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Park HK. The Metastasis Pattern of Renal Cell Carcinoma Is Influenced by Histologic Subtype, Grade, and Sarcomatoid Differentiation. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1845. [PMID: 37893563 PMCID: PMC10608745 DOI: 10.3390/medicina59101845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Metastasis is a major cause of death in renal cell carcinoma (RCC) patients; therefore, a better understanding of the metastatic process and the ability to predict metastasis in advance is important for treating patients with RCC. This study aimed to investigate whether histological subtypes of RCC and other factors, such as nuclear grade and sarcomatoid differentiation, could predict the probability and location of metastases in patients with RCC. Materials and Methods: Cases of clear-cell, papillary, chromophobe, and sarcomatoid RCC were retrieved and analyzed from the Surveillance, Epidemiology, and End Results databases. Results: When comparing the metastatic patterns among the three histologic subtypes, patients with clear-cell RCC were significantly more likely to have brain and lung metastases. Moreover, patients with papillary RCC were significantly less likely to develop bone metastases and more likely to develop lymph node metastases. Patients with chromophobe RCC are significantly more likely to develop liver metastases. As the nuclear grade increased, there was also a significantly increased tendency for clear-cell RCC to metastasize to the lungs. Patients with sarcomatoid RCC had a higher rate of metastasis, with a significantly higher probability of metastasis to the bone and lungs, than those with all three histological subtypes did. Conclusions: Histological subtype, nuclear grade, and sarcomatoid differentiation were significant predictors of metastasis in patients with RCC.
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Affiliation(s)
- Hyung Kyu Park
- Department of Pathology, Chungnam National University School of Medicine, Daejeon 35015, Republic of Korea
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2
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Monjaras-Avila CU, Lorenzo-Leal AC, Luque-Badillo AC, D'Costa N, Chavez-Muñoz C, Bach H. The Tumor Immune Microenvironment in Clear Cell Renal Cell Carcinoma. Int J Mol Sci 2023; 24:ijms24097946. [PMID: 37175653 PMCID: PMC10178526 DOI: 10.3390/ijms24097946] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/15/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Clear cell renal cell carcinoma (ccRCC) is a type of kidney cancer that arises from the cells lining the tubes of the kidney. The tumor immune microenvironment (TIME) of ccRCC is a complex interplay of various immune cells, cytokines, and signaling pathways. One of the critical features of the ccRCC TIME is the presence of infiltrating immune cells, including T cells, B cells, natural killer cells, dendritic cells, and myeloid-derived suppressor cells. Among these cells, CD8+ T cells are particularly important in controlling tumor growth by recognizing and killing cancer cells. However, the TIME of ccRCC is also characterized by an immunosuppressive environment that hinders the function of immune cells. Several mechanisms contribute to the immunosuppressive nature of the ccRCC TIME. For instance, ccRCC cells produce cytokines such as interleukin-10 (IL-10) and transforming growth factor-beta (TGF-β), which suppress immune cell activation and promote the differentiation of regulatory T cells (Tregs). Tregs, in turn, dampen the activity of effector T cells and promote tumor growth. In addition, ccRCC cells can express programmed death-ligand 1 (PD-L1), which interacts with the programmed cell death protein 1 (PD-1) receptor on T cells to inhibit their function. In addition, other immune checkpoint proteins, such as cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and lymphocyte activation gene 3 (LAG-3), also contribute to the immunosuppressive milieu of the ccRCC TIME. Finally, the hypoxic and nutrient-poor microenvironment of ccRCC can stimulate the production of immunosuppressive metabolites, such as adenosine and kynurenine, which further impair the function of immune cells. Understanding the complex interplay between tumor cells and the immune system in the ccRCC TIME is crucial for developing effective immunotherapies to treat this disease.
