Objective： To investigate the imaging manifestation of primary malignant renal tumor with CT. Methods： Forty-three cases of surgically and pathologically confirmed primary malignant renal tumor were retrospectively ...Objective： To investigate the imaging manifestation of primary malignant renal tumor with CT. Methods： Forty-three cases of surgically and pathologically confirmed primary malignant renal tumor were retrospectively reviewed. Un-contrast and contrast CT was performed in all 43 patients in which 15 patients received MRI examination. Results： The residual normal renal tissue of 29 cases out of 34 cases of Wilms＇ tumor was enhanced and manifested ＂crescent sign＂ or ＂ring sign＂. Four cases of malignant rabdoid tumor （RTK） manifested as large mass with notable necrosis and subcapsular fluid collection; Two cases of clear cell sarcoma （CCS） showed metastases to the skull which could indicate the diagnosis; Renal cell carcinoma （RCC） （n=3） showed calcification in 1 case. Conclusion： CT can precisely delineate the location, size, extent of involvement, imaging characteristics and metastases of renal tumor, which can provide information necessary to the clinical staging, therapy planning and prognosis of the tumors.展开更多
Objective:The aim of the study was to report the experience of National Cancer Institute(NCI),Cairo University,Egypt,in managing various benign and malignant renal tumors with nephron sparing surgery(NSS),and to asses...Objective:The aim of the study was to report the experience of National Cancer Institute(NCI),Cairo University,Egypt,in managing various benign and malignant renal tumors with nephron sparing surgery(NSS),and to assess its safety and feasibility.Methods:Reviewing the literature for NSS,and records of patients who underwent NSS in the period from January 2000 to December 2009 at National Cancer Institute,Cairo University regarding the patient and tumor related characteristics,the indication for NSS,operative technique,postoperative complications,full histopathological data,and follow up results.Results:The total number of patients was 17.Mean age at surgery was 30.7 years(range 1.5-65 years).Five patients had bilateral tumors during surgery.The mean tumor size was 4.5 cm(range 1-9 cm).All patients had normal preoperative kidney functions.Seven patients had an absolute indication for NSS,6 patients had a relative indication,and 4 patients had an elective indication.All the 5 patients with bilateral tumors underwent bilateral simultaneous surgery.Cold ischemia was used in 8 patients,1 patient was exposed to warm ischemia,manual compression was used in 2 patients,and no vascular control was applied in 6 patients.Complications were encountered in 2 patients,one of them had urinary leakage which needed reoperation,and the other had subcutaneous hematoma which was treated conservatively.Histopathological analysis revealed Wilm's tumor(8 patients),angiomyolipoma(4 patients),renal cell carcinoma(4 patients),and hydatid cyst(1 patient).All patients had negative surgical margin.For patients with Wilm's tumor,the mean follow up was 21.4 months(range 0-94 months),2 patients had local recurrence,and 1 patient had distant metastasis.For patients with RCC,the mean follow up was 15.3 months(5-33 months),no patients had local recurrence or distant metastasis.All patients had normal kidney functions during postoperative and follow up periods.Conclusion:NSS is a feasible safe procedure that can be done with acceptable complications rate and it provides a good solution for patients with bilateral tumors,early localized renal cell carcinoma,and benign tumors.展开更多
Objective:This study aimed to evaluate the efficacy and safety of selective arterial embolization for hemorrhage after renal surgery and to summarize the clinical experience.Materials and methods:A total of 9 patients...Objective:This study aimed to evaluate the efficacy and safety of selective arterial embolization for hemorrhage after renal surgery and to summarize the clinical experience.Materials and methods:A total of 9 patients underwent arterial embolization after partial nephrectomy from 2010 to 2018.Results:Technical success was achieved in all patients;however,3 patients underwent a secondary arterial embolization because of short-term re-hemorrhage or the co-occurrence of accessory renal arterial hemorrhage.No serious complications occurred during the follow-up.Conclusions:Superselective arterial embolization is an effective and minimally invasive treatment for hemorrhage after partial nephrectomy.To improve the success rate of surgery,attention should be paid to the evaluation of accessory renal arteries and the management of suspected bleeding arteries.展开更多
Background:Renal cysts are common in clinical practice,but some may harbor rare pathological entities such as mixed epithelial and stromal tumors(MEST).Imaging studies are crucial for accurate diagnosis.While laparosc...Background:Renal cysts are common in clinical practice,but some may harbor rare pathological entities such as mixed epithelial and stromal tumors(MEST).Imaging studies are crucial for accurate diagnosis.While laparoscopic deroofing is an established approach for symptomatic renal cysts,encountering MEST within a cyst is uncommon.Case Presentation:We present the case of a 37-year-old female who presented with persistent left flank pain.Imaging revealed a large renal cyst in the lower pole of the left kidney,classified as Bosniak 2.Despite analgesia,the patient's symptoms persisted,leading to a laparoscopic deroofing procedure.Histopathological examination postprocedure revealed a MEST.The patient reported complete resolution of symptoms at the 3-month follow-up.Conclusion:This unique case presents the successful identification and surgical management of a MEST masquerading as a lower pole renal cyst through laparoscopic deroofing.It also contributes to the existing literature by highlighting the importance of considering rare pathological entities in the evaluation of renal cysts and the value of laparoscopic techniques in their management.展开更多
