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Mansour H, Tran-Dang MA, Walkden M, Boleti E, Barod R, Patki P, Mumtaz F, Tran MGB, Bex A, El Sheikh S. Renal mass biopsy - a practical and clinicopathologically relevant approach to diagnosis. Nat Rev Urol 2024:10.1038/s41585-024-00897-5. [PMID: 38907039 DOI: 10.1038/s41585-024-00897-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 06/23/2024]
Abstract
Advancements in imaging modalities have increased the frequency of renal mass discovery. Imaging has typically been considered sufficient to guide management for a large proportion of these tumours, but renal mass biopsies (RMBs) have an increasing role in determining malignancy and can be a valuable tool for preventing unnecessary surgery in patients with benign tumours. A structured approach should be used to help to navigate the expanding repertoire of renal tumours, many of which are molecularly defined. In terms of tumour subtyping, the pathologist's strategy should focus on stratifying patients into clinically different prognostic groups according to our current knowledge of tumour behaviour, including benign, low-grade or indolent, intermediate malignant or highly aggressive. Crucial pathological features and morphological mimicry of tumours can alter the tumour's prognostic group. Thus, pathologists and urologists can use RMB to select patients with tumours at a reduced risk of progression, which can be safely managed with active surveillance within a tailored imaging schedule, versus tumours for which ablation or surgical intervention is indicated. RMB is also crucial in the oncological setting to distinguish between different high-grade tumours and guide tailored management strategies.
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Affiliation(s)
- Hussein Mansour
- Research Department of Pathology, UCL Cancer Institute, London, UK
| | - My-Anh Tran-Dang
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK
| | - Miles Walkden
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK
- UCL Division of Surgery and Interventional Science, Rowland Street, London, UK
| | - Ekaterini Boleti
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK
| | - Ravi Barod
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK
- UCL Division of Surgery and Interventional Science, Rowland Street, London, UK
| | - Prasad Patki
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK
- UCL Division of Surgery and Interventional Science, Rowland Street, London, UK
| | - Faiz Mumtaz
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK
- UCL Division of Surgery and Interventional Science, Rowland Street, London, UK
| | - Maxine G B Tran
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK
- UCL Division of Surgery and Interventional Science, Rowland Street, London, UK
| | - Axel Bex
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK
- UCL Division of Surgery and Interventional Science, Rowland Street, London, UK
| | - Soha El Sheikh
- Research Department of Pathology, UCL Cancer Institute, London, UK.
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK.
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2
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Tian X, Hong P, Tang S, Liu Z, Yang F, Zhang S, Wang G, He H, Ma L. Urothelial carcinoma of the renal pelvis with renal vein and inferior vena cava tumor thrombus: case series and literature review. Transl Androl Urol 2021; 10:2879-2888. [PMID: 34430390 PMCID: PMC8350241 DOI: 10.21037/tau-21-253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/24/2021] [Indexed: 11/06/2022] Open
Abstract
Background Urothelial carcinoma (UC) of the renal pelvis with renal vein and inferior vena cava (IVC) tumor thrombus (TT) was extremely rare. We aimed to explore the clinical and pathological characteristics, diagnosis and treatment of renal pelvis UC with renal vein and IVC TT. Methods From March 2016 to January 2019, eight patients of renal pelvis UC with renal vein and IVC TT were diagnosed and underwent operation in our hospital. Clinical features, operative details, pathological outcomes, and prognosis data were reviewed and collected. Results There were five males and three females (52-84 years old). Their main symptoms were flank pain and hematuria. According to the Mayo classification, the TT was 4 level-0 (1 left and 3 right), 2 level-I (right), and 2 level-II (right). Half the patients underwent retroperitoneal laparoscopic radical nephroureterectomy with thrombectomy, and the other underwent open procedures. The mean operative time was 298.9 minutes. Pathological outcomes revealed high-grade UC, with positive lymph nodes in 6 cases. Four patients received adjuvant chemotherapy, one target therapy and one adjuvant chemotherapy combined with immunotherapy after surgery. The mean follow-up time was 11.1 months. Three patients are alive, and two of them developed recurrence and lung metastasis. Conclusions Preoperative differentiation between renal pelvis UC and renal cell carcinoma with venous TT was very important for the management. Radical nephroureterectomy with thrombectomy might be a reasonable method for renal pelvis UC with venous TT. The prognosis of such cases was poor even if adjuvant therapy was scheduled.
