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Wen H, Zheng L, Zhang M, Pan X, Wang D, Qian J, Zhang X, Zhou Q, Chen N. A Rare Case of Synchronous Fumarate Hydratase-Deficient Renal Cell Carcinoma and Clear Cell Renal Cell Carcinoma With Fumarate Hydratase and von Hippel-Lindau Gene Mutations: A Clinicopathologic and Molecular Study. Int J Surg Pathol 2024; 32:810-816. [PMID: 37715637 DOI: 10.1177/10668969231195072] [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] [Indexed: 09/18/2023]
Abstract
Fumarate hydratase-deficient renal cell carcinoma (FH-deficient RCC) is a rare and aggressive tumor characterized by pathogenic alterations in the fumarate hydratase (FH) gene. Clear cell renal cell carcinoma (clear cell RCC) is a common renal cell carcinoma (RCC) associated with von Hippel-Lindau (VHL) gene variations. Here, we reported a case of bilateral RCCs. A 60-year-old man was admitted to hospital with a 3.6 cm × 3.3 cm mass in the right kidney and a 2.8 cm × 2.3 cm nodule in the left kidney. Pathologically, the right tumor showed a nested growth pattern of cells with clear cytoplasm and was FH positive and 2-succinylcysteine (2SC) negative. The left tumor demonstrated a high-grade papillary pattern and was FH negative and 2SC positive. Whole-exome sequencing and Sanger sequencing identified a germline FH c.563A > T mutation in both the tumors and an additional somatic VHL c.479_480insA mutation in the right tumor, confirming the diagnosis of clear cell RCC and FH-deficient RCC in the right and left kidneys, respectively. We reported a rare case of synchronous bilateral clear cell RCC (right) and FH-deficient RCC (left) likely driven by somatic VHL mutation and germline FH mutation, respectively.
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Affiliation(s)
- Hui Wen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Linmao Zheng
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Mengxin Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiuyi Pan
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Duohao Wang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinyu Qian
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Xingming Zhang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiao Zhou
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Ni Chen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
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2
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Zhang H, Andreou A, Bhatt R, Whitworth J, Yngvadottir B, Maher ER. Characteristics, aetiology and implications for management of multiple primary renal tumours: a systematic review. Eur J Hum Genet 2024:10.1038/s41431-024-01628-5. [PMID: 38802529 DOI: 10.1038/s41431-024-01628-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/16/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024] Open
Abstract
In a subset of patients with renal tumours, multiple primary lesions may occur. Predisposition to multiple primary renal tumours (MPRT) is a well-recognised feature of some inherited renal cancer syndromes. The diagnosis of MPRT should therefore provoke a thorough assessment for clinical and genetic evidence of disorders associated with predisposition to renal tumourigenesis. To better define the clinical and genetic characteristics of MPRT, a systematic literature review was performed for publications up to 3 April 2024. A total of 7689 patients from 467 articles were identified with MPRT. Compared to all patients with renal cell carcinoma (RCC), patients with MPRT were more likely to be male (71.8% versus 63%) and have an earlier age at diagnosis (<46 years, 32.4% versus 19%). In 61.1% of cases MPRT were synchronous. The proportion of cases with similar histology and the proportion of cases with multiple papillary renal cell carcinoma (RCC) (16.1%) were higher than expected. In total, 14.9% of patients with MPRT had a family history of cancer or were diagnosed with a hereditary RCC associated syndrome with von Hippel-Lindau (VHL) disease being the most common one (69.7%), followed by Birt-Hogg-Dubé (BHD) syndrome (14.2%). Individuals with a known or likely genetic cause were, on average, younger (43.9 years versus 57.1 years). In rare cases intrarenal metastatic RCC can phenocopy MPRT. We review potential genetic causes of MPRT and their implications for management, suggest an approach to genetic testing for individuals presenting with MPRT and considerations in cases in which routine germline genetic testing does not provide a diagnosis.
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Affiliation(s)
- Huairen Zhang
- Department of Medical Genetics, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Avgi Andreou
- Department of Medical Genetics, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Rupesh Bhatt
- Department of Urology, Queen Elizabeth Hospital, Birmingham, B15, UK
| | - James Whitworth
- Department of Medical Genetics, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Bryndis Yngvadottir
- Department of Medical Genetics, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Eamonn R Maher
- Department of Medical Genetics, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK.
- Aston Medical School, College of Health and Life Sciences, Aston University, Birmingham, B4 7ET, UK.
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3
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Musthafa TM, Balagobi B, Weerasinghe N, Munasinghe MADN, Jenil A, Priyatharsan K. A rare case of bilateral synchronous renal cancer, characterized by distinct histologies; leiomyosarcoma and clear cell renal cancer. Int J Surg Case Rep 2023; 111:108879. [PMID: 37776688 PMCID: PMC10556767 DOI: 10.1016/j.ijscr.2023.108879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 09/22/2023] [Accepted: 09/23/2023] [Indexed: 10/02/2023] Open
Abstract
INTRODUCTION Renal cancer is a significant global cause of death and clear cell being the most common subtype. Bilateral synchronous renal cancers with different histologies are extremely rare and less reported. Managing bilateral renal cancer is challenging. CLINICAL PRESENTATION A 51-year-old woman with a history of hypertension and hypothyroidism presented with right loin pain, leading to the discovery of a 7 cm right renal mass and a 2.3 × 2.6 cm mass on the upper pole of the left kidney, associated with reactive right para-aortic lymph nodes. The right kidney mass was identified as leiomyosarcoma with liver metastasis while the left kidney mass was diagnosed as clear cell renal carcinoma. Patient was managed with right side nephrectomy, left side microwave ablation and follow-up chemotherapy. DISCUSSION Primary leiomyosarcoma of kidney is extremely rare and aggressive, leading to poor outcome. Synchronous bilateral renal cancer pose surgical challenges due to potential loss of renal function. In this case of differing histologies in synchronous bilateral renal masses, a nephron-sparing approach was taken, but despite aggressive treatment, the patient developed metastases in the liver and peritoneum. CONCLUSION Bilateral synchronous renal cancer, particularly with differing histologies in each kidney, are exceptionally uncommon, making their management challenging. Despite the limited guidance available due to their rarity, addressing these cases aggressively and promptly is crucial, as their prognosis is generally unfavorable, necessitating further research to advance management strategies.
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Affiliation(s)
- Thaha M Musthafa
- Genitourinary Surgical Unit, District General Hospital, Nuwara Eliya, Sri Lanka.
| | - B Balagobi
- Department of Surgery, Faculty of Medicine, University of Jaffna, Sri Lanka
| | - N Weerasinghe
- Genitourinary Surgical Unit, District General Hospital, Nuwara Eliya, Sri Lanka
| | - M A D N Munasinghe
- Department of Pathology, District General Hospital, Nuwara Eliya, Sri Lanka
| | - Anton Jenil
- Department of Interventional Radiology, Teaching Hospital Jaffna, Sri Lanka
| | - K Priyatharsan
- Department of Surgery, Faculty of Medicine, University of Jaffna, Sri Lanka
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Gallo F, Sforza S, Mari A, Luciani L, Schenone M, Minervini A. Robotic Partial Nephrectomy for Bilateral Renal Masses. Curr Urol Rep 2023; 24:157-163. [PMID: 36538282 DOI: 10.1007/s11934-022-01143-4] [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: 11/22/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW There are very few data on patients undergoing robot-assisted partial nephrectomy (RAPN) for bilateral renal masses. The aim of this review is to update the literature and discuss the controversial points on this topic. RECENT FINDINGS Nine papers have been published regarding RAPN for bilateral renal masses. In particular, five papers were case reports while the remaining four reported patient series. Concerning the outcomes, all these papers highlighted the safety, feasibility, and efficacy of bilateral RAPN for bilateral renal masses. The literature confirmed RAPN as an optimal procedure for the treatment of bilateral renal masses. However, these outcomes mainly derived from selected group of patients who underwent complex surgical procedures by expert robotic surgeons at high volume centers and cannot be generalizable to all categories of patients or centers. The simultaneous bilateral approach resulted feasible showing some advantages and without higher complications than a staged procedure in particular when clampless or selective clamping techniques were performed.
