Adenoendocrine Cell Carcinoma of the Gallbladder: Report of a Case

Adenoendocrine cell carcinoma of the gallbladder is an uncommon form of cancer. We treated a 36-year-old woman who came to us with a chief complaint of abdominal pain. The abnormality was diagnosed to be a tumor-like mass in the gallbladder, and adenomyomatosis of the gallbladder was strongly suspected. A laparoscopic cholecystectomy was successfully performed, and the histopathological finding was adenoendocrine cell carcinoma of the gallbladder. The tumor cells of the small round cell carcinoma partly stained positively for synaptophysin, neuron-specific enolase, and CD 56, while adenocarcinoma cells showed positive reactions to keratin, which was thus suggestive of adenoendocrine cell carcinoma. The patient is alive and doing well at 12 months after the treatment.     

Synchronous ipsilateral conventional renal cell and transitional cell carcinoma

Simultaneous occurrence of renal cell carcinoma (RCC) and transitional cell carcinoma (TCC) in the same kidney is unusual. We report a 61-year-old man with ipsilateral synchronous renal adenocarcinoma and renal pelvic TCC. He was referred to our department for gross hematuria and right flank pain. CT and MRI studies revealed a 57 × 50 mm irregular and infiltrative upper right kidney mass with necrotic components. A right radical nephrectomy was done. Pathological diagnosis was a high grade tumor originating from just beneath the intact urothelium of renal pelvis and infiltrating through the parenchyma showing solid and occasional tubular growth patterns. A second tumor in close proximity to the first was reported as well differentiated RCC. This is a rare case of combined renal malignancies.     

�����۰����۰�9���ٴ�����

目的　总结原发性胆囊鳞癌、腺鳞癌的诊治经验。方法　回顾性分析了浙江大学医学院附属第二医院 1994～ 2 0 0 3年收治的少见胆囊癌 9例 (鳞癌 1例 ,腺鳞癌 8例 )。结果　行根治性手术 4例 ,姑息性手术 5例。9例中有 8例得到随访 ,均在术后半年内死亡 ,术后中位生存期 5 1d。结论　胆囊鳞癌腺鳞癌恶性程度较高 ,但淋巴结转移相对较晚。对于合适病例应尽可能行根治性胆囊切除 ,必要时行扩大根治性切除 ,术后放疗可能是一个较好的治疗方式。     

A Phase 2 Trial of Sunitinib in Patients with Advanced Non–clear Cell Renal Cell Carcinoma

Background

Sunitinib is a standard-of-care treatment in advanced clear cell renal cell carcinoma (ccRCC). Retrospective and expanded access data suggest sunitinib has activity in advanced non–clear cell renal cell carcinoma (nccRCC).

Objective

To prospectively determine the clinical efficacy and safety of sunitinib in patients with advanced nccRCC.

Design, setting, and participants

This is a single-arm phase 2 trial with a two-stage design. Eligibility criteria included pathologically confirmed nccRCC or ccRCC with ≥20% sarcomatoid histology, performance status 0–2, measurable disease, a maximum of two prior systemic therapies, and no prior treatment with tyrosine kinase inhibitors directed against the vascular endothelial growth factor receptors.

Intervention

Patients received sunitinib 50 mg daily on a 4-wk on, 2-wk off schedule.

Outcome measurements and statistical analysis

Primary end points were objective response rate (ORR) and progression-free survival (PFS). Secondary end points were safety and overall survival (OS).

Results and limitations

Fifty-seven patients were eligible (nccRCC histology: papillary, 27; chromophobe, 5; unclassified, 8; collecting duct or medullary carcinoma, 6; sarcomatoid, 7; and others, 4). Median PFS for 55 evaluable patients was 2.7 mo (95% confidence interval [CI], 1.4–5.4). Two patients with chromophobe and one patient with unclassified histology had a confirmed partial response (5% ORR). Median PFS for patients with papillary histology was 1.6 mo (95% CI, 1.4–5.4). Median PFS for patients with chromophobe histology was 12.7 mo (95% CI, 8.5–NA). Median OS for all patients was 16.8 mo (95% CI, 10.7–26.3). Treatment-emergent adverse events were consistent with sunitinib's mechanism of action. The nonrandomized design and small number of patients are limitations of this study.

