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Andras I, Pecoraro A, Telecan T, Piana A, Boissier R, Hevia V, Prudhomme T, Amparore D, Bertolo R, Carbonara U, Erdem S, Diana P, Ingels A, Kara O, Marandino L, Marchioni M, Muselaers S, Pavan N, Pecoraro A, Roussel E, Crisan N, Territo A, Campi R. How to manage renal masses in kidney transplant recipients? A collaborative review by the EAU-YAU kidney transplantation and renal cancer working groups. Actas Urol Esp 2023; 47:621-630. [PMID: 37100223 DOI: 10.1016/j.acuroe.2023.04.006] [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: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Kidney transplant (KT) recipients have a four-times higher risk of renal malignancies compared to general population. As these patients frequently harbor bilateral or multifocal tumors, the management of renal masses is still under debate. OBJECTIVE To explore the current management of the native kidney masses in KT patients. ACQUISITION OF EVIDENCE We performed a literature search on MEDLINE/PubMed database. A number of 34 studies were included in the present review. SYNTHESIS OF EVIDENCE In frail patients with renal masses below 3 cm, active surveillance is a feasible alternative. Nephron-sparing surgery is not justified for masses in the native kidney. Radical nephrectomy is the standard treatment for post-transplant renal tumors of the native kidneys in KT recipients, with laparoscopic techniques leading to significantly less perioperative complication rates as compared to the open approach. Concurrent bilateral native nephrectomy at the time of transplantation can be considered in patients with renal mass and polycystic kidney disease, especially if no residual urinary output is present. Patients with localized disease and successful radical nephrectomy do not require immunosuppression adjustment. In metastatic cases, mTOR agents can ensure efficient antitumoral response, while maintaining proper immunosuppression in order to protect the graft. CONCLUSIONS Post-transplant renal cancer of the native kidneys is a frequent occurrence. Radical nephrectomy is most frequently performed for localized renal masses. A standardized and widely-approved screening strategy for malignancies of native renal units is yet to be implemented.
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Affiliation(s)
- I Andras
- Servicio de Urología, Universidad de Medicina y Farmacia «Iuliu Hatieganu», Hospital Municipal Cluj-Napoca, Cluj-Napoca, Romania.
| | - A Pecoraro
- Unidad de Cirugía Robótica Urológica y Trasplante Renal, Universidad de Florencia, Hospital de Careggi, Florencia, Italy; Grupo de Trasplante Renal de la sección de Jóvenes Urólogos Académicos (YAU) de la Asociación Europea de Urología (EAU), Arnhem, The Netherlands
| | - T Telecan
- Servicio de Urología, Universidad de Medicina y Farmacia «Iuliu Hatieganu», Hospital Municipal Cluj-Napoca, Cluj-Napoca, Romania
| | - A Piana
- Grupo de Trasplante Renal de la sección de Jóvenes Urólogos Académicos (YAU) de la Asociación Europea de Urología (EAU), Arnhem, The Netherlands; Sección de Urología, Servicio de Oncología, Facultad de Medicina, Hospital San Luigi, Universidad de Turín, Orbassano, Turín, Italy
| | - R Boissier
- Grupo de Trasplante Renal de la sección de Jóvenes Urólogos Académicos (YAU) de la Asociación Europea de Urología (EAU), Arnhem, The Netherlands; Servicio de Urología y Trasplante Renal, Hospital Universitario La Concepción, Marsella, France
| | - V Hevia
- Grupo de Trasplante Renal de la sección de Jóvenes Urólogos Académicos (YAU) de la Asociación Europea de Urología (EAU), Arnhem, The Netherlands; Servicio de Urología, Hospital Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain
| | - T Prudhomme
- Grupo de Trasplante Renal de la sección de Jóvenes Urólogos Académicos (YAU) de la Asociación Europea de Urología (EAU), Arnhem, The Netherlands; Servicio de Urología, Trasplante Renal y Andrología, Hospital Universitario de Rangueil, Toulouse, France
| | - D Amparore
- Sección de Urología, Servicio de Oncología, Facultad de Medicina, Hospital San Luigi, Universidad de Turín, Orbassano, Turín, Italy; Grupo de trabajo de Cáncer Renal de la sección de Jóvenes Urólogos Académicos (YAU) de la Asociación Europea de Urología (EAU), Arnhem, The Netherlands
| | - R Bertolo