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Affiliation(s)
- Cesar U Monjaras-Avila
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, 2635 Laurel Street, Vancouver, BC V6H 3Z6, Canada
| | - Ana C Lorenzo-Leal
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada
| | - Ana C Luque-Badillo
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, 2635 Laurel Street, Vancouver, BC V6H 3Z6, Canada
| | - Ninadh D'Costa
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, 2635 Laurel Street, Vancouver, BC V6H 3Z6, Canada
| | - Claudia Chavez-Muñoz
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, 2635 Laurel Street, Vancouver, BC V6H 3Z6, Canada
| | - Horacio Bach
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada
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Gverović-Antunica A, Puzović V, Fabris Miletić Z, Arapović Slavić D, Šikić M, Kaštelan S. Metamorphopsia as the first clinical sign of renal cell carcinoma. Int J Ophthalmol 2022; 15:1407-1409. [PMID: 36017043 DOI: 10.18240/ijo.2022.08.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/14/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Antonela Gverović-Antunica
- Department of Ophthalmology, General Hospital Dubrovnik; University of Dubrovnik, Dubrovnik, Dr. Roka Mišetića 2, Dubrovnik 20000, Croatia
| | - Velibor Puzović
- Department of Pathology, General Hospital Dubrovnik, Dr. Roka Mišetića 2, Dubrovnik 20000, Croatia
| | - Zrinka Fabris Miletić
- Department of Radiology, General Hospital Dubrovnik, Dr. Roka Mišetića 2, Dubrovnik 20000, Croatia
| | - Diana Arapović Slavić
- Department of Radiology, General Hospital Dubrovnik, Dr. Roka Mišetića 2, Dubrovnik 20000, Croatia
| | - Maja Šikić
- Medical Centre Dubrovnik, Dr. Ante Starčevićeva 1, Dubrovnik 20000, Croatia
| | - Snježana Kaštelan
- Department of Ophthalmology, Clinical Hospital Dubrava; School of Medicine, University of Zagreb, Zagreb Avenija Gojka Šuška 6, Zagreb 10000, Croatia
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Paner GP, Chumbalkar V, Montironi R, Moch H, Amin MB. Updates in Grading of Renal Cell Carcinomas Beyond Clear Cell Renal Cell Carcinoma and Papillary Renal Cell Carcinoma. Adv Anat Pathol 2022; 29:117-130. [PMID: 35275846 DOI: 10.1097/pap.0000000000000341] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The World Health Organization (WHO) recommends grading of clear cell renal cell carcinoma (RCC) and papillary RCC using the WHO/International Society of Urological Pathology (ISUP) grade, which is primarily based on nuclear features. As the spectrum of RCC continues to evolve, with more recently described subtypes in the past decade, literature evidence on grading these subtypes is limited or not available for some tumor types. Herein, we outline a pragmatic approach to the topic of grading RCC, dividing the contemporarily described RCC subtypes into 7 categories based on the potential clinical applicability of grading as a useful prognostic parameter: (1) RCC subtypes that are reasonably validated and recommended for WHO/ISUP grading; (2) RCC subtypes where WHO/ISUP is not applicable; (3) RCC subtypes where WHO/ISUP grading is potentially clinically useful; (4) inherently aggressive RCC subtypes where histologic classification itself confers an aggressive biologic potential; (5) renal epithelial tumors where WHO/ISUP grading provides potentially misleading prognostic implication; (6) renal epithelial neoplasms where low WHO/ISUP grade features are a prerequisite for accurate histologic classification; and (7) renal epithelial neoplasms with no or limited data on grading or incomplete understanding of the biologic potential. Our aim in outlining this approach is 2-fold: (a) identify the gaps in understanding and application of grading in RCC subtypes so that researchers in the field may perform additional studies on the basis of which the important pathologic function of assignment of grade may be recommended to be performed as a meaningful exercise across a wider spectrum of RCC; and (b) to provide guidance in the interim to surgical pathologists in terms of providing clinically useful grading information in RCC based on currently available clinicopathologic information.
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Affiliation(s)
- Gladell P Paner
- Department of Pathology, University of Chicago
- Department of Surgery, Section of Urology, University of Chicago, Chicago, IL
| | | | - Rodolfo Montironi
- Molecular Medicine and Cell Therapy Foundation, Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, Italy
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Mahul B Amin
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN
- Department of Urology, USC Keck School of Medicine, Los Angeles, CA
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Ren S, Luo C, Wang Y, Wei Y, Ou Y, Yuan J, Li X, Wang J, Lv Q, Yang B, Fan S, Zhou F, Chen Z, Nie Y, Wang D. Birt-Hogg-Dubé syndrome with rare unclassified renal cell carcinoma: A case report. Medicine (Baltimore) 2021; 100:e28380. [PMID: 34941164 PMCID: PMC8702285 DOI: 10.1097/md.0000000000028380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/02/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Birt-Hogg-Dubé syndrome (BHDS) is a rare genetic disease. Renal cell carcinoma is the most serious complication of BHDS. The histological types of BHDS-related renal cell carcinoma are mostly mixed chromophobe/eosinophil and chromophobe cell types. BHDS with unclassified renal cell carcinoma is extremely rare. PATIENT CONCERNS A 37-year-old man was admitted to the hospital because of lumbago and hematuria. DIAGNOSIS Combined with abdominal enhanced CT and pulmonary CT, BHDS complicated with renal cell carcinoma was diagnosed, and right partial nephrectomy was performed. The postoperative pathological diagnosis was unclassified renal cell carcinoma. Gene detection revealed the FLCN frameshift mutation. OUTCOMES No signs of recurrence were observed after regular follow-up. CONCLUSION The pathogenesis of BHDS has not been fully elucidated, and the pathological type of BHDS with unclassified renal cell carcinoma is extremely rare. Through case presentation and review of related literature, this paper summarizes the diagnosis and treatment of BHDS complicated with unclassified renal cell carcinoma.
