Primary retroperitoneal plasmacytoma with tumor thrombus within the renal vein.

A case of primary retroperitoneal plasmacytoma causing a tumor thrombus within the renal vein is described. The use of radiographic techniques, including ultrasonography, computerized tomography and angiography, facilitated an accurate diagnosis. Tumor thrombi within the renal vein are rare except in cases of primary renal or adrenal neoplasms. In a patient with radiological evidence of retroperitoneal tumor and tumor thrombus within the renal vein plasmacytoma should be considered in the differential diagnosis of retroperitoneal neoplasms.     

Giant renal oncocytoma

Renal oncocytoma is a benign neoplasms arising from cells of the distal renal tubule. They acount for 3-7% of all renal tumors. most are incidental findings. Differential diagnosis with renal cells carcinoma is often difficult. Here we report a case of big renal oncocytoma as an incidental finding while performing an abdominal ultrasound in a patient with low abdominal pain. We also review the diagnostic an therapeutic approach in this kind of malignancies.     

腹腔镜下微波消融剜除术治疗肾脏肿瘤的疗效分析

目的 探讨腹腔镜下微波消融肾肿瘤剜除术治疗肾脏肿瘤的疗效与安全性.方法 本组84例肾肿瘤患者,予以腹腔镜下辅助微波消融,尔后手术剜除肾肿瘤,记录术中出血量、手术时间,观察术中、术后并发症及疗效与安全性.结果 84例患者手术均顺利完成,术中均未阻断肾动脉,无术中大出血或中转开放手术,出血量为50~350 ml,手术时间为70~120 min.术后病理诊断为肾透明细胞癌60例,血管平滑肌脂肪瘤16例,嗜酸性细胞瘤4例,嫌色细胞癌2例,乳头状肾细胞癌2例.术中血管平滑肌脂肪瘤普遍出血较多.术后血管平滑肌脂肪瘤出血1例.全部病例随访12个月,无肿瘤复发、远处转移或死亡病例.结论 腹腔镜下微波消融肾肿瘤剜除术是一种安全有效的保留肾单位的手术方式,具有出血量少、手术时间短、术后并发症少等优点.     

Polycythemia secondary to multiloculated renal cyst in a child

Polycythemia has been reported in association with a variety of pediatric renal neoplasms. The authors present the case of a 10-year-old boy with polycythemia and elevated erythropoietin that resolved after resection of a multiloculated renal cyst. This case also is unusual in the small size of the lesion, 0.5 cm in greatest dimension. J Pediatr Surg 37:1491-1492.     

保留肾单位手术治疗肾肿瘤18例分析

目的：评估保留肾单位手术治疗肾肿瘤的效果。方法：1995年4月－2001年5月，采用保留肾单位手术治疗肾肿瘤18例，恶性3例，良性15例，孤立肾1例，17例单侧肿瘤对侧肾正常，肿瘤直径1.0-8.0cm，平均3.5cm。17例行部分肾切除术，1例行肿瘤剜除术。结果：18例手术成功，随访2－72个月，平均32个月，未发现并发症和肿瘤复发。结论：保留肾单位治疗肾肿瘤安全有效，其临床应用越来越广。     

Cystic, exophytic teratoma of conus medullaris presenting with chronic renal failure

BACKGROUND: Pure chronic renal failure as a presentation of a conus neoplasm is a rare entity. In addition, few case reports exist describing an intramedullary teratoma among adults. CASE DESCRIPTION: We present a unique case of intramedullary mature cystic teratoma, presenting as isolated renal failure. CONCLUSIONS: As distinguished radiological criteria cease to exist regarding intramedullary teratomas, these neoplasms continue to provide pathological surprises. Surgical excision remains the treatment of choice. The literature review indicates good surgical outcome.     

Incidental neoplasms in renal biopsies.