- Grupo de trabajo de Cáncer Renal de la sección de Jóvenes Urólogos Académicos (YAU) de la Asociación Europea de Urología (EAU), Arnhem, The Netherlands; Servicio de Urología, Hospital San Carlo Di Nancy, Roma, Italy
| | - U Carbonara
- Grupo de trabajo de Cáncer Renal de la sección de Jóvenes Urólogos Académicos (YAU) de la Asociación Europea de Urología (EAU), Arnhem, The Netherlands; Servicio de Emergencias y Trasplante de Órganos, Unidad de Urología, Andrología y Trasplante Renal, Universidad de Bari, Bari, Italy
| | - S Erdem
- Grupo de trabajo de Cáncer Renal de la sección de Jóvenes Urólogos Académicos (YAU) de la Asociación Europea de Urología (EAU), Arnhem, The Netherlands; Sección de Oncología Urológica, Servicio de Urología, Facultad de Medicina de la Universidad de Estambul, Estambul, Turkey
| | - P Diana
- Grupo de trabajo de Cáncer Renal de la sección de Jóvenes Urólogos Académicos (YAU) de la Asociación Europea de Urología (EAU), Arnhem, The Netherlands; Servicio de Urología, Instituto Clínico y de Investigación Humanitas ICCRS, Rozzano, Italy; Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - A Ingels
- Grupo de trabajo de Cáncer Renal de la sección de Jóvenes Urólogos Académicos (YAU) de la Asociación Europea de Urología (EAU), Arnhem, The Netherlands; Servicio de Urología, APHP, Hospital Universitario Henri Mondor, Créteil, France
| | - O Kara
- Grupo de trabajo de Cáncer Renal de la sección de Jóvenes Urólogos Académicos (YAU) de la Asociación Europea de Urología (EAU), Arnhem, The Netherlands; Servicio de Urología, Hospital Universitario Henri Mondor, APHP, Créteil, France
| | - L Marandino
- Grupo de trabajo de Cáncer Renal de la sección de Jóvenes Urólogos Académicos (YAU) de la Asociación Europea de Urología (EAU), Arnhem, The Netherlands; Servicio de Oncología Médica, Hospital ICCRS San Raffaele, Universidad Vita-Salute San Raffaele, Milán, Italy
| | - M Marchioni
- Grupo de trabajo de Cáncer Renal de la sección de Jóvenes Urólogos Académicos (YAU) de la Asociación Europea de Urología (EAU), Arnhem, The Netherlands; Departamento de Ciencias Médicas, Orales y Biotecnológicas, Laboratorio de Biostadística, Universidad «G. D'Annunzio» Chieti-Pescara, Chieti, Italy; Servicio de Urología, Hospital SS Annunziata, Universidad «G. D'Annunzio» de Chieti, Chieti, Italy
| | - S Muselaers
- Grupo de trabajo de Cáncer Renal de la sección de Jóvenes Urólogos Académicos (YAU) de la Asociación Europea de Urología (EAU), Arnhem, The Netherlands; Servicio de Urología, Centro Médico de la Universidad de Radboud, Nimega, The Netherlands
| | - N Pavan
- Grupo de trabajo de Cáncer Renal de la sección de Jóvenes Urólogos Académicos (YAU) de la Asociación Europea de Urología (EAU), Arnhem, The Netherlands; Clínica de Urología, Departamento de Ciencias Médicas, Quirúrgicas y de la Salud, Universidad de Trieste, Trieste, Italy
| | - A Pecoraro
- Sección de Urología, Servicio de Oncología, Facultad de Medicina, Hospital San Luigi, Universidad de Turín, Orbassano, Turín, Italy; Grupo de trabajo de Cáncer Renal de la sección de Jóvenes Urólogos Académicos (YAU) de la Asociación Europea de Urología (EAU), Arnhem, The Netherlands
| | - E Roussel
- Grupo de trabajo de Cáncer Renal de la sección de Jóvenes Urólogos Académicos (YAU) de la Asociación Europea de Urología (EAU), Arnhem, The Netherlands; Servicio de Urología, Hospital Universitario de Lovaina, Lovaina, Belgium
| | - N Crisan
- Servicio de Urología, Universidad de Medicina y Farmacia «Iuliu Hatieganu», Hospital Municipal Cluj-Napoca, Cluj-Napoca, Romania
| | - A Territo
- Grupo de Trasplante Renal de la sección de Jóvenes Urólogos Académicos (YAU) de la Asociación Europea de Urología (EAU), Arnhem, The Netherlands; Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - R Campi
- Unidad de Cirugía Robótica Urológica y Trasplante Renal, Universidad de Florencia, Hospital de Careggi, Florencia, Italy; Grupo de trabajo de Cáncer Renal de la sección de Jóvenes Urólogos Académicos (YAU) de la Asociación Europea de Urología (EAU), Arnhem, The Netherlands; Departamento de Medicina Experimental y Clínica, Universidad de Florencia, Florencia, Italy
