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Knight AS, Ha FL, de Riese WT. Diagnostic and therapeutic challenges of synchronous renal mass and pancreatic mass: a review. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/2051415820979099] [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
Objective: Synchronous renal cell carcinoma (RCC) and pancreatic tumors are rare clinical events and have been described scarcely in the literature. Our institution has recently encountered one case. This review aims to summarize and present the diagnostic and therapeutic approaches that have been presented in the literature for these synchronous solid malignancies. Methods: After reviewing the literature using PubMed, 16 papers were collected that showed a total of 21 patients with a synchronous solid renal and pancreatic mass. The diagnostic and treatment data were then evaluated and analyzed. Results: Overall, 13 patients (59%) had two independent primary malignancies consisting of RCC and a pancreatic tumor, seven (31%) were diagnosed with primary RCC with synchronous metastasis to pancreas, one (5%) was found to have a primary pancreatic adenocarcinoma with synchronous metastasis to the kidney, and one (5%) was diagnosed with primary RCC with a benign solid pancreatic lesion. Of the 22 patients that were treated, 18 (81%) underwent surgery, one (5%) had no treatment, and three (14%) underwent chemotherapy without surgery. In the cohort of patients with surgical treatment 12 (66%) had no adjuvant therapy, one (6%) had adjuvant chemotherapy, four (22%) had adjuvant immunotherapy, and one (6%) had adjuvant radiation treatment. Conclusions: The occurrence of synchronous malignancies of the kidney and pancreas is rare. No clear guidelines have evolved in the literature in regard to diagnostics and treatment of these patients. This review presents recommended diagnostic and treatment guidelines for these rare clinical cases. Level of evidence: Not applicable for this multicenter review.
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Affiliation(s)
- Andrew S Knight
- Department of Urology, Texas Tech University Health Sciences Center, USA
| | - Freedom L Ha
- Department of Urology, Texas Tech University Health Sciences Center, USA
| | - Werner T de Riese
- Department of Urology, Texas Tech University Health Sciences Center, USA
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Vocke CD, Ricketts CJ, Metwalli AR, Pinto PA, Gautam R, Raffeld M, Merino MJ, Ball MW, Linehan WM. Differential VHL mutation patterns in bilateral clear cell RCC distinguishes between independent primary tumors and contralateral metastatic disease. Urology 2022; 165:170-177. [PMID: 35469800 DOI: 10.1016/j.urology.2022.04.003] [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: 02/02/2022] [Revised: 03/24/2022] [Accepted: 04/03/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate whether bilateral, multifocal clear cell renal cell carcinoma (ccRCC) patients can be differentiated by VHL mutation analysis into cases that represent either multiple independently arising primary tumors, or a single primary tumor which has spread ipsilaterally as well as to the contralateral kidney. The nature of kidney cancer multifocality outside of known hereditary syndromes is as yet poorly understood. MATERIALS AND METHODS DNA from multiple tumors per patient were evaluated for somatic VHL gene mutation and hypermethylation. A subset of tumors with shared VHL mutations were analyzed with targeted, next-generation sequencing assays. RESULTS This cohort contained 5 patients with multiple tumors that demonstrated a shared somatic VHL mutation consistent with metastatic spread including to the contralateral kidney. In several cases this was substantiated by additional shared somatic mutations in ccRCC-associated genes. In contrast, the remaining 14 patients with multiple tumors demonstrated unique, unshared VHL alterations in every analyzed tumor, consistent with independently arising kidney tumors. None of these latter patients showed any evidence of local spread or distant metastasis. CONCLUSION The spectrum of VHL alterations within evaluated bilateral, multifocal ccRCC tumors from a single patient can distinguish between multiple independent tumor growth and metastasis. This can be performed using currently available clinical genetic tests and will improve the accuracy of patient diagnosis and prognosis, as well as informing appropriate management.
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Affiliation(s)
- Cathy D Vocke
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892
| | - Christopher J Ricketts
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892
| | - Adam R Metwalli
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892
| | - Peter A Pinto
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892
| | - Rabindra Gautam
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892
| | - Mark Raffeld
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892
| | - Mark W Ball
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892
| | - W Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892.
