Renal cell carcinoma in children: a single institution's experience

Mediastinal lymph node metastasis of renal cell carcinoma: A case report

Renal cell carcinoma (RCC) may metastasize to mediastinal lymph nodes without any abdominal lymph node involvement. The present study describes an autopsy-proven case of RCC presenting with a large mediastinal mass; the case had been previously misdiagnosed as small cell lung carcinoma due to imaging analysis results, an elevated serum level of neuron-specific enolase and the presence of small atypical cells with a high nuclear/cytoplasmic ratio. Despite RCC occurrence being rare, it should be considered in the differential diagnosis, particularly when a mass located in the kidneys presents with metastases to the mediastinal lymph nodes, even if there is no involvement of the abdominal lymph nodes and the primary lesion is of a small size.

Renal tumors in the second decade of life: results from the California Cancer Registry

BACKGROUND

Renal tumors are rare in adolescents and young adults. The aim of this study was to characterize the histologic condition, epidemiology, and survival of renal tumors in patients aged 11 to 20 years old using a large, population-based database.

METHODS

The California Cancer Registry was reviewed from the years 1988 to 2004. All renal tumors in patients aged 11 to 20 years old were identified. The data were analyzed with relation to patient age, sex and ethnicity, tumor histologic examination, and actuarial mortality rates.

RESULTS

Seventy-seven primary renal malignancies were identified. Thirty-nine (51%) were renal cell carcinoma, 23 (30%) were Wilms' tumor, and 15 (20%) were other tumor types. The mean age of the patients with renal cell carcinoma was 16.7 years old, which was significantly older than the Wilms' tumor patients (13.9 years; P < .01). The 5-year cumulative survival rate of patients with renal cell carcinoma was 54%, which was worse than that of Wilms' tumor patients (77%).

CONCLUSION

Primary renal malignancies are uncommon in the second decade of life. The most common tumor type in this age-group is renal cell carcinoma followed by Wilms' tumor. Patients with renal cell carcinoma tend to be older and have a lower survival than patients with other kidney tumors.

Renal cell carcinoma in the pediatric population: Results from the California Cancer Registry

BACKGROUND

Renal cell carcinoma (RCC) is a rare disease in children and adolescents. This study aimed to review epidemiologic characteristics and survival for pediatric RCC patients using a large, population-based database.

PROCEDURE

The California Cancer Registry (CCR) was reviewed from 1988 to 2004. All cases of RCC in patients younger than 21 years were identified and annual age-adjusted incidence rates were determined for the overall population and subdivided by ethnicity. Tumors were classified by stage and grade, and actuarial mortality rates were calculated.

RESULTS

From 1988 to 2004, 43 cases of RCC were identified in patients younger than 21 years, accounting for 4.3% of all renal tumors in this age group. The overall annual age-adjusted incidence was 0.01/100,000 with the tumor more common in non-Hispanic blacks (0.03/100,000) compared to non-Hispanic whites (0.01/100,000), Hispanics (<0.01/100,000), and non-Hispanic Asians/Pacific Islanders (<0.01/100,000). The mean age at presentation was 15.4 years (SD 4.03, SE 0.615). RCC was identified more frequently in females (58.14%). At the time of presentation, 53.49% of tumors were localized, 20.93% were regionally advanced, and 25.58% were metastatic. The observed actuarial survival at 5 and 10 years was 61% (+/-15.7%).

CONCLUSION

Pediatric RCC is an uncommon and aggressive tumor that occurs most frequently in children in the second decade of life, more often in females and blacks. The epidemiological characteristics of this tumor differ from adult RCC and Wilms tumor, suggesting its distinctive biology and potential need for alternative treatment strategies.

Population-based study of renal cell carcinoma in children in Germany, 1980-2005: more frequently localized tumors and underlying disorders compared with adult counterparts

BACKGROUND

Childhood renal cell carcinomas (RCCs) differ histologically and biologically from their adult counterparts. The characteristics of RCC-affected children and their tumors, the influence of treatment, and outcome have so far not been studied in a nonselected, population-based cohort.

METHODS

A retrospective analysis was undertaken of RCC patients less than 16 years old reported to the German Childhood Cancer Registry and to the Kiel Paediatric Tumor Registry from 1980 to 2005.