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Affiliation(s)
- Fabrizio Gallo
- Department of Urology, San Paolo Hospital, Savona, Italy.
| | - Simone Sforza
- Department of Urology, Careggi University Hospital, Florence, Italy
| | - Andrea Mari
- Department of Urology, Careggi University Hospital, Florence, Italy
| | | | | | - Andrea Minervini
- Department of Urology, Careggi University Hospital, Florence, Italy
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Surgical Management of Synchronous, Bilateral Renal Masses: A 1-decade Referral Center Experience. Eur Urol Focus 2022; 8:1309-1317. [PMID: 35123928 DOI: 10.1016/j.euf.2022.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/01/2021] [Accepted: 01/14/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Management and decision-making in patients with bilateral renal masses are controversial. OBJECTIVE To report our experience of surgical management in patients with bilateral renal masses undergoing surgery at a high-volume center. DESIGN, SETTING, AND PARTICIPANTS We retrospectively collected data from patients treated with partial nephrectomy (PN) or radical nephrectomy for bilateral renal masses at a single referral institution between June 2008 and June 2019. Patient- and tumor-related features, timing (one vs two stage), and surgical approach (open vs robotic) were analyzed. SURGICAL PROCEDURE A one- versus two-stage strategy was adopted according to the opportunity to perform at least one PN using a clampless or selective-clamping approach, in order to avoid acute kidney injury. MEASUREMENTS Operative time, warm ischemia time, and intra- and postoperative complications were recorded. Histopathological results and tumor histology were assessed. RESULTS AND LIMITATIONS Overall, 41 patients were included. The median age was 67 yr and the median preoperative estimated glomerular filtration rate (eGFR) was 84 ml/min/1.73 m2. The median Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score was 8 (interquartile range [IQR] 7-8) for both sides. In 17 (42%) patients, a simultaneous approach was chosen, with a pure robotic approach in 11/17 cases, while among the 24 (58.6%) patients treated with a two-stage strategy, 15 (62.5%) were treated with a robotic approach on both sides. Intraoperative complications and postoperative major (CDC ≥3) complications were recorded in 7.3% and 4.9% of cases, respectively. The overall positive surgical margins rate was 2.4%. At a median follow-up of 42 (IQR 18-59) mo, the median eGFR was 73 (IQR 64-80) ml/min/1.73 m2, while disease-free survival and cancer-specific mortality were 90.2% and 7.3%, respectively. CONCLUSIONS Our experience underlines that both simultaneous and staged surgical treatment of patients with bilateral renal masses are feasible and safe if grounded on proper patient selection. PATIENT SUMMARY Management of patients with bilateral renal masses is challenging, given the heterogeneity of clinical scenarios and the need to optimize the timing of treatment to achieve maximal functional preservation while ensuring oncological efficacy.
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6
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Yin J, Zheng M. Ipsilateral synchronous papillary and clear renal cell carcinoma: A case report and review of literature. World J Clin Cases 2022; 10:5428-5434. [PMID: 35812682 PMCID: PMC9210906 DOI: 10.12998/wjcc.v10.i16.5428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/12/2021] [Accepted: 04/24/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is limited information on ipsilateral synchronous papillary renal cell carcinoma (PRCC) and clear cell renal cell carcinoma (CCRCC). Therefore, these rare tumors are often misdiagnosed preoperatively as a single tumor with intrarenal metastasis or some other diseases. Effective management and long-term overall survival might be affected because the prognosis of the two tumors differs.
CASE SUMMARY We describe a case of ipsilateral synchronous PRCC and CCRCC with two histological variants in a 72-year-old man, whose mass was found incidentally, with no other chief complaints and vital signs were normal. Initial ultrasound revealed a hypoechoic lobular mass with a volume of 7.8 cm × 4.8 cm × 2.8 cm in the middle to lower pole of the left kidney. A subsequent contrast-enhanced computed tomography scan showed a single endophytic mass of 7.5 cm in diameter. The patient underwent laparoscopic left radical nephrectomy. A final diagnosis of ipsilateral synchronous PRCC and CCRCC was confirmed by pathological examination. There was no recurrence or metastasis after 25 mo follow-up.
CONCLUSION We report a case of ipsilateral synchronous PRCC and CCRCC, and review related literature to estimate the prevalence of similar cases. The above descriptions may be expected to help understand the disease, and improve diagnosis in the future.
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Affiliation(s)
- Jing Yin
- Department of Pathology, The Fifth Central Hospital of Tianjin, Binhai New Area, Tianjin 300450, China
| | - Mo Zheng
- Department of Pathology, The Fifth Central Hospital of Tianjin, Binhai New Area, Tianjin 300450, China
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7
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Gallo F, Sforza S, Luciani L, Mattevi D, Barzaghi P, Mari A, Di Maida F, Antonelli A, Cindolo L, Galfano A, Pini G, Mantica G, Schenone M, Schips L, Annino F, Terrone C, Bocciardi AM, Gaboardi F, Minervini A. Simultaneous robotic partial nephrectomy for bilateral renal masses. World J Urol 2022; 40:1005-1010. [PMID: 34999905 DOI: 10.1007/s00345-021-03919-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/26/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE There is currently no consensus regarding the optimal treatment strategy for patients presenting with synchronous bilateral renal masses. The decision to perform bilateral procedures on the same intervention or in staged procedures is debated. The aim of this manuscript is to analyse the outcomes of simultaneous robot-assisted partial nephrectomy (RAPN) in a series of patients with bilateral renal masses treated at five Italian robotic institutions. METHODS Data from a prospectively maintained multi-institutional database on patients subjected to simultaneous RAPN between November 2011 and July 2019 were reviewed. RAPNs were performed with da Vinci Si or Xi surgical system by expert robotic surgeons. Baseline demographics and clinical features, peri- and post-operative data were collected. RESULTS Overall, 27 patients underwent simultaneous bilateral RAPN, and 54 RAPNs were performed without need of conversion; median operative time was 250 minutes, median estimated blood loss was 200 mL. Renal artery clamping was needed for 27 (50%) RAPNs with a median warm ischemia time of 15 minutes and no case of acute kidney injury. Complications were reported in 7 (25.9%) patients, mainly represented by Clavien 2 events (6 blood transfusions). Positive surgical margins were assessed in 2 (3.7%) of the renal cell carcinoma. At the median follow-up of 30 months, recurrence-free survival was 100%. CONCLUSION Our data showed that, in selected patients and expert hands, simultaneous bilateral RAPNs could be a safe and feasible procedure with promising results for the treatment of bilateral synchronous renal masses.
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Affiliation(s)
- Fabrizio Gallo
- Department of Urology, San Paolo Hospital, Savona, Italy.
| | - Simone Sforza
- Department of Urology, Careggi University Hospital, Florence, Italy
| | | | | | - Paolo Barzaghi
- Department of Urology, Careggi University Hospital, Florence, Italy
| | - Andrea Mari
- Department of Urology, Careggi University Hospital, Florence, Italy
| | | | | | - Luca Cindolo
- Department of Urology, Villa Stuart Private Hospital, Rome, Italy
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Guglielmo Mantica
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | | | - Luigi Schips
- Department of Medical, Oral and Biotechnological Sciences, "SS. Annunziata" Hospital, Urology Unit, University of Chieti, Chieti, Italy
| | - Filippo Annino
- Department of Urology, San Donato Hospital, Arezzo, Italy
| | - Carlo Terrone
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | | | - Franco Gaboardi
- Department of Urology, Ospedale San Raffaele-Turro, Milan, Italy
| | - Andrea Minervini
- Department of Urology, Careggi University Hospital, Florence, Italy
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8
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Truong H, Carlo MI. Hereditary Cancer and Genetics in Renal Cell Carcinoma. Urol Oncol 2022. [DOI: 10.1007/978-3-030-89891-5_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Yu Z, Lu W, Su C, Lv Y, Ye Y, Guo B, Liu D, Yan H, Mi H, Li T, Zhang Q, Cheng J, Mo Z. Single-Cell RNA-seq Identification of the Cellular Molecular Characteristics of Sporadic Bilateral Clear Cell Renal Cell Carcinoma. Front Oncol 2021; 11:659251. [PMID: 34168986 PMCID: PMC8217644 DOI: 10.3389/fonc.2021.659251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/29/2021] [Indexed: 12/20/2022] Open
Abstract
Bilateral renal cell carcinoma (RCC) is a rare disease that can be classified as either familial or sporadic. Studying the cellular molecular characteristics of sporadic bilateral RCC is important to provide guidance for clinical treatment. Cellular molecular characteristics can be expressed at the RNA level, especially at the single-cell degree. Single-cell RNA sequencing (scRNA-seq) was performed on bilateral clear cell RCC (ccRCC). A total of 3,575 and 3,568 high-quality single-cell transcriptome data were captured from the left and right tumour tissues, respectively. Gene characteristics were identified by comparing left and right tumours at the scRNA level. The complex cellular environment of bilateral ccRCC was presented by using scRNA-seq. Single-cell transcriptomic analysis revealed high similarity in gene expression among most of the cell types of bilateral RCCs but significant differences in gene expression among different site tumour cells. Additionally, the potential biological function of different tumour cell types was determined by gene ontology (GO) analysis. The transcriptome characteristics of tumour tissues in different locations at the single-cell transcriptome level were revealed through the scRNA-seq of bilateral sporadic ccRCC. This work provides new insights into the diagnosis and treatment of bilateral RCC.