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Urushibara M, Nagata M, Okumura T, Kano H, Matsumoto Y, Tatsuoka S, Nenohi T, Shirakawa T, Kato D, Kawamoto M, Ishizaka K, Matsutani N. Bladder metastasis with additional metastases in multiple other organs 4 years after radical nephrectomy for clear cell renal cell carcinoma: a case report and review of the literature. J Med Case Rep 2022; 16:131. [PMID: 35366927 PMCID: PMC8977018 DOI: 10.1186/s13256-022-03368-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/10/2022] [Indexed: 11/29/2022] Open
Abstract
Background Renal cell carcinoma rarely metastasizes to the bladder, and its biological behavior is not yet fully understood. Case presentation In our case (54-year-old Japanese woman), computed tomography evaluation suggested the presence of a bladder metastasis, associated with additional metastases in the lungs, mediastinal lymph nodes, ribs, and renal bed, 4 years after radical nephrectomy for renal cell carcinoma. The histological findings of the metastatic bladder tumor were consistent with those of clear cell carcinoma. The mediastinal lymph node, rib, and renal bed metastases responded to treatment with an immune checkpoint inhibitor administered for 12 months after surgery for the bladder and lung metastases. In patients with bladder metastasis, absence of metastases in other organs and an interval of more than 1 year after nephrectomy are known to be favorable prognostic factors. Interestingly, in our case, the bladder metastasis was detected more than 1 year after nephrectomy, which was a favorable factor, but there were also metastases in other organs, which was an unfavorable factor. Therefore, we reviewed the literature, including that pertaining to targeted therapy and immune checkpoint inhibitor therapy published in the last two decades, to analyze the clinical significance of the presence of additional metastasis in other organs in renal cell carcinoma (clear cell type, which is the predominant subtype) patients with bladder metastasis. Conclusions Patients with bladder metastasis after nephrectomy for renal cell carcinoma also having metastases in other organs may respond to targeted therapy and immune checkpoint inhibitor therapy. This may suggest that the interval to relapse in the bladder after nephrectomy may be a more important prognostic factor than the presence of synchronous metastases in other organs.
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Gao Y, Yang W, Jin L, Xue L, Yang J, Cui Q. Profiling and bioinformatic analysis reveal differential microRNA expression in the left and right kidneys in normal mice. FEBS Lett 2019; 594:636-645. [PMID: 31642060 DOI: 10.1002/1873-3468.13644] [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] [Received: 10/07/2019] [Revised: 06/07/2019] [Accepted: 10/11/2019] [Indexed: 11/06/2022]
Abstract
Physiological and pathophysiological differences exist between the left and right kidneys; however, the molecular bases for these differences remain unknown. Since miRNAs are involved in kidney function and the development of kidney diseases, we examined their differential expression through miRNA profiling of the left and right kidneys of normal mice. We find that 36 miRNAs exhibit higher expression, whereas 22 miRNAs show lower expression in the left than the right kidneys in mice under physiological condition. Ten miRNAs were further examined by quantitative PCR assays, and four of them with high expression level were confirmed by Northern blot. Through bioinformatic analysis, we dissected the function and network of the differentially expressed miRNAs, providing insights into the physiological and pathophysiological differences between the left and the right kidneys.
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Affiliation(s)
- Yuanxu Gao
- Department of Biomedical Informatics, Department of Physiology and Pathophysiology, School of Basic Medical Sciences, MOE Key Laboratory of Molecular Cardiovascular Sciences, Center for Non-coding RNA Medicine, Peking University, Beijing, China
| | - Weili Yang
- Department of Biomedical Informatics, Department of Physiology and Pathophysiology, School of Basic Medical Sciences, MOE Key Laboratory of Molecular Cardiovascular Sciences, Center for Non-coding RNA Medicine, Peking University, Beijing, China.,Beijing Key Laboratory of Diabetes Research and Care, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ling Jin
- Center of Basic Medical Research, Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing, China
| | - Lixiang Xue
- Center of Basic Medical Research, Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing, China
| | - Jichun Yang
- Department of Biomedical Informatics, Department of Physiology and Pathophysiology, School of Basic Medical Sciences, MOE Key Laboratory of Molecular Cardiovascular Sciences, Center for Non-coding RNA Medicine, Peking University, Beijing, China
| | - Qinghua Cui
- Department of Biomedical Informatics, Department of Physiology and Pathophysiology, School of Basic Medical Sciences, MOE Key Laboratory of Molecular Cardiovascular Sciences, Center for Non-coding RNA Medicine, Peking University, Beijing, China
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Bokhari A, Tiscornia-Wasserman PG. Cytology diagnosis of metastatic clear cell renal cell carcinoma, synchronous to pancreas, and metachronous to thyroid and contralateral adrenal: Report of a case and literature review. Diagn Cytopathol 2016; 45:161-167. [DOI: 10.1002/dc.23619] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 08/31/2016] [Accepted: 09/19/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Aqiba Bokhari
- Division of Cytopathology; Department of Pathology and Cell Biology; New York Presbyterian-Columbia University Medical Center; New York New York
| | - Patricia G. Tiscornia-Wasserman
- Division of Cytopathology; Department of Pathology and Cell Biology; New York Presbyterian-Columbia University Medical Center; New York New York
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