BACKGROUND: Incidental neoplastic lesions are occasionally found in renal biopsy specimens, but there is no evidence to indicate how they should be managed. METHODS: A retrospective review was made of the management and clinical course of patients in whom an unsuspected neoplasm had been found in a renal biopsy. RESULTS: In 11 880 biopsies taken over 22 years, there were incidental neoplasms in 25 (0.2%). Twenty-three of the 25 patients were men, and the median age was 59 years (range, 42-83 years). All had chronic renal damage, with a median index of chronic damage of 37% (range, 10-83%; normal=0%). Twenty-two neoplasms were papillary, two were clear cell renal carcinomas and one was in situ carcinoma in a collecting duct. The two clear cell carcinomas, three papillary neoplasms with residual masses after biopsy and the two papillary neoplasms in renal allografts were resected by nephrectomy or partial nephrectomy. Seven patients without resection were imaged with computerized tomography, six with magnetic resonance imaging and three with ultrasound scanning. Two were not imaged. None of the 11 patients who died, nor any of the other 14, had evidence of renal cell carcinoma at death or last follow-up respectively, at median 3.6 years after biopsy (range, 1 month-18.2 years). CONCLUSIONS: When an incidental neoplasm is found, the pathological type should be defined, and imaging should be performed. Surgery should be considered in patients in whom there is a neoplasm of any type detectable by imaging, and limited resection may be possible. Neoplasms that are undetectable with imaging cannot be resected as the site of the lesion is unknown. We suggest surveillance of these, but whether this is necessary is undetermined. There is no evidence whether neoplasms undetectable with imaging in renal allografts require aggressive treatment.     

Vaginal metastasis from transitional cell carcinoma of renal pelvis in horseshoe kidney

We describe a case of transitional cell carcinoma of the renal pelvis in a horseshoe kidney with vaginal tumor as the first manifestation of remote metastasis. While the occurrence of adenocarcinoma in a horseshoe kidney appears to be no higher than in nonfused kidneys, the incidence of transitional cell carcinoma among neoplasms in horseshoe kidneys is higher. Vaginal metastasis from transitional cell carcinoma of the renal pelvis is considered extremely rare. To our knowledge, this is the first case reported of transitional cell carcinoma of the renal pelvis in a horseshoe kidney with metastasis to the vagina. The patient was successfully treated with surgery, irradiation, and chemotherapy.     

Pure red cell aplasia preceding malignant lymphoma in a renal transplant patient

Malignant disorders are one of the major causes of morbidity and mortality in transplant patients. We present herein a renal transplant recipient with malignant lymphoma which preceded by pure red cell aplasia (PRCA). Acquired PRCA is a rare hematologic disorder in renal transplant recipients. It has been associated with a variety of disorders of immunologic dysfunction and neoplasms, exposure to drugs and toxins, infectious diseases, pregnancy and severe nutritional deficiency. This is the first case with PRCA preceding the malign lymphoma in a renal transplant patient. Treatment of lymphoma and lymphoma-related humoral and cellular changes or other undefined effects that may be related to therapy may be responsible of the resolving of PRCA in this patient. In this regard, renal transplant patients with acquired PRCA, must be closely followed for an underlying neoplastic disorder.     

Synchronous bilateral renal tumour: a case report

We report a case of synchronous bilateral renal carcinoma treated by partial nephrectomy on the right and total nephrectomy on the left. Follow-up at 42 months after surgery showed no recurrence of the disease. The increasing use of diagnostic imaging techniques such as ultrasound tomography, computerised tomography and nuclear magnetic resonance now allows even small-sized renal formations to be identified. Synchronous bilateral renal tumour has a favourable prognosis, especially when compared with single or asynchronous renal tumours. The recommended intervention is total monolateral nephrectomy combined with partial nephrectomy. The treatment of neoplasms at a more advanced stage, of such a nature as to necessitate bilateral nephrectomy or chemotherapy, results in a significant increase in mortality. Recently, biological therapy has been proposed as a more promising short-term option using interferon-alpha (IFN-alpha) and gamma.     

Leiomyosarcoma presenting as a spontaneously ruptured renal tumor-case report

Background  

Ruptured renal neoplasms can be a catastrophic clinical presentation. Angiomyolipoma is the commonest renal tumor which presents in this fashion. Renal sarcomas are rare renal neoplasms. Renal leiomyosarcomas are the most common histological subtype of renal sarcomas, accounting for approximately 50–60% of the reported cases. These tumors are usually peripherally located and appear to arise from either the renal capsule or smooth muscle tissue in the renal pelvic wall.     