Background:Completely endophytic renal tumors(CERT)pose significant challenges due to their anatomical complexity and loss of visual clues about tumor location.A facile scoring model based on three-dimensional(3D)reco...Background:Completely endophytic renal tumors(CERT)pose significant challenges due to their anatomical complexity and loss of visual clues about tumor location.A facile scoring model based on three-dimensional(3D)reconstructed images will assist in better assessing tumor location and vascular variations.Methods:In this retrospective study,80 patients diagnosed with CERT were included.Forty cases underwent preoperative assessment using 3D reconstructed imaging(3D-Cohort),while the remaining 40 cases were assessed using two-dimensional imaging(2D-Cohort).Vascular variations were evaluated by ascertaining the presence of renal arteries>1,prehilar branching arteries,and arteries anterior to veins.The proposed scoring system,termed RAL,encompassed three critical components:(R)adius(maximal tumor diameter in cm),(A)rtery(occurrence of arterial variations),and(L)ocation relative to the polar line.Comparison of the RAL scoring system was made with established nephrometry scoring systems.Results:A total of 48(60%)patients exhibited at least one vascular variation.In the 2D-Cohort,patients with vascular variations experienced significantly prolonged operation time,increased bleeding volume,and extended warm ischemia time compared with those without vascular variations.Conversely,the presence of vascular vari-ations did not significantly affect operative parameters in the 3D-Cohort.Furthermore,the 2D-Cohort demon-strated a notable decline in both short-and long-term estimated glomerular filtration rate(eGFR)changes com-pared with the 3D-Cohort,a trend consistent across patients with warm ischemia time≥25 min and those with vascular variations.Notably,the 2D-Cohort exhibited a larger margin of normal renal tissue compared with the 3D-Cohort.Elevated RAL scores correlated with larger tumor size,prolonged operation time,extended warm is-chemia time,and substantial postoperative eGFR decrease.The RAL scoring system displayed superior predictive capabilities in assessing postoperative eGFR changes compared with conventional nephrometry scoring systems.Conclusions:Our proposed 3D vascular variation-based nephrometry scoring system offers heightened proficiency in preoperative assessment,precise prediction of surgical complexity,and more accurate evaluation of postoper-ative renal function in CERT patients.展开更多
Objective： To review hot issues and future direction of renal tumor biopsy （RTB） technique. Data Sources： The literature concerning or including RTB technique in English was collected from PubMed published from 19...Objective： To review hot issues and future direction of renal tumor biopsy （RTB） technique. Data Sources： The literature concerning or including RTB technique in English was collected from PubMed published from 1990 to 2015. Study Selection： We included all the relevant articles on RTB technique in English, with no limitation of study design. Results： Computed tomography and ultrasound were usually used for guiding RTB with respective advantages. Core biopsy is more preferred over fine needle aspiration because of superior accuracy. A minimum of two good-quality cores for a single renal tumor is generally accepted. The use of coaxial guide is recommended. For biopsy location, sampling different regions including central and peripheral biopsies are recommended. Conclusion： In spite of some limitations, RTB technique is relatively mature to help optimize the treatment of renal tumors.展开更多
Background： The aim of this study was to assess the performance of apparent diffusion coefficient （ADC） measurement obtained with diffusion-weighted magnetic resonance imaging （DW-MRI） to distinguish renal cell c...Background： The aim of this study was to assess the performance of apparent diffusion coefficient （ADC） measurement obtained with diffusion-weighted magnetic resonance imaging （DW-MRI） to distinguish renal cell carcinomas （RCCs） from small benign solid renal tumors （〈4 cm）. Methods： In this cross-sectional study, 49 consecutive patients with histopathologically confirmed small solid renal tumors, and seven healthy volunteers were imaged using nonenhanced MRI and DW-MRI. The ADC map was calculated using the b values of 0, 50, 400, and 600 s/ mm2 and values compared via the Kruskal-Wallis and Mann-Whitney tests. The utility of ADC for differentiating RCCs and benign lesions was assessed using a receiver operating characteristic curve. Multiple nonenhanced MRI features were analyzed by Logistic regression. Results： The tumors consisted of 33 cases of clear-cell RCCs （ccRCCs） and 16 cases of benign tumors, including 14 cases of minimal fat angiomyolipomas and 2 cases ofoncocytomas. The ADCs showed significant differences among benign tumors （[0.90 ±0.52] x 10 x mm2/s）, ccRCCs （[1.53 ± 0.31 ] x 10 ^3 mm2/s） and the normal renal parenchyma （[2.22 ± 0.12]x 10^-3 mmVs） （P 〈 0.001）. Moreover, there was statistically significant difference between high and low-grade ccRCCs （P = 0.004）. Using a cut-offADC of 1.36± 10 3 mm2/s, DW-MRI resulted in an area under the curve （AUC）, sensitivity, and specificity equal to 0.839, 75.8%, and 87.5%, respectively. Nonenhanced MRI alone and the combination of imaging methods led to an AUC, sensitivity and specificity equal to 0.919, 93.9%, and 81.2%, 0.998, 97%, and 100%, respectively. The Logistic regression showed that the location of the center of the tumor （inside the contour of the kidney） and appearance of stiffblood vessel were significantly helpful for diagnosing ccRCCs. Conclusions： DW-MRI has potential in distinguishing ccRCCs from benign lesions in human small solid renal tumors （〈4 cm）, and in increasing the accuracy for diagnosing ccRCCs when combined with nonenhanced MRI.展开更多