RESULTS

Forty-nine RCC in children (24 boys, 25 girls) with a median age of 10.6 years were identified. In about every third child possibly RCC-related underlying disorders (tuberous sclerosis, neuroblastoma, teratoma with chemotherapy, Saethre-Chotzen syndrome, chronic renal failure) or related diseases in their family were found. The pathologic subtypes were papillary in 16 (33%), translocation type in 11 (22%), unclassified in 8 (16%), and rarely clear-cell (n = 3) or others. Thirty-four (69%) patients had localized RCC, 8 (16%) patients regional lymph node metastases, and 4 (8%) patients distant metastases. Event-free survival and overall survival rates at 5 years were 96% for localized RCC, 69% and 75% for regional lymph node-positive, 25% and 33% for distant metastatic RCC, respectively. Two of 4 patients with distant metastases received immunotherapy combined with chemotherapy and surgery, both are alive, 1 of them disease-free for 6.9 years.

CONCLUSIONS

Pediatric RCCs are predominantly localized diseases. Children with RCC frequently suffer underlying disorders. Survival rates in localized and regional lymph node-positive cases are favorable. Because of the rarity of RCC in childhood, an international study is necessary.

Renal Cell Carcinoma in Children: Experience of a Single Center

OBJECTIVE

To evaluate the clinical features and outcome of children with renal cell carcinoma (RCC).

PATIENTS AND METHODS

Eleven patients with RCC who were diagnosed between 1972 and 2004 were retrospectively analyzed. Clinical features, histopathology, treatment regimens and outcomes of the patients were evaluated.

RESULTS

The male/female ratio was 3:8, with a median age of 10 years. The stage distribution was as follows: 3 patients in stage I, 1 patient in stage II, 3 patients in stage IIIb, and 4 patients in stage IV. Five of 7 patients with stage II-IV received an actinomycin D-based regimen, one received a cisplatin-based regimen, and the other was given 5-fluorouracil (5-FU). In the last patient, interferon-alpha was given in combination with 5-FU; 1 of the patients on the actinomycin D regimen received interferon-alpha as well. All of the stage I patients are alive without disease. Three patients with stage IIIb, stage IV and stage II disease are alive without disease 8, 14 and 26 years after their diagnosis, respectively. The other stage IV and stage IIIb patients died of the disease.

CONCLUSION

Nephroureterectomy is the main treatment modality, and it is sufficient for stage I patients. For patients with stage II-IV RCC, interferon-alpha and/or actinomycin D-based chemotherapy is the treatment of choice.

Renal cell carcinoma: Children's Hospital Boston experience

OBJECTIVES

To review our experience to better define pediatric renal cell carcinoma (RCC). Pediatric RCC is rare, and recent data suggest it may be a unique disease.

METHODS

A retrospective review was conducted of hospital and pathology records from 1965 to 2003. Patients with RCC were identified, and the clinical and pathologic data were extracted.

RESULTS

Since 1965, 11 patients with RCC were treated, accounting for 3% of all renal tumors. In the first 20 years, 191 patients with renal tumor were treated, of whom 3 had RCC. In the most recent 15 years, 172 patients with renal tumor were treated, of whom 8 had RCC. The mean age at presentation was 14.7 years (range 9 to 17 years), with a female predominance (2.7:1). The clinical signs and symptoms included hematuria in 36%, flank pain in 27%, and an abdominal mass in 9%; 36% were discovered incidentally. Of the 11 RCC tumors, 45% were papillary and 55% were clear cell carcinoma. Papillary tumors presented at a worse stage and displayed more aggressive clinical behavior. Of 10 patients with available follow-up data, 6 had no evidence of RCC, 1 had died of other causes, 2 had died of metastatic RCC, and 1 was alive with recurrent RCC at a mean follow-up of 4.9 years.

CONCLUSIONS

The clinical presentation, pathologic characteristics, and clinical behavior of pediatric RCC are different than those for adult RCC. A possible increasing incidence of RCC in children would parallel an increased incidence in adults. Our findings warrant additional and coordinated efforts to better characterize RCC in children.

Renal cell carcinoma in a pediatric patient with an inherited mitochondrial mutation

Renal cell carcinoma (RCC) is a rare pediatric renal cancer. Recent molecular genetic studies discovered a tumor-specific mutation involving translocation of a transcription factor TFE3 in a subset of pediatric RCC with distinct histopathology. We reported a case of a 2-year-old boy with RCC associated with TFE3 translocation resulting in a PRCC-TFE3 fusion gene. Interestingly, the case carried a maternally inherited mitochondrial DNA (mtDNA) alteration at the position which is usually found in MELAS (Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-like Episodes) syndrome (A3243G). Although evidence of somatic alterations in mtDNA existed in various cancers, association between inherited mtDNA mutation and pediatric renal cancer has not been reported. Our case provided the first evidence of a co-occurrence between a germ line mutation in mtDNA and the somatic mutation of pediatric RCC. With this information, we speculated a role of mitochondria mutation in the pathogenesis of this cancer.

