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Sun Y, Xu B, Zhang H, Li L, Gao Y, Sun M. Renal clear cell carcinoma undergoing cystic change: A cases report and review of the literature. Int J Surg Case Rep 2024; 123:110198. [PMID: 39173430 DOI: 10.1016/j.ijscr.2024.110198] [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: 07/02/2024] [Revised: 08/14/2024] [Accepted: 08/17/2024] [Indexed: 08/24/2024] Open
Abstract
INTRODUCTION We presented a case diagnosed the renal clear cell carcinoma undergoing cystic change (RCCCC) with detailed clinical data. Along with literature review, we aimed to investigate clinical diagnosis and treatment of RCCCC and explore the differential diagnosis of RCCCC and multilocular cystic renal cell carcinoma (MCRCC). CASE PRESENTATION The patient was diagnosed with a right renal cyst after physical examination, which was misdiagnosed as a renal cyst by imaging examination. Intraoperative surgical treatment was performed to remove the roof and decompress the renal cyst. Rapid pathology revealed MCRCC with low malignant potential during laparoscopic right renal cyst decompression. Radical nephrectomy was performed with the family's signature. The postoperative pathological diagnosis was clear cell carcinoma cystic lesion of kidney (RCCCC). No recurrence or metastasis during 1 year follow-up. CLINICAL DISCUSSION RCCCC cases were similar to classical clear cell renal carcinoma. Radical nephrectomy should be avoided in patients with MCRCC, and radical nephrectomy should be chosen in patients with RCCCC, with postoperative and close follow-up. Unroofing decompression of renal cyst was performed during the operation, and the risk of tumor implantation and metastasis was worried after the operation. The patient agreed to receive eight cycles of immune checkpoint inhibitor therapy after surgery. Adrenal insufficiency occurred after 8 cycles of immune checkpoint inhibitor therapy(ICIs), then the immunotherapy was discontinued. CONCLUSION RCCCC is a rare and special type of renal clear cell carcinoma, and its prognosis is the same as that of renal clear cell carcinoma. The preoperative diagnosis of RCCCC mainly depends on imaging examination (CT or B-ultrasound). The early differential diagnosis from multilocular cystic renal cell carcinoma is difficult, and the diagnosis usually depends on postoperative pathological diagnosis.
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Affiliation(s)
- Yunji Sun
- Department of Urology, Shandong Provincial Third Hospital, Shandong University, Jinan 250012, China; Shandong Stone Disease Prevention and Treatment Center, Jinan 250012, China
| | - Baoqun Xu
- Department of Pathology, Shandong Provincial Third Hospital, Shandong University, Jinan 250012, China
| | - Heng Zhang
- Department of Urology, Shandong Provincial Third Hospital, Shandong University, Jinan 250012, China; Shandong Stone Disease Prevention and Treatment Center, Jinan 250012, China
| | - Lihua Li
- Department of Urology, Shandong Provincial Third Hospital, Shandong University, Jinan 250012, China; Shandong Stone Disease Prevention and Treatment Center, Jinan 250012, China
| | - Yulan Gao
- Department of Urology, Shandong Provincial Third Hospital, Shandong University, Jinan 250012, China; Shandong Stone Disease Prevention and Treatment Center, Jinan 250012, China
| | - Maokun Sun
- Department of Urology, Shandong Provincial Third Hospital, Shandong University, Jinan 250012, China; Shandong Stone Disease Prevention and Treatment Center, Jinan 250012, China.
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MacLennan GT, Cheng L. Five decades of urologic pathology: the accelerating expansion of knowledge in renal cell neoplasia. Hum Pathol 2019; 95:24-45. [PMID: 31655169 DOI: 10.1016/j.humpath.2019.09.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 02/07/2023]
Abstract
Those who are knowledgeable in cosmology inform us that the expansion of the universe is such that the velocity at which a distant galaxy is receding from the observer is continually increasing with time. We humbly paraphrase that as "The bigger the universe gets, the faster it gets bigger." This is an interesting analogy for the expansion of knowledge in the field of renal tumor pathology over the past 30 to 50 years. It is clear that a multitude of dedicated investigators have devoted incalculable amounts of time and effort to the pursuit of knowledge about renal epithelial neoplasms. As a consequence of the contributions of numerous investigators over many decades, the most recent World Health Organization classification of renal neoplasms includes about 50 well defined and distinctive renal tumors, as well as various miscellaneous and metastatic tumors. In addition, a number of emerging or provisional new entities are under active investigation and may be included in future classifications. In this review, we will focus on a number of these tumors, tracing as accurately as we can the origins of their discovery, relating relevant additions to the overall knowledge base surrounding them, and in some instances addressing changes in nomenclature.