Conclusions

The differential response of chromophobe histology to sunitinib suggests a therapeutically relevant biological heterogeneity exists within nccRCC. The low ORR and short PFS with sunitinib in the other nccRCC subtypes underscore the need to enroll patients with these diverse tumors in clinical trials.     

Histologic variants of renal cell carcinoma: does tumor type influence outcome?

Each histologic type of renal cell carcinoma (RCC) has different pathologic and clinical parameters; however, the independent role of histologic type in outcome prediction remains contested. Most studies show relevance for outcome of each histologic type when correlated with survival by univariate analysis, whereas few studies show differences in outcome once other key prognostic factors, such as stage and grade, are considered. These studies highlight the challenges to prove outcome relevance. Despite the contested independent value of type for outcome prediction, separation of RCC into types is well accepted and can be substantiated on clinical, pathologic, molecular, and general outcome differences.     

Concomitment spread of a renal cell carcinoma beyond the kidney and a transitional cell carcinoma beyond the bladder

We report the case of a 61-year-old man, with a rare combination of two advanced urological tumors: a concomitant spread of an adenocarcinomabeyond the kidney and a urothelial carcinoma beyond the bladder. Wesimultaneously performed a primary curative prostatovesiculectomy anda nephroureterectomy on the right with ileal neobladder. To ourknowledge, a case report of concomitant spread of an adenocarcinomabeyond the kidney (pT3 pN0 M0 G3) and a urothelial carcinoma beyondthe bladder (pT3a pN0 M0 G3) with subsequent curative therapy hasthus far not been published. A combination of the two diseasesdescribed here is obviously a remarkable rarity. This revised version was published online in August 2006 with corrections to the Cover Date.     

Erratum

A Quttainah, A Thoma, S Salama. Clinical-pathological review of 14 cases of merkel cell carcinoma. Can J Plast Surg 2002;10(5):196–202.Merkel cell carcinoma (MCC) is a rare, primary, cutaneous, neuroendocrine skin tumour that occurs commonly in the head, neck or extremities of elderly white people. Fourteen cases of MCC in the Hamilton Regional Cancer Centre between 1992 and 2000 have been reviewed. Seven cases required a panel of immunohistochemical markers and two cases required electron microscopy for confirmation. Seven men and seven women were treated, and ranged from 67 to 96 years of age (mean 77.7 years). The primary tumour was located in the head and neck in seven patients (50%), in the extremities in four patients (29%) and on the trunk in two patients (14%). One patient had an unknown primary tumour location. Ten patients had stage Ia disease at presentation, three had stage Ib disease, and one presented with stage II disease. Primary treatment consisted of wide local excision in nine patients, wide local excision and radiotherapy in four patients and radiotherapy only in one patient. Seven patients had recurrence, five were disease free up to their most recent follow-up, one died of unrelated causes, and one was lost to follow-up after primary treatment. Of the seven patients with recurrence, two had local recurrence, two had lymph node recurrence and three developed metastases. Disease-free intervals were 69% and 50% for six-month and one-year follow-up, respectively. No difference in outcome was observed between stage Ia and Ib disease. The patient with stage II disease at presentation developed metastases. Longer duration of disease before presentation had a higher incidence of recurrence with distant metastases. Extremity lesions had the best prognosis associated with disease-free interval. Early management with excision and radiotherapy improved the disease-free interval.     

Gallbladder Metastasis of Renal Cell Carcinoma: Report of Two Cases

We report two extremely rare cases of metastasis to the gallbladder from renal cell carcinoma. In both men, aged 63 and 80 years, a pedunculated polypoid gallbladder tumor was incidentally found 27 and 8 years after surgery for renal cell carcinoma, respectively. The tumors showed hypervascularity on diagnostic imaging. A histopathological examination showed no tumor cells in the gallbladder mucosa, but clear cell carcinoma was predominantly observed below the mucosal layer. Furthermore, based on various specific and immunohistochemical studies as well as the electron-microscopic findings, the patients were pathologically diagnosed to have gallbladder metastasis of renal cell carcinoma. Received: February 16, 2001 / Accepted: September 11, 2001     

Morphine enhances renal cell carcinoma aggressiveness through promotes survivin level

Background: Morphine is an opioid analgesic drug often used for pain relief in cancer patients. However, there is growing evidence that morphine may modulate tumor growth, progression and metastasis. Unfortunately, the results obtained by these studies are still contradictory.

