[Renal epithelioid angiomyolipoma]

Analysis of Clinical Features and Next-Generation Sequencing of 12 Tuberous Sclerosis Families in China

Background

Tuberous sclerosis complex (TSC) is a rare autosomal dominant genetic disease with systemic organ involvement. So far, only a few TSC families in China have been reported. Therefore, more data on the clinical and genetic features of TSC families are required.

Materials and Methods

We retrospectively analyzed 12 TSC family probands and their family members. Next-generation sequencing (NGS) has been applied to confirm the type of TSC mutation along with a detailed physical examination.

Results

In this study, twenty-seven patients in 12 TSC families were reported, including 12 male and 15 female patients, aged 8-67 years. Skin lesions were detected among all patients with TSC, including 25 cases of facial angiofibromas, 18 cases of hypomelanotic macules, 15 cases of ungual fibromas, and 13 cases of shagreen patch. Other clinical features were also revealed: 14 cases of renal angiomyolipoma, 6 cases of subependymal nodules (SENs), and 3 cases of lymphangioleiomyomatosis. All twenty-seven patients with TSC were tested by NGS. Totally, TSC2 mutations were reported in 19 cases (7 frameshift mutations, 10 nonsense mutations, and 2 missense mutations), TSC1 mutations were reported in 4 cases (4 nonsense mutations), and 4 cases were genetically negative. The novel causal mutations (TSC2: c.208dup, c.1874C > G, c.1852del) identified in three families were first reported in TSC.

Conclusion

Our findings expand the mutation spectrum of patients with TSC in China. The clinical characteristics can vary among patients with TSC with the same pathogenic mutation. The genetic results and summary of clinical features of 12 TSC families contribute to a more accurate diagnosis and further genetic counseling.

Epithelioid angiomyolipoma of the pancreas: A case report and review of the literature

BACKGROUND

Angiomyolipomas (AMLs), belonging to the family of mesenchymal tumors, are considered benign lesions that occur mostly in the kidney or as a part of tuberous sclerosis. Epithelioid AML (EAML) is a rare type of AML that appears to have malignant potential. Extrarenal AMLs usually occur in the liver according to the retrieved literature reports. There have been only two previous reports of monofocal primary AML of the pancreas; however, no cases of primary monotypic EAML of the pancreas have been reported.

CASE SUMMARY

An asymptomatic 59-year-old woman incidentally revealed a tumor during abdominal ultrasound examination. Routine blood tests and physical examination were within normal limits. Abdominal ultrasound revealed a 1.9-cm hypoechogenic mass in the tail of the pancreas, clearly visualized by endoscopic ultrasound. However, contrast-enhanced abdominal computed tomography scans did not demonstrate the lesion. A subsequent gadolinium-enhanced magnetic resonance imaging scan showed that the lesion had some characteristic manifestations. The lesion was initially thought to be a neuroendocrine tumor (asymptomatic PanNET). After surgical resection, histopathology and immunohistochemistry confirmed the diagnosis of EAML. At the 6-mo follow-up, no recurrence, spread, or metastasis was identified on computed tomography or magnetic resonance imaging.

CONCLUSION

The preoperative diagnosis of pancreatic AML is extremely difficult. Imaging techniques are essential for providing valuable morphological features for differential diagnosis.

[Malignant renal epithelioid angiomyolipoma (EAML): about a rare case]

L’angiomyolipome rénal épithélioïde malin (AREM) est une entité pathologique rare longtemps considérée comme lésion hamartomateuse et dont le diagnostic positif est purement immuno-histochimique, microscopiquement, il se caractérise par des cellules mononuclées épithélioïdes a cytoplasme clair présentant des atypies cytonucléaires sévères, et exprimant les marqueurs musculaires lisses et mélanocytaires (HMB 45). Nous rapportons un cas rare d’AREM diagnostiqué après analyse anatomopathologique d’une tumeur retropéritonéale dont l’origine ne pourrait être précisée préalablement par la tomodensitométrie.

Comparisons of Quality of Life and Functional and Oncological Outcomes after Orthotopic Neobladder Reconstruction: Prostate-Sparing Cystectomy versus Conventional Radical Cystoprostatectomy

OBJECTIVES

To compare health-related quality of life and oncological and functional outcomes on erectile function, continence, and voiding function among bladder patients who underwent orthotopic neobladder reconstruction after prostate-sparing cystectomy (PSC) and conventional radical cystoprostatectomy (CRC).