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Affiliation(s)
- Gregory T MacLennan
- Department of Pathology and Laboratory Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland, OH.
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
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Hu J, Jin L, Li Y, He T, Liu J, Shi B, Yang S, Gui Y, Mao X, Lai Y, Ni L. Multilocular cystic renal cell carcinoma: A case report and review of the literature. Mol Clin Oncol 2018; 8:326-329. [PMID: 29435299 DOI: 10.3892/mco.2017.1526] [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: 05/19/2016] [Accepted: 06/13/2017] [Indexed: 11/06/2022] Open
Abstract
Multilocular cystic renal cell carcinoma (MCRCC), which exhibits low-stage and low-grade characteristics, is a special type of RCC. MCRCC is extremely rare and generally develops at ages >50 years. We herein report a case of MCRCC in a 28-year-old man, which, to the best of our knowledge, is the youngest case reported worldwide to date. The patient presented with irritative bladder symptoms for 1 year. Dynamic enhanced computed tomography (CT) imaging revealed a mass with inhomogeneous enhancement in the left kidney, with a rich blood supply. B-ultrasonography also revealed a renal protruding mass. As the mass was highly suspicious to be a malignant tumor, laparoscopic radical nephrectomy was performed and MCRCC was definitively diagnosed by pathological examination. The patient has been regularly followed up for 6 months, without complications or disease recurrence.
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Affiliation(s)
- Jia Hu
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China.,Graduate School of Guangzhou Medical University, Guangzhou, Guangdong 510182, P.R. China.,Guangdong Key Laboratory of Male Reproductive Medicine and Genetics, Peking University Shenzhen Hospital, Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong 518036, P.R. China
| | - Lu Jin
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China.,Guangdong Key Laboratory of Male Reproductive Medicine and Genetics, Peking University Shenzhen Hospital, Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong 518036, P.R. China
| | - Yifan Li
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China.,Guangdong Key Laboratory of Male Reproductive Medicine and Genetics, Peking University Shenzhen Hospital, Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong 518036, P.R. China
| | - Tao He
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China.,Graduate School of Guangzhou Medical University, Guangzhou, Guangdong 510182, P.R. China.,Guangdong Key Laboratory of Male Reproductive Medicine and Genetics, Peking University Shenzhen Hospital, Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong 518036, P.R. China
| | - Jiaju Liu
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China.,Guangdong Key Laboratory of Male Reproductive Medicine and Genetics, Peking University Shenzhen Hospital, Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong 518036, P.R. China
| | - Bentao Shi
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China.,Guangdong Key Laboratory of Male Reproductive Medicine and Genetics, Peking University Shenzhen Hospital, Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong 518036, P.R. China
| | - Shangqi Yang
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China.,Guangdong Key Laboratory of Male Reproductive Medicine and Genetics, Peking University Shenzhen Hospital, Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong 518036, P.R. China
| | - Yaoting Gui
- Guangdong Key Laboratory of Male Reproductive Medicine and Genetics, Peking University Shenzhen Hospital, Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong 518036, P.R. China
| | - Xiangming Mao
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China.,Guangdong Key Laboratory of Male Reproductive Medicine and Genetics, Peking University Shenzhen Hospital, Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong 518036, P.R. China
| | - Yongqing Lai
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China.,Guangdong Key Laboratory of Male Reproductive Medicine and Genetics, Peking University Shenzhen Hospital, Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong 518036, P.R. China
| | - Liangchao Ni
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China.,Guangdong Key Laboratory of Male Reproductive Medicine and Genetics, Peking University Shenzhen Hospital, Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong 518036, P.R. China
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Abstract
PURPOSE The purpose of the study is to provide an update on the imaging evaluation of cystic renal masses, to review benign and malignant etiologies of cystic renal masses, and to review current controversies and future directions in the management of these lesions. CONCLUSIONS Cystic renal masses are relatively common in daily practice. The Bosniak classification is a time-proven method for the imaging classification and management of these lesions. Knowledge of the pathognomonic features of certain benign Bosniak 2F/3 lesions is important to avoid surgery on these lesions (e.g., localized cystic disease, renal abscess). For traditionally surgical Bosniak lesions (Classes 3 and 4), there are evolving data that risk stratification based on patient demographics, imaging size, and appearance may allow for expanded management options including tailored surveillance or ablation, along with the traditional surgical approach.