Methods: In this study, we investigated the effect of morphine in human clear cell renal cell carcinoma 786-O, RLC-310 cells and whether morphine affects on tumor growth in human clear cell renal cell carcinoma 786-O, RLC-310 cells. The cell proliferation was determined by MTT assay, cell proliferation, migration and invasion assays. Immunofluorescence staining and Q-PCR was used to determine the Survivin expression.

Results: It was shown that morphine enhances proliferation of 786-O, RLC-310 cells, whereas morphine promoted the growth and aggressive phenotype of 786-O and RLC-310 cells in vitro though Survivin-dependent signaling.

Conclusions: Our data showed that morphine promotes RCC growth and increases RCC progression via over-expression of Survivin.     

Current pathology keys of renal cell carcinoma

Context

Renal cell carcinoma (RCC) in adults comprises a heterogeneous group of tumours with variable clinical outcomes that range from indolent to overtly malignant. The application of molecular genetic techniques to the study of renal neoplasms has resulted in an improved classification of these entities and a better understanding of the biologic mechanisms responsible for tumour development and progression. The current 2004 World Health Organisation classification of adult renal epithelial neoplasms has expanded rapidly with new categories recently incorporated.

Objective

To review and evaluate the evidence implicating pathologic features and classification of RCC in adults as a tool to approach patients’ prognosis and modulate current therapy.

Evidence acquisition

Members of Committee 3: Pathology, under the auspices of the International Consultation on Urological Diseases and the European Association of Urology (ICUD-EAU) International Consultation on Kidney Cancer, performed a systematic review using PubMed. Participating pathologists discussed pathologic categories and diagnostic features of RCC in adults.

Evidence synthesis

We reviewed and discussed articles and the personal experiences of participating uropathologists.

Conclusions

The conclusions reached by the ICUD-EAU 2010 International Consultation on Kidney Cancer emphasise the appropriate pathologic diagnosis of RCC in adults as a tool to approach patients’ prognosis and modulate current therapy. Further emphasis should be placed on defining risk groups of RCC and diagnostic features of unusual tumours such as familial RCC, translocation RCC, and tubular mucinous and spindle cell carcinoma. A number of recently described entities and morphologic variants of classical categories deserves recognition because they can be important in differential diagnosis and therapy.     

Cystic local recurrence of renal cell carcinoma after laparoscopic radical nephrectomy in a hemodialysis patient

Although local recurrence of renal cell carcinoma after laparoscopic radical nephrectomy is sometimes reported, cystic local recurrence of renal cell carcinoma has rarely been reported. We report the case of a 59‐year‐old man with hemodialysis who developed cystic local recurrence of renal cell carcinoma accompanied by acquired cystic disease of the kidney in the retroperitoneal space after laparoscopic radical nephrectomy. A cystic tumor of 5.1 cm in diameter occurred in the left retroperitoneal space 15 months after left laparoscopic radical nephrectomy, and enlarged to 7.2 cm in diameter with enhanced mass along the wall of the cyst 36 months after surgery. The cystic tumor was removed and showed local recurrence of renal cell carcinoma on pathological examination.     

Large cell carcinoma with neuroendocrine morphology of the lung

We experienced a surgical case of large cell carcinoma with neuroendocrine morphology (LCCNM) of the lung. A 76-year-old man was admitted to our hospital because a routine chest X-ray examination had revealed a nodular shadow in the left lung field. 18F-fluorodeoxyglucose positron emission tomography showed accumulation of fluorodeoxyglucose in an area corresponding to the shadow. Transbronchial lung biopsy failed to give a definitive diagnosis, therefore, open lung biopsy was performed because of suspected lung cancer. Needle biopsy was performed, and the tumor was diagnosed as large cell neuroendocrine carcinoma by rapid intraoperative pathological examination. As sampling of hilar lymph nodes revealed no metastasis, left upper segmentectomy was performed for severe obstructive pulmonary disease. Immunohistochemical examination finally diagnosed the tumor as LCCNM. The patient is doing well without recurrence at ten months after surgery.     

Clinical Trials for Specific Renal Cancer Subtypes—The Time Will Come!

