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Bellouki O, Soufiani I, Boualaoui I, Ibrahimi A, El Sayegh H, Nouini Y. Renal cell carcinoma with massive cavo-atrial tumor thrombus leading to pulmonary embolism: Case study and literature review. Int J Surg Case Rep 2024; 117:109577. [PMID: 38537371 PMCID: PMC11010595 DOI: 10.1016/j.ijscr.2024.109577] [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: 03/06/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Renal cell carcinoma (RCC) occasionally involves the inferior vena cava (IVC), but intra-atrial extension is very rare, with the most dreaded complication being thrombi migration into pulmonary arteries. CASE PRESENTATION A 52-year-old male with rheumatoid arthritis and a smoking history presented with dyspnea, weight loss, and a previous episode of hematuria. Echocardiography revealed an intra-atrial thrombus with signs of pulmonary embolism (PE). Subsequent evaluation found a massive right renal tumor with an extensive thrombus extending into the right atrium, causing PE. Multidisciplinary management included surgery involving nephrectomy and thrombectomy via cavotomy and open-heart surgery along with pre- and postoperative anticoagulation. DISCUSSION Intra-caval tumor thrombus (TT) in RCC is infrequent, especially when extending into the right atrium. Accurate diagnosis involves imaging modalities, with echocardiography and MRI playing pivotal roles. Multidisciplinary and personalized management is mandatory to ensure a successful outcome. Surgery remains the primary treatment for RCC with TT but carries significant risks. CONCLUSION Managing RCC with cavo-atrial tumor thrombus is a complex situation that requires a collaborative approach. Accurate staging and tailored treatment are crucial. Surgical intervention remains pivotal in the absence of alternative effective modalities. Ongoing research into adjuvant therapies is crucial for optimal outcomes.
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Affiliation(s)
- Omar Bellouki
- Urology "A" Department, Ibn Sina University Hospital, Rabat, 10000, Morocco; Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, 10000, Morocco.
| | - Ilyas Soufiani
- Urology "A" Department, Ibn Sina University Hospital, Rabat, 10000, Morocco; Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, 10000, Morocco.
| | - Imad Boualaoui
- Urology "A" Department, Ibn Sina University Hospital, Rabat, 10000, Morocco; Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, 10000, Morocco.
| | - Ahmed Ibrahimi
- Urology "A" Department, Ibn Sina University Hospital, Rabat, 10000, Morocco; Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, 10000, Morocco.
| | - Hachem El Sayegh
- Urology "A" Department, Ibn Sina University Hospital, Rabat, 10000, Morocco; Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, 10000, Morocco.
| | - Yassine Nouini
- Urology "A" Department, Ibn Sina University Hospital, Rabat, 10000, Morocco; Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, 10000, Morocco.
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Leyderman M, McElree IM, Nepple KG, Zakharia Y, Ghodoussipour S, Packiam VT. Management of Renal Cell Carcinoma With Supradiaphragmatic Inferior Vena Cava Thrombus Diagnosed During Acute COVID-19 Infection. Cureus 2024; 16:e55565. [PMID: 38576641 PMCID: PMC10993925 DOI: 10.7759/cureus.55565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
Renal cell carcinoma (RCC) tends to undergo intravascular tumor growth along the renal vein, forming tumor thrombi that may extend into the inferior vena cava (IVC) or even the right atrium (Level IV). Managing such cases requires a multidisciplinary approach, especially in patients with acute coronavirus disease 2019 (COVID-19) infection, who face increased risks from surgical interventions. We present a case of RCC with Level IV thrombus and concurrent COVID-19 managed with systemic therapy. We also summarize current literature on treating RCC with IVC thrombus and COVID-19's impact on prognosis. The patient was a 70-year-old female with incidental detection of a 9-cm right heterogeneous renal mass with a supradiaphragmatic tumor thrombus during COVID-19 infection. Due to ongoing pulmonary symptoms, systemic therapy with a combination of ipilimumab and nivolumab was initiated. After an excellent initial response, the patient continued systemic therapy, maintaining a necrotic response in the renal mass and tumor thrombus. The patient continues to tolerate systemic therapy well. We report a rare case of RCC with Level IV tumor thrombus and synchronous acute COVID-19 infection. Our report depicts successful management utilizing systemic therapy with a combination of ipilimumab and nivolumab. The management of such cases necessitates a comprehensive, multidisciplinary approach, considering the risks associated with surgery in the context of recent COVID-19 infection. The case presentation and ensuing literature discussion of the dynamic landscape of RCC management highlights the need for more research to improve treatment plans and guide clinicians in handling such complex situations.