Renal cell carcinoma: case report and literature review

Renal cell carcinoma arising from epithelial cells of the renal tubule is a highly aggressive and malignant tumor in all ages. Less than 2% of cases occur in childhood, relatively in older age group. Only a few pediatric series have been presented in the English literature. Tumor is presented with characteristic findings of flank pain, gross hematuria, and palpable mass. Although one half of the patients have metastasis at the time of diagnosis, most cases are currently being incidentally detected using improved imaging techniques. The overall prognosis in children appears to be similar to that in adults. Tumor stage and complete surgical resection have been reported as the most meaningful prognostic factors for the outcome. The incidence of metastatic disease is same as in adults. The effect of chemotherapy and immunotherapy, either preoperatively or postoperatively, is unclear. Cure is the most likely consequence in localized and completely resected tumors. Here, we present an 8-year-old boy with renal cell carcinoma demonstrating only hematuria without any pathological physical examination findings. The mass was described by abdominal ultrasonography and computed tomography in the left kidney. After the left nephroureterectomy, the patient was given no therapy.

Local lymph node involvement does not predict poor outcome in pediatric renal cell carcinoma

BACKGROUND

Local lymph node involvement in adults with renal cell carcinoma (RCC) is associated with poor outcome. The prognostic significance of local lymph node involvement in children with RCC has not been studied systematically.

METHODS

A retrospective review of patients treated at St Jude Children's Research Hospital (Memphis, TN) and an extensive review of the medical literature were undertaken to evaluate the prognostic significance of local lymph node involvement in pediatric RCC.

RESULTS

Thirteen patients with the diagnosis of RCC were treated at St. Jude since the hospital's inception in 1962. Four patients presented with lymph node-positive, distant metastasis-negative (N + M0) disease, and all 4 remain disease free after resection without adjuvant therapy (follow-up duration, 2-9 years). A systematic review of the literature including 243 pediatric patients with RCC revealed stage-specific survival rates of 92.5%, 84.6%, 72.7%, and 12.7% for Stage I-IV disease, respectively. Of 58 children with N + M0 RCC for whom outcome data were available, 42 (72.4%) were alive without disease at last follow-up. Among patients whose therapy could be discerned, those who received no adjuvant therapy fared as well (15 of 16 alive) as those who received various adjuvant treatments (22 of 31 alive).

CONCLUSIONS

Children with lymph node-positive RCC in the absence of distant metastatic disease had a relatively favorable long-term prognosis, with survival rate nearly triple those of adult historical controls. Until highly effective therapies for RCC are identified, these children should not be exposed to adjuvant treatment. Further investigation of the biologic differences between adult and pediatric RCC is warranted.

Treatment of childhood renal cell carcinoma with lymph node metastasis: two cases and a review of literature

Standard treatment for renal cell carcinoma (RCC) is radical nephrectomy with lymph node dissection. Stages I and II have encouraging prognoses, but Stage III with regional lymph node metastasis can be unfavorable. Adjuvant therapy for pediatric patients with advanced RCC with lymph node involvement or metastatic lesion has not been defined. Advanced pediatric RCC is reported in two patients (boys, aged 6 and 9 years: Stage IIIs, Robson; Stage III and IV, pTNM classification) treated by nephrectomy and lymph node dissection followed by postoperative interferon-alpha (IFN), that can be used as an adjuvant therapy with side effects such as fever, bone marrow suppression, or decreased liver function. One is doing well for 7 years, another is suffered from lung metastases at 3 years after surgery. Although immunotherapy is expected to improve survival in pediatric patients with advanced RCC, surgical resection of renal and metastatic tumors remains the standard treatment.

Renal cell carcinoma in children with diffuse cystic hyperplasia of the kidneys

We report the clinical, pathologic, and genetic features of renal malignancy in two children with diffuse cystic hyperplasia. Both presented with massive bilateral nephromegaly. Neither had a family history or clinical findings suggestive of tuberous sclerosis or von Hippel-Lindau disease. The kidneys of both children were extensively replaced by tubulocystic hyperplasia with large eosinophilic epithelial cells. The masses of hyperplastic tissue were nodular, compressing remnants of uninvolved renal parenchyma. Tubulopapillary carcinoma was present in both children, one of whom had bilateral multicentric carcinoma. No loss of heterozygosity was detected in the tumors at the TSC1, TSC2, or VHL gene regions, and no alterations in the VHL gene were detected using single-strand conformation polymorphism analysis. These cases of bilateral renal enlargement with diffuse cystic hyperplasia appear to represent a new clinical syndrome that may warrant bilateral nephrectomy because of the risk of malignancy.