Renal cell cancer is a heterogeneous group of cancers with different histological phenotypes. Recent 2016 WHO classification acknowledges the genetic background of most renal cancer subtypes, whereas treatment for metastasized renal cell carcinoma (RCC) considers only clear cell and non–clear cell RCCs. Clear cell RCCs are characterized by the presence of at least three tumor suppressor genes on chromosome 3p. Owing to inactivation of von Hippel–Lindau (VHL), clear cell renal cancer produces the hypoxia-inducible factor–responsive vascular endothelial growth factor (VEGF). Other specific gene alterations have been identified in non–clear cell renal cancers, for example, PTEN, p53, and FLCN in chromophobe carcinomas; TFE3, TFEB, and MITF in translocation carcinomas; or MET and FH in variants of papillary RCC. Current treatments target VEGF or VEGF receptor using tyrosine kinase inhibitors, monoclonal antibodies, and mTOR inhibitors. Renal cancer immunotherapy using immune checkpoint inhibitors is currently tested in early clinical phases. We review current clinical trials on the basis of the molecular background of specific renal cancer subtypes.     

Concurrent Renal Cell Carcinoma and Transitional Cell Carcinoma in a Chronic Hemodialysis Patient

A 60-year-old female patient had been on maintenance hemodialysis for 12 years was suffering from gross hematuria. Subsequent image studies revealed left renal and ureteral tumors. She then received left radical nephroureterectomy. Histological examination revealed the renal tumor was renal cell carcinoma and ureteral tumor was transitional cell carcinoma respectively. To our knowledge, this is the first reported case of simultaneous occurrence of these two urological cancers in a chronic hemodialysis patient. Our case may imply the increased susceptibility of urological malignancy in dialysis patients. Physicians should always raise the possibility of urological malignancy when a dialysis patient with gross hematuria is encountered. A thorough and careful screening for the malignancy should be performed on a regular basis in these patients with high risk.     

关木通对大鼠致癌性的实验研究

目的 观察关木通所致大鼠肿瘤的发生演变过程及病理学特征。方法 雄性SD大鼠随机分为两组。关木通组大鼠(n=30)给关木通浸膏水溶液间断灌胃,初始剂量相当于马兜铃酸20mg·kg~(-1)·d~(-1),连续5d;此后剂量减至相当于马兜铃酸15mg·kg~(-1)·d~(-1),隔周给药,直至第15周。对照组大鼠(n=30)给相同体积的自来水灌胃。用药后1、4、8、12和16周分别处死大鼠(每组6只),留取气管、甲状腺、心、肺、肝、脾、胰、胃、小肠、大肠、肾、输尿管、膀胱和睾丸等14个主要脏器,观察肿瘤发生。结果 关木通组大鼠除前胃和膀胱外,其它脏器未发现肿瘤。前胃:给药后4周开始出现鳞状上皮增生及非典型增生,8周起个别大鼠开始发生鳞状细胞癌,至16周时全部大鼠均发生鳞状细胞癌。膀胱:给药后8周开始出现移行上皮增生、非典型增生及移行细胞癌,至16周时全部大鼠均发生移行细胞癌。对照组大鼠各脏器均无异常发现。结论 关木通能诱发大鼠前胃及膀胱癌,此致癌作用具有时间依赖性,并可能具有器官特异性。     

肾嫌色细胞癌(附15例报告)

目的　提高肾嫌色细胞癌的诊治水平和对此类型肾癌的认识。　方法　回顾性分析15例肾嫌色细胞癌的临床资料。男 10例 ,女 5例。年龄 4 7～ 74岁 ,平均 5 7岁。均行根治性肾切除术。　结果　术后病理证实为肾嫌色细胞癌。病理分期 :pT1N0 M0 6例 ,pT2 N0 M0 5例 ,pT3bN0 M0 2例 ,pT1N2 M0 1例 ,pT2 N2 M0 1例。病理分级 :G2 10例 ,G3 5例。 11例获随访 ,随访 2～ 31个月 ,平均19个月 ,1例死于心脏病 ,1例局部复发 ,9例无瘤生存。　结论　肾嫌色细胞癌是一种具有特殊形态的少见肾癌类型。肾根治性切除术是治疗肾嫌色细胞癌的首选方法。与同期、同级的其他类型肾癌相比 ,肾嫌色细胞癌预后较好。