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Abstract
PURPOSE OF REVIEW To review the presentation, natural history and treatment of renal cell carcinoma in children and young adults with renal cell carcinoma (RCC). RECENT FINDINGS Complete resection of lymph nodes at the time of tumor resection can improve clinical outcomes and limit the need for adjuvant chemotherapy. Genetic alterations that lead to translocation tumors are a therapeutic target of receptor tyrosine kinase inhibitors. SUMMARY The incidence of RCC increases with age. Unlike adult patients, young patients with RCC present symptomatically and at higher stage and grade. Translocation tumors predominate RCC in children with biologic activity characterized by early spread to lymph nodes with small primary tumors. Preoperative imaging is poorly sensitive for positive lymph nodes; as such, surgeons should have a low threshold for lymph node sampling during tumor resection. Despite the advanced stage at presentation, the prognosis in children is more favorable than their adult counterparts. Complete resection of lymph nodes at the time of surgical resection improves patient prognosis. Chemotherapy targeting the PI3/AKT pathway has demonstrated clinical benefit.
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Hong B, Cai L, Wang J, Liu S, Zhou J, Ma K, Zhang J, Zhou B, Peng X, Zhang N, Gong K. Differential Expression of PD-L1 Between Sporadic and VHL-Associated Hereditary Clear-Cell Renal Cell Carcinoma and Its Correlation With Clinicopathological Features. Clin Genitourin Cancer 2018; 17:97-104.e1. [PMID: 30522901 DOI: 10.1016/j.clgc.2018.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 10/30/2018] [Accepted: 11/04/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Programmed death ligand-1 (PD-L1) is a potential predictive biomarker for immunotherapy in several malignancies. However, the expression level and clinical significance of PD-L1 in von Hippel-Lindau (VHL)-associated hereditary clear-cell renal cell carcinoma (ccRCC) remain unclear. PATIENTS AND METHODS Surgical specimens were recruited from 129 patients with sporadic ccRCC and 26 patients with VHL-associated hereditary ccRCC. The PD-L1 expression level was assessed using immunohistochemistry. Correlations between PD-L1 expression and clinicopathological features were analyzed. RESULTS In sporadic ccRCC, the positive expression rate of PD-L1 was 47.3% (61/129). Positive PD-L1 expression was correlated with advanced tumor T stage (P = .011), higher Fuhrman nuclear grade (P = .022), poor disease-free survival (P = .037), and sex (P = .025). In the VHL-associated hereditary ccRCC, positive PD-L1 expression rate was 34.6% (9/26), lower than that in sporadic ccRCC. Positive PD-L1 was correlated with higher Fuhrman nuclear grade (P = .008), but not with sex, age, tumor stage, or the onset age of VHL-associated tumors. CONCLUSION Positive PD-L1 expression was correlated with the aggressive clinicopathological features in sporadic and VHL-associated hereditary ccRCC. Whether PD-L1 expression level in ccRCC is related to the effectiveness of programmed death-1/PD-L1 checkpoint inhibitor immunotherapy needs to be further investigated.
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Affiliation(s)
- Baoan Hong
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Lin Cai
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Jiangyi Wang
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Shengjie Liu
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Jingcheng Zhou
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Kaifang Ma
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Jiufeng Zhang
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Bowen Zhou
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Xiang Peng
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Ning Zhang
- Department of Urology, Beijing Cancer Hospital, Beijing, China.
| | - Kan Gong
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China.
