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Son Y, Quiring ME, Dalton RM, Thomas B, Davidson N, DeVincentz D, Payne C, Parikh SH, Fink BA, Mueller T, Brown G. Renal mass imaging modalities: does body mass index (BMI) matter? Int Urol Nephrol 2024; 56:2483-2487. [PMID: 38499727 PMCID: PMC11266215 DOI: 10.1007/s11255-024-03962-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/22/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Accurate measurement of renal mass size is crucial in the management of renal cancer. With the burdensome cost of imaging yet its need for management, a better understanding of the variability among patients when determining mass size remains of urgent importance. Current guidelines on optimal imaging are limited, especially with respect to body mass index (BMI). The aim of this study is to discern which modalities accurately measure renal mass size and whether BMI influences such accuracy. METHODS A multi-institutional chart review was performed for adult patients undergoing partial or radical nephrectomy between 2018 and 2021, with 236 patients ultimately included. Patients were categorized by BMI (BMI 1: 18.5-24.9, BMI 2: 25-29.9, BMI 3: 30-34.9, and BMI 4: ≥ 35). The greatest mass lengths were compared between the pathology report and the following: computerized tomography (CT), renal ultrasound, and magnetic resonance imaging (MRI). RESULTS The difference between greatest length on CT with contrast and MRI were significantly different when compared to pathologic measurement. BMI groups 3 and 4 were found to have a significant difference in size estimates compared to BMI 2 for CT with contrast. No difference was found between size estimates by BMI group for any other imaging modality. CONCLUSION CT with contrast becomes less accurate at estimating mass size for patients with BMI > 30. While contrast-enhanced CT remains a vital imaging modality for tissue enhancement in the context of unknown renal masses, caution must be used for mass size estimation in the obese population.
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Affiliation(s)
- Young Son
- Department of Urology, Jefferson Health New Jersey, 18 E Laurel Rd, Stratford, NJ, 08084, USA.
| | - Mark E Quiring
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Raeann M Dalton
- School of Osteopathic Medicine, Rowan University, Stratford, NJ, USA
| | - Brian Thomas
- School of Osteopathic Medicine, Rowan University, Stratford, NJ, USA
| | - Noah Davidson
- Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | - Dayna DeVincentz
- College of Science and Mathematics, Rowan University, Glassboro, NJ, USA
| | - Collin Payne
- College of Osteopathic Medicine, Nova Southeastern University, Tampa Bay, FL, USA
| | - Sahil H Parikh
- School of Osteopathic Medicine, Rowan University, Stratford, NJ, USA
| | - Benjamin A Fink
- School of Osteopathic Medicine, Rowan University, Stratford, NJ, USA
| | - Thomas Mueller
- Department of Urology, Jefferson Health New Jersey, 18 E Laurel Rd, Stratford, NJ, 08084, USA
| | - Gordon Brown
- Department of Urology, Jefferson Health New Jersey, 18 E Laurel Rd, Stratford, NJ, 08084, USA
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Meza-Martinez DA, Hernandez-Hernandez JH, Fematt-Rodriguez BJ, Meza-Martinez MA, Rios-Rosales H. Eosinophilic Variant of Chromophobe Renal Cell Carcinoma During Pregnancy: A Multidisciplinary Approach and Successful Management in a Tertiary Hospital in Mexico. Cureus 2023; 15:e44955. [PMID: 37701169 PMCID: PMC10493464 DOI: 10.7759/cureus.44955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 09/14/2023] Open
Abstract
Renal cell carcinoma (RCC) is rarely diagnosed during pregnancy and its management represents a challenge as it necessitates considerations for the well-being of both the mother and the developing fetus. Diagnosis can be challenging and is often an incidental finding during routine imaging, which can lead to difficult decision-making. The choice of the ideal imaging study in these cases is a matter of debate. When the tumor is detected at an early stage, radical nephrectomy is indicated. However, there is still controversy regarding whether it should be performed conventionally or laparoscopically, as both techniques have their risks and benefits. In this context, our primary objective was to provide adequate surgical treatment for the patient, while safeguarding fetal health. Here, we present a patient with a history of recurrent miscarriages, in whom a renal tumor was incidentally diagnosed during pregnancy. Adding to the uniqueness of this case, the patient was diagnosed with an eosinophilic variant of chromophobe RCC through histopathological analysis. Our aim is to highlight the controversies surrounding diagnostic and treatment methodologies and to present the surgical techniques employed in this unique situation. This case underscores the importance and need for a multidisciplinary approach, which, in our instance, resulted in favorable outcomes for both maternal and neonatal health.