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Affiliation(s)
- Nicole M Hindman
- Department of Radiology, NYU School of Medicine, 660 First Avenue, New York, NY, 10016, USA.
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Multilocular cystic renal cell carcinoma: similarities and differences in immunoprofile compared with clear cell renal cell carcinoma. Am J Surg Pathol 2012; 36:1425-33. [PMID: 22982885 DOI: 10.1097/pas.0b013e31825b37f0] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Multilocular cystic renal cell carcinoma (RCC) is an uncommon renal neoplasm composed of thin fibrous septa lining multiple cystic spaces and associated with an excellent prognosis. Clear cells with generally low-grade nuclear features line the cystic spaces and may be present within the fibrous septa, although solid mass-forming areas are by definition absent. Despite the excellent prognosis, molecular-genetic alterations are similar to those of clear cell RCC. Immunohistochemical staining characteristics, however, have not been well elucidated. We studied 24 cases of multilocular cystic RCC, classified according to the 2004 World Health Organization System. Immunohistochemical analysis was performed using an automated immunostainer for CD10, cytokeratin 7 (CK7), α-methylacyl-CoA-racemase, epithelial membrane antigen (EMA), cytokeratin CAM 5.2, carbonic anhydrase IX (CA-IX), estrogen/progesterone receptors, smooth muscle actin, PAX-2, and vimentin. Twenty-four cases of grade 1 to 2 clear cell RCC were stained for comparison. Multilocular cystic RCC and control cases of clear cell RCC showed the following results, respectively: CD10 (63%, 96%), CK7 (92%, 38%), α-methylacyl-CoA-racemase (21%, 67%), vimentin (58%, 33%), estrogen receptor (8%, 8%), CAM 5.2 (100%, 96%), EMA, CA-IX, PAX-2 (all 100%), and progesterone receptor (0%). Smooth muscle actin highlighted myofibroblastic cells within the septa of multilocular cystic RCC and the fine capillary vascular network of clear cell RCC. In summary, multilocular cystic RCC showed expression of common clear cell RCC markers CA-IX, EMA, and PAX-2, supporting the hypothesis that multilocular cystic RCC is a subtype of clear cell RCC. In contrast to clear cell RCC, tumors less frequently expressed CD10 (63% and often focal vs. 96% and diffuse) and more frequently expressed CK7 (92%), often diffusely (63%). Coexpression of CA-IX and CK7 represents a point of overlap with the recently described clear cell papillary RCC, which also may show a prominent cystic architecture. However, the latter lacks mutation of the VHL gene and deletion of chromosome 3p by molecular methodologies.
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Park HS, Lee K, Moon KC. Determination of the cutoff value of the proportion of cystic change for prognostic stratification of clear cell renal cell carcinoma. J Urol 2011; 186:423-9. [PMID: 21679991 DOI: 10.1016/j.juro.2011.03.107] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE Cystic renal cell carcinoma has more favorable biology than noncystic renal cell carcinoma. Recently cystic change detected grossly or by low power microscopy was found to be a good prognostic factor for clear cell renal cell carcinoma. We assessed the optimal cutoff value of the proportion of cystic change with prognostic significance for clear cell renal cell carcinoma. MATERIALS AND METHODS We identified 223 patients with clear cell renal cell carcinoma who underwent partial or radical nephrectomy between 2001 and 2003. The cystic proportion of the tumor cut surface was calculated objectively and its prognostic significance was evaluated. RESULTS The ROC curve showed that a cystic percent of between 6% and 10% was appropriate to detect patients with renal cell carcinoma at low risk for cancer mortality and progression. A cutoff of 6% was adopted as a break point of cystic change for patient stratification. We analyzed the records of 87 patients (39.0%) with tumors with a cystic proportion of greater than 5%, that is 6% or greater. They had significantly lower stage and lower Fuhrman nuclear grade than patients with tumors with a cystic change of 5% or less (each p<0.0001). On multivariate analysis a cystic proportion of more than 5% was a good prognostic indicator of cancer specific and progression-free survival (HR 0.221, p=0.044 and HR 0.214, p=0.004, respectively). CONCLUSIONS In patients with clear cell renal cell carcinoma a cystic change comprising more than 5% of the tumor is a good independent predictor of survival.