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Kassouf W, Monteiro LL, Drachenberg DE, Fairey AS, Finelli A, Kapoor A, Lattouf JB, Leveridge MJ, Power NE, Pouliot F, Rendon RA, Sabbagh R, So AI, Tanguay S, Breau RH. Canadian Urological Association guideline for followup of patients after treatment of non-metastatic renal cell carcinoma. Can Urol Assoc J 2018; 12:231-238. [PMID: 30139427 DOI: 10.5489/cuaj.5462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Wassim Kassouf
- Division of Urology, McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Adrian S Fairey
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Antonio Finelli
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | - Ricardo A Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Robert Sabbagh
- Division of Urology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Alan I So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Simon Tanguay
- Division of Urology, McGill University Health Centre, Montreal, QC, Canada
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, ON, Canada
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Sims JN, Yedjou CG, Abugri D, Payton M, Turner T, Miele L, Tchounwou PB. Racial Disparities and Preventive Measures to Renal Cell Carcinoma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1089. [PMID: 29843394 PMCID: PMC6024978 DOI: 10.3390/ijerph15061089] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 04/27/2018] [Accepted: 05/01/2018] [Indexed: 02/06/2023]
Abstract
Kidney cancer ranks among the top 10 cancers in the United States. Although it affects both male and female populations, it is more common in males. The prevalence rate of renal cell carcinoma (RCC), which represents about 85% of kidney cancers, has been increasing gradually in many developed countries. Family history has been considered as one of the most relevant risk factors for kidney cancer, although most forms of an inherited predisposition for RCC only account for less than four percent. Lifestyle and other factors such as occupational exposure, high blood pressure, poor diet, and heavy cigarette smoking are highly associated with its incidence and mortality rates. In the United States, White populations have the lowest prevalence of RCC compared to other ethnic groups, while Black Americans suffer disproportionally from the adverse effects of RCC. Hence, this review article aims at identifying the major risk factors associated with RCC and highlighting the new therapeutic approaches for its control/prevention. To achieve this specific aim, articles in peer-reviewed journals with a primary focus on risk factors related to kidney cancer and on strategies to reduce RCC were identified. The review was systematically conducted by searching the databases of MEDLINE, PUBMED Central, and Google Scholar libraries for original articles. From the search, we found that the incidence and mortality rates of RCC are strongly associated with four main risk factors, including family history (genetics), lifestyle (poor diet, cigarette smoking, excess alcohol drinking), environment (community where people live), and occupation (place where people work). In addition, unequal access to improvement in RCC cancer treatment, limited access to screening and diagnosis, and limited access to kidney transplant significantly contribute to the difference observed in survival rate between African Americans and Caucasians. There is also scientific evidence suggesting that some physicians contribute to racial disparities when performing kidney transplant among minority populations. New therapeutic measures should be taken to prevent or reduce RCC, especially among African Americans, the most vulnerable population group.
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Affiliation(s)
- Jennifer N Sims
- Department of Behavioral and Environmental Health, School of Public Health, Jackson State University, 350 W. Woodrow Wilson Dr., P.O. Box 17038, Jackson, MS 39217, USA.
| | - Clement G Yedjou
- Department of Biology, College of Science, Engineering and Technology, Jackson State University, 1400 Lynch St., Jackson, MS 39217, USA.
- Natural Chemotherapeutics Research Laboratory, RCMI Center for Environmental Health, Jackson State University, 1400 Lynch St., Jackson, MS 39217, USA.
| | - Daniel Abugri
- Department of Chemistry and Department of Biology, Laboratory of Ethno-Medicine, Parasitology and Drug Discovery, College of Arts and Science, Tuskegee University, 1200 Old Montgomery Road, Tuskegee, AL 36088, USA.
| | - Marinelle Payton
- Department of Behavioral and Environmental Health, School of Public Health, Jackson State University, 350 W. Woodrow Wilson Dr., P.O. Box 17038, Jackson, MS 39217, USA.
| | - Timothy Turner
- Department of Biology, College of Science, Engineering and Technology, Jackson State University, 1400 Lynch St., Jackson, MS 39217, USA.
| | - Lucio Miele
- Department of Genetics, Louisiana State University, Health Sciences Center, School of Medicine, 533 Bolivar St., Room 657, New Orleans, LA 70112, USA.
| | - Paul B Tchounwou
- Natural Chemotherapeutics Research Laboratory, RCMI Center for Environmental Health, Jackson State University, 1400 Lynch St., Jackson, MS 39217, USA.