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Affiliation(s)
- Daniel A Meza-Martinez
- General Surgery, Instituto Mexicano del Seguro Social, Hospital General de Zona No. 33, Monterrey, MEX
| | - Jose H Hernandez-Hernandez
- Urology, Instituto Mexicano del Seguro Social, Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 2 Luis Donaldo Colosio Murrieta, Obregón, MEX
| | - Brando J Fematt-Rodriguez
- General Surgery, Instituto Mexicano del Seguro Social, Hospital General de Zona No. 33, Monterrey, MEX
| | - Miguel A Meza-Martinez
- Urology, Instituto Mexicano del Seguro Social, Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 2 Luis Donaldo Colosio Murrieta, Obregón, MEX
| | - Helio Rios-Rosales
- Urology, Instituto Mexicano del Seguro Social, Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 2 Luis Donaldo Colosio Murrieta, Obregón, MEX
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Molecular Properties of Drugs Handled by Kidney OATs and Liver OATPs Revealed by Chemoinformatics and Machine Learning: Implications for Kidney and Liver Disease. Pharmaceutics 2021; 13:pharmaceutics13101720. [PMID: 34684013 PMCID: PMC8538396 DOI: 10.3390/pharmaceutics13101720] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 12/31/2022] Open
Abstract
In patients with liver or kidney disease, it is especially important to consider the routes of metabolism and elimination of small-molecule pharmaceuticals. Once in the blood, numerous drugs are taken up by the liver for metabolism and/or biliary elimination, or by the kidney for renal elimination. Many common drugs are organic anions. The major liver uptake transporters for organic anion drugs are organic anion transporter polypeptides (OATP1B1 or SLCO1B1; OATP1B3 or SLCO1B3), whereas in the kidney they are organic anion transporters (OAT1 or SLC22A6; OAT3 or SLC22A8). Since these particular OATPs are overwhelmingly found in the liver but not the kidney, and these OATs are overwhelmingly found in the kidney but not liver, it is possible to use chemoinformatics, machine learning (ML) and deep learning to analyze liver OATP-transported drugs versus kidney OAT-transported drugs. Our analysis of >30 quantitative physicochemical properties of OATP- and OAT-interacting drugs revealed eight properties that in combination, indicate a high propensity for interaction with "liver" transporters versus "kidney" ones based on machine learning (e.g., random forest, k-nearest neighbors) and deep-learning classification algorithms. Liver OATPs preferred drugs with greater hydrophobicity, higher complexity, and more ringed structures whereas kidney OATs preferred more polar drugs with more carboxyl groups. The results provide a strong molecular basis for tissue-specific targeting strategies, understanding drug-drug interactions as well as drug-metabolite interactions, and suggest a strategy for how drugs with comparable efficacy might be chosen in chronic liver or kidney disease (CKD) to minimize toxicity.
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Cancer survival in women diagnosed with pregnancy-associated cancer: An overview using nationwide registry data in Sweden 1970-2018. Eur J Cancer 2021; 155:106-115. [PMID: 34371441 DOI: 10.1016/j.ejca.2021.07.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/22/2021] [Accepted: 07/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pregnancy-associated cancer (PAC) is increasing over time in many countries. We provide a comprehensive, population-based overview of cancer survival in women with PAC across five decades. METHODS We performed a nationwide cohort study of 121,382 women diagnosed with cancer at age 15-49 between 1970 and 2018 using birth and cancer registers in Sweden. Pregnancy-associated cancer was defined as diagnosed during pregnancy and within one year of delivery, while non-PAC was outside this window. Cox regression estimated adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) comparing cancer mortality for PAC versus non-PAC. RESULTS In total, 5079 women had a diagnosis of PAC. Cutaneous malignant melanoma, breast, cervical, thyroid and central nervous system (CNS) were the most common sites of PAC. A higher cancer mortality was observed in PAC versus non-PAC for breast (HR = 1.72, 95% CI 1.54-1.93) and uterine cancer (myometrium/unspecified) (8.62, 2.80-26.53), in which all PAC deaths were uterine sarcomas. Increased mortality was also observed in upper digestive tract cancer diagnosed during pregnancy and colon cancer diagnosed during first year after delivery. Contrary, the HR for CNS tumours was significantly decreased (0.71, 0.55-0.91). Survival after PAC improved for most sites over time, with survival after breast cancer during pregnancy in recent years being similar to that of non-pregnancy associated breast cancer. CONCLUSION For the majority of sites, PAC was not associated with poorer prognosis compared to non-PAC, a finding which was stable over time. The main exceptions were breast cancer and rarer cancers, such as uterine sarcoma.