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Piana A, Andras I, Diana P, Verri P, Gallioli A, Campi R, Prudhomme T, Hevia V, Boissier R, Breda A, Territo A. Small renal masses in kidney transplantation: overview of clinical impact and management in donors and recipients. Asian J Urol 2022; 9:208-214. [PMID: 36035353 PMCID: PMC9399547 DOI: 10.1016/j.ajur.2022.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/24/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022] Open
Abstract
Kidney transplantation is the best replacement treatment for the end-stage renal disease. Currently, the imbalance between the number of patients on a transplant list and the number of organs available constitutes the crucial limitation of this approach. To expand the pool of organs amenable for transplantation, kidneys coming from older patients have been employed; however, the combination of these organs in conjunction with the chronic use of immunosuppressive therapy increases the risk of incidence of graft small renal tumors. This narrative review aims to provide the state of the art on the clinical impact and management of incidentally diagnosed small renal tumors in either donors or recipients. According to the most updated evidence, the use of grafts with a small renal mass, after bench table tumor excision, may be considered a safe option for high-risk patients in hemodialysis. On the other hand, an early small renal mass finding on periodic ultrasound-evaluation in the graft should allow to perform a conservative treatment in order to preserve renal function. Finally, in case of a renal tumor in native kidney, a radical nephrectomy is usually recommended.
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De Novo Malignancy After Liver Transplantation: Risk Assessment, Prevention, and Management-Guidelines From the ILTS-SETH Consensus Conference. Transplantation 2022; 106:e30-e45. [PMID: 34905760 DOI: 10.1097/tp.0000000000003998] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
De novo malignancies (DNMs) following liver transplantation (LT) have been reported as 1 of the major causes of late mortality, being the most common cause of death in the second decade after LT. The overall incidence of DNMs is reported to be in the range of 3.1% to 14.4%, and the incidence is 2- to 3-fold higher in transplant recipients than in age- and sex-matched healthy controls. Long-term immunosuppressive therapy, which is the key in maintaining host tolerance and achieving good long-term outcomes, is known to contribute to a higher risk of DNMs. However, the incidence and type of DNM also depends on different risk factors, including patient demographics, cause of the underlying chronic liver disease, behavior (smoking and alcohol abuse), and pre-existing premalignant conditions. The estimated standardized incidence ratio for different DNMs is also variable. The International Liver Transplantation Society-Spanish Society of Liver Transplantation Consensus Conference working group on DNM has summarized and discussed the current available literature on epidemiology, risk factors, management, and survival after DNMs. Recommendations for screening and surveillance for specific tumors, as well as immunosuppression and cancer-specific management in patients with DNM, are summarized.
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4
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Urological Cancers and Kidney Transplantation: a Literature Review. Curr Urol Rep 2021; 22:62. [PMID: 34913107 DOI: 10.1007/s11934-021-01078-2] [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: 09/24/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to provide an overview of epidemiology, risk factors, and treatment of urological malignancies in renal transplant recipients (RTR). RECENT FINDINGS Although optimal immunosuppressive therapy and cancer management in these patients remain controversial, adherence to general guidelines is recommended. Kidney transplantation is recognized as the standard of care for the treatment of end-stage renal disease (ESRD) as it offers prolonged survival and better quality of life. In the last decades, survival of RTRs has increased as a result of improved immunosuppressive therapy; nonetheless, the risk of developing cancer is higher among RTRs compared to the general population. Urological malignancies are the second most common after hematological cancer and often have more aggressive behavior and poor prognosis.