The role of surgery in renal cell carcinoma

Renal cell carcinoma accounts about three percent of all adult neoplasms. This review provides a current status about the surgical management of renal cell carcinoma. In localised carcinomas radical nephrectomy is still the standard treatment and provides 5 Year survival rates up to 98 %. As nephron-sparing surgery in mandatory indications can achieve similar survival doubt can be expressed whether lymphadenectomy or adrenalectomy are necessary in every case. Nephron-sparing surgery is associated with a higher rate of operative complications up to 40 % and probably with a higher risk of local recurrence. However, parenchymal-sparing surgery in elective indications is possible for small tumors, if long term follow up is guaranteed. But there is no convincing advantage of nephron-sparing surgery to recommend this procedure as a general approach in patients with a normal contralateral kidney. Radical surgery in renal carcinomas invading to the vena cava still remains a challenging surgical intervention. Nevertheless, in selected patients surgery can realise long term survival in over a third of cases. Palliative nephrectomy in metastatic renal carcinomas is only justified in real palliative indications (bleeding, pain) or in clinical trials investigating cytoreductive surgery before immunotherapy. In highly selected patients with metastatic renal carcinoma a radical surgical approach including nephrectomy and complete metastasectomy can achieve long term survival.     

The role of surgery in renal cell carcinoma

Renal cell carcinoma accounts about three percent of all adult neoplasms. This review provides a current status about the surgical management of renal cell carcinoma. In localised carcinomas radical nephrectomy is still the standard treatment and provides 5 Year survival rates up to 98 %. As nephron-sparing surgery in mandatory indications can achieve similar survival doubt can be expressed whether lymphadenectomy or adrenalectomy are necessary in every case. Nephron-sparing surgery is associated with a higher rate of operative complications up to 40 % and probably with a higher risk of local recurrence. However, parenchymal-sparing surgery in elective indications is possible for small tumors, if long term follow up is guaranteed. But there is no convincing advantage of nephron-sparing surgery to recommend this procedure as a general approach in patients with a normal contralateral kidney. Radical surgery in renal carcinomas invading to the vena cava still remains a challenging surgical intervention. Nevertheless, in selected patients surgery can realise long term survival in over a third of cases. Palliative nephrectomy in metastatic renal carcinomas is only justified in real palliative indications (bleeding, pain) or in clinical trials investigating cytoreductive surgery before immunotherapy. In highly selected patients with metastatic renal carcinoma a radical surgical approach including nephrectomy and complete metastasectomy can achieve long term survival.     

Severe hemorrhage secondary to primary, isolated in situ carcinoma of renal pelvis

Primary transitional cell carcinoma in situ of the renal pelvis is usually found in association with ureteral or vesical neoplasms. However, a case of primary carcinoma in situ of the renal pelvis without previous or concomitant ureteral or vesical carcinoma is presented. Microscopic hematuria is a common finding in cases of carcinoma in situ. Gross hematuria is unusual, but not rare. However, severe hemorrhage (hematocrit 12.1, hemoglobin 3.3 g/dL) as the presenting feature is rare. Diagnosis of such microscopic isolated lesions can be difficult to make pre-operatively. Only after nephrectomy will such a lesion be diagnosed, as was the case in this patient.     

经皮肾穿刺活检术中的临床应用

经皮肾穿刺活检术是较为安全、准确的肾肿瘤诊断方法。良性肾肿瘤通常无需手术治疗,穿刺活检术可以用于良性肾肿瘤的诊断,使患者避免不必要的外科治疗。经皮肾穿刺活检能明确肿瘤性质,为临床医师选择合理的治疗方案提供重要依据。目前经皮肾穿刺活检也应用于射频消融治疗肾肿瘤术后病灶残留或复发的评估与确诊。本文就经皮肾穿刺活检的诊断效果、适应证及风险作一综述。     

Carcinosarcoma of the renal pelvis: report of a case and review of the literature

Carcinosarcomas arising in the renal pelvis are uncommon neoplasms. All previously reported cases are isolated reports and have shown to carry a poor prognosis. We report a new case of a 59-year-old man, describing the clinical, radiological and histopathological features.     