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Völler M, Mahmud W, Vallo S, Grabbert M, John P, Khoder WY. A 27-Year-Old Primigravida with a Right Renal Cell Carcinoma Removed at 30 Weeks of Gestation by Robot-Assisted Retroperitoneoscopic Partial Nephrectomy. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e927164. [PMID: 33866322 PMCID: PMC8063764 DOI: 10.12659/ajcr.927164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 03/12/2021] [Accepted: 01/22/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Large renal tumors during pregnancy are rare findings (0.07-0.1%). Current guidelines recommend surgical removal. This surgery should be carefully planned in an interdisciplinary team and involves special risks for mother and fetus. This report describes a case of a 27-year-old primigravida woman with a right renal cell carcinoma involving the lower pole of the kidney, which was removed at 30 weeks of gestation by robot-assisted retroperitoneoscopic partial nephrectomy (RARPN). CASE REPORT The patient was referred by the treating obstetrician with a newly diagnosed right lower pole renal mass of 6×4 cm in greatest diameter extending deeply into the parenchyma. No metastasis or enlarged lymph nodes were described in subsequent magnetic resonance tomography. Clinical and laboratory examinations documented a healthy mother and fetus. A right-sided RARPN was advised and planned by an interdisciplinary team of treating physicians (gynecologists, oncologists, and urologists). The surgery was conducted under general anesthesia with an obstetrician on stand-by. Surgery was performed without any complications (operation time 95 min, renal-ischemia time 15 min, and negligible blood loss) and histopathology confirmed the diagnosis of a chromophobe renal cell carcinoma. Further follow-up consultations showed regular wound healing and normal progression of pregnancy, and the patient gave birth to a healthy child at term. Follow-up examinations of the patient were uneventful. CONCLUSIONS This case shows that RARPN can be a safe and effective surgical procedure for partial nephrectomy during pregnancy, where surgery is performed in a specialist center and by an interdisciplinary experienced surgical team. It seems to offer advantages and better risk profile over the laparoscopic approach.
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Affiliation(s)
- Moritz Völler
- Department of Urology, Darmstadt Hospital, Hessen, Germany
| | - Walid Mahmud
- Department of Urology, Hochtaunus-Hospitals, Bad Homburg vor der Höhe, Germany
| | - Stefan Vallo
- Department of Urology, Hochtaunus-Hospitals, Bad Homburg vor der Höhe, Germany
| | - Markus Grabbert
- Department of Urology, Freiburg University, Freiburg in Breisgau, Germany
| | - Patricia John
- Department of Urology, University Hospital, Köln, Germany
| | - Wael Y. Khoder
- Department of Urology, Freiburg University, Freiburg in Breisgau, Germany
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Swaminathan N, Sedhom R, Shahzad A, Azmaiparashvili Z. Post-partum occurrence of Wunderlich syndrome and microangiopathic haemolytic anaemia (MAHA): a case report. J Community Hosp Intern Med Perspect 2021; 11:277-279. [PMID: 33889338 PMCID: PMC8043530 DOI: 10.1080/20009666.2021.1883812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
This is a case of a 27-year-old primigravida with monochorionic diamniotic twin gestation who was admitted to the hospital for induction of labour. Her postpartum course was complicated by microangiopathic haemolytic anemia (MAHA). The etiology for the MAHA was initially thought to be secondary to pre-eclampsia and vitamin B12/folate deficiency. However, she had persistent anemia and further workup demonstrated that she had a left renal cell carcinoma (RCC) with perinephric haemorrhage consistent with Wunderlich syndrome. This case was intriguing because of its unusual presentation and the several diagnostic and therapeutic challenges along the way. Abbreviations: MAHA: microangiopathic haemolytic anaemia; RCC: renal cell carcinoma; BP: blood pressure; WS: Wunderlich syndrome; CT: computed tomography; LFTs: liver function tests; LDH: lactate dehydrogenase; HELLP: haemolysis elevated liver enzymes, low platelets; DIC: disseminated intravascular coagulation; PLASMIC: score for TTP - includes platelet count <30 x 109/L, evidence of haemolysis (reticulocyte count >2.5%, haptoglobin undetectable, or indirect bilirubin >2mg/dL), active cancer, history of solid organ transplant, mean corpuscular volume (MCV) <90fL, INR <1.5, creatinine <2mg/dL. Each item is sored as being present (YES) or not (NO). Absence of active cancer and solid organ transplant gets scored with a point each. The total points are added up to categorize the severity and risk of TTP. Low risk <4, Intermediate 5, high risk >6; TTP: thrombotic thrombocytopenic purpura; APLA- anti-phophospholipid antibody; BMI: body mass index; TMAs: thrombotic microangiopathies; HUS: haemolytic uremic syndrome; vWF: von Willebrand factor.