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Affiliation(s)
- Heae Surng Park
- Department of Pathology, Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea
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Cheong MS, Koo DH, Kim IS, Moon KC, Ku JH. Concurrent Multilocular Cystic Renal Cell Carcinoma and Leiomyoma in the Same Kidney: Previously Unreported Association. Case Rep Oncol 2010; 3:218-222. [PMID: 20740200 PMCID: PMC2920003 DOI: 10.1159/000317523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We present an unusual case of concurrent occurrence of a multilocular cystic renal cell carcinoma and a leiomyoma in the same kidney of a patient with no evident clinical symptoms. A 38-year-old man was found incidentally to have a cystic right renal mass on computed tomography. Laparoscopic radical nephrectomy was performed under a preoperative diagnosis of cystic renal cell carcinoma. Histology revealed a multilocular cystic renal cell carcinoma and a leiomyoma. This is the first report of this kind of presentation.
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Affiliation(s)
- Min Su Cheong
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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Cheng L, Williamson SR, Zhang S, MacLennan GT, Montironi R, Lopez-Beltran A. Understanding the molecular genetics of renal cell neoplasia: implications for diagnosis, prognosis and therapy. Expert Rev Anticancer Ther 2010; 10:843-864. [DOI: 10.1586/era.10.72] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Park HS, Jung EJ, Myung JK, Moon KC. The Prognostic Implications of Cystic Change in Clear Cell Renal Cell Carcinoma. KOREAN JOURNAL OF PATHOLOGY 2010. [DOI: 10.4132/koreanjpathol.2010.44.2.149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Heae Surng Park
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Eun-Jung Jung
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Kyung Myung
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Chul Moon
- Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
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Moreno FBMB, de Oliveira TM, Martil DE, Viçoti MM, Bezerra GA, Abrego JRB, Cavada BS, Filgueira de Azevedo W. Identification of a new quaternary association for legume lectins. J Struct Biol 2008; 161:133-43. [DOI: 10.1016/j.jsb.2007.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Revised: 09/27/2007] [Accepted: 10/04/2007] [Indexed: 10/22/2022]
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Surgical Resection Provides Excellent Outcomes for Patients With Cystic Clear Cell Renal Cell Carcinoma. Urology 2007; 70:900-4; discussion 904. [DOI: 10.1016/j.urology.2007.05.029] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Revised: 03/15/2007] [Accepted: 05/17/2007] [Indexed: 11/19/2022]
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Compérat EV, Vasiliu V, Ferlicot S, Camparo P, Sibony M, Vieillefond A. [Tumors of the kidneys: new entities]. Ann Pathol 2005; 25:117-33. [PMID: 16142163 DOI: 10.1016/s0242-6498(05)86175-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Since 1998 new entities have surfaced in renal tumor classification and have been included in the WHO 2004 classification. In this article, we will discuss the following entities: multilocular clear cell renal carcinoma, Xp11 translocation carcinoma, low grade mucinous tubular carcinoma, epithelioid angiomyolipoma, benign mixed epithelial and stromal tumor. We will investigate new concepts of hybrid oncocytoma and chromophobe renal cell carcinoma and the syndrome of Birt-Hogg-Dube which is associated to kidney tumors. At least, we will touch on new elements in the Bellini carcinoma definition.
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Affiliation(s)
- Eacute Va Compérat
- Service d'Anatomie Pathologique, Hôpital La Pitié Salpêtrière, 47 boulevard de l'Hôpital, 75651 Paris Cedex 13, France
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Magro G, Lopes M. Cystic Tumors of the Kidney. Revision of the Literature and Authors'Cases. Urologia 2004. [DOI: 10.1177/039156030407100401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors report the clinico-pathological features of the so-called “cystic tumors of the kidney”, discussing data of the English literature and providing grossly and histologically illustrations. The following tumor entities will be discussed in detail: “cystic multilocular renal cell carcinoma”, “cystic nephroma”, “cystic partially differentiated nephroblastoma” and mixed (benign or malignant) epithelial/stromal tumor. The awareness of these clinico-pathologic entities by Urologist is important to assure patient a correct treatment and prognostic informations.
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Affiliation(s)
- G Magro
- Anatomia Patologica, Università di Catania, Catania
| | - M. Lopes
- Unità Operativa di Urologia, Azienda Ospedaliera Vittorio Emanuele, Gela (Caltanissetta)
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