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Affiliation(s)
- Zhenyuan Yu
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.,Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Institute of Urology and Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Key Laboratory of Colleges and Universities, Nanning, China
| | - Wenhao Lu
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.,Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Institute of Urology and Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Key Laboratory of Colleges and Universities, Nanning, China
| | - Cheng Su
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.,Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Key Laboratory of Colleges and Universities, Nanning, China
| | - Yufang Lv
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.,Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Institute of Urology and Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Key Laboratory of Colleges and Universities, Nanning, China
| | - Yu Ye
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Institute of Urology and Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Key Laboratory of Colleges and Universities, Nanning, China.,Scientific Research Department, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Bingqian Guo
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Key Laboratory of Colleges and Universities, Nanning, China
| | - Deyun Liu
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.,Institute of Urology and Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Haibiao Yan
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.,Institute of Urology and Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hua Mi
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.,Institute of Urology and Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Tianyu Li
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.,Institute of Urology and Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qingyun Zhang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Institute of Urology and Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Key Laboratory of Colleges and Universities, Nanning, China.,Department of Urology, Affiliated Tumour Hospital of Guangxi Medical University, Nanning, China
| | - Jiwen Cheng
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.,Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Institute of Urology and Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Key Laboratory of Colleges and Universities, Nanning, China
| | - Zengnan Mo
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.,Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Institute of Urology and Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.,Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Key Laboratory of Colleges and Universities, Nanning, China
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10
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Foschi N, Ragonese M, Russo P, Nigro D, Di Gianfrancesco L, Sica S, Tinelli G, Thsomba Y, Bassi P. Synchronous Partial Nephrectomy and Renal Artery Aneurysm Repair in Bilateral Renal Cancers: Case Report and Literature Review. Urol Int 2021; 105:525-530. [PMID: 33601386 DOI: 10.1159/000511755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/19/2020] [Indexed: 11/19/2022]
Abstract
The treatment of renal cancer has changed in the last decades with an increase in application of conservative surgery such as partial nephrectomy (PN) in order to achieve an optimal oncological outcome with the maximum preservation of renal function. The indication for PN is mandatory in case of bilateral tumors or in case of impaired renal function. Renal artery (RA) aneurysm (RAA) is a rare occurrence, and its treatment could be radiological or surgical according to the anatomy of the aneurysm and the clinical characteristics of the patients. Here, we report a case of simultaneous ipsilateral occurrence of renal cancer and RAA in a patient with bilateral renal masses, treated with 1 surgical procedure with good functional and oncological outcomes. This rare occurrence must be known by surgeons treating renal cancers, and it is possible to perform the 2 procedures in 1 surgical step.
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Affiliation(s)
- Nazario Foschi
- Unit of Urology, A. Gemelli Hospital, IRCCS - Catholic University of the Sacred Heart, Rome, Italy
| | - Mauro Ragonese
- Unit of Urology, A. Gemelli Hospital, IRCCS - Catholic University of the Sacred Heart, Rome, Italy,
| | - Pierluigi Russo
- Unit of Urology, A. Gemelli Hospital, IRCCS - Catholic University of the Sacred Heart, Rome, Italy
| | - Domenico Nigro
- Unit of Urology, A. Gemelli Hospital, IRCCS - Catholic University of the Sacred Heart, Rome, Italy
| | - Luca Di Gianfrancesco
- Unit of Urology, A. Gemelli Hospital, IRCCS - Catholic University of the Sacred Heart, Rome, Italy
| | - Simona Sica
- Unit of Vascular Surgery, A. Gemelli Hospital, IRCCS - Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Tinelli
- Unit of Vascular Surgery, A. Gemelli Hospital, IRCCS - Catholic University of the Sacred Heart, Rome, Italy
| | - Yamume Thsomba
- Unit of Vascular Surgery, A. Gemelli Hospital, IRCCS - Catholic University of the Sacred Heart, Rome, Italy
| | - PierFrancesco Bassi
- Unit of Urology, A. Gemelli Hospital, IRCCS - Catholic University of the Sacred Heart, Rome, Italy
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11
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Bilateral Single-Stage Nephrectomy for Synchronous Bilateral Renal Cell Carcinoma. J Kidney Cancer VHL 2021; 8:7-11. [PMID: 33564613 PMCID: PMC7842839 DOI: 10.15586/jkcvhl.v8i1.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 01/14/2021] [Indexed: 11/18/2022] Open
Abstract
Bilateral synchronous renal cell carcinoma (RCC) is uncommonly encountered. Debate exists among urologists in managing these cases in a single surgery versus staged surgeries. We aim to report our experience in managing encountered cases using single-stage surgeries. Retrospective collection of cases with pathologically confirmed RCC that had single-stage bilateral renal surgery over the past 2 years. Three cases were identified. Patients were managed using bilateral transverse lateral lumbotomy. All patients did not have intraoperative or postoperative complications. Kidney function stayed stable after surgery. Single-stage bilateral renal surgery is a safe procedure. Bilateral transverse lateral lumbotomy allows for a fast and safe surgery with minimal complications. There is a possible histological dis-concordance in bilateral synchronous RCC.
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12
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Unilateral synchronous papillary renal neoplasm with reverse polarity and clear cell renal cell carcinoma: a case report with KRAS and PIK3CA mutations. Diagn Pathol 2020; 15:123. [PMID: 33023600 PMCID: PMC7539524 DOI: 10.1186/s13000-020-01042-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/30/2020] [Indexed: 12/20/2022] Open
Abstract
Background The presence of histologically different neoplasms in the same organ is rare in pathologic practice. We report the first case of synchronous clear cell renal cell carcinoma (clear cell RCC) and papillary renal neoplasm with reverse polarity (PRNRP) with comprehensive immunohistochemical and molecular characterization using next-generation sequencing (NGS). Case presentation A 61-year-old man was incidentally found to have a left renal mass on imaging studies performed for workup of left back pain and urine color change for 1 week. A laparoscopic left radical nephrectomy was performed. Gross examination showed lobulated masses measuring 5.6 × 4.0 × 3.3 cm in the upper to mid pole and 1.1 × 1.0 × 1.0 cm in the lower pole. Microscopic findings revealed these to be two different separate masses of clear cell renal cell carcinoma and papillary renal neoplasm with reverse polarity. NGS analyses revealed KRAS gene mutation (c.35G > T/p.G12V in exon 2) in the papillary renal neoplasm with reverse polarity, with PIK3CA gene mutation restricted to the clear cell renal cell carcinoma (c.1624G > A/p.E542K in exon 10). Conclusions We report here an extraordinarily rare case of synchronous renal tumors of papillary renal neoplasm with reverse polarity and clear cell renal cell carcinoma. We identified simultaneous KRAS and PIK3CA mutations in two different renal masses in the same kidney for the first time. New pathologic assessment with comparative molecular analysis of mutational profiles may be helpful for tumor studies.
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Musquera M, Sierra A, Diekmann F, Perez M, Mercader C, Peri L, Esforzado N, Paredes D, Alcaraz A. Increasing kidney grafts for transplantation. World J Urol 2020; 39:2795-2800. [PMID: 33000340 DOI: 10.1007/s00345-020-03463-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/18/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The current pool of organs available for transplantation does not cover requirements, for this reason non-standard risk donors need to be incorporated into the pool. In this way, donors with small renal tumour are considered for transplantation after bench tumour excision. The aim of our study was to analyse our experience in using these grafts for transplantation. MATERIALS AND METHODS Retrospective analysis from our prospective accrued database of donors with incidental renal mass used for kidney transplantation between January 2007 and August 2018. RESULTS Twenty kidney transplantations were performed, thirteen cases received the affected kidney (after tumour removal) and seven the contralateral kidney; from six living and eleven deceased donors. Donor and recipient median age was 58 years (range 22-82) and 56.5 years (range 38-74), respectively. Mean tumour diameter was 12.7 mm (SD 9.5). Tumours resulted in two benign lesions and fifteen renal cell carcinoma. Surgical margins were negative. Two cases presented with bleeding after reperfusion was solved without repercussion. One case presented with immediate vein thrombosis. None of them present delayed graft function. After a 69 month follow-up none of the donors or the recipients presented tumour recurrence. CONCLUSIONS Kidneys with small incidental tumours seem to be a good option for kidney transplantation in selected patients after bench surgery excision with good functional and oncologic results. More studies and longer follow-up are needed to confirm these results.
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Affiliation(s)
- Mireia Musquera
- Hospital Clinic de Barcelona, Instituto Clínic de Nefrología y Urología, Urology, Villarroel 170, 08036, Barcelona, Spain.
| | - Alba Sierra
- Hospital Clinic de Barcelona, Instituto Clínic de Nefrología y Urología, Urology, Villarroel 170, 08036, Barcelona, Spain
| | - Fritz Diekmann
- Hospital Clinic de Barcelona, Instituto Clínic de Nefrología y Urología, Nefrology, Villarroel 170, 08036, Barcelona, Spain
| | - Meritxell Perez
- Hospital de Terrassa. Torrebonica, s/n, 08227 Terrassa, Barcelona, Spain
| | | | - Lluis Peri
- Hospital Clinic de Barcelona, Instituto Clínic de Nefrología y Urología, Urology, Villarroel 170, 08036, Barcelona, Spain
| | - Nuria Esforzado
- Hospital Clinic de Barcelona, Instituto Clínic de Nefrología y Urología, Nefrology, Villarroel 170, 08036, Barcelona, Spain
| | - David Paredes
- Hospital Clinic de Barcelona, Coordination Unit, Villarroel 170 Barcelona, 08036, Catalunya, Spain
| | - Antonio Alcaraz
- Hospital Clinic de Barcelona, Instituto Clínic de Nefrología y Urología, Urology, Villarroel 170, 08036, Barcelona, Spain
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Shigehisa R, Karashima T, Kobayashi S, Atagi K, Takemori D, Fukuhara H, Fukata S, Murakami I, Kuroda N, Inoue K. Synchronous bilateral renal cell carcinomas with differing histologies. IJU Case Rep 2020; 3:196-199. [PMID: 32914073 PMCID: PMC7469849 DOI: 10.1002/iju5.12186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/03/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Bilateral renal cell carcinomas with different histological types are rare. We report herein the first description of bilateral renal carcinomas with clear cell renal cell carcinoma and mucinous tubular and spindle cell carcinoma occurring synchronously. CASE PRESENTATION A 62-year-old man was referred to our hospital with bilateral renal tumors. The tumors on each side showed different findings from both contrast-enhanced computed tomography and magnetic resonance imaging. The tumors were partially resected. Histopathological and immunohistochemical examination of the left renal tumor diagnosed clear cell renal carcinoma. Histopathological and immunohistochemical examination of the right renal tumor diagnosed mucinous tubular and spindle cell carcinoma. CONCLUSION We encountered a case with clear cell renal cell carcinoma and mucinous tubular and spindle cell carcinoma occurring simultaneously in bilateral kidneys.