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Hereditary renal cell carcinoma syndromes: diagnosis, surveillance and management. World J Urol 2018; 36:1891-1898. [PMID: 29680948 PMCID: PMC6280834 DOI: 10.1007/s00345-018-2288-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/31/2018] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Genetic factors have been implicated in the pathogenesis of renal cell carcinoma (RCC), with around 3% of cases having a family history. A greater knowledge of the genetics of inherited RCC has the potential to translate into novel therapeutic targets for sporadic RCC. METHODS A literature review was performed summarising the current knowledge on hereditary RCC diagnosis, surveillance and management. RESULTS Familial RCC is usually inherited in an autosomal dominant manner, although inherited RCC may present without a relevant family history. A number of familial RCC syndromes have been identified. Familial non-syndromic RCC is suspected when ≥ 2 relatives are affected in the absence of syndromic features, although clear diagnostic criteria are lacking. Young age at onset and bilateral/multicentric tumours are recognised characteristics which should prompt molecular genetic analysis. Surveillance in individuals at risk of inherited RCC aims to prevent morbidity and mortality via early detection of tumours. Though screening and management guidelines for some inherited RCC syndromes (e.g. von Hippel-Lindau disease, Birt-Hogg-Dube syndrome, hereditary leiomyomatosis) are well defined for rare cause of inherited RCC (e.g. germline BAP1 mutations), there is limited information regarding the lifetime RCC risks and the most appropriate screening modalities. CONCLUSION Increasing knowledge of the natural history and genetic basis has led to characterisation and tailored management of hereditary RCC syndromes. International data sharing of inherited RCC gene variant information may enable evidence-based improvements in the diagnosis, surveillance protocols and management of these rare conditions.
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May M, Surcel C, Capitanio U, Dell'Oglio P, Klatte T, Shariat S, Ecke T, Wolff I, Vergho D, Wagener N, Huck N, Pahernik S, Zastrow S, Wirth M, Borgmann H, Haferkamp A, Musquera M, Krabbe LM, Herrmann E, Scavuzzo A, Mirvald C, Hutterer G, Zigeuner R, Stief CG, Waidelich R, Cindolo L, Kalusova K, Brookman-May SD. Prognostic and discriminative power of the 7th TNM classification for patients with surgically treated papillary renal cell carcinoma: results of a multi-institutional validation study (CORONA subtype project). Scand J Urol 2017; 51:269-276. [PMID: 28399699 DOI: 10.1080/21681805.2017.1300187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Studies on the prognostic reliability of the Union for International Cancer Control tumor, node, metastasis (TNM) staging system for renal cell carcinoma (RCC) predominantly focus on clear-cell RCC. Therefore, the aim of this study was to investigate whether the oncological prognosis of surgically treated papillary RCC (papRCC) patients is reliably given by the current TNM system, by analyzing the largest database reported to date. MATERIALS AND METHODS Data on 2325 papRCC patients who underwent surgical treatment in 1984- 2015 were collated from 17 international centers (median follow-up 47 months). Tumor stage was adapted to the 7th edition of the TNM system. Multivariable, bootstrap-corrected Cox regression models were applied to assess the independent impact of the TNM system on cancer-specific mortality (CSM) and all-cause mortality (ACM). RESULTS The median age at diagnosis was 63 years (interquartile range 54-70 years) and 77% of patients were male. Nephron-sparing surgery was performed in 42%, and 82% were with symptom free at diagnosis. In 6.7% (n = 156), organ metastasis (stage M1) was present at the time of surgery. On multivariable analysis, the TNM system and Fuhrman grade had an independent impact on both CSM and ACM, while patient age affected ACM only. The discriminative ability of the pT classification was significant for both endpoints: 5 year CSM rates were 5%, 17%, 36% and 56% for stages pT1, pT2, pT3 and pT4, respectively (each p < 0.001). The pT classification contributed significantly to the predictive accuracy of the CSM and ACM models by 6.3% and 2.5%, respectively (each p < 0.001). CONCLUSIONS The 2010 TNM staging system can be reliably applied to papRCC patients and allows certain prognostic discrimination.