METHODS

This is a retrospective cohort study from a single surgeon. During 2007 to 2015, we identified 25 of 186 male patients receiving radical cystectomies due to bladder cancer who underwent orthotopic neobladder reconstruction, 14 patients with PSC and the other 11 patients with CRC. International Index of Erectile Function-5 (IIEF-5), International Prostate Symptom Score (IPSS), European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire-Core 30-item questionnaire (EORTC-QLQ-C30), and self-catheterizations were used to evaluate functional outcomes in the baseline and 1 year after operation.

RESULTS

There were better physical and social functioning scales, less fatigue symptoms, better IIEF (16 versus 3.7, p = 0.01), and less self-catheterization rate (33% versus 89%  p = 0.006) in the PSC group. The oncologic outcomes were the same between two groups.

CONCLUSIONS

For selected patients with bladder cancer who underwent neobladder reconstruction, prostate-sparing cystectomy provided better sexuality preservation, less daily self-catheterization, and better physical function and social function scales without compromising overall survival.

[Renal epithelioid angiomyolipoma mimicking renal carcinoma]

L'angiomyolipome épithélioide est une forme rare d'angiomyolipome à potentiel malin, considéré récemment par l'OMS comme une entité à part dans la classification des tumeurs rénales. Cette lésion pose un problème dans le diagnostic différentiel avec les carcinomes à cellules claires. Il n'y a pas de critère spécifique clinique ou radiologique caractérisant cette tumeur. L'immunohistochimie en révélant la positivité des cellules épithélioide au marqueur HMB45 est essentielle au diagnostic. Le traitement doit être discuté en concertation pluridisciplinaire.

Malignant renal epithelioid angiomyolipoma associated with abdominopelvic hydatid cysts: a case report

Introduction

The World Health Organization defines epithelioid angiomyolipoma as a potentially malignant mesenchymal neoplasm characterized by proliferation of predominantly epithelioid cells and as closely related to the triphasic (classic) angiomyolipoma. It can be benign, potentially aggressive or malignant. The pathologist's role is crucial in making a positive diagnosis, providing appropriate patient management and assessing prognosis. In this report, we present a case of a patient with an epithelioid angiomyolipoma and hydatid cyst association. To the best of our knowledge, such an association has not been reported previously in the literature.

Case presentation

A 70-year-old Arabian woman presented to our hospital with a 6-month history of a right lumbago and weight loss. Computed tomography objectified a mid-right renal tumor, several locoregional lymph nodes and four abdominopelvic cystic formations. The patient underwent a right nephroureterectomy and removal of abdominal and pelvic masses. Histologically, the tumor corresponded to a proliferation of large eosinophil cells, polygonal or ovoid, with epithelial appearance, and associated with thickened, hyalinized vessel walls, fat cells and bundles of smooth muscle cells. Mitoses were estimated at 2 per 50 high-power fields. In immunohistochemical study, epithelioid tumor cells expressed S-100 protein and Melan-A. The diagnosis of malignant epithelioid angiomyolipoma was made. The wall of the abdominopelvic cysts was eosinophilic and lamellar, corresponding to the cuticular membrane of hydatid cysts.

Conclusion

In our patient, careful histological examination and immunohistochemical study allowed us to make the correct diagnosis of angiomyolipoma in its malignant form. The association with hydatid cysts is what makes our case original.

[Renal angiomyolipoma with inferior vena cava thrombosis during pregnancy]

The diagnosis of angiomyolipoma with tumor thrombus from the renal vein into the inferior vena cava is rare, especially during pregnancy. We report the case of a 31-year-old pregnant woman who was diagnosed with a 9 cm angiomyolipoma of the right kidney with inferior vena cava thrombosis, managed by active surveillance during pregnancy and delayed surgery after childbirth.

Two- and three-dimensional contrast-enhanced sonography for assessment of renal tumor vasculature: preliminary observations

OBJECTIVES

The purpose of this study was to show potential applications of 2-dimensional (2D) and 3-dimensional (3D) contrast-enhanced sonography for assessment of the vascularity of benign and malignant renal tumors.

METHODS

Sixty-eight patients with renal tumors were examined with both 2D and reconstructed 3D contrast-enhanced sonography. The contrast enhancement characteristics of benign and malignant renal tumors were compared on both 2D and 3D contrast-enhanced sonograms. The diagnoses of the lesions were made by surgical pathologic examination in 50 patients and by contrast-enhanced computed tomography in 18 patients.

RESULTS

Both 2D and 3D contrast-enhanced sonography showed hypoenhancement with a few small peritumoral feeding blood vessels and regular intratumoral branches in 18 benign tumors, whereas hyperenhancement with multiple irregular peritumoral feeding vessels and tortuous intratumoral branches was shown in 50 malignant tumors. Compared to 2D contrast-enhanced sonography, 3D contrast-enhanced sonography displayed more intratumoral microvessels and spatial distributions, especially for the vessel network, and tortuous branches in the malignant tumors. Compared to 2D contrast-enhanced sonography, 3D contrast-enhanced sonography was better for detecting and displaying renal tumor vascularity, with a statistically significant difference (P < .05).