Background:The clinical management of children with renal tumors including Wilms'tumor,clear cell sarcoma,rhabdoid tumor and other renal tumors in our center was designed according to the National Wilms'Tumor ...Background:The clinical management of children with renal tumors including Wilms'tumor,clear cell sarcoma,rhabdoid tumor and other renal tumors in our center was designed according to the National Wilms'Tumor Study Group protocols.Methods:A total of 142 consecutive patients who had been diagnosed as having renal tumors at Shanghai Children's Medical Center were reviewed retrospectively in the period of December 1998 and September 2012.Diagnosis and treatment were decided by a multi-disciplinary team including oncologists,surgeons,pathologists and sub-specialized radiologists.Results:The median age of the patients at the time of diagnosis was 27 months.The tumor stages of the patients were as follows:stage I 24.6%,stage II 23.2%,stage III 32.3%,stage IV 14.1%,and stage V 5.6%.Favorable histology was diagnosed in 80.3%,anaplasia in 4.2%,clear cell sarcoma in 9.8%,rhabdoid tumor in 4.9%,and other renal tumors in 0.7%of the patients.The event-free and overall 5-year survival rates were 80%and 83%,respectively.Tumor relapse and progress was seen in 25 patients(17.6%).The median relapse time was 6 months(range:2-37 months).Seven relapsing patients were re-treated and four of them got second complete remission(three in stage II,one in stage I).Conclusion:A multi-disciplinary team work model is feasible in developing countries,and the renal tumors protocols basically from developed countries are safe in developing countries.展开更多
The imaging appearance of renal granuloma is very similar to that of a renal tumor.Granulomatous lesions usually do not require surgical treatment,while kidney tumors typically necessitate surgical removal.The diagnos...The imaging appearance of renal granuloma is very similar to that of a renal tumor.Granulomatous lesions usually do not require surgical treatment,while kidney tumors typically necessitate surgical removal.The diagnosis of renal granuloma typically relies on the history of bacillus Calmette-Guérin perfusion and the position of the renal pelvis in the image(malignant tumors usually destroy or compress the surrounding renal pelvis).However,in this case,the patient has no history of bacillus Calmette-Guérin perfusion,making the diagnosis more challenging.The ultrasound and enhanced CT findings were consistent with renal papillary carcinoma.Laparoscopic partial nephrectomy was performed,revealing degeneration and necrosis of the renal cortex and formation of granulomas.The imaging diagnosis of renal granuloma is difficult.Ultrasound-guided biopsy may be a preferable method to avoid unnecessary surgery.展开更多
Objective To explore the roles of cytokines in the pathogenesis of hemorrhagic fever with renal syndrome(HFRS). Methods Double-antibody sandwich ELISA was used to determine serum interleukin (IL)-6, urine tumor necros...Objective To explore the roles of cytokines in the pathogenesis of hemorrhagic fever with renal syndrome(HFRS). Methods Double-antibody sandwich ELISA was used to determine serum interleukin (IL)-6, urine tumor necrosis factor (TNF), IL-6 and IL-8 levels in 56 patients with HFRS. Results Serum IL-6, urine TNF, IL-6 and IL-8 concentrations in HFRS patients were significantly higher than those in control group, respectively (P<0.001). The concentrations increased at fever stage, then continued to increase during hypotension stage and peaked at oliguria stage. The concentrations of serum IL-6, urine TNF, IL-6 and IL-8 increased in accord with the severity of the disease and differed greatly among different types of the disease. Serum IL-6 had remarkable relationships with serum specific antibodies. It was positively related to serum β_2-microglobulin (β_2-MG), blood ureanitrogen (BUN) and creatinine (Cr). Significant positive relationships were also found both between urine IL-6 and TNF, and between IL-6 and IL-8 (r=0.5768, P<0.05; r=0.3760, P<0.01). Conclusion TNF, IL-6 and IL-8 activated during the course of the disease. IL-6 is associated with the immunopathological lesions caused by the hyperfunction of humoral immune response. IL-6, IL-8 and TNF are involved in the renal immune impairment. Determining them might, in certain extent, be used in predicting the prognosis and outcome of patients with HFRS.展开更多
BACKGROUND Renal involvement in lymphoma is commonly associated with widespread nodal or extranodal lymphoma.Primary renal diffuse large B-cell lymphoma is an extremely rare extranodal lymphoma,accounting for fewer th...BACKGROUND Renal involvement in lymphoma is commonly associated with widespread nodal or extranodal lymphoma.Primary renal diffuse large B-cell lymphoma is an extremely rare extranodal lymphoma,accounting for fewer than 1%of all renal masses.Interestingly,the patient in this study had a renal vein tumor thrombus that was observed after laparoscopic radical nephrectomy.CASE SUMMARY We report the case of a 56-year-old female patient with primary renal lymphoma and a renal vein tumor thrombus whose first symptom was right pain in the back and gross hematuria.Histopathology revealed primary renal diffuse large B-cell lymphoma.The patient received 8 standard cycles of rituximab with cyclophosphamide,doxorubicin,vincristine,and prednisone chemotherapy after surgery,and no obvious signs of recurrence were observed during the one-year follow-up.CONCLUSION We evaluated comprehensive treatment of primary renal diffuse large B-cell lymphoma and multidisciplinary management of this malignancy.展开更多
