Oncocytic carcinoma of the nasal cavity with widespread lymph node metastases

The first case of oncocytic carcinoma which arose from the inferior turbinate of the nasal cavity with orbital invasion through the nasolacrimal canal and widespread lymph node metastases in the neck and face is reported here. The tumor metastasized rapidly, spread widely to the whole neck and face, and produced tumor emboli in the lymphatics and extranodal extension by rupture of the lymph node capsule in the absence of clinically palpable regional lymph node enlargement. We think the oncocytic carcinoma of the nasal cavity may be a high-grade malignancy tumor.

Combined Percutaneous Radiofrequency Ablation and Ethanol Injection of Renal Tumours: Midterm Results

OBJECTIVES

To evaluate the safety and efficacy of combined percutaneous, image-guided, radiofrequency (RF) ablation and ethanol injection of renal tumours, and to present our midterm results.

METHODS

Since February 2002, 27 consecutive patients (22 men, 5 women; age range: 39-84 yr; mean: 69) with 28 renal tumours (mean diameter: 2.87cm) were treated with combined percutaneous RF and ethanol ablation, and were prospectively evaluated. Twenty-five patients were considered nonsurgical candidates because of comorbid conditions (16 patients) or had previous nephrectomy (9 patients), and 2 had refused surgery. Thirty-three ablation sessions were performed, with computed tomography (26 sessions), ultrasound (6), or combined magnetic resonance imaging/fluoroscopic guidance in 1. Absolute ethanol (0.5-3ml; mean: 1.7) was injected into the tumour immediately before treatment with radiofrequency. Mean follow-up period was 18.6 mo (range: 3-56).

RESULTS

Twenty-seven of the 28 tumours were completely ablated with either one (21 tumours) or two treatment sessions (6 tumours). One patient with residual disease refused further treatment. Only three minor complications, including a subcapsular haematoma and two patients with loin pain, occurred; all three patients were treated conservatively. None of the complications was related to the ethanol injection. During the follow-up period, no evidence of local recurrence or metastatic disease was seen. Creatinine levels have not changed significantly in any of the patients following ablation.

CONCLUSIONS

Combined use of percutaneous RF and ethanol ablation is a safe and effective alternative treatment for selective patients with renal tumours.

Malignant Oncocytoma of the Lacrimal Sac as an Unusual Cause of Epiphora

A 72-year-old man presented with a 2-year history of epiphora. CT revealed an extensive inferomedial orbital tumor connected to the lacrimal sac and duct. Incisional biopsy revealed malignant oncocytoma of the lacrimal sac. The patient was treated with exenteration and maxillectomy followed by a course of postoperative radiotherapy. Patients with malignant oncocytoma may present with simple epiphora in absence of other signs and symptoms such as blood stained tearing or purulent rhinorrhea.

Oncocytic carcinoma of the parotid gland

BACKGROUND

Oncocytic carcinoma is a rare tumor of major salivary glands. Despite being described 5 decades ago, not much is known about these rare tumors. Histochemical or electron microscopic confirmation of the oncocytic nature of the tumor cell is needed for differential diagnosis. The main treatment modality is surgery with or without adjuvant radiotherapy. Malignant oncocytomas have the potential risk of developing distant metastases and demand long term follow-up after therapy.

CASE REPORT

A 58-year old man presented with a recurrent mass in the left parotid gland with a prior diagnosis of monomorphic adenoma in the same localization which had been treated by tumor excision in July 2002. Left superficial parotidectomy followed by radiotherapy into tumor bed and upper neck were carried out in September 2004. To date, he has had no evidence of recurrence for 14 months.

CONCLUSION

For an accurate approach in the management of patients, oncocytic adenocarcinoma should be considered in the differential diagnosis of lesions of the parotid gland, most of which are benign.

Prognostic factors of recurrence in encapsulated Hurthle cell carcinoma of the thyroid gland: a clinicopathologic study of 50 cases

BACKGROUND

Follicular carcinomas of the thyroid gland, including its oncocytic variant (so-called Hurthle cell carcinoma), are subdivided into the indolent encapsulated ("minimally invasive") and the clinically aggressive widely invasive tumors. There are, however, cases of encapsulated follicular carcinoma that recur and metastasize. Identifying these cases at the time of diagnosis is crucial for prognostic and therapeutic considerations. Because to the authors' knowledge most studies do not focus exclusively on the encapsulated Hurthle cell carcinoma (EHC), the current study attempted to identify predictors of recurrence in EHC.