CONCLUSIONS

Reconstructed 3D contrast-enhanced sonography is a useful complementary tool in addition to 2D contrast-enhanced sonography for assessing the characteristics and distribution of blood vascularity in renal tumors.

Comparison of human glomerulus proteomic profiles obtained from low quantities of samples by different mass spectrometry with the comprehensive database

BACKGROUND

We have previously constructed an in-depth human glomerulus proteome database from a large amount of sample for understanding renal disease pathogenesis and aiding the biomarker exploration. However, it is usually a challenge for clinical research to get enough tissues for large-scale proteomic characterization. Therefore, in this study, we focused on high-confidence proteomics analysis on small amounts of human glomeruli comparable to those obtained from biopsies using different mass spectrometers and compared these results to the comprehensive database.

RESULTS

One microgram of human glomerular protein digest was analyzed each on five LC- combined mass spectrometers (LIT-TOF, LTQ-Orbitrap, Q-TOF, LIT and MALDI-TOF/TOF) yielding 139, 185, 94, 255 and 108 proteins respectively identified with strict criteria to ensure high confidence (> 99%) and low false discovery rate (FDR) (< 1%). An integrated profile of 332 distinct glomerular proteins was subsequently generated without discerned bias due to protein physicochemical properties (pI and MW), of which around 60% were detected commonly by more than two LC-MS/MS platforms. Comparative analysis with the comprehensive database demonstrated 14 proteins uniquely identified in this study and more than 70% of identified proteins in small datasets were concentrated to the top abundant 500 in the comprehensive database which consists of 2775 non-redundant proteins.

CONCLUSION

This study showed representative human glomerulus proteomic profiles obtained from biopsies through analysis of comparable amounts of samples by different mass spectrometry. Our results implicated that high abundant proteins are more likely to be reproducibly identified in multiple mass spectrometers runs and different mass spectrometers. Furthermore, many podocyte essential proteins such as nephrin, podocin, podocalyxin and synaptopodin were also identified from the small samples in this study. Bioinformatic enrichment analysis results extended our understanding of the major glomerular proteins about their subcellular distributions and functions. The present study indicated that the proteins localized in certain cellular compartments, such as actin cytoskeleton, mitochondrial matrix, cell surface, basolateral plasma membrane, contractile fiber, proteinaceous extracellular matrix and adherens junction, represent high abundant glomerular proteins and these subcellular structures are also highly significantly over-represented in the glomerulus compared to the whole human background.

[Preventive and emergency embolization of angiomyolipomas: our experience]

AIM

To present our experience with emergency or programmed embolization of angiomyolipomas.

PATIENTS AND METHODS

The retrospective study 1999-2000 included a total of 20 patients with AML, five of whom had hypothyroidism. Group I emergency embolization: 11 patients age being 61.4 ± 15.6 years and the size of AML 8.2 ± 2.8 cm presented retroperitoneal hemorrhage from spontaneous rupture. Two had a hemorrhagic shock. A transfusion of 3.4 blood units per patient was performed for five patients. A clinical and radiological follow-up was done by scanning during the first week and in one month. Group II preventive embolization: nine patients, with age between 58.3 ± 15.2 years and tumor size 5.2 ± 2.2 cm, all asymptomatic. All successfully received a unilateral preventive embolization. A scan was performed one month later.

RESULTS

Group I: the embolization was effective in 100% of patients. No intraoperative incident was reported. After one month, the reduction in tumor volume was 40%. At eight months, a patient underwent nephrectomy because of a new fracture, and another a second embolization after 14 months. The technical result was maintained in 83% of cases after 18 months. Two patients developed HTA after embolization controlled by a single treatment, and five had limited renal ischemic sequels. Group II: no intraoperative incidents and no postoperatively complications have been reported. One month after embolization, the reduction in tumor volume was 23%. After 24 months, patients remained completely asymptomatic, no spontaneous bleeding has been reported, no surgery has been performed, and no HTA has been described. Only one re-embolization was done at 20 months (artery duplicity). Limited renal ischemic sequels were reported for one patient but no renal failure.

CONCLUSIONS

The required embolization became the method of choice in emergency with excellent results and few complications at distance. Programmed embolization effectively prevented the risk of bleeding, without impact on the renal function, with a low economic cost compared to hospitalization and emergency care. The significance of the observed AML--hypothyroidism association in our series requires a confrontation with more important cohorts.