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Affiliation(s)
- Neeraja Swaminathan
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Ramy Sedhom
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Anum Shahzad
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Zurab Azmaiparashvili
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA
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Incidence of Pregnancy-Associated Cancer in Two Canadian Provinces: A Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063100. [PMID: 33802896 PMCID: PMC8002657 DOI: 10.3390/ijerph18063100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 12/04/2022]
Abstract
Pregnancy-associated cancer—that is diagnosed in pregnancy or within 365 days after delivery—is increasingly common as cancer therapy evolves and survivorship increases. This study assessed the incidence and temporal trends of pregnancy-associated cancer in Alberta and Ontario—together accounting for 50% of Canada’s entire population. Linked data from the two provincial cancer registries and health administrative data were used to ascertain new diagnoses of cancer, livebirths, stillbirths and induced abortions among women aged 18–50 years, from 2003 to 2015. The annual crude incidence rate (IR) was calculated as the number of women with a pregnancy-associated cancer per 100,000 deliveries. A nonparametric test for trend assessed for any temporal trends. In Alberta, the crude IR of pregnancy-associated cancer was 156.2 per 100,000 deliveries (95% CI 145.8–166.7), and in Ontario, the IR was 149.4 per 100,000 deliveries (95% CI 143.3–155.4). While no statistically significant temporal trend in the IR of pregnancy-associated cancer was seen in Alberta, there was a rise in Ontario (p = 0.01). Pregnancy-associated cancer is common enough to warrant more detailed research on maternal, pregnancy and child outcomes, especially as cancer therapies continue to evolve.
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Koetter P, Martin K. Management of renal cell carcinoma presenting during teenage pregnancy. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Maggen C, Linssen J, Gziri MM, Zola P, Cardonick E, de Groot CJM, Garcia AC, Fruscio R, Drochytek V, Van Calsteren K, Albersen M, Amant F. Renal and Bladder Cancer During Pregnancy: A Review of 47 Cases and Literature-based Recommendations for Management. Urology 2020; 151:118-128. [PMID: 33203520 DOI: 10.1016/j.urology.2020.08.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/23/2020] [Accepted: 08/10/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To provide contemporary gestational age-specific recommendations for management, a retrospective series of patients with renal or bladder cancer during pregnancy is reported. METHODS Obstetric and oncological data of pregnant patients with a diagnosis of renal or bladder cancer were selected from the worldwide registry of the International Network of Cancer, Infertility and Pregnancy. In addition, the literature was reviewed for recent case reports since last reviews in 2014 for renal cancer and 2004 for bladder cancer. RESULTS International Network of Cancer, Infertility and Pregnancy registered 22 cases (14 renal cancer and 8 bladder cancer), diagnosed between 1999 and 2017, and the literature reported 15 cases with renal cancer and 10 cases with bladder cancer between 2004 and 2019. Most common symptoms for renal and bladder cancer were pain (28%) and hematuria (66%), respectively. In more than half of the patients, surgical treatment was performed during pregnancy. Preterm deliveries were mostly medically induced (12 of 17, 71%) and all patients with a planned delivery before 34 weeks had advanced cancer. For renal and bladder cancer respectively, 79% and 87% of patients obtained complete remission. Advanced cancer stages had worse prognosis; 3 of 7 patients with known follow-up deceased within 15 months after diagnosis. CONCLUSION Gestational age at diagnosis determines further management of renal and bladder cancers during pregnancy. Advanced stages challenge decision-making. The maternal needs for immediate treatment, and the neonatal risks including the impact of a preterm delivery should be discussed in a multidisciplinary setting while respecting the patient's autonomy.