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Affiliation(s)
- Ryu Shigehisa
- Department of UrologyKochi Medical SchoolNankokuJapan
| | | | - Shu Kobayashi
- Department of UrologyKochi Medical SchoolNankokuJapan
| | - Kaya Atagi
- Department of UrologyKochi Medical SchoolNankokuJapan
| | | | | | | | - Ichiro Murakami
- Laboratory of Diagnostic PathologyKochi Medical School HospitalNankokuJapan
| | - Naoto Kuroda
- Department of Diagnostic PathologyKochi Red Cross HospitalKochiJapan
| | - Keiji Inoue
- Department of UrologyKochi Medical SchoolNankokuJapan
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15
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Simultaneous versus staged partial nephrectomies for bilateral synchronous solid renal masses. Urol Oncol 2020; 38:640.e13-640.e22. [PMID: 32402769 DOI: 10.1016/j.urolonc.2020.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 03/31/2020] [Accepted: 04/09/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVES The optimal management approach for synchronous bilateral renal masses is unknown, particularly regarding surgical sequencing of bilateral partial nephrectomy (PN). We evaluated the impact of simultaneous vs. staged bilateral PN on renal functional, perioperative, and oncologic outcomes. PATIENTS AND METHODS We reviewed our institutional nephrectomy registry to identify patients who underwent simultaneous or staged (within 6 months) bilateral PN for nonmetastatic bilateral synchronous solid renal masses between 1980 and 2015. Short-term and long-term renal function changes were assessed at 3 and 12 months, respectively. Perioperative outcomes were pooled across staged surgeries by taking the sum of each outcome. Local recurrence-free, distant metastases-free, cancer-specific, and overall survival were estimated using the Kaplan-Meier method. Outcomes were compared by surgical sequencing approach. A sensitivity analysis was performed that grouped approaches by preoperative intent. RESULTS Among the 107 patients studied, 77 (72%) underwent simultaneous and 30 (28%) underwent staged PN. The majority of PN were performed by open approach. Clinicopathologic features were similar between groups. Patients who underwent simultaneous PN had lower mean short-term (-6% vs. -24%, P = 0.015) and median long-term (-4% vs. -22%, P < 0.001) reduction in eGFR vs. staged PN, respectively. Furthermore, patients with simultaneous PN had lower pooled length of stay (median 6 vs. 8 days, P < 0.001), rate of urine leak (3% vs. 17%, P = 0.018), and rate of high-grade complications (8% vs. 23%, P = 0.044), relative to staged PN, respectively. However, on sensitivity analysis, only differences in long term reduction in estimated glomerular filtration rate and length of stay remained. There were no significant differences in oncologic outcomes between groups. CONCLUSIONS Our results suggest that when technically feasible, simultaneous PN yields comparable outcomes vs. staged PN, offering a reasonable surgical sequencing approach for patients presenting with bilateral synchronous renal masses.
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Rasner PI, Vasilyev AO, Govorov AV, Pushkar DY, Pushkarev AV, Shakurov AV, Tsiganov DI, Zherdev AA. [One-stage cryoablation of two renal tumors]. Khirurgiia (Mosk) 2019:95-100. [PMID: 30789616 DOI: 10.17116/hirurgia201901195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The progressive development of medical technologies allowed the introduction of alternative methods of treatment of localized renal cell carcinoma with a tendency to organ-sparing approach. Cryoablation, radiofrequency ablation, and some experimental methods of treatment (microwave and laser ablation, therapy with high-intensity focused ultrasound) are referred to minimally invasive treatment of renal cell carcinoma. Cryoablation is highly effective alternative method of treatment of renal cell carcinoma. The main advantages of this technique are tumor visualization and formation of 'ice ball' in real time, fewer complications compared with other methods, as well as the possibility of cryotherapy in critically ill patients. Compared to other ablative technologies, cryoablation is followed by low percentage of redo treatment and good intermediate oncological results. We described the experience of one-stage cryoablation of two kidney tumors in this report.
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Affiliation(s)
- P I Rasner
- Department of Urology of the Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A O Vasilyev
- Department of Urology of the Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A V Govorov
- Department of Urology of the Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - D Yu Pushkar
- Department of Urology of the Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A V Pushkarev
- Bauman Moscow State Technical University, Moscow, Russia
| | - A V Shakurov
- Bauman Moscow State Technical University, Moscow, Russia
| | - D I Tsiganov
- Bauman Moscow State Technical University, Moscow, Russia
| | - A A Zherdev
- Bauman Moscow State Technical University, Moscow, Russia
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Aurangabadkar HU, Palle L, Ali Z. Synchronous bilateral renal cell carcinomas in "Asynchrony of metabolism". World J Nucl Med 2019; 18:63-65. [PMID: 30774550 PMCID: PMC6357702 DOI: 10.4103/wjnm.wjnm_5_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Here, we present a case of bilateral synchronous renal cell carcinoma in a 52-year-old male patient, who underwent fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) scan followed by surgical removal of both tumors. On PET scan, left renal mass showed intense FDG uptake while uptake in the right renal mass was minimal. Histopathologically, both tumors were conventional clear cell carcinoma (Fuhrman Grade III). Only the FDG-avid tumor in the left kidney had lymphovascular invasion and necrosis, which are markers of aggressive form of any tumor. FDG PET-CT can act as strong and noninvasive prognostic parameter that could help to identify patients with aggressive disease before treatment.
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Affiliation(s)
| | - Lalitha Palle
- Department of Radiology, Yashoda Hospital, Hyderabad, Telangana, India
| | - Zakir Ali
- Department of Nuclear Medicine and PET/CT, Basavatarakam Indo-American Cancer Hospital, Hyderabad, Telangana, India
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Shuch B, Zhang J. Genetic Predisposition to Renal Cell Carcinoma: Implications for Counseling, Testing, Screening, and Management. J Clin Oncol 2018; 36:JCO2018792523. [PMID: 30372385 DOI: 10.1200/jco.2018.79.2523] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In many individuals with renal cell carcinoma (RCC), a hereditary cause may have contributed to cancer development. Various risk factors can be suggestive of a genetic contribution, including early disease onset, multifocal or bilateral tumors, family history of RCC, and personal/family history of other benign or malignant tumors. Genetic counseling and understanding of the entire family tree are the first steps in evaluation and will determine if the patient should proceed with testing. Methods of testing have changed to next-generation sequencing, which allows multiple genes to be evaluated together. The results of testing have significant implications for the individual and his or her family members. Screening of the kidney and at-risk organs ensues, with most algorithms focused on early diagnosis and intervention to limit morbidity and mortality of disease manifestations. A comprehensive clinical program that can offer multidisciplinary care is useful for several complex cancer syndromes. Management of localized and advanced hereditary kidney cancers may differ from the sporadic forms of RCC. Knowledge of the genetics can have significant management implications and if necessary genetic evaluation can be expedited to allow treatment decisions.
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Affiliation(s)
- Brian Shuch
- Brian Shuch, Yale School of Medicine and Yale Cancer Center, New Haven, CT; and Jin Zhang, RenJi Hospital and Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jin Zhang
- Brian Shuch, Yale School of Medicine and Yale Cancer Center, New Haven, CT; and Jin Zhang, RenJi Hospital and Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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Kiremit MC, Acar Ö, Sağlıcan Y, Esen T. Bilateral renal cell carcinoma with leiomyomatous stroma: A rare entity diagnosed synchronously and treated surgically in a staged fashion. Turk J Urol 2017; 43:566-570. [PMID: 29201528 DOI: 10.5152/tud.2017.68639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/18/2017] [Indexed: 11/22/2022]
Abstract
Renal cell carcinoma (RCC) accounts for approximately 3% of adult malignancies and 90-95% of kidney neoplasms. Renal cell carcinoma with leiomyomatous stroma (RCCLS) is an extremely rare histopathological entity based on available literature data. Herein, we report a 31-year-old male with incidentally detected synchronous bilateral renal masses who was eventually found to harbor RCCLS after being operated sequentially via nephron-sparing surgery.