<strong>Objective:</strong> To investigate the value of the number of circulating tumor cells (CTC) in peripheral blood in the prognosis and coagulation-related indicators of patients with renal cancer. &l...<strong>Objective:</strong> To investigate the value of the number of circulating tumor cells (CTC) in peripheral blood in the prognosis and coagulation-related indicators of patients with renal cancer. <strong>Methods:</strong> 65 patients with renal cell carcinoma (RCC) confirmed pathologically were divided into CTC positive group and CTC negative group according to the CTC count (5 pcs/3.5 ml). Compare the age, gender, tumor location, TNM (clinical stage), pathological grade, tissue type, lymph node metastasis, distant metastasis, prognosis and prothrombin time (PT), fibrinogen (FIB), partial coagulation of the two groups of patients The correlation between the results of zymogen time (APTT) and D-dimer (DD) and the number of CTC. <strong>Results:</strong> There were significant differences in TNM, lymph node metastasis, and distant metastasis between the two groups (P < 0.05). The number of CTC in patients was correlated with FIB and D-D levels (P < 0.05). <strong>Conclusion:</strong> The number of CTC in patients with renal cell carcinoma is correlated with some clinical phenotypes (TNM, lymph node metastasis, distant metastasis) and some coagulation indexes (FIB, D-D), and can jointly predict the prognosis of renal cancer.展开更多
Objective: To study the expression of dendritic cells in human renal cell carcinoma and explore the cause, so to reveal the mechanism of escaping immune surveillance in RCC. Methods: The expressions of CD83+DCS, CD1a+...Objective: To study the expression of dendritic cells in human renal cell carcinoma and explore the cause, so to reveal the mechanism of escaping immune surveillance in RCC. Methods: The expressions of CD83+DCS, CD1a+DCS,VEGF and TGF-β1 in tumoral, peritumoral and normal kidney tissues of RCC in 30 cases were detected by immunohistochemistry using streptavidin/peroxidese(SP) Results: CD83+DCS were mainly located in the peritumoral areas; whereas CD1a+DCS、were mainly retained within the cancer nests. The number of CD83+DCS was inversely correlated with the clinical stage(P<0.05); but there were no significant correlations between the number of CD1a+DCS、and the clinical stage(P>0.05). The expressions of CD83+DCS and CD1a+DCS have significant difference between the tumoral, peritumoral and normal kidney tissues(P<0.001). The expression of VEGF and TGF-β1 were significantly lower in samples with highly infiltrating CD83+DCS(P<0.05); Whereas CD1a+DCS were not (P>0.05). Conclusion: DC has the tendency to gathering in tumor, but because of the immunosuppressive cytokins, for example VEGF and TGF-β1, inhibits the maturation of DC, there are less mature TIDCS(CD83+TIDCS) in the tumoral tissues, they are mainly located in the peritumoral areas. This may contribute to the mechanism of escaping immune surveillance in RCC.展开更多
The therapeutic options for patients with metastatic renal cell carcinoma(mRCC) have completely changed during the last ten years. With the sequential use of targeted therapies, median overall survival has increased i...The therapeutic options for patients with metastatic renal cell carcinoma(mRCC) have completely changed during the last ten years. With the sequential use of targeted therapies, median overall survival has increased in daily practice and now it is not uncommon to see patients surviving kidney cancer for more than four to five years. Once treatment fails with the first line targeted therapy, head to head comparisons have shown that cabozantinib, nivolumab and the combination of lenvatinib plus everolimus are more effective than everolimus alone and that axitinib is more active than sorafenib. Unfortunately, it is very unlikely that we will ever have prospective data comparing the activity of axitinib, cabozantinib, lenvatinib or nivolumab. It is frustrating to observe the lack of biomarkers that we have in this field, thus there is no firm recommendation about the optimal sequence of treatment in the second line. In the absence of reliable biomarkers, there are several clinical endpoints that can help physicians to make decisions for an individual patient, such as the tumor burden, the expected response rate and the time to achieve the response to each agent, the prior response to the agent administered, the toxicity profile of the different compounds and patient preference. Here, we propose the introduction of the tumor-growth rate(TGR) during first-line treatment as a new tool to be used to select the second line strategy in m RCC. The rapidness of TGR before the onset of the treatment reflects the variability between patients in terms of tumor growth kinetics and it could be a surrogate marker of tumor aggressiveness that may guide treatment decisions.展开更多
Although invasion of renal cell carcinoma (RCC) into the inferior vena cava is common, pulmonary tumor embolism is rare. We present a case of a pulmonary tumor embolism from type II papillary renal cell carcinoma succ...Although invasion of renal cell carcinoma (RCC) into the inferior vena cava is common, pulmonary tumor embolism is rare. We present a case of a pulmonary tumor embolism from type II papillary renal cell carcinoma successfully treated using a staged approach. Such staged procedures are particularly effective in cases of massive renal tumors. Pulmonary tumor embolectomy using normothermic cardiopulmonary bypass is considerably less invasive than under deep hypothermic circulatory arrest.展开更多