Genetic profiles in renal tumors

Renal cell carcinoma in adult comprises a heterogeneous group of tumors with variable clinical outcomes, which ranges from indolent to aggressively malignant. The application of molecular genetics techniques to the study of renal neoplasms has resulted in improved classification of these entities and better understanding of biological mechanisms responsible for tumor development and progression. In the present article we review the molecular genetic profiles of different renal cell tumors and discuss their relevance to the carcinogenesis mechanisms and to the clinical diagnosis of renal cell carcinoma. Understanding of the molecular genetics of renal tumors is beneficial in making accurate diagnoses, assessing prognoses, and selecting appropriate and targeted therapeutic options.     

Benefits of a combined approach to sampling of renal neoplasms as demonstrated in a series of 351 cases

Percutaneous radiofrequency ablation is increasingly used for curative treatment of primary cancers of the kidney. We reviewed our experience of percutaneous sampling performed under computed tomographic guidance with fine needle aspiration biopsy (FNAB) and core biopsy (CB), and we report on the complementary roles of these 2 techniques in a series of 351 consecutive patients undergoing radiofrequency ablation for renal neoplasms. Both FNAB and CB were obtained in 290 cases, of which 156 patients (54%) were positive for neoplasm in both specimens, and 27 (9%) were negative for tumor in both specimens. In 58 (20%) patients, the FNABs were positive, but the CBs were negative, and the reverse occurred in 11 patients (4%). When suspicious interpretations by FNAB and CB are included as positives in the calculations, both their complementary nature and the relative higher diagnostic yield of FNAB persisted. In 25 cases with FNABs positive for neoplasm, the CB allowed a more specific tumor classification. The 19 cases of FNAB which were read as negative/benign had corresponding CBs that were also negative/benign in 13 cases; yet, 6 were diagnostic of renal cell carcinoma not otherwise specified (1 case), renal cell carcinoma clear cell/conventional (4 cases), and non-Hodgkin lymphoma (1 case). These and additional findings illustrate the complementary value of the combination of the 2 biopsy methods for a reliable pretherapy morphologic confirmation of specific renal neoplasms. FNAB has relatively greater sensitivity and utility for on-site evaluation, whereas CB provides an additional sample for more specific subclassification and additional studies.     

Coexistence of colonic carcinoma, renal cell carcinoma and gastrointestinal stromal tumour-A case report

The occurrence of synchronous primary neoplasms remains an issue of great interest to surgeons and oncologists in particular, and the medical field in general. The question of common genetic pathways in the pathogenesis of such neoplasms is always raised when such associations are seen-whether metachronously or synchronously. The possibility of the coexistence of multiple tumours in the same patient must be taken into consideration when preparing patients for operation and a thorough search of the intraperitoneal organs for such coexistence remains important.A case of synchronously resected caecal carcinoma, jejunal gastrointestinal stromal tumour and renal cell carcinoma is presented here, along with a literature review on synchronous tumour resection.     

肾移植术后并发泌尿系统肿瘤8例报告

目的总结肾移植术后并发泌尿系统肿瘤的诊治体会。方法8例患者在肾移植术后3-16年出现间歇性血尿,通过B超、静脉尿路造影（IVU）、膀胱镜、输尿管镜、逆行肾盂造影、CT及内窥镜下取材活检等,证实1例为肾盂肿瘤,3例为输尿管肿瘤,3例为膀胱肿瘤,1例为尿道肿瘤。肾盂肿瘤和输尿管肿瘤的5例均采取肾、输尿管全程及膀胱部分切除术;3例膀胱肿瘤患者中,2例行经尿道膀胱肿瘤电切术,1例膀胱全切术,在行肿瘤切除术前后需适当调整免疫抑制治疗方案。术后通过膀胱灌注给予丝裂霉素、吡柔比星、表阿霉素等进行化疗。结果1例患者因肿瘤复发或新发而接受了二次肿瘤切除术,1例发生肺转移;8例患者10次手术均顺利,治疗效果满意。结论对肾移植术后并发泌尿系统肿瘤的患者,关键在于早期诊断、积极治疗,应慎重对待肾移植术后出现血尿的患者,以免漏诊。