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Affiliation(s)
- Charlotte Maggen
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium
| | - Jasmijn Linssen
- Department of Gynecological Oncology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Mina Mhallem Gziri
- Department of Obstetrics, Cliniques Universitaires St Luc, UCL, Sint-Lambrechts-Woluwe, Belgium
| | - Paolo Zola
- Department Surgical Sciences, University of Torino, Torino, Italy
| | - Elyce Cardonick
- Department of Obstetrics and Gynecology, Cooper, University Health Care, Camden, New Jersey, USA
| | - Christianne J M de Groot
- Department of Obstetrics and Gynecology, and Amsterdam Reproduction and Development, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Alvaro Cabrera Garcia
- Hospital Regional de Alta Especialidad de Ixtapaluca (HRAEI) " Reference clinic for hemato-oncological diseases during pregnancy CREHER" Estado de México, México
| | - Robert Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan - Bicocca, San Gerardo Hospital, Monza, Italy
| | - Vit Drochytek
- Faculty Hospital Kralovske, Vinohrady and 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | - Kristel Van Calsteren
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Frédéric Amant
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium; Department of Gynecological Oncology, Amsterdam University Medical Centres, Amsterdam, The Netherlands; Department of Gynecological Oncology, Amsterdam University Medical Centres, Amsterdam, The Netherlands and the Department of Gynecology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Zhang J, Peng P, Cao D, Yang J, Shen K. Clinicopathological features and maternal and foetal management of pregnancy‑complicating Krukenberg tumours. Mol Clin Oncol 2020; 12:581-587. [PMID: 32337041 DOI: 10.3892/mco.2020.2025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/21/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jingjing Zhang
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Dongcheng, Beijing 100730, P.R. China
| | - Peng Peng
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Dongcheng, Beijing 100730, P.R. China
| | - Dongyan Cao
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Dongcheng, Beijing 100730, P.R. China
| | - Jiaxin Yang
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Dongcheng, Beijing 100730, P.R. China
| | - Keng Shen
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Dongcheng, Beijing 100730, P.R. China
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Varytė G, Zakarevičienė J, Ramašauskaitė D, Laužikienė D, Arlauskienė A. Pregnancy and Multiple Sclerosis: An Update on the Disease Modifying Treatment Strategy and a Review of Pregnancy's Impact on Disease Activity. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E49. [PMID: 31973138 PMCID: PMC7074401 DOI: 10.3390/medicina56020049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 12/17/2019] [Accepted: 01/16/2020] [Indexed: 01/28/2023]
Abstract
Pregnancy rates are rapidly increasing among women of reproductive age diagnosed with multiple sclerosis (MS). Through pre-conception, pregnancy and post-partum periods, there is a need for disease control management, to decrease chances of MS relapses while avoiding potential risks to the mother and the fetus. However, pregnancy is not always compatible with the available highly effective MS treatments. This narrative review provides the aspects of pregnancy's outcomes and the impact on disease activity, choices of anesthesia and the management of relapses during the pregnancy and breastfeeding period. Available disease modifying treatment is discussed in the article with new data supporting the strategy of continuing natalizumab after conception, as it is related to a decreased risk of MS relapses during the pregnancy and postpartum period.