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Abbas M, Pätzel M, Thurn A, Brinkmann OA, Bettendorf O. Incidental occurrence of papillary renal cell carcinoma in the native kidney with autosomal dominant polycystic kidney disease after renal transplantation: A case report. Mol Clin Oncol 2021; 15:223. [PMID: 34548922 PMCID: PMC8447179 DOI: 10.3892/mco.2021.2386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/13/2021] [Indexed: 11/05/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is one of the best-known genetic diseases. Almost half of the patients with ADPKD will develop end-stage renal disease, and the majority of patients are treated with renal transplantation. The current study presents a case that developed papillary renal cell carcinoma (PRCC) in the native right kidney 10 years after renal transplantation. PRCC is a not common malignant tumour entity (18.5% of all cases of renal cell carcinoma) compared with common clear cell renal carcinoma (65-70% of all cases of RCC).
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Affiliation(s)
- Mahmoud Abbas
- Institute of Pathology and Cytology, D-48465 Schüttorf, Germany
| | - Melanie Pätzel
- Urology Department, Bonifatius Hospital, D-49808 Lingen, Germany
| | - Angelika Thurn
- Institute of Pathology and Cytology, D-48465 Schüttorf, Germany
| | | | - Olaf Bettendorf
- Institute of Pathology and Cytology, D-48465 Schüttorf, Germany
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Sultan S, Finn C, Craig-Schapiro R, Aull M, Watkins A, Kapur S, Del Pizzo J. Simultaneous Living Donor Kidney Transplant and Laparoscopic Native Nephrectomy: An Approach to Kidney Transplant Candidates with Suspected Renal-Cell Carcinoma. J Endourol 2020; 35:1001-1005. [PMID: 33238756 DOI: 10.1089/end.2020.0841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Kidney transplant candidates are occasionally found during the pre-transplant evaluation to have a suspicious mass in a native kidney. Further work-up and management of such a mass may delay transplantation for several months, which may create logistic barriers to transplant, particularly if there are timing constraints of the donor. In this study, we report our experience with simultaneous living donor kidney transplant and laparoscopic native nephrectomy, where the indication for nephrectomy was a suspicious lesion. Methods: We performed a retrospective review of patients who underwent simultaneous kidney transplant and native nephrectomy using prospectively collected data. We analyzed relevant patient characteristics, surgical details, pathologic results, and long-term follow-up. Results: We identified 16 patients who underwent simultaneous living donor kidney transplantation and laparoscopic native nephrectomy at our institution between 2013 and 2018. Ten (62.5%) patients were found to have renal-cell carcinoma (RCC) on the final pathology. No patients had recurrent RCC, at a median follow-up of 4 years. Conclusion: For patients who are planning to undergo a living donor kidney transplant and are found to have a small mass that is suspicious for RCC, a simultaneous living donor kidney transplant and laparoscopic native nephrectomy is a possible approach in selected patients.
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Affiliation(s)
- Samuel Sultan
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Caitlin Finn
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Rebecca Craig-Schapiro
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Meredith Aull
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Anthony Watkins
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Sandip Kapur
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Joseph Del Pizzo
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
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Haehn DA, Kahn AE, Parikh KA, Bajalia EM, Ball CT, Thiel DD. Perioperative Outcomes of Laparoscopic Radical Nephrectomy for Renal Mass in Patients on Dialysis or with Renal Transplant in Place Compared to Normal Controls. J Laparoendosc Adv Surg Tech A 2020; 31:189-193. [PMID: 32584655 DOI: 10.1089/lap.2020.0383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: The risk of renal cell carcinoma (RCC) development in the native kidney of patients on dialysis or with a renal transplant is increased compared to the general population. This study examines perioperative outcomes of laparoscopic radical nephrectomy (LN) in dialysis patients or renal transplant patients compared to normal controls. Methods: Four hundred twelve consecutive LN were evaluated (July 2007 to October 2018). Patients were divided into three groups (control, dialysis, and transplant). Perioperative outcomes, including operating room time (OT), postoperative complications, hospital length of stay, and 90-day readmission rates, were evaluated for the three groups. Results: There were 62 patients in the dialysis group, 20 renal transplants, and 330 normal controls. Dialysis patients were younger (median: 58 years versus 67 years; P = .002) and predominantly male (73% versus 59%, P = .047). Dialysis patients compared to controls had shorter total OT (median: 133 versus 149; P = .022), more papillary RCC (27% versus 10%; P < .001), and fewer high grade tumors (73% [8/11] versus 94% [100/106]; P = .038). Renal transplant patients had a higher rate of 90-day readmission (20% versus 6%; P = .034) and more papillary RCC (30% versus 10%; P = .016) compared to controls. Conclusion: LN on dialysis patients does not alter expected perioperative outcomes compared to a large cohort of control LN. LN on renal transplant patients carries a higher 90-day readmission rate than control LN.