To evaluate the operative characteristics and efficacy of retroperitoneoscopic resection of renal,ureter and partial bladder for the treatment of native renal pelvic and ureteral transitional cell cancer occurring at ...To evaluate the operative characteristics and efficacy of retroperitoneoscopic resection of renal,ureter and partial bladder for the treatment of native renal pelvic and ureteral transitional cell cancer occurring at the same side of transplanted kidney.Methods In 5 cases of renal transplantation,there were 2 cases of right native renal pelvic cancer,1 case of right native renal pelvic and ureter cancer and 2 cases of right ureter cancer respectively.The transplanted kidney was in the same iliac fossa side of the tumor.All 5 patients were subjected to nephroureterectomy and bladder cuff excision by retroperitoneoscopic technique.Results Five operations were completed successfully.The operative time was 180 to 280 min,and the blood loss was 50 to 200 ml.The recovery of intestinal function after operation was 12 to 36 h.The urine output was 1 500 to 4 000 per day.Postoperative serum creatinine was still normal.The mean hospital stay after operation was 4.5 days.Conclusion Retroperitoneal laparoscopic nephroureterectomy and bladder cuff excision is a good method to treat the native renal pelvic and ureteral transitional cell cancer occurring at the same side of transplanted kidney.The procedure is safe and less invasive,which provides a good protection of transplanted kidney.12 refs.展开更多
文摘Objective： To investigate the imaging manifestation of primary malignant renal tumor with CT. Methods： Forty-three cases of surgically and pathologically confirmed primary malignant renal tumor were retrospectively reviewed. Un-contrast and contrast CT was performed in all 43 patients in which 15 patients received MRI examination. Results： The residual normal renal tissue of 29 cases out of 34 cases of Wilms＇ tumor was enhanced and manifested ＂crescent sign＂ or ＂ring sign＂. Four cases of malignant rabdoid tumor （RTK） manifested as large mass with notable necrosis and subcapsular fluid collection; Two cases of clear cell sarcoma （CCS） showed metastases to the skull which could indicate the diagnosis; Renal cell carcinoma （RCC） （n=3） showed calcification in 1 case. Conclusion： CT can precisely delineate the location, size, extent of involvement, imaging characteristics and metastases of renal tumor, which can provide information necessary to the clinical staging, therapy planning and prognosis of the tumors.
文摘Objective:The aim of the study was to report the experience of National Cancer Institute(NCI),Cairo University,Egypt,in managing various benign and malignant renal tumors with nephron sparing surgery(NSS),and to assess its safety and feasibility.Methods:Reviewing the literature for NSS,and records of patients who underwent NSS in the period from January 2000 to December 2009 at National Cancer Institute,Cairo University regarding the patient and tumor related characteristics,the indication for NSS,operative technique,postoperative complications,full histopathological data,and follow up results.Results:The total number of patients was 17.Mean age at surgery was 30.7 years(range 1.5-65 years).Five patients had bilateral tumors during surgery.The mean tumor size was 4.5 cm(range 1-9 cm).All patients had normal preoperative kidney functions.Seven patients had an absolute indication for NSS,6 patients had a relative indication,and 4 patients had an elective indication.All the 5 patients with bilateral tumors underwent bilateral simultaneous surgery.Cold ischemia was used in 8 patients,1 patient was exposed to warm ischemia,manual compression was used in 2 patients,and no vascular control was applied in 6 patients.Complications were encountered in 2 patients,one of them had urinary leakage which needed reoperation,and the other had subcutaneous hematoma which was treated conservatively.Histopathological analysis revealed Wilm's tumor(8 patients),angiomyolipoma(4 patients),renal cell carcinoma(4 patients),and hydatid cyst(1 patient).All patients had negative surgical margin.For patients with Wilm's tumor,the mean follow up was 21.4 months(range 0-94 months),2 patients had local recurrence,and 1 patient had distant metastasis.For patients with RCC,the mean follow up was 15.3 months(5-33 months),no patients had local recurrence or distant metastasis.All patients had normal kidney functions during postoperative and follow up periods.Conclusion:NSS is a feasible safe procedure that can be done with acceptable complications rate and it provides a good solution for patients with bilateral tumors,early localized renal cell carcinoma,and benign tumors.
文摘Objective:This study aimed to evaluate the efficacy and safety of selective arterial embolization for hemorrhage after renal surgery and to summarize the clinical experience.Materials and methods:A total of 9 patients underwent arterial embolization after partial nephrectomy from 2010 to 2018.Results:Technical success was achieved in all patients;however,3 patients underwent a secondary arterial embolization because of short-term re-hemorrhage or the co-occurrence of accessory renal arterial hemorrhage.No serious complications occurred during the follow-up.Conclusions:Superselective arterial embolization is an effective and minimally invasive treatment for hemorrhage after partial nephrectomy.To improve the success rate of surgery,attention should be paid to the evaluation of accessory renal arteries and the management of suspected bleeding arteries.
文摘Background:Renal cysts are common in clinical practice,but some may harbor rare pathological entities such as mixed epithelial and stromal tumors(MEST).Imaging studies are crucial for accurate diagnosis.While laparoscopic deroofing is an established approach for symptomatic renal cysts,encountering MEST within a cyst is uncommon.Case Presentation:We present the case of a 37-year-old female who presented with persistent left flank pain.Imaging revealed a large renal cyst in the lower pole of the left kidney,classified as Bosniak 2.Despite analgesia,the patient's symptoms persisted,leading to a laparoscopic deroofing procedure.Histopathological examination postprocedure revealed a MEST.The patient reported complete resolution of symptoms at the 3-month follow-up.Conclusion:This unique case presents the successful identification and surgical management of a MEST masquerading as a lower pole renal cyst through laparoscopic deroofing.It also contributes to the existing literature by highlighting the importance of considering rare pathological entities in the evaluation of renal cysts and the value of laparoscopic techniques in their management.
