery and make it one of the most difficult and dangerous operations. Robot assisted RNU with RPLND remains a technical feasible and safe option in such patients. Source of Funding: None

Renal pelvic urothelial carcinoma in horse shoe kidney with recurrence in urinary bladder—a case report and adjuvant treatment review

Background: Horse shoe kidney is rare, rarer is urothelial carcinoma of renal pelvis in horse shoe kidney, but is more common than that in normal kidney. Radical nephroureterectomy with removal of a cuff of urinary bladder is the standard of treatment. Despite of complete surgery, there are loco-regional recurrences. Case Report: Presenting a case of 60-year male with gross hematuria of 2 months. On imaging found to have horse show kidney with right kidney upper pole mass, believing it to be renal cell carcinoma, nephrectomy was done. However, histopathology turned out to be low-grade urothelial carcinoma of pelvis. Patient had recurrence in left over ureteral stump and ureteric orifice after 10 months. Completion surgery followed by adjuvant intra-vesical bacille calmette guerin (BCG) was given and patient has no recurrence since past 2 years. Conclusion: Urothelial carcinoma of renal pelvis although rare, but it is three to four times more common than that in normal kidney due to chronic obstruction in horse shoe kidney. Due to multifocality of urothelial carcinoma of renal pelvis, gold standard treatment remains complete nephroureterectomy with removal of a cuff of urinary bladder. Post-operative locoregional recurrences are seen and judicious use of intravesical BCG, chemotherapy, and radiotherapy has shown to beneficial.

Delayed post-diuretic 18F-FDG PET/CT for preoperative evaluation of renal pelvic cancer

Background: Application of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) in urological oncology was relatively slowly due to the urinary elimination of 18F-FDG. We investigated whether delayed post-diuretic 18F-FDG PET/CT could be used for diagnosing renal pelvic cancer.Methods: 51 patients were included who underwent delayed post-diuretic 18F-FDG PET/CT for detecting renal pelvic space-occupying lesions. The comparations of delayed PET/CT parameters and clinical characteristics between renal pelvic cancer and benign polyp were investigated.Results: Among the 51 patients, 47 were found to have renal pelvic urothelial carcinoma, and 4 had benign polyp. ROC analysis identified the lesion maximum standardized uptake value (SUVmax) of 6.2 as the optimal cut-off value to distinguish from renal pelvic urothelial carcinoma to benign polyp. With the SUVmax cut-off of 6.2, the sensitivity, and specificity for predicting of renal pelvic urothelial carcinoma were 91.5% (43/47), and 100% (4/4). We also found a significant difference in tumor size between the positive (SUVmax > 6.2) and negative (SUVmax ≤ 6.2) PET groups in renal pelvic cancers. In patients with tumor size < 1.1 cm, the probability of being in the negative PET group was 75%. In such patients, a substantial proportion of renal pelvic cancer demonstrated negative SUVmax similar to that in patients with benign polyp.Conclusion: Delayed 18F-FDG PET/CT could be used for differentiating renal pelvic cancer from benign polyp. In patients with small tumor size, renal pelvic cancer may present low 18F-FDG uptake, mimicking the metabolic phenotypes of patients with benign polyp.

Detection of pagetoid urothelial intraepithelial neoplasia extending to the vagina by cervical screening cytology: a case report with renewed immunochemical summary

BackgroundPagetoid spread of urothelial carcinoma (UC) to the lower genital tract is quite a rare and diagnostically challenging condition. Pagetoid urothelial intraepithelial neoplasia extending to the vagina is difficult to diagnose, especially in remote recurrences without symptomatic or macroscopic lesions typical to Paget disease. However, its identification by cervical screening cytology is important because UC is often characterized by a long history of relapse.Case presentationA 68-year-old Japanese postmenopausal woman developed brown vaginal discharge after radical cystectomy for bladder cancer (high-grade UC, pT2a pN0 cM0 [Union for International Cancer Control, 8th edition]) concomitant with focal in-situ UC in the urethra. She had a history of left renal pelvis UC, which was surgically removed 9 months before the radical cystectomy. Gynecologic examination of the lower genital tract was unremarkable although cervical screening cytology demonstrated severely atypical cells with pleomorphism repeatedly. Cervical colposcopy and diagnostic conization revealed no cervical neoplasm. In retrospect, immunocytochemical p16/Ki-67 dual staining for the previous cervical screening was negative for p16 labeling, and the neoplastic cells were positive for cytokeratins 7 and 20, p63, and GATA binding protein 3. No high-risk human papillomavirus genotype was identified by an automated DNA chip system using liquid-based cytology samples. Eleven months post-cystectomy, punch biopsy of the vulva and vagina confirmed intraepithelial UC in the juxtaposed squamous epithelium with pagetoid spread demonstrating positivity for specific urothelial markers: uroplakins II and III and thrombomodulin. Concurrent invasive malignancy was ruled out, and CO2 laser vaporization of the vulvar and vaginal lesion was performed. The patient remained alive without evidence of invasive malignancy for 14 months after the radical cystectomy for bladder cancer.ConclusionsTo detect recurrent pagetoid urothelial intraepithelial neoplasia with pagetoid spread in the lower genital tract, pathologists should recognize the history of prior UC with special attention to absence of p16 labeling in cervical cytology as a pointer to the diagnosis of urothelial cancer. Using further biopsy and immunohistochemical confirmation of UC relapse, investigation to rule out invasive malignancies and careful follow-up throughout the patient’s lifetime is recommended.