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Affiliation(s)
- Shangqing Ren
- Department of Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Cheng Luo
- Department of Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Yaoqian Wang
- Department of Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Yi Wei
- Department of Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Yong Ou
- Department of Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Jiazheng Yuan
- Department of Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Xinglan Li
- Department of Pathology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Junyao Wang
- Department of Pathology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Qian Lv
- Department of Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Bo Yang
- Department of Pediatric Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Shida Fan
- Department of Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Fang Zhou
- Department of Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Zhengjun Chen
- Department of Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Yu Nie
- Department of Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Dong Wang
- Department of Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
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Ohsugi H, Ohe C, Yoshida T, Ikeda J, Sugi M, Kinoshita H, Matsuda T. Predictors of postoperative recurrence in patients with non-metastatic pT3a renal cell carcinoma. Int J Urol 2021; 28:1060-1066. [PMID: 34346110 DOI: 10.1111/iju.14648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/29/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To analyze the effect of patterns of extrarenal tumor extension with other pathological factors on postoperative recurrence in patients with non-metastatic pT3a renal cell carcinoma. METHODS We retrospectively reviewed 587 non-metastatic renal cell carcinoma patients who underwent radical surgery between 2006 and 2017 at Kansai Medical University Hospital, Hirakata, Osaka, Japan. We extracted a subset of 114 patients with pT3a of predominant histological types: 93 with clear cell renal cell carcinoma (81.6%), 13 with unclassified renal cell carcinoma (11.4%), six with chromophobe renal cell carcinoma (5.3%) and two with papillary renal cell carcinoma. The primary end-point was recurrence-free survival. The Kaplan-Meier method and Cox proportional hazards model were used for statistical analysis. RESULTS Of the 114 patients with pT3a renal cell carcinoma, 42 patients (36.8%) experienced recurrence. Multivariate analysis showed that perinephric fat invasion (hazard ratio 2.36, P = 0.009), sarcomatoid or rhabdoid component (hazard ratio 2.88, P = 0.022) and necrosis (hazard ratio 2.34, P = 0.030) were independent factors for recurrence-free survival. The high-risk pT3a group, which had more than two independent predictors, had poor prognosis. Recurrence-free survival of the high-risk pT3a group and the pT3b or greater group were similar (median recurrence-free survival 23.0 and 10.8 months, respectively). CONCLUSIONS Perinephric fat invasion, sarcomatoid or rhabdoid component and necrosis are independent predictors of recurrence-free survival in patients with pT3a-predominant renal cell carcinoma. Patients with more than two of these predictors have poor oncological outcomes. These findings will aid in risk stratification for predicting recurrence and provide prognostic information for patient counseling.
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Affiliation(s)
- Haruyuki Ohsugi
- Department of, Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Chisato Ohe
- Department of, Pathology and Laboratory Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Takashi Yoshida
- Department of, Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Junichi Ikeda
- Department of, Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Motohiko Sugi
- Department of, Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Hidefumi Kinoshita
- Department of, Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Tadashi Matsuda
- Department of, Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
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7
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Contemporary Characterization and Recategorization of Adult Unclassified Renal Cell Carcinoma. Am J Surg Pathol 2021; 45:450-462. [PMID: 33239504 DOI: 10.1097/pas.0000000000001629] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Our recent study of early-onset unclassified eosinophilic renal cell carcinoma (RCC) demonstrated that two third of cases could be reclassified by performing a limited number of immunohistochemistry stains. Following the same approach, we aimed to investigate what proportion of adult unclassified RCC could be reclassified. We identified 79 cases. The mean age at presentation was 58 years (range, 29 to 84 y). Tumors were grouped based on their predominant morphologic features as oncocytic (n=23); papillary (n=22); clear cell (n=22); mucinous tubular and spindle cell (MTSC; n=5); rhabdoid (n=4); or lacking a dominant pattern (n=3). By reviewing the morphologic features and performing ancillary studies, we were able to reclassify 10 cases (13%). Four cases were positive for CK20 and showed morphologic features consistent with eosinophilic solid and cystic RCC. Four cases were reclassified as MTSC based on VSTM2A expression by RNA in situ hybridization. One case was negative for SDHB and reclassified as succinate dehydrogenase-deficient RCC. None of the cases showed loss of expression of fumarate hydratase. One case was diffusely positive for CK7 and negative for CD117 and reclassified as a low-grade oncocytic tumor. Four cases were positive for both cathepsin-K and TFE3 by immunohistochemistry, although fluorescence in situ hybridization failed to identify rearrangement in either TFE3 or TFEB genes. Of the tumors that remained unclassified, those with oncocytic features were less likely to be a high grade (odds ratio [OR]=0.22, P=0.013) or advanced stage (OR=0.19, P=0.039) and were more common in women (OR=3.4, P=0.05) compared with those without oncocytic features. Tumors with rhabdoid morphology were associated with advanced stage (relative risk=3.6, P=0.009), while tumors with clear cell or papillary features had a wide range of grades and stages at presentation. In summary, the most frequent reclassified entity is eosinophilic solid and cystic RCC. Investigation of expression of succinate dehydrogenase or fumarate hydratase in individuals older than 35 years with unclassifiable tumors is low yield in the absence of specific morphologic features. A subset of MTSC without well-developed morphologic features can be reclassified by using RNA-ISH for VSTM2A. Recognition of more-recently described RCC subtypes allows for their distinction from the unclassified subtype and improves the prognostic information provided.