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Affiliation(s)
| | - Ömer Acar
- Department of Urology, Koç University Hospital, İstanbul, Turkey
| | - Yeşim Sağlıcan
- Department of Pathology, Acıbadem University, İstanbul, Turkey
| | - Tarık Esen
- Department of Urology, Koç University, İstanbul, Turkey
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Qi N, Li T, Ning X, Peng X, Cai L, Gong K. Clinicopathologic Features and Prognosis of Sporadic Bilateral Renal Cell Carcinoma: A Series of 148 Cases. Clin Genitourin Cancer 2017. [PMID: 28648756 DOI: 10.1016/j.clgc.2017.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The purpose of this study was to investigate the clinicopathologic features, treatment, and prognosis of sporadic bilateral renal cell carcinoma (RCC). PATIENTS AND METHODS A total of 148 patients with sporadic bilateral RCC treated in our center from June 1986 to December 2015 were included in this retrospective study. Their clinicopathologic features and treatments were evaluated. The survival and prognostic factors were assessed based on data from follow-up. RESULTS The median age was 54 years (range, 31-78 years). There were 88 patients with synchronous bilateral RCC and 60 with metachronous bilateral RCC. The median interval between bilateral tumors of metachronous bilateral RCC was 75.5 months. There was no significant difference in tumor size, nuclear grade, or T stage between metachronous tumors (P = .385, P = .544, and P = .263, respectively). Of 148 patients, 124 patients underwent bilateral surgery, 16 underwent unilateral surgery, and 8 patients did not undergo surgery. Of the 317 tumors with pathologic results, 297 (93.7%) were clear-cell subtype. A total of 136 (91.9%) patients were followed-up, and the median follow-up period was 77 months (range, 2-398 months). During follow-up, 38 (27.9%) patients died. The 5-year overall survival rate was 85.9%. The median survival time of patients with no surgery was 5 months. Older age (P = .001), bilateral nonoperative treatment (P < .001), higher T stage (P < .001), and multifocality (P = .02) were related to worse prognosis in multivariate analysis. CONCLUSION In metachronous bilateral RCC, the latter occurrence does not bear a significantly worse pathologic biology. The prognosis of sporadic bilateral RCC with no surgery is poor. The overall oncologic results of patients with sporadic bilateral RCC are comparable with that of patients with unilateral RCC.
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Affiliation(s)
- Nienie Qi
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Teng Li
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Xianghui Ning
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Xiang Peng
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Lin Cai
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China.
| | - Kan Gong
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China.
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Nguyen KA, Syed JS, Shuch B. Hereditary Kidney Cancer Syndromes and Surgical Management of the Small Renal Mass. Urol Clin North Am 2017; 44:155-167. [PMID: 28411908 DOI: 10.1016/j.ucl.2016.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The management of patients with hereditary kidney cancers presents unique challenges to clinicians. In addition to an earlier age of onset compared with patients with sporadic kidney cancer, those with hereditary kidney cancer syndromes often present with bilateral and/or multifocal renal tumors and are at risk for multiple de novo lesions. This population of patients may also present with extrarenal manifestations, which adds an additional layer of complexity. Physicians who manage these patients should be familiar with the underlying clinical characteristics of each hereditary kidney cancer syndrome and the suggested surgical approaches and recommendations of genetic testing for at-risk individuals.
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Affiliation(s)
- Kevin A Nguyen
- Department of Urology, Yale School of Medicine, 789 Howard Avenue, New Haven, CT 06520, USA
| | - Jamil S Syed
- Department of Urology, Yale School of Medicine, 789 Howard Avenue, New Haven, CT 06520, USA
| | - Brian Shuch
- Department of Radiology, Yale School of Medicine, PO Box 208058, New Haven, CT 06520-8058, USA; Department of Urology, Yale School of Medicine, PO Box 208058, New Haven, CT 06520-8058, USA.
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Hu XY, Xu L, Guo JM, Wang H. Surgical strategy of bilateral synchronous sporadic renal cell carcinoma-experience of a Chinese university hospital. World J Surg Oncol 2017; 15:53. [PMID: 28245846 PMCID: PMC5331631 DOI: 10.1186/s12957-016-1071-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 12/15/2016] [Indexed: 12/14/2022] Open
Abstract
Background The objective of this study is to investigate the optimal therapeutic protocol for BSSRCC. Methods A total of 32 BSSRCC patients, including 28 males and 4 females, were enrolled the study from January 2004 to May 2016. The diagnoses were defined by the measurements of CT, ultrasound, and MRI. Patients with hereditary syndrome were excluded. The management of surgical manner, operation staging, and sequence were scheduled in accordance with the tumor’s location and size (based on Zhongshan score, ZS score), as well as the performance status of the patients. Among them, 8 cases were conducted with bilateral surgical procedure simultaneously and 24 cases were implemented with staged operations. NSS on the one side with contralateral RN, and NSS on both sides were performed in 17 and 15 patients separately. Results Thirty cases were conducted 56 operations in total. The average operation time was 260 ± 52 min in simultaneous operations and 162 ± 40 min in staged operations. The length of hospital stay in average was 11.5 ± 1.8 and 7.5 ± 1.4 days, respectively. Twenty-eight cases were followed up by 6–138 months. The level of creatinine was elevated in 5 cases without hemodialysis conducted. Conclusions The location and size of the carcinomas, and the performance status of patients should be considered in determination of an appropriate surgical approach. Both renal function preservation and tumor eradication were similarly critical, whereas the latter is of more importance. ZS score may be helpful in the dilemma. Longer follow-up period and more patient enrolment are required.
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Affiliation(s)
- Xiao-Yi Hu
- Department of Urology, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Lei Xu
- Department of Urology, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Jian-Ming Guo
- Department of Urology, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China.
| | - Hang Wang
- Department of Urology, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China.
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Ju X, Li P, Shao P, Lv Q, Wang Z, Qin C, Li J. Retroperitoneal Laparoscopic Nephrectomy Combined with Bench Surgery and Autotransplantation for Renal Cell Carcinoma in the Solitary Kidney or Tumor Involving Bilateral Kidneys: Experience at a Single Center and Technical Considerations. Urol Int 2016; 97:473-479. [DOI: 10.1159/000448594] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 07/19/2016] [Indexed: 11/19/2022]
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Wang B, Gong H, Zhang X, Li H, Ma X, Song E, Gao J, Dong J. Bilateral Synchronous Sporadic Renal Cell Carcinoma: Retroperitoneoscopic Strategies and Intermediate Outcomes of 60 Patients. PLoS One 2016; 11:e0154578. [PMID: 27136191 PMCID: PMC4852891 DOI: 10.1371/journal.pone.0154578] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 04/15/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the presentation, management, pathology, and functional and oncological outcomes of patients undergoing retroperitoneoscopic treatment of bilateral synchronous sporadic RCC at our institution. METHODS We retrospectively evaluated the records of 60 patients with bilateral synchronous sporadic RCC who underwent retroperitoneoscopic treatment at the General Hospital of People's Liberation Army from 2008 to 2014. The estimated glomerular filtration rate was calculated and compared among different surgical procedures. The overall survival and recurrence free survival were assessed based on information from recent follow-up. RESULTS Fifty-six patients underwent bilateral retroperitoneoscopic surgeries in staged procedures, and four patients underwent bilateral retroperitoneoscopic surgeries in simultaneous procedures. Among the former group of patients, 34 underwent bilateral partial nephrectomy, 12 underwent radical nephrectomy followed by partial nephrectomy, and 10 underwent partial nephrectomy followed by radical nephrectomy. Bilateral partial nephrectomy can better preserve renal function (p = 0.040) and the sequence of partial nephrectomy and radical nephrectomy did not affect functional outcomes (p = 0.790). One patient undergoing simultaneous procedures developed acute renal failure and required temporary hemodialysis. At 3 and 5 years, overall survival rates were 93.0% and 89.4%, and recurrence free survival rates were 90.5% and 81.6%. High nuclear grade (p = 0.014) was related to disease recurrence. CONCLUSIONS Staged bilateral partial nephrectomy was efficient in preserving renal function. The survival of patients with bilateral synchronous sporadic renal tumors was similar to that of patients with unilateral nonmetastatic tumors. Nuclear grade was an independent prognostic factor of disease recurrence.
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Affiliation(s)
- Baojun Wang
- Department of Urology, Chinese PLA General Hospital/Chinese PLA Medical Academy, Beijing, P. R. China
| | - Huijie Gong
- Department of Urology, Chinese PLA General Hospital/Chinese PLA Medical Academy, Beijing, P. R. China
| | - Xu Zhang
- Department of Urology, Chinese PLA General Hospital/Chinese PLA Medical Academy, Beijing, P. R. China
- * E-mail:
| | - Hongzhao Li
- Department of Urology, Chinese PLA General Hospital/Chinese PLA Medical Academy, Beijing, P. R. China
| | - Xin Ma
- Department of Urology, Chinese PLA General Hospital/Chinese PLA Medical Academy, Beijing, P. R. China
| | - Erlin Song
- Department of Urology, Chinese PLA General Hospital/Chinese PLA Medical Academy, Beijing, P. R. China
| | - Jiangping Gao
- Department of Urology, Chinese PLA General Hospital/Chinese PLA Medical Academy, Beijing, P. R. China
| | - Jun Dong
- Department of Urology, Chinese PLA General Hospital/Chinese PLA Medical Academy, Beijing, P. R. China
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Abstract
PURPOSE OF REVIEW Despite the controversy surrounding the benefits of nephron-sparing surgery, multiple absolute indications for nephron-sparing surgery still exist, including the classic indications of hereditary and bilateral kidney tumors. RECENT FINDINGS Multiple genetic mutations have been identified which lead to hereditary kidney cancer conditions. These are briefly reviewed because the surgical management of hereditary kidney tumors depends on the genetic and histologic subtypes involved. Clear understanding of these hereditary conditions is crucial for proper surgical management of these tumors. SUMMARY Complex partial nephrectomy for multiple renal tumors, or multiplex partial nephrectomy, requires not only exceptional surgical skills but expertise of numerous nonsurgical methodologies, such as hands-on intraoperative ultrasonography and interpretation of multiple imaging modalities. In addition, multidisciplinary management is crucial for optimal outcomes in patient care. This review evaluates the most advanced surgical techniques and perioperative management required to successfully care for these challenging cases.