基金We thank researchers for patients enrolled from the FUSCC cohort.This work was supported by grants from the National Natural Science Foundation of China(grant numbers:81802525 and no.82172817)the Natural Science Foundation of Shanghai(grant number:20ZR1413100)+3 种基金Beijing Xisike Clinical Oncology Research Foundation(grant number:Y-HR2020MS-0948)the Shanghai“Science and Technology Innova-tion Action Plan”medical innovation research Project(grant num-ber:22Y11905100)the Shanghai Anti-Cancer Association Eyas Project(grant number:SACA-CY21A06 and no.SACA-CY21B01)Fudan University Fuqing scholars Project(grant number:FQXZ202304A).
文摘Background:Completely endophytic renal tumors(CERT)pose significant challenges due to their anatomical complexity and loss of visual clues about tumor location.A facile scoring model based on three-dimensional(3D)reconstructed images will assist in better assessing tumor location and vascular variations.Methods:In this retrospective study,80 patients diagnosed with CERT were included.Forty cases underwent preoperative assessment using 3D reconstructed imaging(3D-Cohort),while the remaining 40 cases were assessed using two-dimensional imaging(2D-Cohort).Vascular variations were evaluated by ascertaining the presence of renal arteries>1,prehilar branching arteries,and arteries anterior to veins.The proposed scoring system,termed RAL,encompassed three critical components:(R)adius(maximal tumor diameter in cm),(A)rtery(occurrence of arterial variations),and(L)ocation relative to the polar line.Comparison of the RAL scoring system was made with established nephrometry scoring systems.Results:A total of 48(60%)patients exhibited at least one vascular variation.In the 2D-Cohort,patients with vascular variations experienced significantly prolonged operation time,increased bleeding volume,and extended warm ischemia time compared with those without vascular variations.Conversely,the presence of vascular vari-ations did not significantly affect operative parameters in the 3D-Cohort.Furthermore,the 2D-Cohort demon-strated a notable decline in both short-and long-term estimated glomerular filtration rate(eGFR)changes com-pared with the 3D-Cohort,a trend consistent across patients with warm ischemia time≥25 min and those with vascular variations.Notably,the 2D-Cohort exhibited a larger margin of normal renal tissue compared with the 3D-Cohort.Elevated RAL scores correlated with larger tumor size,prolonged operation time,extended warm is-chemia time,and substantial postoperative eGFR decrease.The RAL scoring system displayed superior predictive capabilities in assessing postoperative eGFR changes compared with conventional nephrometry scoring systems.Conclusions:Our proposed 3D vascular variation-based nephrometry scoring system offers heightened proficiency in preoperative assessment,precise prediction of surgical complexity,and more accurate evaluation of postoper-ative renal function in CERT patients.
文摘Objective： To review hot issues and future direction of renal tumor biopsy （RTB） technique. Data Sources： The literature concerning or including RTB technique in English was collected from PubMed published from 1990 to 2015. Study Selection： We included all the relevant articles on RTB technique in English, with no limitation of study design. Results： Computed tomography and ultrasound were usually used for guiding RTB with respective advantages. Core biopsy is more preferred over fine needle aspiration because of superior accuracy. A minimum of two good-quality cores for a single renal tumor is generally accepted. The use of coaxial guide is recommended. For biopsy location, sampling different regions including central and peripheral biopsies are recommended. Conclusion： In spite of some limitations, RTB technique is relatively mature to help optimize the treatment of renal tumors.
文摘Background： The aim of this study was to assess the performance of apparent diffusion coefficient （ADC） measurement obtained with diffusion-weighted magnetic resonance imaging （DW-MRI） to distinguish renal cell carcinomas （RCCs） from small benign solid renal tumors （〈4 cm）. Methods： In this cross-sectional study, 49 consecutive patients with histopathologically confirmed small solid renal tumors, and seven healthy volunteers were imaged using nonenhanced MRI and DW-MRI. The ADC map was calculated using the b values of 0, 50, 400, and 600 s/ mm2 and values compared via the Kruskal-Wallis and Mann-Whitney tests. The utility of ADC for differentiating RCCs and benign lesions was assessed using a receiver operating characteristic curve. Multiple nonenhanced MRI features were analyzed by Logistic regression. Results： The tumors consisted of 33 cases of clear-cell RCCs （ccRCCs） and 16 cases of benign tumors, including 14 cases of minimal fat angiomyolipomas and 2 cases ofoncocytomas. The ADCs showed significant differences among benign tumors （[0.90 ±0.52] x 10 x mm2/s）, ccRCCs （[1.53 ± 0.31 ] x 10 ^3 mm2/s） and the normal renal parenchyma （[2.22 ± 0.12]x 10^-3 mmVs） （P 〈 0.001）. Moreover, there was statistically significant difference between high and low-grade ccRCCs （P = 0.004）. Using a cut-offADC of 1.36± 10 3 mm2/s, DW-MRI resulted in an area under the curve （AUC）, sensitivity, and specificity equal to 0.839, 75.8%, and 87.5%, respectively. Nonenhanced MRI alone and the combination of imaging methods led to an AUC, sensitivity and specificity equal to 0.919, 93.9%, and 81.2%, 0.998, 97%, and 100%, respectively. The Logistic regression showed that the location of the center of the tumor （inside the contour of the kidney） and appearance of stiffblood vessel were significantly helpful for diagnosing ccRCCs. Conclusions： DW-MRI has potential in distinguishing ccRCCs from benign lesions in human small solid renal tumors （〈4 cm）, and in increasing the accuracy for diagnosing ccRCCs when combined with nonenhanced MRI.