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8
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Chen YY, Hu HH, Wang YN, Liu JR, Liu HJ, Liu JL, Zhao YY. Metabolomics in renal cell carcinoma: From biomarker identification to pathomechanism insights. Arch Biochem Biophys 2020; 695:108623. [PMID: 33039388 DOI: 10.1016/j.abb.2020.108623] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/14/2020] [Accepted: 10/04/2020] [Indexed: 12/27/2022]
Abstract
Renal cell carcinoma (RCC) is a frequently diagnosed cancer with high prevalence, which is inversely associated with survival benefit. Although myriad studies have shed light on disease causality, unfortunately, thus far, RCC diagnosis is faced with numerous obstacles partly due to the insufficient knowledge of effective biomarkers, hinting deeper mechanistic understanding are urgently needed. Metabolites are recognized as final proxies for gene-environment interactions and physiological homeostasis as they reflect dynamic processes that are ongoing or have been taken place, and metabolomics may therefore offer a far more productive and cost-effective route to disease discovery, particularly within the arena for new biomarker identification. In this review, we primarily expatiate recent advances in metabolomics that may be amenable to novel biomarkers or therapeutic targets for RCC, which may expand our armaments to win more bettles against RCC.
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Affiliation(s)
- Yuan-Yuan Chen
- Faculty of Life Science & Medicine, Northwest University, No. 229 Taibai North Road, Xi'an, Shaanxi, 710069, China
| | - He-He Hu
- Faculty of Life Science & Medicine, Northwest University, No. 229 Taibai North Road, Xi'an, Shaanxi, 710069, China
| | - Yan-Ni Wang
- Faculty of Life Science & Medicine, Northwest University, No. 229 Taibai North Road, Xi'an, Shaanxi, 710069, China
| | - Jing-Ru Liu
- Faculty of Life Science & Medicine, Northwest University, No. 229 Taibai North Road, Xi'an, Shaanxi, 710069, China
| | - Hai-Jing Liu
- Shaanxi Institute for Food and Drug Control, Xi'an, Shaanxi, 710065, China.
| | - Jian-Ling Liu
- Faculty of Life Science & Medicine, Northwest University, No. 229 Taibai North Road, Xi'an, Shaanxi, 710069, China.
| | - Ying-Yong Zhao
- Faculty of Life Science & Medicine, Northwest University, No. 229 Taibai North Road, Xi'an, Shaanxi, 710069, China.
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Akgul M, Cheng L. Immunophenotypic and pathologic heterogeneity of unclassified renal cell carcinoma: a study of 300 cases. Hum Pathol 2020; 102:70-78. [PMID: 32619439 DOI: 10.1016/j.humpath.2020.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 12/15/2022]
Abstract
Renal cell carcinoma, unclassified (RCC-U), is a heterogenous group of tumors that do not fit in any of the recognized histologic types. Immunohistochemical studies are frequently used to characterize these tumors. Herein, we sought to investigate the immunophenotypes of 300 cases of RCC-U. The cases were morphologically classified into three groups: oncocytoma/chromophobe renal cell carcinoma-like, group 1; clear cell renal cell carcinoma-like, group 2; and others (ie, papillary renal cell carcinoma-like/collecting duct-like/pure sarcomatoid), group 3. The male-to-female ratio was 1.4. Most cases (168, 66%) were group 1. Group 3 was associated with larger tumor size, advanced stage, and frequent lymph node metastases. The most commonly used immunohistochemical stains were CK7 (n = 270; 89.5%), vimentin (n = 186, 82%), CD10 (n = 181; 59.9%), and AMACR (n = 162; 54%). Pancytokeratin (79/101; 78.2%) and PAX8 (54/61; 88.5%) were diffusely positive in most cases, followed by AMACR (69/117; 59%). CD117 was positive in 53 of 118 cases (45%). RCC-U is a morphologically and immunophenotypically heterogenous group of tumors, and comprehensive workup is needed before rendering the diagnosis.