Rates of lymph node invasion and their impact on cancer specific mortality in upper urinary tract urothelial carcinoma

PurposeTo analyze lymph node invasion (LNI) rates according to tumor characteristics and to test the impact of LNI and its extent on cancer specific mortality (CSM) in surgically-treated non metastatic urothelial upper urinary tract carcinoma (UTUC) patients. Materials and methodsWithin the SEER database (2004–2014), we identified 2098 patients with histologically confirmed non-metastatic urothelial carcinoma of renal pelvis or ureter who underwent NU with LND. LNI rates stratified according to tumor location and stage were described. Kaplan-Meier plots illustrated CSM rates according to LNI and its extent. Multivariable Cox regression models (MCRMs) tested the effect of LNI and its extent on CSM. ResultsOf 2098 UTUC patients, who underwent nephroureterectomy with lymph node dissection, 646 (33%) had LNI. The median number of removed lymph nodes was 3 [Interquartile range (IQR): 1–7]. The median number of positive lymph nodes in patients, who harbored LNI was 1 (IQR:1–3). LNI rates according to tumor location were, respectively, 23.6% for ureteral and 36.5% for renal pelvis tumors. LNI rates according to tumor stage were 9.6, 18.0, 38.7 and 63.9%, for respectively, T1, T2, T3 and T4 UTUC. In MCRMs, LNI achieved independent predictor status for higher CSM (HR 3.00; p < 0.001). Finally, in MCRMs, number of positive lymph nodes defined as the 75th percentile (n ≥ 3) achieved independent predictor status for higher CSM (HR 1.37; p = 0.04). ConclusionsLNI in non-metastatic UTUC patients is the most important determinant of CSM. Number of positive lymph node is independently associated with higher CSM. In consequence, lymph node dissection can provide extensive prognostic information.

Osteoclast-rich undifferentiated carcinoma of the bladder: A case report

Osteoclast-rich undifferentiated carcinomas of the bladder are rare, aggressive neoplasms with less than 20 cases being reported in the English literature. We report a 73-year-old woman with a history of ovarian high grade serous carcinoma at age 65 and conventional invasive urothelial carcinoma of renal pelvis at age 71, who then presented with a 3 cm left sided bladder wall tumour. The patient underwent biopsy and subsequent radical cystectomy. Histological examination revealed predominantly malignant spindle cells and malignant mononuclear cells closely intermixed with small islands of conventional invasive urothelial carcinoma. Throughout the tumour, bland osteoclast-like multinucleated giant cells were present. Background urothelium showed non-invasive high-grade papillary urothelial carcinoma. Immunohistochemistry showed cytokeratin, p40 and p53 positivity in the malignant spindled and mononuclear cells, as well as the areas of conventional invasive urothelial carcinoma. Osteoclast-like giant cells were positive for CD68 and LCA, but negative for cytokeratin, p40 and p53. Ki67 index was elevated in malignant spindle cells, mononuclear cells and conventional invasive urothelial carcinoma but completely negative in osteoclast-like giant cells. These findings give further evidence that undifferentiated spindle cells and mononuclear cells are dedifferentiated urothelial carcinomas, while bland osteoclast-like giant cells are benign stromal reaction of histiocytic lineage.

A phase I study of the safety and immunogenicity of a multipeptide personalized genomic vaccine in the adjuvant treatment of solid cancers.