METHODS

A tumor was defined as EHC if it was encapsulated, macroscopically well defined with microscopic but no macroscopic evidence of vascular or capsular invasion, and composed of > 75% follicular oncocytic cells. Retrospective chart review and microscopic examination identified 50 primary tumors meeting the above criteria at the Memorial Sloan-Kettering Cancer Center between 1967 and 2005. The cases were analyzed for various histologic and clinical parameters. Each parameter was correlated with recurrence-free survival (RFS).

RESULTS

Seven of 50 (14%) patients developed disease recurrence. All patients who developed recurrence were found to have a high number of foci of vascular invasion (> or = 4). In univariate analysis, > or = 4 foci of vascular invasion (P <.0001), tumor size > 4 cm (P = .049), the presence of mitosis (P = .018), and a solid/trabecular growth pattern (P = .009) were found to be correlated with a decreased RFS. Extensive capsular invasion, gender, and age did not confer a statistically higher recurrence rate. The finding of a solid/trabecular growth and mitosis correlated with the presence of numerous foci (> or = 4) of vascular invasion (P = .01 and P = .005, respectively).

CONCLUSIONS

A diligent search for vascular invasion is recommended in EHC that display mitosis or a solid/trabecular growth pattern. The presence of > or = 4 foci of vascular invasion should alert the pathologist and the clinician to a significantly higher risk of recurrence in EHC.

[Renal oncocytoma]

Due to its nonspecific clinical and radiological features, renal oncocytoma is usually diagnosed on the operative specimen. Histological confirmation of the diagnosis is based on the distinction between oncocytoma and renal cell carcinoma (RCC), which can be difficult. Description of cases in which RCC and oncocytoma are present in the same tumour and the hypothesis of a link between oncocytoma and RCC further complicate the diagnosis of this tumour by the urologist. The authors reviewed the management of tumours suspected to be oncocytoma based on a review of the international literature concerning the diagnosis, natural history and treatment of renal oncocytoma.

Aggressiveness of therapy and prognosis of patients with Hürthle cell papillary thyroid carcinoma

Hürthle cell papillary thyroid carcinoma (HCPTC) has been studied separately from other types of thyroid carcinoma in relatively few studies. The aim of our study was to determine the factors associated with the survival of patients with HCPTC in Slovenia, an iodine-deficient region. A total of 1552 patients with thyroid carcinoma were seen at our institute during the period of 1976-2003; of them, 42 patients (33 females, 9 males; age 10-85 years, median 56.5 years) had histopathologically verified HCPTC. The data on the patients' gender, age, disease history, extent of disease, morphologic characteristics, therapy, locoregional control, disease-free interval, and survival were collected. The statistical correlation between possible prognostic factors and the disease-free interval and survival was analyzed by chi2 test and log rank analysis. The tumor diameter ranged from 1 to 9 cm (median, 3 cm). Extrathyroid tumor growth was found in 19 patients, lymph node metastases in 13 patients, and distant metastases in 2 patients. Primary treatment consisted of total or near-total thyroidectomy (39 patients), lobectomy (2 patients), radioiodine ablation of the thyroid remnant (37 patients), external irradiation (14 patients), and chemotherapy (3 patients). Locoregional recurrence was diagnosed in four patients, and dissemination in 1 patient during the follow-up period of 0.75-20 years (median, 5.5 years). Three patients died of thyroid carcinoma during the follow-up period. The 5-year and 10-year survivals were 94% and 87%, respectively. The 5-year and 10-year disease-free intervals were 93% and 81%, respectively. The factors correlated with the survival were: age, extrathyroid tumor growth, primary tumor stage, and regional and distant metastases. Although extrathyroidal tumor growth was found in 45% of the patients with HCPTC, our patients had a favorable prognosis. Long-term survival and locoregional control of disease are likely after the radical tumor resection, radioiodine ablation of the thyroid remnant, and external irradiation.

The treatment and prognosis of Hürthle cell follicular thyroid carcinoma compared with its non-Hürthle cell counterpart

BACKGROUND

This population study compared the treatment and prognosis of Hürthle cell follicular thyroid carcinoma (HCFC) and non-HCFC.