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Affiliation(s)
- Mahmut Akgul
- Departments of Pathology, Indiana University, Indianapolis, IN 46202, USA
| | - Liang Cheng
- Departments of Pathology, Indiana University, Indianapolis, IN 46202, USA; Departments Urology, Indiana University, Indianapolis, IN 46202, USA.
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10
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Specimen Handling: Radical and Partial Nephrectomy Specimens. KIDNEY CANCER 2020. [DOI: 10.1007/978-3-030-28333-9_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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11
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Lopez-Beltran A, Raspollini MR, Cheng L, Scarpelli M, Cimadamore A, Santoni M, Gasparrini S, Montironi R. Staging and Reporting of Renal Cell Carcinomas. KIDNEY CANCER 2020. [DOI: 10.1007/978-3-030-28333-9_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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12
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Major Subtypes of Renal Cell Carcinoma. KIDNEY CANCER 2020. [DOI: 10.1007/978-3-030-28333-9_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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13
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Jing L, Guigonis JM, Borchiellini D, Durand M, Pourcher T, Ambrosetti D. LC-MS based metabolomic profiling for renal cell carcinoma histologic subtypes. Sci Rep 2019; 9:15635. [PMID: 31666664 PMCID: PMC6821699 DOI: 10.1038/s41598-019-52059-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 09/25/2019] [Indexed: 12/20/2022] Open
Abstract
Renal cell carcinomas (RCC) are classified according to their histological features. Accurate classification of RCC and comprehensive understanding of their metabolic dysregulation are of critical importance. Here we investigate the use of metabolomic analyses to classify the main RCC subtypes and to describe the metabolic variation for each subtype. To this end, we performed metabolomic profiling of 65 RCC frozen samples (40 clear cell, 14 papillary and 11 chromophobe) using liquid chromatography-mass spectrometry. OPLS-DA multivariate analysis based on metabolomic data showed clear discrimination of all three main subtypes of RCC (R2 = 75.0%, Q2 = 59.7%). The prognostic performance was evaluated using an independent cohort and showed an AUROC of 0.924, 0.991 and 1 for clear cell, papillary and chromophobe RCC, respectively. Further pathway analysis using the 21 top metabolites showed significant differences in amino acid and fatty acid metabolism between three RCC subtypes. In conclusion, this study shows that metabolomic profiling could serve as a tool that is complementary to histology for RCC subtype classification. An overview of metabolic dysregulation in RCC subtypes was established giving new insights into the understanding of their clinical behaviour and for the development of targeted therapeutic strategies.
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Affiliation(s)
- Lun Jing
- Laboratory Transporter in Imaging and Radiotherapy in Oncology (TIRO), Institut de biosciences et biotechnologies d'Aix-Marseille (BIAM), Commissariat à lEnergie Atomique, Nice, France.,Laboratory Transporter in Imaging and Radiotherapy in Oncology (TIRO), school of medicine, Université Nice Sophia Antipolis, Université Côte d'Azur, Nice, France
| | - Jean-Marie Guigonis
- Laboratory Transporter in Imaging and Radiotherapy in Oncology (TIRO), Institut de biosciences et biotechnologies d'Aix-Marseille (BIAM), Commissariat à lEnergie Atomique, Nice, France.,Laboratory Transporter in Imaging and Radiotherapy in Oncology (TIRO), school of medicine, Université Nice Sophia Antipolis, Université Côte d'Azur, Nice, France
| | | | - Matthieu Durand
- Urology Department, Centre Hospitalier Universitaire, Nice, France
| | - Thierry Pourcher
- Laboratory Transporter in Imaging and Radiotherapy in Oncology (TIRO), Institut de biosciences et biotechnologies d'Aix-Marseille (BIAM), Commissariat à lEnergie Atomique, Nice, France. .,Laboratory Transporter in Imaging and Radiotherapy in Oncology (TIRO), school of medicine, Université Nice Sophia Antipolis, Université Côte d'Azur, Nice, France.
