肾细胞癌并发同侧肾上腺肿瘤

目的 分析肾细胞癌并发同侧肾上腺转移癌的发生率，探讨肾癌根治术作同侧蛹 腺切除要响声生。方法 报告５年间行肾癌根治术５６例，其中３例并发同肾腺肿瘤，仅１例为肾上腺转移癌。结果 ３例均行同侧肾上腺切除的肾癌根治术。均痊愈出院。１例肾癌并发肾上腺转移癌者术后随访２年。健在。另２例分别为产发肾上腺皮质腺瘤及哮铬细胞瘤，术后随访５年及２．５年健 在，结论肾 同侧肾上腺肿瘤并不都是转移癌。肾癌根治术不必都作     

肾细胞癌并发同侧肾上腺肿瘤(附三例报告)

目的分析肾细胞癌并发同侧肾上腺转移癌的发生率,探讨肾癌根治术作同侧肾上腺切除的可行性。方法报告５年间行肾癌根治术５６例,其中３例并发同侧肾上腺肿瘤,仅１例为肾上腺转移癌。结果３例均行同侧肾上腺切除的肾癌根治术,均痊愈出院。１例肾癌并发肾上腺转移癌者术后随访２年,健在。另２例分别为并发肾上腺皮质腺瘤及嗜铬细胞瘤,术后随访５年及２５年,健在。结论肾细胞癌并发同侧肾上腺肿瘤并不都是转移癌。肾癌根治术不必都作肾上腺切除,只有肾上极肾癌直接蔓延至肾上腺及肾上腺有转移癌时才作肾上腺切除。术前影像学检查及术中探查肾上腺正常者肾上腺可不必切除。     

肾结核合并同侧肾细胞癌一例

患者,男,66岁,查体时发现右肾占位性病变。28年前曾有肺结核接触史。体检:全身浅表淋巴结无肿大,心肺未见异常,腹部未及异常包块,双肾区无叩击痛,双侧睾丸及附睾未扪及结节,前列腺Ⅱ°增生,质地中,表面光滑。胸部正位X光片可见双肺斑片状钙化影。B超:左肾大小,结构无异常,右肾上半部显示不清,仅见形态不规则的强回声,后伴声影,下半     

同侧肾细胞癌并发输尿管尿路上皮癌l例

患者,男,52岁。于1个月前无明显诱因出现全程肉眼血尿,无发热、尿频、尿痛,彩超及CT检查发现左肾多发囊肿及占位性病变,以左肾占位病变收入院。彩超显示左肾8．8cm×3．8cm大小,     

同侧肾脏同时发生透明细胞型与乳头状肾细胞癌

目的探讨同侧肾脏发病并且相对独立的透明细胞型和肾乳头状细胞癌的临床病理特点及免疫表型,提高对该肿瘤的认识和诊断水平。方法本研究回顾了2例病理诊断为透明细胞型合并肾乳头状细胞癌的临床资料,通过光镜和免疫组织化学染色,针对肾细胞癌相关蛋白标志物[包括 Vimentin、CD10、CK（AE1/AE3）、CK7、CK8/18、PAX2、PAX8、CAⅨ、AMACR]进行了观察和分析。结果2例患者为男性,年龄分别为70、63岁。2例患者的两处独立肿瘤均位于左侧肾脏,镜下观察均可见两处独立肿瘤,肿瘤间隔有正常肾脏组织,分别为乳头状肾细胞癌及透明细胞型肾细胞癌,且免疫组化显示2例患者肿瘤的表型一致。结论单侧肾脏肾透明细胞癌合并肾乳头状细胞癌是一种少见的临床现象,这种现象的存在以及类似的免疫组化表型提示透明细胞型肾细胞癌和乳头状肾细胞癌在发生过程中可能存在着内部的联系。     

同侧肾盂癌肾上腺腺瘤1例报告

患者，男，42岁。5年前出现不明原因的无痛性肉眼血尿，乏力，无尿痛、尿频。当地医院X线片示右肾结石，给予排石治疗无好转，遂来我院以右肾结石、血尿原因待查收入院。体检：血压28／16kPa，一般情况较差，体检无阳性体征。实验室检查：血钾2．1mmol／L，二氧化碳结合力34．7mmol／L。血清醛固闭818．9pg／ml。B超示在例肾上腺3．1cm×1．2cm，有例肾脏外形不规则，中上部探及5．4cm×3．4cm不规则光团，回声不均匀，边缘不整齐，与肾盂分界不清，肾益扩张不规则。CT平扫示右肾中上部和肾益内有一团块状高密度影，最大截面5．5cm×5．5…     

同侧肾、肾上腺不同类肿瘤一例

同侧肾、肾上腺不同类肿瘤一例贾振郡，王程患者，男，２７岁。因右腰部及右季肋部持续性钝痛８个月，渐进性加重半月，伴发热３天，于１９９３年１２月１４日入院。体检：Ｔ３８．４℃，ＢＰ２０／１２ｋＰａ，消瘦面容，心肺未见异常，右侧中上腹部可触及成人拳头大小包...     