METHODS

The Surveillance, Epidemiology and End Results database identified patients with HCFC and non-HCFC from 1988 to 1993 who were followed to 2001. Treatment of each carcinoma was compared, and the effect of prognostic factors on survival was analyzed.

RESULTS

Eight hundred forty-five patients were identified; 172 patients (20%) had HCFC and 673 patients (80%) had non-HCFC. Total thyroidectomy was performed in 80% of patients with HCFC compared with 69% with non-HCFC (P = .005). Radioactive iodine was used in 33% with HCFC and 45% with non-HCFC (P = .003). The crude 10-year survival was 73% in HCFC and 83% in non-HCFC patients. Older age (> or =50 vs <50 years; hazard ratio, 6.35; 95% CI, 4.07-9.93), men (hazard ratio, 2.07; 95% CI, 1.52-2.81), larger tumor size (>5 vs < or =5 cm; hazard ratio, 2.20; 95% CI, 1.55-3.13; >10 cm vs < or =5 cm; hazard ratio, 3.28; 95% CI, 1.12-9.61), nodal metastases (hazard ratio, 3.11; 95% CI, 1.80-5.37), and distant metastases (hazard ratio, 3.91; 95% CI, 1.94-7.90) were associated with a higher mortality rate. Histologic type (non-HCFC vs HCFC; hazard ratio, 0.85; 95% CI, 0.60-1.19; P = .34), local extension, extent of thyroidectomy, and radioactive iodine use had no effect on the mortality rate.

CONCLUSIONS

Histologic distinction between HCFC and non-HCFC is not as prognostically important as age, gender, and tumor stage. This study suggests that patients with HCFC should be treated the same as patients with equivalent stage non-HCFC.

Follow-up of renal oncocytoma diagnosed by percutaneous tumor biopsy

OBJECTIVES

To evaluate the outcome of patients with oncocytoma of the kidney diagnosed in our center by percutaneous biopsy and treated with watchful waiting.

METHODS

From January 1998 to April 2004, of 148 solid renal tumors biopsied in our center, 15 were renal oncocytomas. The mean (+/- standard deviation) follow-up was 30 +/- 19.8 months. We report on the outcome of these patients.

RESULTS

The mean age at diagnosis was 57.6 +/- 14.4 years, and mean tumor size was 3.49 +/- 2.43 cm, corresponding to a mean tumor volume of 62.3 +/- 135.4 cm3. During follow-up, 6 of 15 patients needed surgery: two partial and four total nephrectomies. Indications for surgery were initial tumor burden, greater than 0.5 cm/yr tumor growth, and patient's preference in 1 case, 4 cases, and 1 case, respectively. The patients who received surgical treatment were significantly younger (45.5 +/- 11.1 years versus 65.6 +/- 10.3 years) and had more bulky tumors at diagnosis (50 +/- 30.1 mm versus 27.3 +/- 10.5 mm). In 1 patient, a chromophobic renal cell carcinoma was associated with the oncocytoma. All 9 patients who did not receive surgical treatment remained asymptomatic.

CONCLUSIONS

The evolution of renal oncocytoma seems to be increase of tumor size with variable velocity. Treatment must be conservative. Initial management might be nonsurgical with close follow-up. Monitoring should not miss the time of conservative surgery. Initial tumor volume or fast tumor growth are indications for surgery. Partial nephrectomy, if the tumor size and localization are reasonable, is currently the technique of choice.

Contemporary management of thyroid cancer

Thyroid cancer is a relatively common and frequently curable malignant neoplasm, accounting for nearly 2% of all new cancers diagnosed annually in the United States. The diagnostic and management options have evolved considerably in the past decade, and a current understanding of these trends in the standard of care have assumed an important consideration in the practices of head and neck surgeons and endocrinologists alike. We sought to review the epidemiology and pathology of the several types of thyroid cancer and to present our evidence-based management algorithm. Every effort was made to offer alternative treatment strategies and supporting data where available. In addition to reviewing well-established approaches to diagnosis and management, emphasis is placed on newer techniques, including minimally invasive thyroidectomy, molecular detection of disease propensity, and the use of recombinant thyrotropin prior to radioiodine ablation.

[Kidney oncocytoma: diagnostic and therapeutic approach in the INCMNSZ]

INTRODUCTION

Renal oncocytoma is a benign tumor that in some series represents up to 18% of all solid neoplasms measuring 4 cm or less. Since radiologic distinction between a renal cell carcinoma and oncocitoma is practically impossible, the histologic examination represents the cornerstone of diagnosis. Follow up will be greatly modified by the diagnosis of oncocytoma since it displays a benign course. Eight cases are presented here that were treated at our institution with special mention to diagnosis and therapy.