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Coexisting papillary and clear renal cell carcinoma in the same kidney. Case Rep Urol 2014; 2014:575181. [PMID: 25180117 PMCID: PMC4142564 DOI: 10.1155/2014/575181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 07/23/2014] [Indexed: 12/26/2022] Open
Abstract
Renal cell carcinoma (RCC) is the most common solid lesion of the kidney. Bilateral synchronous benign and malignant renal tumors have been defined in some reports. However, unilateral concordance of malignant renal tumors is very rare and there are only a few cases that had synchronous different subtypes of malignant renal tumors arising within the same kidney. Herein, we describe a 67-year-old male patient who had clear cell RCC and papillary RCC in his right kidney that were successfully treated with radical nephrectomy. We also reviewed the pertinent literature.
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Karthikeyan VS, Dorairajan LN, Kumar S, Vijayakumar AR, Ramesh A, Ganesh Rajesh N, Halanaik D, Gupta S. Sporadic bilateral synchronous multicentric papillary renal cell carcinoma masquerading as bilateral multifocal pyelonephritis. Ann R Coll Surg Engl 2014; 96:e7-10. [PMID: 24992402 DOI: 10.1308/003588414x13814021679113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Pyelonephritis is defined as an inflammation of the kidney and renal pelvis. The diagnosis is usually clinical. Acute multifocal bacterial nephritis is a rare form of pyelonephritis that is more severe and sepsis is more common. We report a patient who presented with fever and right-sided abdominal pain associated with right flank tenderness, suggesting right acute pyelonephritis. Bilateral multifocal pyelonephritis was diagnosed on ultrasonography, radionuclide renal scintigraphy and computed tomography. However, owing to non-resolution of symptoms, a biopsy was performed, which showed bilateral papillary renal cell carcinoma (PRCC). PRCC is known to exhibit multicentricity. To our knowledge, a case of bilateral multicentric PRCC masquerading as bilateral multifocal pyelonephritis has not been reported in the English literature. This case highlights the need to be vigilant while treating patients with focal lesions of the kidney as an inflammatory condition lest a malignancy should be missed.
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Affiliation(s)
- V S Karthikeyan
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Oshiro Y, Hida AI, Tamiya S, Toyoshima S, Kuroda N, Hes O, Michal M. Bilateral atrophic kidney-like tumors. Pathol Int 2014; 64:478-80. [DOI: 10.1111/pin.12193] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Yumi Oshiro
- Department of Pathology; Matsuyama Red Cross Hospital; Matsuyama Japan
| | - Akira I Hida
- Department of Pathology; Matsuyama Red Cross Hospital; Matsuyama Japan
| | - Sadafumi Tamiya
- Department of Clinical Laboratory; Kitakyushu Municipal Medical Center; Kitakyushu Japan
| | | | - Naoto Kuroda
- Department of Diagnostic Pathology; Kochi Red Cross Hospital; Kochi Japan
| | - Ondrej Hes
- Department of Pathology; Faculty of Medicine in Pilsen; Charles University in Prague; Pilsen Czech Republic
| | - Michal Michal
- Department of Pathology; Faculty of Medicine in Pilsen; Charles University in Prague; Pilsen Czech Republic
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Singer EA, Vourganti S, Lin K, Gupta GN, Pinto PA, Rastinehad AR, Linehan WM, Bratslavsky G. Outcomes of patients with surgically treated bilateral renal masses and a minimum of 10 years of followup. J Urol 2012; 188:2084-8. [PMID: 23083858 PMCID: PMC3810017 DOI: 10.1016/j.juro.2012.08.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Indexed: 12/15/2022]
Abstract
PURPOSE Nephron sparing surgery has been advocated for patients with bilateral renal masses but long-term functional and oncological outcomes are lacking. We report the outcomes of patients with bilateral renal masses and a minimum 10-year followup. MATERIALS AND METHODS Patients with bilateral renal masses evaluated at our institution who were treated with initial surgery at least 10 years ago and underwent interventions on each renal unit were included in the analysis. Collected data included demographics, hereditary diagnosis, number of renal interventions, renal function and mortality status. Overall and renal cell carcinoma specific survival was assessed. Comparisons were made of renal function and overall survival between groups with 2 renal units and a surgically solitary kidney. RESULTS A total of 128 patients met study inclusion criteria. Median followup in our cohort was 16 years (mean 17, range 10 to 49). The median number of surgical interventions was 3 (range 2 to 10). Of the patients 87 (68%) required repeat interventions on the ipsilateral renal unit at last followup with a median of 6.2 years (range 0.7 to 21) between interventions. Overall and renal cell cancer specific survival was 88% and 97%, respectively. Six patients (4.7%) ultimately underwent bilateral nephrectomy. Although renal function was better preserved in patients with 2 kidneys (70 vs 53 ml/minute/1.73 m(2), p = 0.0002), there was no difference in overall survival between those with bilateral kidneys or a surgically solitary kidney. CONCLUSIONS At a minimum 10-year followup after initial surgery, nephron sparing surgery allowed for excellent oncological and functional outcomes. Despite the need for repeat surgical interventions, nephron sparing surgery enabled dialysis to be avoided in more than 95% of patients.
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Affiliation(s)
- Eric A. Singer
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Srinivas Vourganti
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kelly Lin
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Gopal N. Gupta
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter A. Pinto
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ardeshir R. Rastinehad
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - W. Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Gennady Bratslavsky
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Department of Urology, Upstate Medical University, Syracuse, NY
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Sorbellini M, Bratslavsky G. Decreasing the indications for radical nephrectomy: a study of multifocal renal cell carcinoma. Front Oncol 2012; 2:84. [PMID: 22888474 PMCID: PMC3412268 DOI: 10.3389/fonc.2012.00084] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 07/16/2012] [Indexed: 12/11/2022] Open
Abstract
Multifocal renal cell carcinoma (RCC) has been reported in 5-25% of cases worldwide. Although management of patients with multifocal RCC has not been clearly defined, presence of multifocal renal masses in one kidney and a normal contralateral kidney has often been considered a reason for performing radical nephrectomy. This study reviews the world literature to provide an accurate estimate of the prevalence of multifocal RCC and evaluates the oncologic outcomes of multifocal RCC after exclusion of patients with known hereditary and familial renal syndromes. A PubMed search of the literature was performed for articles in the English language using the following terms for the query: "multifocal RCC," "multifocality and RCC," "multicentric RCC," or "bilateral RCC." The references of the published articles were also reviewed for additional publications. Articles that did not specifically exclude patients with familial RCC or known hereditary RCC syndromes were excluded for estimation of multifocality prevalence and oncologic outcomes. After applying our exclusion criteria, nine articles were selected and form the basis of the current analysis. Weighted averages were used to calculate the prevalence of multifocality. Multifocal RCC was found in 6.8% of cases (373 of 5433 patients). Ipsilateral multifocality was found in 6.8% of cases. Bilateral multifocality was found in 11.7% of cases. Of all cases reported in this study, only 10% underwent partial nephrectomy. The rest of the study cohort underwent radical nephrectomy. The review of the literature showed that the use of nephron-sparing techniques in patients with multifocal disease did not compromise oncologic outcomes, despite the need for reoperation in certain cases. In conclusion, multifocal RCC remains a prevalent entity. Most clinicians still prefer to perform radical nephrectomies in these patients despite proven equivalent oncologic outcomes compared to nephron-sparing techniques. Urologists should be aware of these data when proposing treatment options to patients with multifocal RCC.