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Affiliation(s)
- Xiaojun Tian
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Peng Hong
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Shiying Tang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Feilong Yang
- Department of Urology, Peking University Third Hospital, Beijing, China.,Department of Urology, General Hospital of Ningxia Medical University, Ningxia, China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Guoliang Wang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Huiying He
- Department of Pathology, Peking University Third Hospital, Beijing, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
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3
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Chen S, Luo X, Zhao Z. Renal Urothelial Carcinoma Complicated by Inferior Vena Cava Tumor Thrombus and Acute Pyelonephritis. Urology 2020; 148:e1-e2. [PMID: 33373702 DOI: 10.1016/j.urology.2020.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/05/2020] [Accepted: 12/11/2020] [Indexed: 11/19/2022]
Abstract
Renal urothelial carcinoma (UC) with inferior vena cava tumor thrombus is rare, especially when it is concomitant with acute pyelonephritis. In this report, a 70-year-old diabetic man with right flank pain, intermittent painless gross hematuria, and recurrent high fever was described. On the basis of the symptoms, physical examination, cytology and imaging results, renal UC with extension into inferior vena cava, and acute pyelonephritis was established. The patient was unresponsive to antimicrobial chemotherapy. Nephroureterectomy, lymphadenectomy, thrombectomy, and bladder cuff excision were performed. Postoperative histopathological examination revealed high grade UC and lymph node metastasis.
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Affiliation(s)
- Shulian Chen
- Department of Urology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Xu Luo
- Department of Urology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Zeju Zhao
- Department of Urology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
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4
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Li M, Shi A, Kong W, Zhang J, Chen Y, Huang J, Huang Y. Transitional cell carcinoma with extension of the renal vein and IVC tumor thrombus: report of three cases and literature review. World J Surg Oncol 2016; 14:309. [PMID: 28031042 PMCID: PMC5192594 DOI: 10.1186/s12957-016-1041-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/07/2016] [Indexed: 11/18/2022] Open
Abstract
Background Transitional cell carcinoma (TCC) originating from the renal pelvis with a venous tumor thrombus is a rare entity. However, clinicians should be aware of it because of its high malignancy and poor prognosis. Case presentation Here, we report three cases of pathologically confirmed TCC originating from the renal pelvis with extension into the renal vein or inferior vena cava (IVC). Of these patients, two are males and one is female (58~73 years old). Their main symptom is flank pain; besides, gross hematuria and weight loss is observed in one of the patients. Computed tomography (CT) scan of the first patient revealed multiple space-occupying lesions in the left renal pelvis and left medium and lower ureter with a tumor thrombus in the left renal vein. CT scan of the second patient revealed a right renal mass and extension into the IVC. Abdominal magnetic resonance imaging (MRI) of the third patient showed a soft tissue mass in the region of the left renal sinus, and the signal of the soft tissue was observed in the left renal vein. The preoperative diagnoses of the first and third patient were TCC, while the second patient was renal cell carcinoma (RCC). Two patients with the preoperative diagnosis of TCC underwent laparoscopic radical nephroureterectomy with thrombectomy, and the other patient underwent radical nephrectomy with thrombectomy. The surgeries were successful. Although two of our patients underwent chemotherapy and radiotherapy, they died 2 and 19 months after the surgery, respectively. The other patient refused any adjuvant therapy and died 3 months after the operation. Conclusions Compared to the extension of RCC to the renal vein or IVC, extension of TCC to the renal vein or IVC is rare. TCC with a venous tumor thrombus is often misdiagnosed as RCC. However, a correct preoperative or intraoperative diagnosis is of great importance to decide surgical strategy. Laparoscopic radical nephroureterectomy with thrombectomy may be a safe and feasible operative method in treatment of TCC with a renal vein thrombus. The prognosis of such cases is poor even if chemotherapy and radiotherapy are scheduled.
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Affiliation(s)
- Mingyang Li
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai, 200127, China
| | - An Shi
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai, 200127, China
| | - Wen Kong
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai, 200127, China
| | - Jin Zhang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai, 200127, China
| | - Yonghui Chen
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai, 200127, China
| | - Jiwei Huang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai, 200127, China.
| | - Yiran Huang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai, 200127, China.
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6
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Pouliot F, Shuch B, LaRochelle JC, Pantuck A, Belldegrun AS. Contemporary Management of Renal Tumors With Venous Tumor Thrombus. J Urol 2010; 184:833-41; quiz 1235. [DOI: 10.1016/j.juro.2010.04.071] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Frédéric Pouliot
- Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Brian Shuch
- Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Jeffrey C. LaRochelle
- Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Allan Pantuck
- Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Arie S. Belldegrun
- Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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7
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Cerwinka WH, Manoharan M, Soloway MS, Ciancio G. The role of liver transplantation techniques in the surgical management of advanced renal urothelial carcinoma with or without inferior vena cava thrombus. Int Braz J Urol 2009; 35:19-23. [DOI: 10.1590/s1677-55382009000100004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2008] [Indexed: 11/22/2022] Open
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Cilliers G, Naidoo A, Ackermann C, Parsons JJ, Andronikou S. Renal vein thrombosis in transitional cell carcinoma. ACTA ACUST UNITED AC 2007; 51 Spec No.:B62-3. [PMID: 17875162 DOI: 10.1111/j.1440-1673.2007.01769.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A rare case of renal transitional cell carcinoma (TCC) associated with bland thrombus of the renal vein extending into the inferior vena cava is described. Tumour thrombus in renal cell carcinoma is frequently encountered, but only very rarely occurs with TCC. Bland renal vein thrombosis occurring with renal TCC has not been described before. Contrast enhanced computed tomography assisted in distinguishing between bland and tumour thrombosis and aided in surgical management.