MATERIAL AND METHOD

A retrospective review was performed using records of 288 patients with kidney tumors from 1971 to 2002. Cases had to have several tissue staining including E&O, Schiff's peryodic acid, coloidal Iron, Alcian blue and mucicarmin.

RESULTS

A total of 8 cases (4 men and 4 women) of oncocitoma were detected (2.7%). Patients had a mean age of 50 years (36-69), none had familial history of renal tumors and hipertension was detected in 6. Patients were diagnosed after surgery since radiologic studies suspected renal carcinoma in all patients. The neoplasms measuring more than 8 cm and association with renal cancer in a patient. Follow up was course benign in all patients without recurrence.

DISCUSSION

Renal oncocytoma represent a small proportion of renal tumors seen in our institution. It must be suspected in solid renal neoplasms measuring less than 4 cm more so if a centrally located scar is seen on CT scan creating a wagon wheel appearance. Definitive diagnosis is made by histologic examination after a chromophobe tumor is ruled out. Since it has a benign course, minimal radiologic follow up is warrented.

Prognostic indicators of outcomes in patients with distant metastases from differentiated thyroid carcinoma

BACKGROUND

Distant metastasis is uncommon in differentiated thyroid cancer and the prognosis is unclear. This study aims to evaluate outcomes and to define independent variables that are associated with tumor-related mortality in patients with distant metastasis from thyroid carcinoma.

STUDY DESIGN

A retrospective review of the thyroid cancer research database identified 336 patients with distant metastasis from differentiated thyroid carcinoma treated at a single institution between 1941 and 2000. After excluding patients with local or regional recurrence, distant disease was either the first site of recurrence or was detected at the time of diagnosis of the primary tumor in 242 patients (72%). Patient, tumor, and treatment-related factors were analyzed for their relation to disease-specific survival (DSS) using multivariate Cox regression and the log-rank test.

RESULTS

Median survival was 4.1 years and 10-year DSS was 26%. Distant disease was synchronous with the primary diagnosis in 97 of 242 (40%) patients. The site of metastasis was lung only in 103 (43%) patients, bone only in 80 (33%), other sites in 14 (6%), and more than one organ system in 45 (19%). Multivariate analysis identified age 45 years or more, symptoms, site other than lung only or bone only, and no radioactive iodine treatment for the metastasis as predictors of poor outcome with 13%, 11%, 16%, and 12% 10-year DSS, respectively. This compares with age less than 45 years, asymptomatic presentation, metastasis only in the lung or bone, and radioactive iodine treatment with 10-year DSS rates of 58%, 45%, 32%, and 33%, respectively (all p < 0.0001). Radioactive iodine treatment was more often given in patients who were less than 45 years of age, asymptomatic, and with metastasis only in the lung or bone only (p = 0.03, 0.11, 0.01).

CONCLUSIONS

Longterm survival is possible in patients with distant metastasis from differentiated thyroid cancer. This retrospective study found that age of 45 years or more, site other than lung only or bone only, and symptoms at the time of diagnosis are associated with poorer outcomes.

Postoperative management of differentiated thyroid cancer

The large numbers of studies on the postoperative management of differentiated thyroid carcinoma allows us to use adjuvant treatment and follow-up studies more selectively based on patient risk for recurrence and mortality. Recurrent differentiated thyroid carcinoma is more easily and more effectively treated with early diagnosis. With this in mind, patients who are at high risk for life-threatening recurrent disease should be treated aggressively and followed up expectantly. In these patients, adjuvant treatment with 131I ablation and thyroid hormone suppression is appropriate. External irradiation may be considered, especially for patients with postoperative residual disease. Close follow-up with stimulated thyroglobulin and 131I whole body scans should be performed to facilitate early detection of recurrent disease. Low-risk patients may be effectively treated with more conservative management. 131I ablation has not resulted in improved survival in these patients. Follow-up with serum thyroglobulin after initial negative 131I whole body scan may be appropriate in these patients. Management of patients at intermediate risk remains controversial. Recombinant human thyrotropin allows us to obtain stimulated serum thyroglobulin and promises the ability to perform 131I ablation and whole body scan without the need for thyroid hormone withdrawal. Functional radionuclide imaging, such as FDG PET, now allows us to localize recurrent disease in patients with elevated serum thyroglobulin but negative 131I scan.