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Shuch B, Singer EA, Bratslavsky G. The Surgical Approach to Multifocal Renal Cancers: Hereditary Syndromes, Ipsilateral Multifocality, and Bilateral Tumors. Urol Clin North Am 2012; 39:133-48, v. [DOI: 10.1016/j.ucl.2012.01.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Siracusano S, Novara G, Antonelli A, Artibani W, Bertini R, Carini M, Carmignani G, Ciciliato S, Cunico SC, Lampropoulou N, Longo N, Martorana G, Minervini A, Mirone V, Simeone C, Simonato A, Valotto C, Zattoni F, Ficarra V. Prognostic role of tumour multifocality in renal cell carcinoma. BJU Int 2012; 110:E443-8. [DOI: 10.1111/j.1464-410x.2012.11121.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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34
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Zhang S, Zhao X, Ji C, Liu G, Li X, Zhang G, Gan W, Guo H. Radiofrequency ablation of synchronous bilateral renal cell carcinoma. Int J Urol 2011; 19:241-7. [DOI: 10.1111/j.1442-2042.2011.02918.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hillyer SP, Autorino R, Laydner H, Yang B, Altunrende F, White M, Spana G, Khanna R, Isac W, Hernandez AV, Simmons M, Stein R, Haber GP, Kaouk J. Robotic Versus Laparoscopic Partial Nephrectomy for Bilateral Synchronous Kidney Tumors: Single-institution Comparative Analysis. Urology 2011; 78:808-12. [DOI: 10.1016/j.urology.2011.06.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 06/02/2011] [Accepted: 06/02/2011] [Indexed: 01/20/2023]
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Patel AR, Lee BH, Campbell SC, Zhou M, Fergany AF. Bilateral synchronous sporadic renal tumors: pathologic concordance and clinical implications. Urology 2011; 78:1095-9. [PMID: 21937095 DOI: 10.1016/j.urology.2011.06.051] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 05/09/2011] [Accepted: 06/04/2011] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the pathologic concordance rates in patients with bilateral synchronous sporadic renal tumors (BSSRT) and to determine factors predictive of concordance. METHODS A retrospective chart review from 1985 to 2008 was completed with search criteria of all patients diagnosed with bilateral renal tumors. We included patients who had image-documented BSSRT or via reported history. We excluded patients with bilateral metachronous renal tumors, cystic renal masses, familial renal cell carcinoma (RCC) syndromes, urothelial cell carcinomas, and other variant histology. Univariate and multivariate analysis were conducted to assess for factors predictive of concordance. RESULTS We identified 297 patients eligible for analysis. RCC concordance was exhibited in 222 of 249 (89%) of patients. Benign tumor concordance, specifically oncocytoma, was found in 41 of 59 (71%) of patients. Factors such as age, gender, and tumor size on imaging did not have an association with concordance rates for bilateral RCC or bilateral oncocytoma. On multivariate analysis, multifocal tumors were associated with benign concordance (OR = 6.9, 95% CI = 1.6-29.2, P = .009). CONCLUSION Malignant and benign concordance rates are high for patients with BSSRT. Given the high concordance of RCC, the data support a management approach consisting of bilateral nephron-sparing surgery whenever possible. However, given the high concordance rate of oncocytoma in this population as well, less aggressive management (renal mass biopsy and surveillance) of the contralateral kidney may be considered after histologic confirmation of one side.
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Affiliation(s)
- Amit R Patel
- Section of Urology, University of Chicago Medical Center, Chicago, Illinois, USA
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Takagi T, Kondo T, Izuka J, Kobayashi H, Tomita E, Hashimoto Y, Tanabe K. Prognosis and characteristics of renal cell carcinoma in hemodialysis patients: bilateral occurrence does not influence cancer-specific survival. Int J Urol 2011; 18:806-12. [PMID: 21917022 DOI: 10.1111/j.1442-2042.2011.02852.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To compare characteristics and prognosis unilateral and bilateral renal cell carcinoma (RCC) in hemodialysis (HD) patients. METHODS Overall 246 HD patients who had undergone a radical nephrectomy for RCC were enrolled in this study. Unilateral RCC occurred in 201 patients, synchronous bilateral RCC in 15 and metachronous bilateral RCC in 30. Cancer-specific survival (CSS) was accessed by the Kaplan-Meier method. RESULTS Five-year CSS was not significantly different between the two groups (unilateral, 90%; bilateral, 90%; P=0.9509). In total 17 of the 201 patients (8.5%) with unilateral occurrence and four of the 45 patients (8.9%) with bilateral occurrence died from kidney cancer during the follow-up period. The presence of acquired cystic disease of kidney (unilateral, 73%; bilateral 91%; P=0.00319) and the mean duration of HD before surgery (unilateral: 157±91 months, bilateral: 189±83.5, P = 0.0319) were significantly different between the two groups. There were more multifocal tumors in bilateral than in unilateral occurrence (bilateral: 74%, unilateral: 30%, P<0.0001). There were significant differences in CSS according to HD duration before surgery (5-year CSS >180 months 82%, ≤180 months 95%; P=0.0004), tumor grade (G1 100%, G2 90%, G3 38%; P<0.0001), and tumor size (>4 cm 75%, ≤4 cm 98%; P<0.0001). CONCLUSIONS The type of occurrence of RCC, unilateral or bilateral, in HD patients does not appear to influence CSS. Patients with a longer duration of HD have to be followed up rigorously because they tend to have poor cancer prognosis.
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Affiliation(s)
- Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
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The current role of lymph node dissection in the management of renal cell carcinoma. Int J Surg Oncol 2011; 2011:816926. [PMID: 22312526 PMCID: PMC3263665 DOI: 10.1155/2011/816926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 04/03/2011] [Indexed: 12/13/2022] Open
Abstract
The role of lymph node dissection remains controversial in the surgical management of renal cell carcinoma. Incidental renal masses are being diagnosed at increasing rates due to the routine use of CT scans. Despite the increase in incidental diagnosis of renal masses, 20% to 30% of patients present with metastatic disease. Currently, surgeons do not routinely perform lymph node dissection unless there is gross evidence of lymphadenopathy, as patients without clinical evidence of lymphadenopathy rarely have positive nodes at the time of surgery. Patients with metastatic disease to the regional lymph nodes have a poor overall prognosis. However, some evidence supports a therapeutic benefit of lymphadenectomy in these patients. Further, the staging information gained from diagnosing lymph node involvement may allow for the use of new agents to treat metastatic disease and effect outcomes.
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Heintz J, Berkowitz J, Sausville J, Phelan M. Combined nephron-sparing techniques for the management of bilateral synchronous renal masses. Urology 2011; 77:772-4. [PMID: 21333329 DOI: 10.1016/j.urology.2010.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 10/08/2010] [Accepted: 12/06/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Jay Heintz
- Division of Urology, University of Maryland Medical School, Baltimore, Maryland, USA
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Abstract
Patients with bilateral multifocal renal cell carcinoma are at increased risk of developing locally recurrent or de novo tumors after nephron-sparing procedures. When dealing with recurrent renal masses the options are limited to observation, total nephrectomy, ablation, or repeat surgical intervention. The main reason for recurrence after nephron-sparing surgery is likely to be the presence of multifocal disease, which is identified in 4.3-25.0% of radical nephrectomy specimen. Bilateral renal involvement is seen in almost 90% of cases of multifocal renal carcinoma, and conversely the majority of patients with bilateral disease will have multifocal tumors. Many patients who are treated for multifocal disease, therefore, require subsequent surgical interventions. The outcome data for repeat renal interventions demonstrate reasonable functional and oncologic outcomes despite higher rates of perioperative complications. Our own results support the use of reoperative renal surgery rather than total nephrectomy and renal replacement therapy.
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Bernhard JC, Pantuck AJ, Wallerand H, Crepel M, Ferrière JM, Bellec L, Maurice-Tison S, Robert G, Albouy B, Pasticier G, Soulie M, Lopes D, Lacroix B, Bensalah K, Pfister C, Thuret R, Tostain J, De La Taille A, Salomon L, Abbou C, Colombel M, Belldegrun AS, Patard JJ. Predictive Factors for Ipsilateral Recurrence After Nephron-sparing Surgery in Renal Cell Carcinoma. Eur Urol 2010; 57:1080-6. [DOI: 10.1016/j.eururo.2010.02.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Accepted: 02/10/2010] [Indexed: 12/22/2022]
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Henry N, Rouach Y, Nguyen K, Verkarre V, Mejean A, Timsit MO. Particularités pronostiques, histopathologiques, génétiques et thérapeutiques du carcinome à cellules rénales tubulopapillaire. Prog Urol 2010; 20:393-401. [DOI: 10.1016/j.purol.2010.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 01/10/2010] [Accepted: 02/05/2010] [Indexed: 01/20/2023]
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Amano H, Kondo T, Hashimoto Y, Kobayashi H, Iizuka J, Shimada K, Nakazawa H, Ito F, Tanabe K. Contralateral metachronous tumor occurrence is more frequently associated with distant metastases or postoperative intrarenal recurrence in renal cell carcinoma patients. Int J Urol 2010; 17:615-22. [DOI: 10.1111/j.1442-2042.2010.02541.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Bigot P, Bernhard JC, Crepel M, Bensalah K, Azzouzi AR, de la Taille A, Salomon L, Tostain J, Ficarra V, Pantuck AJ, Belldegrun AS, Méjean A, Ferrière JM, Pfister C, Albouy B, Colombel M, Zini L, Villers A, Montorsi F, Shariat S, Rioux-Leclercq N, Patard JJ. [How radical nephrectomy compares to partial nephrectomy for the treatment of pT1a papillary renal cell carcinomas?]. Prog Urol 2010; 20:350-5. [PMID: 20471579 DOI: 10.1016/j.purol.2010.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 12/22/2009] [Accepted: 01/19/2010] [Indexed: 01/20/2023]
Abstract
PURPOSE Our objective was to compare oncologic results of nephron sparing surgery (NSS) versus radical nephrectomy (RN) in T1aN0-x M0 papillary renal cell carcinoma (PRCC). PATIENTS AND METHODS We retrospectively reviewed 277 patients treated for a pT1aN0M0 PRCC selected from an academic database from 12 centres. We compared the clinico-pathological features by using Chi-square and Student statistical analyses. Survivals analyses using Kaplan-Meier and Log-rank models were performed. RESULTS The two groups were composed by 186 patients treated by NSS and 91 by RN. The TNM stage was fixed and the two groups were, in terms of age and Fuhrman grade, comparable. Median age at diagnosis was 59 years (27-85). Median tumor size was 2.7 cm (0.4-4). The average follow-up was 49 months (1-246). Very few events arose in both groups: two local recurrences were observed in the NSS group (1.07%), three patients died of cancer in the NSS treated group (1.6%) and five in the RN treated group (5.5%). The five and 10 cancer-specific survival rate were comparable in the two groups (98% vs. 100% and 98% vs. 97%). The specific survival curves were perfectly similar for both groups (log rank test, p=0.25). CONCLUSION NSS is equivalent to RN as far as oncologic control of pT1aN0M0 PRCC is concerned.