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Affiliation(s)
- Daniela A Haehn
- Department of Urology, Mayo Clinic, Jacksonville, Florida, USA
| | - Amanda E Kahn
- Department of Urology, Mayo Clinic, Jacksonville, Florida, USA
| | - Kevin A Parikh
- Department of Urology, Mayo Clinic, Jacksonville, Florida, USA
| | - Essa M Bajalia
- Department of Urology, Mayo Clinic, Jacksonville, Florida, USA
| | - Collen T Ball
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida, USA
| | - David D Thiel
- Department of Urology, Mayo Clinic, Jacksonville, Florida, USA
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Chan EYH, Warady BA. Acquired cystic kidney disease: an under-recognized condition in children with end-stage renal disease. Pediatr Nephrol 2018; 33:41-51. [PMID: 28444445 DOI: 10.1007/s00467-017-3649-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/04/2017] [Accepted: 03/07/2017] [Indexed: 12/27/2022]
Abstract
Acquired cystic kidney disease (ACKD) is a condition that occurs predominantly in patients with end-stage renal disease (ESRD). In contrast to hereditary cystic kidney disease, ACKD is characterized by the presence of multiple small cysts in bilaterally small kidneys. Limited pediatric data suggest a high incidence (21.6-45.8%) of ACKD in children on dialysis, comparable to that in adults, with an increased frequency associated with a longer duration of dialysis. Recent research has shed light on the pathogenesis of ACKD, such as activation of proto-oncogenes. Although most patients with ACKD are asymptomatic, the condition can be complicated by renal cell carcinoma. Routine surveillance should therefore be considered in at-risk populations.
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Affiliation(s)
- Eugene Y H Chan
- Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Bradley A Warady
- Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA.
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Hickman LA, Sawinski D, Guzzo T, Locke JE. Urologic malignancies in kidney transplantation. Am J Transplant 2018; 18:13-22. [PMID: 28985026 DOI: 10.1111/ajt.14533] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 09/22/2017] [Accepted: 09/26/2017] [Indexed: 01/25/2023]
Abstract
With advances in immunosuppression, graft and patient outcomes after kidney transplantation have improved considerably. As a result, long-term complications of transplantation, such as urologic malignancies, have become increasingly important. Kidney transplant recipients, for example, have a 7-fold risk of renal cell carcinoma (RCC) and 3-fold risk of urothelial carcinoma (UC) compared with the general population. While extrapolation of data from the general population suggest that routine cancer screening in transplant recipients would allow for earlier diagnosis and management of these potentially lethal malignancies, currently there is no consensus for posttransplantation RCC or UC screening as supporting data are limited. Further understanding of risk factors, presentation, optimal management of, and screening for urologic malignancies in kidney transplant patients is warranted, and as such, this review will focus on the incidence, surveillance, and treatment of urologic malignancies in kidney transplant recipients.