Well-differentiated carcinoma of the thyroid

Thyroid cancer will be diagnosed in more than 20,000 individuals in the United States in 2002. Approximately 16,000 of these patients will be women. During the same year, an estimated 1300 deaths from thyroid cancer are expected. The various types of thyroid cancer include papillary carcinoma, follicular carcinoma, Hurthle cell carcinoma, medullary carcinoma, anaplastic carcinoma, and thyroid lymphoma. Papillary, follicular, and Hurthle cell carcinoma are considered well-differentiated thyroid cancers and constitute the focus of this article.

Update on oncocytoma

Oncocytoma is the most common benign solid renal tumor, comprising roughly 5% of resected renal masses. Typically discovered incidentally, oncocytoma is generally asymptomatic and very rarely metastasizes; however, multifocal disease and coexistence with renal cell carcinoma can occur. No currently used imaging techniques can reliably distinguish between oncocytoma and malignant lesions; therefore, patients must undergo resection, or in certain circumstances, biopsy, to definitively establish diagnosis. Careful attention to pathologic features and the adjunctive use of immunostains can aid in discriminating oncocytoma from other renal tumors characterized by granular, eosinophilic cytoplasm, especially chromophobe renal cell carcinoma. Nephron-sparing and laparoscopic surgical approaches can be used to treat appropriately selected patients.

Cell-specific viral gene therapy of a Hurthle cell tumor

We evaluated the effectiveness of a replication-defective adenovirus-transducing thymidine kinase (TK) gene under the control of the rat Tg (rTg) promoter (AdrTgtk) in therapy of a human Hurthle cancer (XTC-1 cell) in vitro and in vivo. The ganciclovir (GCV) sensitivity of infected XTC-1 cells was assessed in vitro by H(3)-thymidine incorporation assay and Trypan-blue exclusion, and by an in vivo tumor development assay. Proliferation was strongly inhibited by adding GCV into the culture medium of infected cells, but not uninfected cells, proving cell infection and expression of TK in the XTC-1 cells. AdrTgtk, and also viruses that have the noncell-specific cytomegalovirus (CMV) promoter-directing expression of TK (AdCMVtk), or luciferase (AdCMVLuc), were used to transduce XTC-1 cells to evaluate killing effects. After infection with AdCMVtk or AdrTgtk, followed by GCV treatment, 70% of infected cells were killed in the presence of GCV, compared with less than 20% of cells infected by AdCMVLuc and treated with GCV. In vivo toxicity was studied in BALB/c mice. When adenovirus is given iv, liver is the major organ infected. No significant changes of the serum transaminase levels and no histological abnormalities were found in animals treated with AdrTgtk/GCV given iv, compared with control animals. High levels of serum transaminases, lymphocyte infiltration, some Kupffer's cell prominence, and extensive single-cell hepatocyte death were found in AdCMVtk/GCV-treated animals, indicating severe liver damage induced, as expected, by the noncell-specific CMV promoter. XTL-1 cells (2 x 10(6)) were injected sc into BALB/c-severe combined immunodeficient mice (BALB/c-SCID), and the mice developed tumors after 3 wk. After intratumoral injection of AdrTgtk and treatment with GCV, tumors stabilized in 15 of 17 mice within 3 wk, 9 tumors remained stabilized after 5 wk of treatment, and 2 disappeared during observation. In AdCMVLuc/GCV-treated control mice, almost all tumors grew continuously. The average tumor size in AdrTgtk-treated mice was significantly smaller than that of control animals after 2 wk of treatment. Our data confirm the effectiveness and specificity of an adenovirus using rTg promoter to express TK, and support its future application to thyroid cancer gene therapy in humans.

Current approaches to the treatment of well-differentiated thyroid cancer

The management of well-differentiated thyroid cancer requires a multidisciplinary approach. The majority of patients are diagnosed only after a nodule is palpable. A cytologic evaluation can readily diagnose a papillary thyroid carcinoma but a follicular carcinoma requires determination of capsular or vascular invasion. Surgical considerations in well-differentiated thyroid cancer are frequently complicated by the need to operate on patients with indeterminate nodules. Also, the extent of surgery remains controversial. A total or near-total thyroidectomy has several advantages: (1) radioactive iodine can be used to ablate any residual thyroid tissue or cancer cells; (2) thyroglobulin levels can be used to follow a patient for recurrence; (3) the risk of leaving a focus of carcinoma in the remaining lobe is eliminated.