基金supported by the Shanghai"Priority"clinical key discipline construction project.
文摘Background:The clinical management of children with renal tumors including Wilms'tumor,clear cell sarcoma,rhabdoid tumor and other renal tumors in our center was designed according to the National Wilms'Tumor Study Group protocols.Methods:A total of 142 consecutive patients who had been diagnosed as having renal tumors at Shanghai Children's Medical Center were reviewed retrospectively in the period of December 1998 and September 2012.Diagnosis and treatment were decided by a multi-disciplinary team including oncologists,surgeons,pathologists and sub-specialized radiologists.Results:The median age of the patients at the time of diagnosis was 27 months.The tumor stages of the patients were as follows:stage I 24.6%,stage II 23.2%,stage III 32.3%,stage IV 14.1%,and stage V 5.6%.Favorable histology was diagnosed in 80.3%,anaplasia in 4.2%,clear cell sarcoma in 9.8%,rhabdoid tumor in 4.9%,and other renal tumors in 0.7%of the patients.The event-free and overall 5-year survival rates were 80%and 83%,respectively.Tumor relapse and progress was seen in 25 patients(17.6%).The median relapse time was 6 months(range:2-37 months).Seven relapsing patients were re-treated and four of them got second complete remission(three in stage II,one in stage I).Conclusion:A multi-disciplinary team work model is feasible in developing countries,and the renal tumors protocols basically from developed countries are safe in developing countries.
文摘The imaging appearance of renal granuloma is very similar to that of a renal tumor.Granulomatous lesions usually do not require surgical treatment,while kidney tumors typically necessitate surgical removal.The diagnosis of renal granuloma typically relies on the history of bacillus Calmette-Guérin perfusion and the position of the renal pelvis in the image(malignant tumors usually destroy or compress the surrounding renal pelvis).However,in this case,the patient has no history of bacillus Calmette-Guérin perfusion,making the diagnosis more challenging.The ultrasound and enhanced CT findings were consistent with renal papillary carcinoma.Laparoscopic partial nephrectomy was performed,revealing degeneration and necrosis of the renal cortex and formation of granulomas.The imaging diagnosis of renal granuloma is difficult.Ultrasound-guided biopsy may be a preferable method to avoid unnecessary surgery.
文摘Objective To explore the roles of cytokines in the pathogenesis of hemorrhagic fever with renal syndrome(HFRS). Methods Double-antibody sandwich ELISA was used to determine serum interleukin (IL)-6, urine tumor necrosis factor (TNF), IL-6 and IL-8 levels in 56 patients with HFRS. Results Serum IL-6, urine TNF, IL-6 and IL-8 concentrations in HFRS patients were significantly higher than those in control group, respectively (P<0.001). The concentrations increased at fever stage, then continued to increase during hypotension stage and peaked at oliguria stage. The concentrations of serum IL-6, urine TNF, IL-6 and IL-8 increased in accord with the severity of the disease and differed greatly among different types of the disease. Serum IL-6 had remarkable relationships with serum specific antibodies. It was positively related to serum β_2-microglobulin (β_2-MG), blood ureanitrogen (BUN) and creatinine (Cr). Significant positive relationships were also found both between urine IL-6 and TNF, and between IL-6 and IL-8 (r=0.5768, P<0.05; r=0.3760, P<0.01). Conclusion TNF, IL-6 and IL-8 activated during the course of the disease. IL-6 is associated with the immunopathological lesions caused by the hyperfunction of humoral immune response. IL-6, IL-8 and TNF are involved in the renal immune impairment. Determining them might, in certain extent, be used in predicting the prognosis and outcome of patients with HFRS.
基金Supported by Foundation of Health Commission of Guizhou Province of China,No.gzwkj2021-211.
文摘BACKGROUND Renal involvement in lymphoma is commonly associated with widespread nodal or extranodal lymphoma.Primary renal diffuse large B-cell lymphoma is an extremely rare extranodal lymphoma,accounting for fewer than 1%of all renal masses.Interestingly,the patient in this study had a renal vein tumor thrombus that was observed after laparoscopic radical nephrectomy.CASE SUMMARY We report the case of a 56-year-old female patient with primary renal lymphoma and a renal vein tumor thrombus whose first symptom was right pain in the back and gross hematuria.Histopathology revealed primary renal diffuse large B-cell lymphoma.The patient received 8 standard cycles of rituximab with cyclophosphamide,doxorubicin,vincristine,and prednisone chemotherapy after surgery,and no obvious signs of recurrence were observed during the one-year follow-up.CONCLUSION We evaluated comprehensive treatment of primary renal diffuse large B-cell lymphoma and multidisciplinary management of this malignancy.