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Affiliation(s)
- P Bigot
- UMR 60-61 CNRS, service d'urologie, CHU de Rennes, université Rennes 1, 2 rue Henri-Le-Guilloux, Rennes, France
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Haferkamp A, Kurosch M, Pritsch M, Hatiboglu G, Macher-Goeppinger S, Pfitzenmaier J, Pahernik S, Wagener N, Hohenfellner M. Prognostic Factors Influencing Long-Term Survival of Patients Undergoing Nephron-Sparing Surgery for Nonmetastatic Renal-Cell Carcinoma (RCC) with Imperative Indications. Ann Surg Oncol 2009; 17:544-51. [DOI: 10.1245/s10434-009-0812-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Indexed: 11/18/2022]
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Lowrance WT, Yee DS, Maschino AC, Cronin AM, Bernstein M, Thompson RH, Russo P. Developments in the surgical management of sporadic synchronous bilateral renal tumours. BJU Int 2009; 105:1093-7. [PMID: 19751262 DOI: 10.1111/j.1464-410x.2009.08844.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine our experience with managing sporadic bilateral renal masses, focusing on trends in surgical management over time, because as loss of renal function is associated with adverse cardiovascular outcomes, nephron-sparing approaches are increasingly emphasized in the treatment of kidney tumours, creating new challenges for the treatment of bilateral tumours. PATIENTS AND METHODS We identified all patients who underwent partial or radical nephrectomy (PN or RN) at Memorial Sloan-Kettering Cancer Center (MSKCC) during 1989-2008. We compared patients presenting with synchronous bilateral renal masses with those with unilateral tumour and evaluated trends in management using logistic regression. RESULTS Of the 2777 patients studied, 73 (3%) presented with synchronous bilateral disease. The overall survival and clinical/pathological features between groups were similar. Of those patients receiving bilateral operations for synchronous tumours, three had bilateral RN (all before 2003), 28 (38%) had an RN followed by a PN, 10 (14%) had a PN then an RN, and 32 (44%) had bilateral PN. Over time, the proportion of patients receiving bilateral PN increased (P < 0.001); 13 of 14 patients after 2005 had bilateral PN, compared with only 34% (16 of 45) between 1995 and 2004. Forty-five patients (62%) had the larger tumour removed during the first operation. The concordance rate between tumours in a specific histological subtype was 70% (51/73), and concordance for benign vs malignant disease was 90% (66/73). CONCLUSION The use of PN in the management of synchronous bilateral renal masses has increased over time. The contemporary treatment of synchronous bilateral renal masses at MSKCC involves staged PN when feasible, with the more involved kidney (often larger tumour) operated on first.
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Affiliation(s)
- William T Lowrance
- Department of Surgery - Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Boris R, Proano M, Linehan WM, Pinto PA, Bratslavsky G. Initial experience with robot assisted partial nephrectomy for multiple renal masses. J Urol 2009; 182:1280-6. [PMID: 19683275 DOI: 10.1016/j.juro.2009.06.036] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Indexed: 01/20/2023]
Abstract
PURPOSE We evaluated the feasibility of performing robot assisted partial nephrectomy in patients with multiple renal masses and examined the results of our initial experiences. MATERIALS AND METHODS We reviewed the records of 10 patients with multiple renal masses who underwent attempted robot assisted partial nephrectomy within the last 2 years. Demographic information, and intraoperative, perioperative and renal function outcome data on these patients were reviewed. RESULTS A total of 24 tumors in 9 patients were removed with robot assistance. There was 1 open conversion with successful completion of partial nephrectomy. Of the patients 70% had a known hereditary renal cancer syndrome and the remainder had multifocal disease with unknown germline genetic alterations. Frozen section from the tumor bed evaluated in 5 of 10 cases was negative. One patient experienced urinary leak postoperatively, which resolved by postoperative day 9 without intervention. Of the 24 robotically resected masses 22 were malignant. Our most recent 3 patients underwent successful partial nephrectomy without hilar clamping, obviating the need for warm ischemia. Overall renal function was unchanged at most recent followup with a minimal decrease in operated kidney differential function. CONCLUSIONS Robot assisted partial nephrectomy for multiple renal masses was feasible in our early experience. Patient selection is paramount for successful minimally invasive surgery. Robot assisted partial nephrectomy without hilar clamping, especially in the hereditary patient population in which repeat ipsilateral partial nephrectomy may be anticipated, appears promising but requires further evaluation.
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Affiliation(s)
- Ronald Boris
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892-1107, USA
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Capitanio U, Jeldres C, Patard JJ, Perrotte P, Zini L, de La Taille A, Ficarra V, Cindolo L, Bensalah K, Artibani W, Tostain J, Valeri A, Zigeuner R, Méjean A, Descotes JL, Lechevallier E, Mulders PF, Lang H, Jacqmin D, Karakiewicz PI. Stage-specific effect of nodal metastases on survival in patients with non-metastatic renal cell carcinoma. BJU Int 2008; 103:33-7. [PMID: 18990161 DOI: 10.1111/j.1464-410x.2008.08014.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To quantify the survival disadvantage related to the presence of exclusive nodal metastases (eNM) in patients with otherwise non-metastatic (M0) renal cell carcinoma (RCC). PATIENTS AND METHODS Data were retrieved from 12 institutional databases and yielded 3507 patients with T1-3N1-2M0 RCC treated with partial or radical nephrectomy. Cox regression analyses relied on T stage, Fuhrman grade and presence of eNM. Data were analysed using univariable, multivariable and stratified analyses. RESULTS Overall 165 (4.7%) patients had eNM; of 2023 patients of stage T1, 23 (1.1%) had eNM, vs 20 of 448 (4.5%) for T2 and 122 of 993 (12.3%) for T3. In univariable analyses the presence of eNM increased the rate of cancer specific mortality (CSM) by 7.1 times. After adjusting for T stage and Fuhrman grade, in all patients eNM increased the rate of CSM by 3.2 times. In stratified analyses adjusted for Fuhrman grade, the increase in CSM related to the presence of eNM was 28.9, 4.3 and 2.5 times (all P < 0.001) for stages T1, T2 and T3, respectively. CONCLUSIONS From the prognostic perspective, staging lymphadenectomy appears of most value in patients with T1-2 RCC, but the low prevalence of eNM questions the practical applicability of nodal staging in those patients. Conversely, in patients with T3 RCC, the prevalence and the prognostic impact of eNM might make a staging lymphadenectomy worthwhile.
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Affiliation(s)
- Umberto Capitanio
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
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Patard JJ. Editorial comment on: The impact of temporal presentation on clinical and pathological outcomes for patients with sporadic bilateral renal masses. Eur Urol 2008; 54:864. [PMID: 18487008 DOI: 10.1016/j.eururo.2008.04.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Becker F, Siemer S, Tzavaras A, Suttmann H, Stoeckle M. Long-term survival in bilateral renal cell carcinoma: a retrospective single-institutional analysis of 101 patients after surgical treatment. Urology 2008; 72:349-53. [PMID: 18485459 DOI: 10.1016/j.urology.2008.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Revised: 03/26/2008] [Accepted: 04/01/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Bilateral renal cell carcinomas (bRCC) account for <4% of all renal tumors. We report on the management, histopathologic results, and long-term follow-up of 101 patients with bRCC. METHODS A total of 101 patients with bRCC who had undergone surgery from 1975 to 2005 at our institution were identified from our kidney tumor database and included in this retrospective analysis. Cancer-specific survival was assessed using the Kaplan-Meier method. Subgroups were compared using the log-rank test. Statistical analysis was performed with the Statistical Package for Social Sciences for Windows. RESULTS Of 3097 kidney tumor patients, 101 (3.3%) had bRCC on final histopathologic examination. Synchronous tumors were found in 43 patients (42.6%) and metachronous tumors in 58 (57.4%). The cancer-specific survival rate of the entire cohort was 91.9%, 79.1%, and 56.7% after 5, 10, and 20 years, respectively. The survival of patients with synchronous or metachronous bRCCs did not differ significantly. Patients with metachronous bRCC were significantly younger at first diagnosis than those with synchronous bRCCs (median age 53.6 vs 58.7 years, P < .05). The histopathologic results revealed significantly greater rates of papillary bRCCs in synchronous tumors (P < .05). CONCLUSIONS Standardized techniques of nephron-sparing surgery can achieve excellent survival rates in bRCC. Among other arguments for nephron-sparing surgery, kidney-preserving strategies are of particular importance in younger patients with unilateral RCC against the background of an increasing risk of developing a contralateral neoplasm with older age.
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Affiliation(s)
- Frank Becker
- Department of Urology, University of Saarland, Homburg, Germany.
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