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Affiliation(s)
- Matthias May
- a Department of Urology , Klinikum St. Elisabeth Straubing , Straubing , Germany
| | - Cristian Surcel
- b Centre of Urological Surgery, Dialysis and Renal Transplantation , Fundeni Clinical Institute , Bucharest , Romania
| | - Umberto Capitanio
- c Department of Urology , Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Paolo Dell'Oglio
- c Department of Urology , Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Tobias Klatte
- d Department of Urology , Medical University of Vienna , Vienna , Austria
| | - Shahrokh Shariat
- d Department of Urology , Medical University of Vienna , Vienna , Austria
| | - Thorsten Ecke
- e Department of Urology , Hospital Bad Saarow , Bad Saarow , Germany
| | - Ingmar Wolff
- f Department of Urology , Carl-Thiem-Klinikum Cottbus , Cottbus , Germany
| | - Daniel Vergho
- g Department of Urology and Paediatric Urology , Julius-Maximilians-University Medical Centre of Wuerzburg , Wuerzburg , Germany
| | - Nina Wagener
- h Department of Urology , University Hospital Mannheim , Mannheim , Germany
| | - Nina Huck
- h Department of Urology , University Hospital Mannheim , Mannheim , Germany
| | - Sascha Pahernik
- i Department of Urology , Klinikum Nürnberg , Nürnberg, Germany
| | - Stefan Zastrow
- j Department of Urology , Carl Gustav Carus University Dresden, University Hospital , Germany
| | - Manfred Wirth
- j Department of Urology , Carl Gustav Carus University Dresden, University Hospital , Germany
| | - Hendrik Borgmann
- k Department of Urology , University Hospital Mainz , Mainz , Germany
| | - Axel Haferkamp
- k Department of Urology , University Hospital Mainz , Mainz , Germany
| | - Mireia Musquera
- l Department of Nephrology and Urology , University of Barcelona , Barcelona , Spain
| | - Laura M Krabbe
- m Department of Urology , University of Muenster Medical Center , Muenster , Germany
| | - Edwin Herrmann
- m Department of Urology , University of Muenster Medical Center , Muenster , Germany
| | - Anna Scavuzzo
- n Department of Urology , Instituto Nacional de Cancerologia-INCan , Mexico City , Mexico
| | - Cristian Mirvald
- b Centre of Urological Surgery, Dialysis and Renal Transplantation , Fundeni Clinical Institute , Bucharest , Romania
| | - Georg Hutterer
- o Department of Urology , Medical University Graz , Graz , Austria
| | - Richard Zigeuner
- o Department of Urology , Medical University Graz , Graz , Austria
| | - Christian G Stief
- p Department of Urology , Ludwig-Maximilians University, Campus Grosshadern , Munich , Germany
| | - Raphaela Waidelich
- p Department of Urology , Ludwig-Maximilians University, Campus Grosshadern , Munich , Germany
| | - Luca Cindolo
- q Department of Urology , Pio Da Pietrelcina Hospital , Vasto , Italy
| | - Krystina Kalusova
- r Department of Urology , Faculty of Medicine, Charles University , Pilsen , Czech Republic
| | - Sabine D Brookman-May
- p Department of Urology , Ludwig-Maximilians University, Campus Grosshadern , Munich , Germany
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TREATMENT OF RENAL CARCINOMA IN A BINTURONG (ARCTICTIS BINTURONG) WITH NEPHRECTOMY AND A TYROSINE KINASE INHIBITOR. J Zoo Wildl Med 2017; 47:1109-1113. [PMID: 28080923 DOI: 10.1638/2015-0285.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A 13-yr-old female binturong ( Arctictis binturong ) presented with a 1 wk history of decreased appetite. The animal was thin, with hypercalcemia (calcium 12.2 mg/dl). A right renal mass was identified on ultrasound and removed via nephrectomy. Histopathology indicated a renal adenocarcinoma. Treatment with toceranib phosphate, a tyrosine-kinase inhibitor, was initiated and well tolerated by the animal. Four months after initial diagnosis radiographs indicated metastases to the lungs and the animal was euthanized. Necropsy revealed disseminated adenocarcinoma. Although treatment did not prevent metastasis, it was minimally invasive and well tolerated by the animal with minimal side effects. Review of records at the institution revealed that the cause of death for the primary case's dam and sire was disseminated renal carcinoma. These cases suggest that there may be a hereditary component to development of renal neoplasia in binturongs. Renal carcinoma should be considered an aggressive neoplasia in binturongs with a poor prognosis.