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Affiliation(s)
- Michael Leyderman
- Urology, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, USA
| | - Ian M McElree
- Urology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Kenneth G Nepple
- Urology, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Yousef Zakharia
- Internal Medicine - Hematology/Oncology, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Saum Ghodoussipour
- Division of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, USA
| | - Vignesh T Packiam
- Division of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, USA
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Zhu B, Yang Y, Huangfu Z, Zhang W, Jiang A, Wang L. Construction of the prognostic model in non-metastatic renal cancer patients with venous tumor thrombus. Transl Androl Urol 2023; 12:1645-1657. [PMID: 38106682 PMCID: PMC10719766 DOI: 10.21037/tau-23-341] [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: 06/13/2023] [Accepted: 10/20/2023] [Indexed: 12/19/2023] Open
Abstract
Background Venous system invasion is a prominent characteristic of local progression in renal cancer and treatment-naïve renal cancer patients with venous tumor thrombus (VTT) gained short natural course and poor prognosis. This study aimed to investigate the efficacy of the surgery and prognostic factors in non-metastatic renal cancer patients with VTT and to construct a nomogram prognostic model. Methods Clinical data of 114 non-metastatic renal cancer patients with VTT who underwent surgical treatment from January 2011 to September 2022 were retrospectively analyzed. In order to find independent risk factors of prognosis, survival analysis was performed via univariate and multivariate Cox regression models and Kaplan-Meier method. Nomogram prognostic model was established to calculate patients' risk scores. Receiver operating characteristic curve and decision curve analysis were conducted to evaluate the efficacy of the prognostic model. Results A total of 114 patients were included in this study and there were 48, 12, 25, 23, and 6 cases of grade 0-IV VTT. No perioperative death occurred. The 3-year probabilities of overall survival (OS) and 5-year probabilities of OS were 67% and 43.8%, respectively. Multivariate Cox regression analysis revealed that kidney tumor diameter, preoperative lactate dehydrogenase (LDH), and preoperative neutrophils were independent risk factors. Nomogram was constructed to predict prognosis in renal cancer patients with VTT based on above indicators and Mayo VTT grading. The area under the ROC curve of 1-, 2-, 3-, and 5-year OS of the patients were 0.82, 0.67, 0.57, and 0.55 respectively. Conclusions Surgical treatment enables renal cancer patients with VTT to gain a better prognosis. Kidney tumor diameter, preoperative LDH, and preoperative neutrophils were independent risk factors. The nomogram perfects the Mayo grading, and provides a reliable reference for evaluation of prognosis of renal cancer patients with VTT.
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Affiliation(s)
- Baohua Zhu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yiren Yang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhao Huangfu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Wei Zhang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Aimin Jiang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Linhui Wang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Niu Y, Yu C, Li Z, Li Z. A case report of surgical treatment for locally advanced renal carcinoma. Asian J Surg 2023; 46:5120-5121. [PMID: 37442701 DOI: 10.1016/j.asjsur.2023.06.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 05/24/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Affiliation(s)
- Yuanjian Niu
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chenhui Yu
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhuoheng Li
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhipeng Li
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China.