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Affiliation(s)
- Laura A Hickman
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Deirdre Sawinski
- Department of Medicine, Renal Electrolyte and Hypertension Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Thomas Guzzo
- Department of Urology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jayme E Locke
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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Billis A, Freitas L, Costa L, Barreto I, Asato M, Araujo K, Losada D, Herculiani A, Tabosa G, Zaidan B, Oliveira G, Bastos L, Rocha R. Genitourinary Malignancies in Transplant or Dialysis Patients: The Frequency of Two Newly Described 2016 World Health Organization Histopathologic Types. Transplant Proc 2017; 49:1783-1785. [DOI: 10.1016/j.transproceed.2017.06.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 05/18/2017] [Accepted: 06/01/2017] [Indexed: 11/27/2022]
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Vernadakis S, Karaolanis G, Moris D, Zavvos V, Liapis G, Zavos G. Multiple bilateral oncocytomas of the native kidneys following renal transplantation: report of a rare case and review of the literature. World J Surg Oncol 2013; 11:119. [PMID: 23721502 PMCID: PMC3671224 DOI: 10.1186/1477-7819-11-119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 05/12/2013] [Indexed: 11/10/2022] Open
Abstract
Renal oncocytomas are benign tumors of the kidneys, which are usually diagnosed postoperatively, due to differential diagnostic problems, from a sample of a renal cell carcinoma. The development of a renal oncocytoma in the native kidneys following renal transplantation is a very rare condition and only a few cases have been published in the world literature. In this case report we present a unique case of bilateral multifocal renal oncocytomas of the native kidneys in a female transplant recipient 6 years after renal transplantation. The patient’s postoperative clinical course was uneventful and no local recurrence or distant metastasis has been found so far. The pathology, clinical characteristics, and treatment of renal oncocytomas are also reviewed.
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Affiliation(s)
- Spyridon Vernadakis
- Transplantation Unit, LAIKO General Hospital, Athens, Laiko General Hospital, Medical School of Athens, Athens, Greece.
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Gerth HU, Pohlen M, Thoennissen NH, Suwelack B, Pavenstädt HJ, Störkel S, Abbas M, Spieker T, Thölking G. Two papillary renal cell carcinomas of different origin following renal transplantation (Case report). Oncol Lett 2012; 4:80-82. [PMID: 22807965 DOI: 10.3892/ol.2012.704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 03/14/2012] [Indexed: 01/20/2023] Open
Abstract
Papillary renal cell carcinoma (PRCC) is a rare malignant tumor entity compared to common clear cell renal carcinoma. In the present study, we report a patient who was diagnosed with PRCC twice and successfully treated each time following renal transplantation. The first PRCC was located in the left native kidney two years following transplantation, and the second PRCC was diagnosed in the allograft 13 years following transplantation. The two tumors were completely removed by surgery in stage I of the disease with sufficient conservation of the allograft function. Notably, the tumors had a different origin as indicated by the microsatellite analysis, which reflects the exceptional course of the case. Risk factors for PRCC were identified in our patient. We concluded that high-risk candidates for malignancies in renal transplant recipients should receive shorter ultrasonic screening intervals, which may facilitate early tumor detection and improve outcome rates.
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Affiliation(s)
- Hans-Ulrich Gerth
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, D-48149 Münster
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14
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Russo P. End stage and chronic kidney disease: associations with renal cancer. Front Oncol 2012; 2:28. [PMID: 22649783 PMCID: PMC3355889 DOI: 10.3389/fonc.2012.00028] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Accepted: 03/10/2012] [Indexed: 12/17/2022] Open
Abstract
There is a well known association between end stage renal disease and the development of kidney cancer in the native kidney of patients requiring renal replacement therapy. There is now emerging evidence that lesser degrees of renal insufficiency (chronic kidney disease, CKD) are also associated with an increased likelihood of cancer in general and kidney cancer in particular. Nephropathological changes are commonly observed in the non-tumor bearing portions of kidney resected at the time of partial and radical nephrectomy (RN). In addition, patients with renal cancer are more likely to have CKD at the time of diagnosis and treatment than the general population. The exact mechanism by which renal insufficiency transforms normal kidney cells into tumor cells is not known. Possible mechanisms include uremic immune inhibition or increased exposure to circulating toxins not adequately cleared by the kidneys. Surgeons managing kidney tumors must have an increased awareness of their patient's renal functional status as they plan their resection. Kidney sparing approaches, including partial nephrectomy (PN) or active surveillance in older and morbidly ill patients, can prevent CKD or delay the further decline in renal function which is well documented with RN. Despite emerging evidence that PN provides equivalent local tumor control to RN while at the same time preventing CKD, this operation remains under utilized in the United States and abroad. Increased awareness of the bi directional relationship between kidney function and kidney cancer is essential in the contemporary management of kidney cancer.
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Affiliation(s)
- Paul Russo
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer CenterNew York, NY, USA
- Memorial Sloan Kettering Cancer Center, Weill Medical College, Cornell UniversityNew York, NY, USA
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