Hürthle cell carcinoma: a 60-year experience

BACKGROUND

The aim of this study was to define the clinical behavior and prognostic indicators of outcome in Hürthle cell cancer (HCC).

METHODS

Diagnosis was confirmed for 56 patients with HCC treated between 1940 and 2000, who form the basis of this study. Primary end points were relapse-free survival (RFS) and disease-specific survival (DSS). Data were analyzed with the Kaplan-Meier method and by log-rank test.

RESULTS

The extent of thyroid resection did not predict outcome. Recurrence was a significant predictor of tumor-related mortality. Significant adverse predictors of RFS and DSS were degree of invasion, size >4 cm, extrathyroidal extension, and initial nodal or distant metastases. The most significant predictor of outcome was extent of invasion. Eight-year RFS values for low- and high-risk groups were 100% and 24%. Corresponding rates of 8-year DSS were 100% and 58%.

CONCLUSIONS

Widely invasive HCC is an aggressive malignancy that identifies patients who are at high risk for recurrence and tumor-related death. Patients with HCC have a prognosis that is reliably predicted by degree of invasion, tumor size, extrathyroidal disease extension, and initial nodal or distant metastasis. Recurrence portends a poor outcome. High-risk patients and those with recurrence should be considered for adjuvant therapy.

Prognostic value of serial serum thyroglobulin determinations after total thyroidectomy for differentiated thyroid cancer

Serial weekly serum samples (for 3 weeks) were obtained from 42 patients with differentiated thyroid cancer (DTC, papillary no.=35, follicular no.=6, Hurthle cell no.=1) for serum thyroid hormone, TSH and TG before and after total thyroidectomy. Serum specimens were also obtained one month after radioiodine (131I) therapy followed by suppressive dose of L-thyroxine (L-T4, 2.5 microg/kg). The patients were subdivided into four groups: group I: the DTC was confined to a single solid nodule (no.=1 2); group II: thyroid malignancy invaded local cervical structures but there were no lymph node metastases (no.=8); group III: DTC with lymph node metastases (no.=6); and group IV: DTC with distant metastases (no.=16). In all group I patients serum TG remained undetectable in spite of elevated serum TSH levels at the 3rd week post-surgery (PS). Only one of group II patients had a detectable serum TG value of 5.2 ng/ml (3rd week PS). By contrast, 37.5% of group III patients had detectable serum TG levels, ranging from 3.4 to 16.8 ng/ml (3rd week PS). Lymph node metastases were detected in 5 of these patients by whole body scan (WBS) and removed surgically in 3. As expected, group IV patients had elevated serum TG values ranging 33.0-958.0 ng/ml and distant metastases were confirmed in all of them by WBS. From the calculations through univariate logistic regression comparing TG concentrations at the 3rd week PS from groups I and II vs groups III and IV, we obtained a cut-off value of 2.3 ng/ml with the following efficacy features: sensitivity=74.5%; specificity=95%; positive predictive value=92.3%; negative predictive value=65.5%; and accuracy=73.8%. After 131I and L-T4 suppressive therapy, only 5 out of 36 patients of groups I, II and III had detectable serum TG levels (3.1-7.0 ng/ml) whereas serum TG was detectable in all group IV patients (ranging 2.5-8.6 ng/ml). We concluded that serum TG concentrations above 2.3 ng/ml at the 3rd week PS could be suggestive of lymph node or distant metastases in patients with DTC. Patients with serum TG above this limit could be considered at risk for metastatic disease and higher doses of diagnostic iodine-131 (131I) may be indicated for actinic ablation.

Renal cancer: molecular mechanisms and newer therapeutic options

Renal cell carcinomas account for 80-85% of all primary renal neoplasms. Recent identification of VHL, c-met and TSC as candidate genes mutated in various types of renal carcinomas has greatly enhanced our understanding of the pathogenesis of renal carcinomas and has provided novel therapeutic options for patients with renal cancer. Furthermore, developments in angiogenesis and in tumor immunology have given us additional treatment modalities for cancer patients, especially those with renal cancer. This review highlights the genetic abnormalities seen in renal cell carcinomas and reviews current and future therapeutic options.