Renal cell carcinoma in children under 14 years old: long-term survival

OBJECTIVES

To assess the treatment and long-term survival of children under 14 years old operated upon for renal cell carcinoma (RCC).

PATIENTS AND METHODS

The records of five patients (aged 2, 4, 6, 9 and 13 years) who had been treated for RCC between 1982 and 1993 were reviewed. All had undergone nephrectomy with (two) or without (three) regional lymphadenectomy. After surgery four patients received chemotherapy (vincristine with actinomycin-D, three, vinblastine, one), and two with advanced-stage disease received other agents (interferon alpha, interleukin-2). They were followed for 5 to 15 years.

RESULTS

Three patients with stage I-II RCC were well at 13, 15 and 15 years after treatment. Of the two patients with regional lymph node involvement (stage III), one was well 5 years after surgery while the other developed hepatic, lung and bone metastases, and died 2 years after presentation.

CONCLUSION

The prognosis and long-term survival of children under 14 years old with RCC is very good for those with low-stage tumours. Nephrectomy with complete tumour extirpation is the main mode of treatment. For advanced-stage tumours, the role of adjuvant chemotherapy and/or biological agents must be defined more clearly.

Renal-cell carcinoma in children: a different disorder from its adult counterpart?

BACKGROUND

Renal-cell carcinoma (RCC) is a rare tumor in children. To address whether RCC in children differs from its adult counterpart, we report a series of 16 children with RCC (5 boys, 11 girls, mean age 9.6 years, range 3-19 years) presenting between 1979 and 1996 at three pediatric centers.

PROCEDURE

Pathology showed papillary RCC in five patients (31%). Nonpapillary tumors were present in 11 (69%), of which nine were clear-cell type (56%), one was chromophobe-cell type (6%), and one was granular-cell type (6%). Cytogenetic studies were performed on four.

RESULTS

In two tumors, normal karyotypes (45,XX or 45,XY) were found. In another, there were translocations: t(X;1), t(X;2) and t(6;14). In the fourth, analysis revealed 46,XX/46,X,t(X;17)(p11.2;q25),t(1;12). Several features in this series differ from those reported in adults. In adults, RCC is more frequent in males, is usually nonpapillary, and is characterized cytogenetically by deletions or rearrangements in the short arm of chromosome 3. In contrast, in our series there was no male predominance and a higher proportion of papillary tumors. In addition, two of four cytogenetically analyzed tumors had translocations involving the X chromosome. Translocations involving the Xp11.2 locus have been infrequently reported in both adults and children with papillary RCC.

CONCLUSIONS

The higher frequency of papillary histology and the presence of translocations involving Xp.11.2 in two cases raise the possibility of a unique subtype of RCC in children.

Metastatic renal cell carcinoma in a child: 11-year disease-free survival following surgery

A child with metastatic renal cell carcinoma (RCC) is presented. This case is unusual in that the patient has remained disease free for 11 years following surgery and only one course of chemotherapy prior to thoracotomy. The management of metastatic RCC is reviewed and the genetic mechanisms leading to its development briefly discussed.

Bone metastasizing renal tumor of childhood. A clinicopathological study of eleven cases from the Prague Pediatric Tumor Registry

Eleven patients with bone metastasizing renal tumor of childhood (BMRTCh) who were diagnosed and treated in our departments over a 20-year period were reviewed. The incidence among all malignant renal tumors in children up to 15 years of age in our files was 3.7%. The male to female ratio was 10:1. The morphology had a uniform, predominantly clear cell finely vascularized pattern in all of them. Various previously recognized variations of the classic pattern such as hyalinization, nuclear palisading and cyst formation were observed in some patients. Electron microscopy showed that coarse vacuolization of the tumor seen at the light microscopic level was due to distended extracellular spaces surrounded by tumor cells and their cytoplasmic processes. Immunohistochemistry of the tumor cells revealed positive vimentin in all cases, and focally positive muscle specific actin in one. A prominent feature was fascicles of perivascular spindle cells. They were considered to be tumor cells rather than stromal elements since their morphology was close to the appearance of the polygonal tumor cells. The follow up data were available for ten patients. Four developed bone metastases, three of them died of the disease progression. Another patient died of lymph node dissemination and gastrointestinal bleeding. Six patients survived for a period of 29 months to 14 years following the diagnosis.