| | - Damien Ambrosetti
- Central Laboratory of Anatomopathology, Centre Hospitalier Universitaire, Nice, France
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Lee JB, Park HS, Park S, Lee HJ, Kwon KA, Choi YJ, Kim YJ, Nam CM, Cho NH, Kang B, Chung HC, Rha SY. Temsirolimus in Asian Metastatic/Recurrent Non-clear Cell Renal Carcinoma. Cancer Res Treat 2019; 51:1578-1588. [PMID: 30999721 PMCID: PMC6790860 DOI: 10.4143/crt.2018.671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 04/08/2019] [Indexed: 01/25/2023] Open
Abstract
Purpose Temsirolimus is effective in the treatment for metastatic non-clear cell renal cell carcinoma (nccRCC) with poor prognosis. We aim to investigate the efficacy and tolerability of temsirolimus in treatment of naïve Asian patients with metastatic/recurrent nccRCC. Materials and Methods From January 2008 to July 2017, data of treatment-naïve, metastatic/recurrent nccRCC patients, who were treated with temsirolimus according to the standard protocol, were collected. The primary end-point was progression-free survival (PFS). Secondary end points were overall survival (OS), objective response rate (ORR), and tolerability of temsirolimus. Results Forty-four metastatic/recurrent nccRCC patients, 10 from prospective and 34 from retrospective groups, were enrolled; 24 patients (54%) were papillary type, and other histology subtypes included 11 chromophobes (25%), two collecting ducts (5%), one Xp11.2 translocation (2%), and six others (14%). The median PFS and OS were 7.6 months and 17.6 months, res-pectively. ORR was 11% and disease control rate was 83%. Patients with prior nephrectomy had longer PFS (hazard ratio [HR], 0.16; 95% confidence interval [CI], 0.06 to 0.42; p < 0.001) and OS (HR, 0.15; 95% CI, 0.05 to 0.45; p < 0.001). Compared to favorable/intermediate prognosis group, poor prognosis group had shorter median PFS (4.7 months vs. 7.6 months [HR, 2.91; 95% CI, 1.39 to 6.12; p=0.005]) and median OS (9.2 months vs. 17.6 months [HR, 2.84; 95% CI, 1.23 to 6.56; p=0.015]). Conclusion Temsirolimus not only benefits poor-risk nccRCC patients, but it is also effective in favorable or intermediate-risk group in Asians. Temsirolimus was well-tolerated with manageable adverse events.
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Affiliation(s)
- Jii Bum Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.,Song-Dang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Soon Park
- Division of Medical Oncology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Sejung Park
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Jin Lee
- Department of Internal Medicine, Chungnam National University, Daejeon, Korea
| | - Kyung A Kwon
- Division of Hematology-Oncology, Department of Internal Medicine, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea
| | - Young Jin Choi
- Division of Hematology-Oncology, Pusan National University, Busan, Korea
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chung Mo Nam
- Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Hoon Cho
- Division of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Beodeul Kang
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.,Song-Dang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, Korea.,Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Cheol Chung
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.,Song-Dang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, Korea.,Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Young Rha
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.,Song-Dang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, Korea.,Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea
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15
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Perrino CM, Grignon DJ, Williamson SR, Idrees MT, Eble JN, Cheng L. Morphological spectrum of renal cell carcinoma, unclassified: an analysis of 136 cases. Histopathology 2017; 72:305-319. [PMID: 28833389 DOI: 10.1111/his.13362] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 08/16/2017] [Indexed: 12/28/2022]
Abstract
AIMS Renal cell carcinoma, unclassified (RCCU) is a category that includes a morphologically and biologically heterogeneous group of tumours that are unable to be diagnosed as other well-defined entities. We aim to describe the morphological findings of tumours within this category and to determine the most frequent morphological features leading to classification difficulty. METHODS AND RESULTS One hundred and thirty-six cases of RCCU were examined. Patients ranged in age from 23 to 87 years. Seventy-seven patients were men and 59 were women. International Society of Urological Pathology (ISUP) grade was most commonly 3 (n = 66), followed by 2 (n = 42) and 4 (n = 28). Tumour size ranged from 0.6 to 24.9 cm. The American Joint Committee on Cancer (AJCC) pathological T categories included pT1a (n = 50), pT1b (n = 14), pT2a (n = 7), pT2b (n = 4), pT3a (n = 50) and pT4 (n = 9). Forty-four cases included lymph node(s), 41% of which (n = 18) had metastases. Tumours were assessed for a variety of histological features and assigned to the following morphological groups: predominantly oncocytoma/chromophobe RCC-like; clear cell RCC-like; papillary RCC-like; collecting duct-like; and pure sarcomatoid differentiation. The majority of the oncocytoma/chromophobe and clear cell RCC-like phenotypes were low stage (pT1 or pT2). The papillary RCC-like, collecting duct-like and pure sarcomatoid phenotypes were mainly high stage (pT3 or pT4). CONCLUSIONS Renal cell carcinoma, unclassified is a term that encompasses tumours with a variety of morphological features and a wide biological spectrum. The most common source of diagnostic difficulty was tumours composed of predominantly eosinophilic cells.