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Yang L, Liu J, Li S, Liu X, Zheng F, Xu S, Fu B, Xiong J. Based on disulfidptosis, revealing the prognostic and immunological characteristics of renal cell carcinoma with tumor thrombus of vena cava and identifying potential therapeutic target AJAP1. J Cancer Res Clin Oncol 2023; 149:9787-9804. [PMID: 37247081 DOI: 10.1007/s00432-023-04877-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/19/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Patients with clear cell renal cell carcinoma (ccRCC) with venous tumor thrombus have a poor prognosis, high surgical risk, and lack of targeted therapeutic agents. METHODS Genes with consistent differential expression trends in tumor tissues and VTT groups were first screened, and then differential genes associated with disulfidptosis were found by correlation analysis. Subsequently, identifying ccRCC subtypes and constructing risk models to compare the differences in prognosis and the tumor microenvironment in different subgroups. Finally, constructing a nomogram to predict the prognosis of ccRCC and validate key gene expression levels in cells and tissues. RESULTS We screened 35 differential genes related to disulfidptosis and identified 4 ccRCC subtypes. Risk models were constructed based on the 13 genes, and the high-risk group had a higher abundance of immune cell infiltration, tumor mutational load, and microsatellite instability scores, predicting high sensitivity to immunotherapy. The 1-year AUC = 0.869 for predicting OS by nomogram has a high application value. The expression level of the key gene AJAP1 was low in both tumor cell lines and cancer tissues. CONCLUSIONS Our study not only constructed an accurate prognostic nomogram for ccRCC patients but also identified an AJAP1 biomarker as a potential biomarker for the disease.
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Affiliation(s)
- Lin Yang
- Department of Urology, First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
| | - Jiahao Liu
- Department of Urology, First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
| | - Sheng Li
- Department of Urology, First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
| | - Xiaoqiang Liu
- Department of Urology, First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
| | - Fuchun Zheng
- Department of Urology, First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
| | - Songhui Xu
- Department of Urology, First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
| | - Bin Fu
- Department of Urology, First Affiliated Hospital of Nanchang University, Nanchang, 330000, China.
| | - Jing Xiong
- Department of Urology, First Affiliated Hospital of Nanchang University, Nanchang, 330000, China.
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Drăgan A, Sinescu I. The Role of the Cardiac Biomarkers in the Renal Cell Carcinoma Multidisciplinary Management. Diagnostics (Basel) 2023; 13:1912. [PMID: 37296764 PMCID: PMC10253077 DOI: 10.3390/diagnostics13111912] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/27/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
Renal cell carcinoma, an aggressive malignancy, is often incidentally diagnosed. The patient remains asymptomatic to the late stage of the disease, when the local or distant metastases are already present. Surgical treatment remains the choice for these patients, although the plan must adapt to the characteristics of the patients and the extension of the neoplasm. Systemic therapy is sometimes needed. It includes immunotherapy, target therapy, or both, with a high level of toxicity. Cardiac biomarkers have prognosis and monitoring values in this setting. Their role in postoperative identification of myocardial injury and heart failure already have been demonstrated, as well as their importance in preoperative evaluation from the cardiac point of view and the progression of renal cancer. The cardiac biomarkers are also part of the new cardio-oncologic approach to establishing and monitoring systemic therapy. They are complementary tests for assessment of the baseline toxicity risk and tools to guide therapy. The goal must be to continue the treatment as long as possible with the initiation and optimisation of the cardiological treatment. Cardiac atrial biomarkers are reported to have also antitumoral and anti-inflammatory properties. This review aims to present the role of cardiac biomarkers in the multidisciplinary management of renal cell carcinoma patients.
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Affiliation(s)
- Anca Drăgan
- Department of Cardiovascular Anaesthesiology and Intensive Care, Prof. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 258 Fundeni Road, 022328 Bucharest, Romania
| | - Ioanel Sinescu
- Department of Urological Surgery, Dialysis and Kidney Transplantation, Fundeni Clinical Institute, 258 Fundeni Road, 022328 Bucharest, Romania;
- Department of Uronephrology, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania
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