TPS3114 Background: Mutation-derived tumor antigens (MTAs) arise as a direct result of somatic variations, including nucleotide substitutions, insertions, and deletions that occur during carcinogenesis. These somatic variations can be characterized via genetic sequencing and used to identify MTAs. We propose a platform for a fully-personalized MTA-based vaccine in the adjuvant treatment of solid tumors. Methods: This clinical trial is a single-arm, open label, proof-of-concept phase I study designed to test the safety and immunogenicity of the Personalized Genomic Vaccine 001 (PGV001). The single-center study will enroll 20 eligible subjects with histological diagnosis of the following tumor types: (a) head and neck squamous cell cancer, (b) non-small cell lung cancer, (c) ductal or lobular breast cancer, (d) serous carcinoma of the ovary, uterine adnexa, (e) urothelial carcinoma of renal pelvis or bladder, (f) cutaneous squamous cell cancer. Subjects must have no measurable disease at time of first vaccine administration, and 5-year disease recurrence risk of &gt; 30%. Patients will receive 10 doses of PGV001 as well as 10 doses of poly-ICLC (toll-like receptor-3 agonist, vaccine adjuvant), administered 1 day after PGV001 vaccination. Toxicity (endpoint 1) will be defined by Common Terminology Criteria for Adverse Events v5.0. Blood samples will be collected at various time points for immune response monitoring of MTA-specific humoral and cellular immune responses. For each patient, immunogenicity (endpoint 2) will be defined as an epitope-specific T cell response, detectable in peripheral blood samples after PGV001 vaccination. The change in the frequency of vaccine-induced epitope-specific T lymphocyte populations post-vaccination relative to baseline will be determined using mixed effects linear regression modeling. Conclusions: Our clinical trial will test for the first time the safety and immunogenicity of PGV001 in patients with multiple solid cancers. The information learned from this clinical trial will instruct the next generation of MTA-based vaccines, future development of immunotherapeutic approaches and rational combinations. Clinical trial information: NCT02721043.

Synchronous urothelial carcinoma of renal pelvis and ipsilateral renal cell carcinoma

The coexistence of urothelial carcinoma (UC) of renal pelvis and ipsilateral renal cell carcinoma (RCC) is remarkably rare. We present a case of an 80-year-old male who was admitted with a history of the left flank pain, painless hematuria, and passage of blood clot in urine. Computerized tomography revealed a solid mass in the left renal pelvis extending into the calyces and renal parenchyma which gave an impression of UC of renal pelvis. Left nephroureterectomy was performed for tumor in renal pelvis, and histopathological examination showed an infiltrating high-grade papillary UC of the renal pelvis with an incidental clear cell type RCC in the renal parenchyma. This is a rare case of combined renal malignancies in the same kidney. There are only 52 cases reported in English language literature till 2017.

Lipomatosis of Kidney Mimicking Hydronephrosis or Urothelial Carcinoma of Renal Pelvis on Sonography

Lipomatosis of Kidney Mimicking Hydronephrosis or Urothelial Carcinoma of Renal Pelvis on Sonography

CLINICAL ANALYSIS ABOUT PERCUTANEOUS NEEDLE BIOPSY FOR RENAL MASSES

(Objective) We investigated the efficacy and safety of percutaneous renal mass biopsy retrospectively. (Methods) A retrospective review was performed of 44 patients (46 renal masses) who received ultrasound and/or computed tomography guided percutaneous biopsy of a solid renal mass between April 2004 and December 2012 in National Defense Medical College Hospital. (Results) The median renal mass size was 45 (range 15-140) mm with a median of 2 (1-5) cores taken. Thirteen masses were biopsied for differential diagnosis between RCC and other malignancies (or benign renal tumors), 11 were biopsied for differential diagnosis between RCC and renal pelvic urothelial carcinoma, 10 unresectable masses were biopsied to confirm the diagnosis pathologically before starting medication, and 12 small masses were biopsied before radio-frequency ablation. Of the initial 46 biopsies, 38 (82.6%) were diagnostic. The median lesion sizes in the diagnostic and nondiagnostic biopsy specimens were 45 (15-140) mm and 43 (17-128) mm. The median numbers of diagnostic and nondiagnostic cores were 2 (1-5) and 1.5 (1-4). These size and core number differences between the diagnostic and nondiagnostic biopsy specimens are not statistically significant. Of initial nondiagnostic 8 masses, 3 masses that were performed repeat biopsy resulted in determined diagnosis finally. There were mild postprocedural hematomas not requiring blood transfusion. There was no tumor dissemination after renal mass biopsy. (Conclusions) Percutaneous biopsy of renal masses is a safe procedure that provides diagnostic information.

Acute Tumor Lysis Syndrome after Cisplatin and Gemcitabine for Treatment of Urothelial Carcinoma of the Renal Pelvis: Case Report and Review of Literature

Tumor lysis syndrome (TLS) is a potentially fatal complication of oncological therapy. It is rarely described in patients with solid tumors, even rare in urological cancer. To the best of our knowledge, there were only two cases describing TLS following chemotherapy for metastatic urothelial carcinoma documented in the literature, although only one occurred after gemcitabine, another case occurred after PD-1 Immunotherapy. Case presentation: We present the case of a 67-year-old female who developed acute renal failure and tumor lysis syndrome after a single infusion of cisplatin and gemcitabine for metastatic renal pelvic urothelial carcinoma. Conclusions: Patients with urothelial carcinoma that are highly proliferative and have high tumor burden are at high risk of developing hyperuricemia and TLS, while undergoing chemotherapy. Although TLS is rare in solid tumor, oncologists should be alert when treating patients at high risk of TLS, and determine appropriate prophylaxis. We also proposed biomarker based risk stratification for patients with high risk for TLS.