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Affiliation(s)
- G Cilliers
- Department of Radiology, University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa.
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Nguyen BD, Roarke MC, Ram PC. Transitional Cell Carcinoma With Metastases to Spermatic Vein and Spermatic Cord: PET/CT Imaging. Clin Nucl Med 2005; 30:708-10. [PMID: 16166854 DOI: 10.1097/01.rlu.0000178250.38901.4d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Transitional cell carcinoma of the kidney with venous tumor thrombus is uncommon with only a limited number of cases published in the medical literature. The authors present a case of renal urothelial carcinoma with PET/CT imaging. PET, in addition to the demonstration of tumor thrombus in the left renal vein and inferior vena cava, showed a thrombosed left spermatic vein with metastases to the left spermatic cord and epidydimis.
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Affiliation(s)
- Ba D Nguyen
- Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Arizona 85259, USA.
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Fraser ET, Coakley FV, Meng MV, Yeh BM, Joe BN, Qayyum A. Computed Tomography and Magnetic Resonance Imaging of Inferior Vena Caval Thrombus Associated with Metastasis to the Kidney. J Comput Assist Tomogr 2004; 28:131-3. [PMID: 14716246 DOI: 10.1097/00004728-200401000-00022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The computed tomography and magnetic resonance imaging findings in 2 cases of inferior vena caval thrombus associated with metastases to the kidney are presented. In both cases, the radiologic findings were suggestive of renal cell carcinoma. Recognition that metastases to the kidney can be associated with inferior vena caval thrombus broadens the differential diagnosis in a patient with a renal mass, an inferior vena caval filling defect, and a known primary malignancy, potentially altering the diagnostic approach.
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Affiliation(s)
- Ezra T Fraser
- Department of Radiology, University of California-San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628, USA
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11
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Ord J, Potter M, Reynard J, Cranston D. Transitional cell carcinoma of the kidney invading the inferior vena cava, treated by excision and grafting, with a review of vena cava replacement. BJU Int 2003; 92 Suppl 3:e38-e40. [PMID: 19127633 DOI: 10.1111/j.1464-410x.2003.04056.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J Ord
- The Churchill Hospital, Oxford, UK.
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12
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Waidelich R, Weninger E, Denzlinger C, Müller-Lisse U, Hofstetter A, Schmeller N. Use of veno-venous bypass for resection of malignant pheochromocytoma with vena caval thrombus. Int Urol Nephrol 2003; 34:241-3. [PMID: 12775104 DOI: 10.1023/a:1023286917251] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Surgical management of malignant pheochromocytoma with tumor-induced venous obstruction involving the entrance to the right atrium is challenging. The risk of marked hypotension and hemodynamic instability following clamping of the vena cava is increased as a consequence of the sudden decrease in circulating catecholamines. The use of cardiac bypass, however is burdened with additional operating time and coagulopathy. The present report illustrates that veno-venous bypass is a valuable tool during resection of phenochromocytoma with a large vena caval tumor thrombus.
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Juan YS, Jang MY, Shen JT, Chou YH, Huang CH, Hsieh TJ. Transitional cell carcinoma of the renal pelvis with extension into the inferior vena cava: a report of two cases. Kaohsiung J Med Sci 2003; 19:362-7. [PMID: 12926523 DOI: 10.1016/s1607-551x(09)70439-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Of all primary malignant renal tumors, 10% to 15% originate from the renal pelvis, and 90% to 92% of these tumors are transitional cell carcinomas. Nonetheless, renal pelvis transitional cell carcinoma extending into the inferior vena cava is very rare. We report one confirmed case and one highly suspicious case of renal pelvis transitional cell carcinoma with a tumor thrombus in the inferior vena cava. Both of our patients died within 6 months of initial diagnosis, indicating the poor prognosis and advanced stage of transitional cell carcinoma with an inferior vena cava thrombus. Transitional cell carcinoma should be considered in patients with obstruction of the renal vein and the inferior vena cava.
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Affiliation(s)
- Yung-Shun Juan
- Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan.
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