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Gaur S, Turkbey B, Choyke P. Hereditary Renal Tumor Syndromes: Update on Diagnosis and Management. Semin Ultrasound CT MR 2016; 38:59-71. [PMID: 28237281 DOI: 10.1053/j.sult.2016.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hereditary renal cancers account for approximately 5%-8% of all renal tumors. Over the past 2 decades, a number of syndromes have been identified that predispose patients to early renal cancer development, representing all the major histologic types of tumor pathology. In this article, we describe the current knowledge concerning the cell type, known mechanism of tumor development, other manifestations of the syndrome, imaging findings, genetic screening, and imaging surveillance recommendations for each of the major syndromes associated with hereditary renal cancers.
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Affiliation(s)
- Sonia Gaur
- Molecular Imaging Program, National Cancer Institute, Bethesda, MD; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Baris Turkbey
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Peter Choyke
- Molecular Imaging Program, National Cancer Institute, Bethesda, MD.
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Low G, Huang G, Fu W, Moloo Z, Girgis S. Review of renal cell carcinoma and its common subtypes in radiology. World J Radiol 2016; 8:484-500. [PMID: 27247714 PMCID: PMC4882405 DOI: 10.4329/wjr.v8.i5.484] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 01/20/2016] [Accepted: 03/09/2016] [Indexed: 02/06/2023] Open
Abstract
Representing 2%-3% of adult cancers, renal cell carcinoma (RCC) accounts for 90% of renal malignancies and is the most lethal neoplasm of the urologic system. Over the last 65 years, the incidence of RCC has increased at a rate of 2% per year. The increased incidence is at least partly due to improved tumor detection secondary to greater availability of high-resolution cross-sectional imaging modalities over the last few decades. Most RCCs are asymptomatic at discovery and are detected as unexpected findings on imaging performed for unrelated clinical indications. The 2004 World Health Organization Classification of adult renal tumors stratifies RCC into several distinct histologic subtypes of which clear cell, papillary and chromophobe tumors account for 70%, 10%-15%, and 5%, respectively. Knowledge of the RCC subtype is important because the various subtypes are associated with different biologic behavior, prognosis and treatment options. Furthermore, the common RCC subtypes can often be discriminated non-invasively based on gross morphologic imaging appearances, signal intensity on T2-weighted magnetic resonance images, and the degree of tumor enhancement on dynamic contrast-enhanced computed tomography or magnetic resonance imaging examinations. In this article, we review the incidence and survival data, risk factors, clinical and biochemical findings, imaging findings, staging, differential diagnosis, management options and post-treatment follow-up of RCC, with attention focused on the common subtypes.
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Abstract
Renal cell carcinomas associated with syndromes of a heritable nature account for about 4% of all renal cell carcinomas. They are characterized by an earlier age of onset, and are often multicentric and bilateral. Some of these patients may fit into well-characterized kidney cancer syndromes, while many more may have a genetic component that is not fully recognized or understood. The presence of extrarenal clinical features may suggest a specific renal tumor susceptibility syndrome. Moreover, each syndrome is associated with specific renal pathology findings. Recognition of individuals and families with a high risk of renal neoplasia is important so that surveillance for renal tumors may be initiated. This manuscript reviews the clinical, pathological, and molecular features of hereditary renal cell carcinoma syndromes with emphasis on the morphologic features of these tumors and the molecular mechanisms of hereditary renal tumorigenesis.
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Young EE, Brown CT, Merguerian PA, Akhavan A. Pediatric and adolescent renal cell carcinoma. Urol Oncol 2016; 34:42-9. [DOI: 10.1016/j.urolonc.2015.06.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 06/16/2015] [Accepted: 06/16/2015] [Indexed: 12/13/2022]
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