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Affiliation(s)
- Guoda Varytė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | - Jolita Zakarevičienė
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (J.Z.); (D.R.); (D.L.); (A.A.)
| | - Diana Ramašauskaitė
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (J.Z.); (D.R.); (D.L.); (A.A.)
| | - Dalia Laužikienė
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (J.Z.); (D.R.); (D.L.); (A.A.)
| | - Audronė Arlauskienė
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (J.Z.); (D.R.); (D.L.); (A.A.)
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Li G, Xie ZK, Zhu DS, Guo T, Cai QL, Wang Y. KIF20B promotes the progression of clear cell renal cell carcinoma by stimulating cell proliferation. J Cell Physiol 2019; 234:16517-16525. [PMID: 30805928 DOI: 10.1002/jcp.28322] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 01/24/2023]
Abstract
Renal cell carcinoma (RCC) is a common urinary system cancer with high morbidity and mortality rate. Clear cell renal cell carcinoma (ccRCC) is a highly aggressive and common type of RCC. More and effective therapeutic targets are badly needed for the treatment of ccRCC. Kinesin family protein (KIF)20B, also named M-phase phosphoprotein 1, was reported as a microtubule-associated, plus-end-directed kinesin. KIF20B was involved in multiple cellular processes such as cytokinesis. Multiple studies indicated the oncogenic role for KIF20B in several types of tumors, including breast cancer and bladder cancer. However, the possible role of KIF20B in the progression of renal carcinoma is still unknown. Herein, our study demonstrated that KIF20B was relatively highly expressed in ccRCC tissues. In addition, KIF20B was inversely related to the clinical features including tumor size and T stage. We further found that inhibition of the KIF20B expression by a specific short hairpin RNA obviously reduces proliferation of ccRCC cells both in vitro and in vivo. Our study reveals the involvement of KIF20B in ccRCC progression. Generally, KIF20B is a promising novel therapeutic for the treatment of clear cell RCC.
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Affiliation(s)
- Gang Li
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zun-Ke Xie
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Dong-Sheng Zhu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Tao Guo
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Qi-Liang Cai
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yi Wang
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
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Chys B, Dumont S, Van Calsteren K, Albersen M, Joniau S. Renal Neoplasm During Pregnancy: A Single Center Experience. Clin Genitourin Cancer 2018; 16:e501-e507. [DOI: 10.1016/j.clgc.2018.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 02/20/2018] [Indexed: 11/29/2022]
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Majdoub A, Zakhama W, Chaouch A, Abidi S, Ajili K, Haddad B, Binous M. Cancer du rein et Grossesse: A propos d’une nouvelle observation. AFRICAN JOURNAL OF UROLOGY 2017. [DOI: 10.1016/j.afju.2016.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Scavuzzo A, Santana Rios Z, Diaz-Gomez C, Varguez Gonzalez B, Osornio-Sanchez V, Bravo-Castro E, Linden-Castro E, Martinez-Cervera P, Jimenez-Rios MA. Renal Cell Carcinoma in a Pregnant Woman With Horseshoe Kidney. Urol Case Rep 2017; 13:58-60. [PMID: 28507908 PMCID: PMC5429143 DOI: 10.1016/j.eucr.2015.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 11/04/2015] [Indexed: 11/29/2022] Open
Abstract
To our knowledge, this is the first reported case of renal cell carcinoma in kidney horseshoe diagnosed in the second trimester of pregnancy. We performed open radical nephrectomy when the pregnancy was completed. Kidney cancer is rare during pregnancy and the symptoms can be mimic urinary infection. The diagnosis and its management can be a challenge.