文摘<strong>Objective:</strong> To investigate the value of the number of circulating tumor cells (CTC) in peripheral blood in the prognosis and coagulation-related indicators of patients with renal cancer. <strong>Methods:</strong> 65 patients with renal cell carcinoma (RCC) confirmed pathologically were divided into CTC positive group and CTC negative group according to the CTC count (5 pcs/3.5 ml). Compare the age, gender, tumor location, TNM (clinical stage), pathological grade, tissue type, lymph node metastasis, distant metastasis, prognosis and prothrombin time (PT), fibrinogen (FIB), partial coagulation of the two groups of patients The correlation between the results of zymogen time (APTT) and D-dimer (DD) and the number of CTC. <strong>Results:</strong> There were significant differences in TNM, lymph node metastasis, and distant metastasis between the two groups (P < 0.05). The number of CTC in patients was correlated with FIB and D-D levels (P < 0.05). <strong>Conclusion:</strong> The number of CTC in patients with renal cell carcinoma is correlated with some clinical phenotypes (TNM, lymph node metastasis, distant metastasis) and some coagulation indexes (FIB, D-D), and can jointly predict the prognosis of renal cancer.
文摘Objective: To study the expression of dendritic cells in human renal cell carcinoma and explore the cause, so to reveal the mechanism of escaping immune surveillance in RCC. Methods: The expressions of CD83+DCS, CD1a+DCS,VEGF and TGF-β1 in tumoral, peritumoral and normal kidney tissues of RCC in 30 cases were detected by immunohistochemistry using streptavidin/peroxidese(SP) Results: CD83+DCS were mainly located in the peritumoral areas; whereas CD1a+DCS、were mainly retained within the cancer nests. The number of CD83+DCS was inversely correlated with the clinical stage(P<0.05); but there were no significant correlations between the number of CD1a+DCS、and the clinical stage(P>0.05). The expressions of CD83+DCS and CD1a+DCS have significant difference between the tumoral, peritumoral and normal kidney tissues(P<0.001). The expression of VEGF and TGF-β1 were significantly lower in samples with highly infiltrating CD83+DCS(P<0.05); Whereas CD1a+DCS were not (P>0.05). Conclusion: DC has the tendency to gathering in tumor, but because of the immunosuppressive cytokins, for example VEGF and TGF-β1, inhibits the maturation of DC, there are less mature TIDCS(CD83+TIDCS) in the tumoral tissues, they are mainly located in the peritumoral areas. This may contribute to the mechanism of escaping immune surveillance in RCC.
文摘The therapeutic options for patients with metastatic renal cell carcinoma(mRCC) have completely changed during the last ten years. With the sequential use of targeted therapies, median overall survival has increased in daily practice and now it is not uncommon to see patients surviving kidney cancer for more than four to five years. Once treatment fails with the first line targeted therapy, head to head comparisons have shown that cabozantinib, nivolumab and the combination of lenvatinib plus everolimus are more effective than everolimus alone and that axitinib is more active than sorafenib. Unfortunately, it is very unlikely that we will ever have prospective data comparing the activity of axitinib, cabozantinib, lenvatinib or nivolumab. It is frustrating to observe the lack of biomarkers that we have in this field, thus there is no firm recommendation about the optimal sequence of treatment in the second line. In the absence of reliable biomarkers, there are several clinical endpoints that can help physicians to make decisions for an individual patient, such as the tumor burden, the expected response rate and the time to achieve the response to each agent, the prior response to the agent administered, the toxicity profile of the different compounds and patient preference. Here, we propose the introduction of the tumor-growth rate(TGR) during first-line treatment as a new tool to be used to select the second line strategy in m RCC. The rapidness of TGR before the onset of the treatment reflects the variability between patients in terms of tumor growth kinetics and it could be a surrogate marker of tumor aggressiveness that may guide treatment decisions.
文摘Although invasion of renal cell carcinoma (RCC) into the inferior vena cava is common, pulmonary tumor embolism is rare. We present a case of a pulmonary tumor embolism from type II papillary renal cell carcinoma successfully treated using a staged approach. Such staged procedures are particularly effective in cases of massive renal tumors. Pulmonary tumor embolectomy using normothermic cardiopulmonary bypass is considerably less invasive than under deep hypothermic circulatory arrest.
文摘To evaluate the operative characteristics and efficacy of retroperitoneoscopic resection of renal,ureter and partial bladder for the treatment of native renal pelvic and ureteral transitional cell cancer occurring at the same side of transplanted kidney.Methods In 5 cases of renal transplantation,there were 2 cases of right native renal pelvic cancer,1 case of right native renal pelvic and ureter cancer and 2 cases of right ureter cancer respectively.The transplanted kidney was in the same iliac fossa side of the tumor.All 5 patients were subjected to nephroureterectomy and bladder cuff excision by retroperitoneoscopic technique.Results Five operations were completed successfully.The operative time was 180 to 280 min,and the blood loss was 50 to 200 ml.The recovery of intestinal function after operation was 12 to 36 h.The urine output was 1 500 to 4 000 per day.Postoperative serum creatinine was still normal.The mean hospital stay after operation was 4.5 days.Conclusion Retroperitoneal laparoscopic nephroureterectomy and bladder cuff excision is a good method to treat the native renal pelvic and ureteral transitional cell cancer occurring at the same side of transplanted kidney.The procedure is safe and less invasive,which provides a good protection of transplanted kidney.12 refs.