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Affiliation(s)
- Carmen M Perrino
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - David J Grignon
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sean R Williamson
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI, USA.,Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, USA.,Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Muhammad T Idrees
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John N Eble
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Liang Cheng
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
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16
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Adra N, Cheng L, Pili R. Unclassified Renal Cell Carcinoma With Significant Response to Nivolumab. Clin Genitourin Cancer 2017; 15:e517-e519. [DOI: 10.1016/j.clgc.2016.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
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17
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Hirsch MS, Signoretti S, Dal Cin P. Adult Renal Cell Carcinoma: A Review of Established Entities from Morphology to Molecular Genetics. Surg Pathol Clin 2016; 8:587-621. [PMID: 26612217 DOI: 10.1016/j.path.2015.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
According to the current World Health Organization (WHO), renal cell carcinomas (RCCs) that primarily affect adults are classified into 8 major subtypes. Additional emerging entities in renal neoplasia have also been recently recognized and these are discussed in further detail by Mehra et al (Emerging Entities in Renal Neoplasia, Surgical Pathology Clinics, 2015, Volume 8, Issue 4). In most cases, the diagnosis of a RCC subtype can be based on morphologic criteria, but in some circumstances the use of ancillary studies can aid in the diagnosis. This review discusses the morphologic, genetic, and molecular findings in RCCs previously recognized by the WHO, and provides clues to distinction from each other and some of the newer subtypes of RCC. As prognosis and therapeutic options vary for the different subtypes of RCC, accurate pathologic distinction is critical for patient care.
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Affiliation(s)
- Michelle S Hirsch
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Paola Dal Cin
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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18
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Ueda K, Suekane S, Mitani T, Chikui K, Ejima K, Suyama S, Nakiri M, Nishihara K, Matsuo M, Igawa T. Spontaneous regression of multiple pulmonary nodules in a patient with unclassified renal cell carcinoma following laparoscopic partial nephrectomy: A case report. Mol Clin Oncol 2016; 5:49-52. [PMID: 27330764 DOI: 10.3892/mco.2016.900] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/24/2016] [Indexed: 11/06/2022] Open
Abstract
Spontaneous regression of metastatic renal cell carcinoma (RCC) is rare, but well-documented in clear cell RCC. However, there are no reports on spontaneous regression of unclassified RCC. Since the radiological findings of pulmonary infarcts and inflammatory pseudotumors are similar to those of metastases from RCC, a definitive diagnosis is difficult without performing a histological examination. A 56-year-old woman underwent medical examination by a physician. An abdominal computed tomography (CT) scan revealed a 22-mm mass with a cystic area in the right kidney, as well as multiple enlarged lymph nodes in the common iliac, external iliac and groin areas, bilaterally. A chest CT revealed multiple pulmonary nodules bilaterally, the largest measuring 15 mm. Since the right renal tumor was suspected to be an RCC, laparoscopic partial nephrectomy was performed. The final pathological diagnosis of the renal tumor was unclassified RCC. One month following surgery, a CT scan revealed spontaneous regression of the pulmonary nodules. We herein present a rare case of spontaneous regression of pulmonary nodules in a patient with unclassified RCC following laparoscopic partial nephrectomy. To the best of our knowledge, this is the first case of spontaneous regression in unclassified RCC.