The Significance of BerEp4 and Cytokeratin 19 Expressions in Epithelial Tumors of Kidney and Renal Pelvis

Objective: The differential diagnosis in the epithelial tumors of kidney and renal pelvis can be problematic due to their overlapping morphologic features. This is much more complicated in some conditions, such as renal oncocytoma (RO) vs chromophobe renal cell carcinoma (ChRCC) and renal cell carcinoma (RCC) vs urothelial carcinoma of renal pelvis (UC-RP). The purpose of this study was to assess potential contributions of BerEP4 and cytokeratin 19 (CK19) expressions in the differential diagnosis of these challenging cases. Methods: A total 57 cases consisted of 11 chromophobe (ChRCC), 18 clear cell (CCRCC), 12 papillary (PRCC), and 2 unclassified RCCs, 1 multilocular cystic renal cell neoplasm (MCRCN) with low malignant potential, 7 UC-RP, and 6 renal oncocytomas (RO) were stained against BerEp4 and CK19 antibodies using automated immunostainer. Results: All ROs demonstrated membranous BerEP4 expression, but no CK19 expression. Unlike ROs, most ChRCCs exhibited diffuse and strong CK19 expression, but no or focal and weak BerEP4 expression. This distinctive opposite expression pattern was highlighted in hybrid oncocytic chromophobe tumor (HOCT). CCRCCs showed highly variable expression patterns for both markers. PRCC type 1 tumors demonstrated diffuse and strong BerEp4 and CK19 expressions. PRCC type 2 exhibited BerEP4 and CK19 expressions, but their expressions were focal and weaker than for PRCC type 1. MCRCN demonstrated diffuse and strong BerEP4 expression, but no expression for CK19 unlike cystic CCRCC, which is strongly positive for both markers. Epithelioid cells in unclassified RCC showed strong CK19 and weak BerEP4 expression, whereas spindle cells in the tumor did not express CK19 and BerEp4 or exhibited scattered and weak expressions. UC-RP showed diffuse and strong CK19 expression, but no or scattered BerEP4expression was seen in the tumor. We also evaluated CK19 and BerEP4 expression in non-neoplastic adjacent kidney and renal pelvis. Conclusion: This study revealed that 1) BerEP4 and CK19 exhibit variable and distinctive immunoprofiles in epithelial tumors of kidney and renal pelvis, 2) an immunoprofile of BerEP4 (+)/CK19 (-) favors RO in contrast to an opposite profile for ChRCC, 3) The heterogeneous expressions of BerEP4 and CK19 in low grade RCC with eosinophilic cytoplasm favors HOCT, 4) PRCC type 1 strongly express both biomarkers, and 5) although RCC subtypes express CK19 in a variable proportion and intensity, diffuse and strong CK19 expression favors UC-RP.

Synchronous ipsilateral renal cell carcinoma and urothelial carcinoma of kidney or ureter: Cases report and literature review

Synchronous ipsilateral renal cell carcinoma and urothelial carcinoma of kidney or ureter: Cases report and literature review

Rare case report-synchronuos renal cell carcinoma and renal pelvis urothelial carcinoma in a post kidney transplantation young male

Rare case report-synchronuos renal cell carcinoma and renal pelvis urothelial carcinoma in a post kidney transplantation young male

Laparoscopic transperitoneoscopic nephroureterectomy in a patient with situs inversus totalis.

This article discusses the case of a 78-year-old female with painless gross hematuria. Chest X-rays showed dextrocardia with situs inversus, and whole-body computed tomography scanning showed a renal mass in the right renal pelvis, no evidence of metastasis, and mirror-image organs with left-to-right transposition, which resulted in a diagnosis of situs inversus totalis (SIT). A laparoscopic transperitoneoscopic right nephroureterectomy was scheduled. To our knowledge, our case is the second case of laparoscopic nephroureterectomy in renal pelvic urothelial carcinoma with SIT to be presented, but it is the first case of laparoscopic transperitoneoscopic nephroureterectomy. Laparoscopic transperitoneoscopic nephroureterectomy was successfully performed in a renal pelvic urothelial carcinoma patient with SIT with a correct description of renal vascularity and abdominal anatomy.