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Affiliation(s)
- Anna Scavuzzo
- Department of Urology, Instituto Nacional de Cancerologia, Mexico City 14080, Mexico
| | - Zael Santana Rios
- Department of Urology, Instituto Nacional de Cancerologia, Mexico City 14080, Mexico
| | - Cristobal Diaz-Gomez
- Department of Urology, Instituto Nacional de Cancerologia, Mexico City 14080, Mexico
| | | | | | - Edgar Bravo-Castro
- Department of Urology, Instituto Nacional de Cancerologia, Mexico City 14080, Mexico
| | - Edgar Linden-Castro
- Department of Urology, Instituto Nacional de Cancerologia, Mexico City 14080, Mexico
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16
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Khaled H, Lahloubi NA, Rashad N. Review on renal cell carcinoma and pregnancy: A challenging situation. J Adv Res 2016; 7:575-80. [PMID: 27408760 PMCID: PMC4921780 DOI: 10.1016/j.jare.2016.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 12/15/2022] Open
Abstract
Renal cell carcinoma is rarely diagnosed during pregnancy. Its management is a real challenge due to the sparse literature and lack of standard guidelines. In this situation, the diagnosis is often delayed as the clinical presentation might resemble other pregnancy-related disorders but it should be one of the diagnostic possibilities in women with recurrent or refractory urinary tract symptoms, renal pain, or mass that could be palpated. Diagnostic approach may include ultrasound examination and sometimes magnetic resonance imaging. If localized, surgery would be the preferred line of treatment. Other treatment modalities, end results of treatment, and review of literature of this rare association will be presented.
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Affiliation(s)
- Hussein Khaled
- Department of Medical Oncology, National Cancer Institute, Cairo University, Egypt
| | - Nasr Al Lahloubi
- Department of Medical Oncology, National Cancer Institute, Cairo University, Egypt
| | - Noha Rashad
- Department of Medical Oncology, Military Armed Hospital Caner Center, Cairo, Egypt
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17
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Mangel L, Bíró K, Battyáni I, Göcze P, Tornóczky T, Kálmán E. A case study on the potential angiogenic effect of human chorionic gonadotropin hormone in rapid progression and spontaneous regression of metastatic renal cell carcinoma during pregnancy and after surgical abortion. BMC Cancer 2015; 15:1013. [PMID: 26704433 PMCID: PMC4691015 DOI: 10.1186/s12885-015-2031-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 12/17/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Treatment possibilities of metastatic renal cell carcinoma (mRCC) have recently changed dramatically prolonging the overall survival of the patients. This kind of development brings new challenges for the care of mRCC. CASE PRESENTATION A 22 year-old female patient with translocation type mRCC, who previously had been treated for nearly 5 years, became pregnant during the treatment break period. Follow-up examinations revealed a dramatic clinical and radiological progression of mRCC in a few weeks therefore the pregnancy was terminated. A few days after surgical abortion, CT examination showed a significant spontaneous regression of the pulmonary metastases, and the volume of the largest manifestation decreased from ca. 30 to 3.5 cm(3) in a week. To understand the possible mechanism of this spectacular regression, estrogen, progesterone and luteinizing hormone receptors (ER, PGR and LHR, respectively) immuno-histochemistry assays were performed on the original surgery samples. Immuno-histochemistry showed negative ER, PGR and positive LHR status suggesting the possible angiogenic effect of human chorionic gonadotropin hormone (hCG) in the background. CONCLUSION We hypothesize that pregnancy may play a causal role in the progression of mRCC via the excess amount of hCG, however, more data are necessary to validate the present notions and the predictive role of LHR overexpression.
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Affiliation(s)
- László Mangel
- Institute of Oncotherapy, University of Pécs, H-7624, Édesanyák útja 17, Pécs, Hungary.
| | - Krisztina Bíró
- Department of Chemotherapy, National Institute of Oncology, Budapest, Hungary.
| | | | - Péter Göcze
- Clinic of Obstetrics and Gynecology, University of Pécs, Pécs, Hungary.
| | | | - Endre Kálmán
- Institute of Pathology, University of Pécs, Pécs, Hungary.
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18
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Rapidly enlarging renal tumor during pregnancy: diagnostic and management dilemma. J Kidney Cancer VHL 2014; 1:12-16. [PMID: 28326245 PMCID: PMC5345512 DOI: 10.15586/jkcvhl.2014.6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 04/12/2014] [Indexed: 11/23/2022] Open
Abstract
Urological tumors diagnosed during pregnancy are rare. However, the incidence seems to be increasing largely due to advancements in modern imaging techniques and improved antenatal care. The diagnosis and management of renal tumors during pregnancy poses a dilemma to clinicians. This case report highlights the challenges in managing a large chromophobe renal cell carcinoma in a young primigravida patient. Proper antenatal assessment, a multidisciplinary team approach and appropriate discussion with patient are important determinants to achieve the best clinical outcomes for both the mother and the baby.
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