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Affiliation(s)
- Kosuke Ueda
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Shigetaka Suekane
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Tomotaro Mitani
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Katsuaki Chikui
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Kazuhisa Ejima
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Shunsuke Suyama
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Makoto Nakiri
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Kiyoaki Nishihara
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Mitsunori Matsuo
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Tsukasa Igawa
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
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19
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Ciccarese C, Massari F, Santoni M, Heng DY, Sotte V, Brunelli M, Conti A, Cheng L, Lopez-Beltran A, Scarpelli M, Cascinu S, Tortora G, Montironi R. New molecular targets in non clear renal cell carcinoma: An overview of ongoing clinical trials. Cancer Treat Rev 2015; 41:614-22. [DOI: 10.1016/j.ctrv.2015.05.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 05/07/2015] [Accepted: 05/09/2015] [Indexed: 12/20/2022]
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20
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Kryvenko ON, Jorda M, Argani P, Epstein JI. Diagnostic approach to eosinophilic renal neoplasms. Arch Pathol Lab Med 2014; 138:1531-41. [PMID: 25357116 PMCID: PMC4352320 DOI: 10.5858/arpa.2013-0653-ra] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Eosinophilic renal neoplasms include a spectrum of solid and papillary tumors ranging from indolent benign oncocytoma to highly aggressive malignancies. Recognition of the correct nature of the tumor, especially in biopsy specimens, is paramount for patient management. OBJECTIVE To review the diagnostic approach to eosinophilic renal neoplasms with light microscopy and ancillary techniques. DATA SOURCES Review of the published literature and personal experience. CONCLUSIONS The following tumors are in the differential diagnosis of oncocytic renal cell neoplasm: oncocytoma, chromophobe renal cell carcinoma (RCC), hybrid tumor, tubulocystic carcinoma, papillary RCC, clear cell RCC with predominant eosinophilic cell morphology, follicular thyroid-like RCC, hereditary leiomyomatosis-associated RCC, acquired cystic disease-associated RCC, rhabdoid RCC, microphthalmia transcription factor translocation RCC, epithelioid angiomyolipoma, and unclassified RCC. In low-grade nonpapillary eosinophilic neoplasms, distinction between oncocytoma and low-grade RCC mostly rests on histomorphology; however, cytokeratin 7 immunostain may be helpful. In high-grade nonpapillary lesions, there is more of a role for ancillary techniques, including immunohistochemistry for cytokeratin 7, CA9, CD10, racemase, HMB45, and Melan-A. In papillary eosinophilic neoplasms, it is important to distinguish sporadic type 2 papillary RCC from microphthalmia transcription factor translocation and hereditary leiomyomatosis-associated RCC. Histologic and cytologic features along with immunohistochemistry and fluorescence in situ hybridization tests for TFE3 (Xp11.2) and TFEB [t(6;11)] are reliable confirmatory tests. Eosinophilic epithelial neoplasms with architecture, cytology, and/or immunoprofile not qualifying for either of the established types of RCC should be classified as unclassified eosinophilic RCC and arbitrarily assigned a grade (low or high).
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MESH Headings
- Adenoma, Oxyphilic/diagnosis
- Adenoma, Oxyphilic/pathology
- Angiomyolipoma/diagnosis
- Angiomyolipoma/pathology
- Basic Helix-Loop-Helix Leucine Zipper Transcription Factors/genetics
- Carcinoma, Renal Cell/diagnosis
- Carcinoma, Renal Cell/genetics
- Carcinoma, Renal Cell/pathology
- Chromosomes, Human, X/genetics
- Eosinophilia/pathology
- Female
- Humans
- Kidney Diseases, Cystic/complications
- Kidney Diseases, Cystic/pathology
- Kidney Neoplasms/diagnosis
- Kidney Neoplasms/etiology
- Kidney Neoplasms/genetics
- Kidney Neoplasms/pathology
- Leiomyomatosis/diagnosis
- Leiomyomatosis/pathology
- Male
- Microphthalmia-Associated Transcription Factor/genetics
- Neoplastic Syndromes, Hereditary
- Skin Neoplasms/diagnosis
- Skin Neoplasms/pathology
- Translocation, Genetic
- Uterine Neoplasms/diagnosis
- Uterine Neoplasms/pathology
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Affiliation(s)
- Oleksandr N Kryvenko
- From the Departments of Pathology (Drs Kryvenko and Jorda) and Urology (Drs Kryvenko and Jorda), University of Miami Miller School of Medicine, Miami, Florida; and the Departments of Pathology (Drs Argani and Epstein), Oncology (Drs Argani and Epstein), and Urology (Dr Epstein), The Johns Hopkins Medical Institutions, Baltimore, Maryland
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21
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Raheem OA, Godebu E, Cohen SA, Shabaik A, Parsons JK. Unclassified mucinous renal cell carcinoma: a rare histopathological entity. Korean J Urol 2014; 55:690-2. [PMID: 25324954 PMCID: PMC4198770 DOI: 10.4111/kju.2014.55.10.690] [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: 09/02/2013] [Accepted: 10/16/2013] [Indexed: 11/25/2022] Open
Abstract
Renal cell carcinoma (RCC) with mucin production is extremely rare. We present the case of a previously healthy 76-year-old woman who underwent a robotic-assisted laparoscopic right nephrectomy for a 5-cm heterogeneously enhancing right renal mass. Pathology revealed mucin-producing epithelial RCC. We discuss the presentation and pathological features of this case and comment on its definitive treatment.
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Affiliation(s)
- Omer A Raheem
- Department of Urology, University of California, San Diego Medical Center, San Diego, California, USA
| | - Elana Godebu
- Department of Urology, University of California, San Diego Medical Center, San Diego, California, USA
| | - Seth A Cohen
- Department of Urology, University of California, San Diego Medical Center, San Diego, California, USA
| | - Ahmed Shabaik
- Department of Pathology, University of California, San Diego Medical Center, San Diego, California, USA
| | - J Kellogg Parsons
- Department of Urology, University of California, San Diego Medical Center, San Diego, California, USA
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