根治性肾切除术治疗肾癌是否需要常规切除同侧肾上腺

目的 探讨根治性肾切除时是否需要常规切除同侧肾上腺.方法 分析263例肾癌患者的临床资料.比较同侧肾上腺切除组与保留组手术时间、出血量、手术并发症以及生存率有无差异(t检验);分析肾上腺受侵患者的临床特点.生存分析采用Kaplan-Meier法,组间差异采用longrank检验.结果 临床分期T_(1～2)N_0M_0 214例,T_(3～4)N_(0～2)M_0 26例,T_(1～4)N_(0～2)M_1 23例.根治性肾切除术时切除同侧肾上腺146例,保留同侧肾上腺117例.同侧肾上腺切除组与保留组手术时间、出血量、手术并发症比较差异均无统计学意义(P＞0.05).术后病理证实肾肿瘤侵及同侧肾上腺8例,其肾原发肿瘤最大径平均为9.7 cm,肿瘤最大径≥8 cm 5例,肿瘤位于肾上极6例,累及全肾2例.临床分期为Ⅰ期或Ⅱ期者切除同侧肾上腺129例,病理结果证实同侧肾上腺受侵仅4例(3.1%);Ⅲ期或Ⅳ期患者切除同侧肾上腺17例,病理证实同侧肾上腺受侵4例(23.5%).随访3～102个月,平均28个月.同侧肾上腺切除组与保留组按各病理分期比较生存率差异均无统计学意义.结论 肿瘤直径≥8 cm、位于肾上极或累及全肾、临床分期≥Ⅲ期均是肾癌侵及肾上腺的危险因素,此类患者行根治性肾切除术时应切除同侧肾上腺,其余早期肾癌患者实施手术治疗时可以保留同侧肾上腺.     

Predictive Factors for Ipsilateral Recurrence After Nephron-sparing Surgery in Renal Cell Carcinoma

Background

Ipsilateral recurrence after nephron-sparing surgery (NSS) is rare, and little is known about its specific determinants.

Objective

To determine clinical or pathologic features associated with ipsilateral recurrence after NSS performed for renal cell carcinoma (RCC).

Design, setting, and participants

We analysed 809 NSS procedures performed at eight academic institutions for sporadic RCCs retrospectively.

Measurements

Age, gender, indication, tumour bilaterality, tumour size, tumour location, TNM stage, Fuhrman grade, histologic subtype, and presence of positive surgical margins (PSMs) were assessed as predictors for recurrence in univariate and multivariate analysis by using a Cox proportional hazards regression model.

Results and limitations

Among 809 NSS procedures with a median follow-up of 27 (1–252) mo, 26 ipsilateral recurrences (3.2%) occurred at a median time of 27 (14.5–38.2) mo. In univariate analysis, the following variables were significantly associated with recurrence: pT3a stage (p = 0.0489), imperative indication (p < 0.01), tumour bilaterality (p < 0.01), tumour size >4 cm (p < 0.01), Fuhrman grade III or IV (p = 0.0185), and PSM (p < 0.01). In multivariate analysis, tumour bilaterality, tumour size >4 cm, and presence of PSM remained independent predictive factors for RCC ipsilateral recurrence. Hazard ratios (HR) were 6.31, 4.57, and 11.5 for tumour bilaterality, tumour size >4 cm, and PSM status, respectively. The main limitations of this study included its retrospective nature and a short follow-up.

Conclusions

RCC ipsilateral recurrence risk after NSS is significantly associated with tumour size >4 cm, tumour bilaterality (synchronous or asynchronous), and PSM. Careful follow-up should be advised in patients presenting with such characteristics.     

Prospective Analysis of the Incidence of Ipsilateral Adrenal Metastasis in Localized Renal Cell Carcinoma

Purpose

The incidence of ipsilateral adrenal metastasis in renal cell carcinoma was evaluated in a prospective fashion to understand more fully the natural history of this disease.

Materials and Methods

During a 15-month period 128 radical nephrectomies were performed for stages T1 to T3bN0M0 renal cell carcinoma at our institution. Of these specimens 100 adrenal glands were of sufficient integrity to allow for thin sectioning.

Results

Among the 100 adrenal glands 4 adrenal lesions were discovered (2 metastatic renal cell carcinomas and 2 benign adrenal lesions). All 4 lesions were identified preoperatively by computerized tomography or magnetic resonance imaging.

Conclusions

Our prospective investigation demonstrates that the rate of ipsilateral adrenal metastasis from renal cell carcinoma is approximately 2 percent, and suggests that when the ipsilateral adrenal gland is well visualized and of normal integrity on preoperative magnetic resonance imaging or computerized tomography adrenal sparing nephrectomy may be considered a viable treatment option.     

Native Renal Cysts and Dialysis Duration Are Risk Factors for Renal Cell Carcinoma in Renal Transplant Recipients

Urinary tract cancers are the third most common cancers in renal transplant recipients (RTX). This study examined the impact of dialysis duration and native renal cyst(s) (NRC) on renal cell carcinoma (RCC) occurrence among 1036 RTX followed‐up from 1995 to July 2007. Abdominal ultrasonography was planned within 1‐month of transplant, then every 5 years, or 2 years if renal cysts developed. Based on presence and time of development of NRC, RTX were grouped into those with no (No‐NRC), new (New‐NRC), preexisting (Pre‐NRC) and time‐indeterminate NRC (TI‐NRC). Ten asymptomatic RTX were diagnosed with RCC at a median of 5.8 years posttransplant and had 5‐year graft and patient survivals of 90% and 100%, respectively, following appropriate therapy. RCC occurred only in Pre‐NRC and TI‐NRC who had significantly longer dialysis duration than No‐ or New‐NRC (6.7 ± 3.9 and 3.3 ± 3.2 vs. 2.7 ± 3.1 and 2.6 ± 2.4 years, respectively). These results suggest that NRC and increased dialysis duration are risk factors for RCC posttransplant. Since early treatment of RCC gives excellent outcomes, regular ultrasonography performed within a month of transplantation, then every 5 years for those without cysts and every 2 years for those with cysts for early detection of RCC is recommended.     

Partial Adrenalectomy for Renal Cell Carcinoma With Bilateral Adrenal Metastases

Resection of the adrenal glands precludes participation in many immunotherapy protocols for metastatic renal cell carcinoma. We performed radical nephrectomy with adrenalectomy and contralateral partial adrenalectomy, including adrenal vein ligation for a 4 cm. hilar metastasis without perioperative complications or local recurrence after 30 months. Adrenal function, measured by cosyntropin stimulation tests 6 weeks and 10 months postoperatively, was normal. Partial adrenalectomy with preservation of adrenal function is possible.     

Ectopic Adrenal Tissue as Radiographic Lymphadenopathy in Renal Cell Carcinoma

In the presence of solid, contrast-enhancing renal mass, concomitant contrast-enhancing retroperitoneal mass is usually viewed as regional lymph node metastasis unless proven otherwise. The present report of ectopic adrenal tissue demonstrates that the presence of retroperitoneal contrast-enhancing mass may be a benign finding in patients with renal malignancy. Pathology remains the definitive method for diagnosis in such situation.     

Laparoscopic Adrenalectomy for Solitary Metachronous Contralateral Adrenal Metastasis from Renal Cell Carcinoma

Purpose

We report our experience with laparoscopic adrenalectomy for malignant adrenal disease.

Materials and Methods

Between June 1995 and January 1996, 2 patients with a solitary metachronous contralateral adrenal metastasis from renal cell cancer were evaluated. Both patients had undergone radical nephrectomy for localized renal cancer 5 years previously. Laparoscopic transperitoneal adrenalectomy was performed.

Results

The laparoscopic procedures required 2.5 and 4.3 hours. Hospital stay was 3 and 4 days. The specimens weighed 98 and 81 gm. All surgical margins were free of metastatic clear cell cancer. Both patients were begun on prednisone and fludrocortisone replacement therapy. One patient experienced an increase in creatinine, which has since stabilized at 3.0 mg./dl. Neither patient had recurrent cancer at 11 and 16 months of followup.

Conclusions

Laparoscopic adrenalectomy for metastatic renal cell cancer was performed successfully in 2 patients. However, the short-term benefits to the patient of earlier ambulation, decreased pain, minimal incisions and shortened convalescence must be weighed against the as yet unknown long-term (5 years) results.     

Prognostic Factors and Staging Systems for Renal Cell Carcinoma

ObjectivesPrimary tumour local extension, lymph-node status, and the presence of metastases have always been considered the most important prognostic factors in renal cell carcinoma (RCC). In recent years, many other clinical, pathological, and molecular factors able to independently predict survival in RCC have been proposed and discussed. The aim of this unsystematic literature review is to describe the most important advances in RCC prognostication.ResultsThe review provides updated information regarding the most important clinical (performance status, localized or systemic symptoms), pathological (Fuhrman nuclear grade, histological subtypes, sarcomatoid features, tumour necrosis), and molecular (molecules involved in the hypoxia-inducible pathway, proliferation, cell cycle regulation, or cell adhesion) prognostic factors. It also highlights the issues related to RCC staging systems, such as the debate about the ideal cut-off to stratify patients with localized disease into two categories with different survival as well as the different prognostic impact of perinephric fat invasion, ipsilateral adrenal gland involvement, venous axis neoplastic thrombosis, and the possible synergistic role of their association in locally advanced disease.ConclusionsThe ongoing development of integrated models combining different features improves the accuracy of survival prediction, thus allowing more detailed patient information, correct follow-up planning, and adequate recruitment and interpretation of clinical trials.