Prognostic significance of subclassifying stage pT3a renal tumors with fat invasion: a retrospective study of 99 patients

PurposeTo analyze the recurrence in patients with clinic stage T1 renal cell carcinoma (RCC) who were upstaged to stage T3a after partial nephrectomy (PN) using a new sub-classification criterion.MethodsA retrospective study of pathological characteristics was performed in patients who were upstaged to pT3a on the basis of fat invasion (FI).ResultsAfter analyzing the pathological findings, we proposed the following new sub-classification criteria for pT3a RCC with FI: (1) renal tumor invades the pseudo-capsule and contacts the perinephric adipose tissue directly or the tumor protrudes into the perinephric adipose tissue like a tongue (Type A); and (2) tumor nodules are distributed in perinephric adipose tissues (Type B). A significant difference was observed in the recurrence rate between the two subtypes A and B. For Type B, the recurrence rate after radical nephrectomy (RN) and PN was 15.79% and 63.64%, respectively. The recurrence rates for Types A and B after PN were 11.11% and 63.64%, respectively.ConclusionsT3a RCC with tumor nodules in perinephric adipose and/or an irregular tumor protruding into the adipose tissues lead to a higher recurrence rate. We recommend that T3a RCC be carefully analyzed and patients be treated on an individual basis.     

Usefulness of intraoperative contrast-enhanced ultrasonography in laparoscopic enucleation of small pancreatic metastases from renal cell carcinoma: A case report

Pancreatic metastasis from renal cell carcinoma (RCC) is relatively rare. Surgical resection of the lesion is recommended if no residual tumor remains. Although there is no clear standard for surgical procedures, enucleation can be considered for small lesions. Lesion identification is important for enucleation, and contrast-enhanced ultrasound which takes advantage of the characteristics of hypervascular lesions was useful in a 68-year-old woman who underwent a left nephrectomy for RCC 11 years ago that was pathologically diagnosed as clear cell carcinoma. Recent computed tomography checkup showed a hypervascular tumor of 6 mm in the uncinated process and 10 mm in the pancreatic tail. Endoscopic ultrasonography-guided fine-needle aspiration was performed for the tail lesion, a diagnosis of clear cell carcinoma was made, and laparoscopic enucleation of the pancreatic tumors was performed aided by intraoperative contrast-enhanced ultrasound. The postoperative course was uneventful, and no pancreatic fistula occurred.     

Construction and validation of a novel prognostic nomogram for patients with metastatic renal cell carcinoma: a SEER-based study

ObjectiveWe aimed to establish and validate nomograms to evaluate overall survival (OS) and cancer-specific survival (CSS) in patients with metastatic renal cell carcinoma (MRCC).MethodsBetween 2010 and 2015, the clinical information of patients with MRCC was selected using the Surveillance, Epidemiology, and End Results database. Two nomograms were constructed based on Cox regression analysis, and their prediction accuracy was evaluated by concordance index (C-index), receiver operating characteristic (ROC) curve, and decision curve analysis (DCA).ResultsAfter propensity score matching, there were 568 patients with MRCC in the training group and 568 in the validation group. Multivariate analyses revealed that age, residence, pathology, T stage, N stage, surgery, and metastatic sites were independent prognostic factors for the OS and CSS of MRCC. The C-index and ROC curves indicated that the two nomograms of OS and CSS showed satisfactory discriminative power. Furthermore, DCA displayed that the nomograms achieved more clinical net benefit than the American Joint Committee on Cancer staging system.ConclusionWe constructed and validated two effective prognostic nomograms for patients with MRCC that accurately predicted the probabilities of 1-, 2-, and 3-year OS and CSS.     

miR-145在肾细胞癌患者肿瘤细胞中低表达及其临床意义

目的:鉴定与肾细胞癌CD40信号调控相关的micro-RNA,探讨micro-RNA对肾细胞癌CD40信号的调控作用,为未来肾细胞癌的诊治提供新的有效潜在靶点。方法:通过基因芯片分析肾细胞癌与癌旁对照细胞的micro-RNA表达谱差异,通过生物信息学预测可能调控CD40的micro-RNA,并通过RT-PCR验证其表达。体外转染目标micro-RNA inhibitor及mimics,研究其对CD40、CD40L表达的影响,及对肾细胞癌细胞分泌细胞因子和细胞增殖能力的影响。结果:miR-145在肾细胞癌中表达显著降低(P0.01);转染miR-145 inhibitor后,CD40在肾细胞癌细胞中表达显著增高,CD40L表达变化差异无统计学意义;转染miR-145 mimics后,CD40在肾细胞癌细胞中表达显著降低,CD40L表达变化无统计学差异。功能性高表达miR-145后,TNF-α及IFN-γ的表达显著下降,肿瘤细胞增殖减慢,功能性低表达miR-145后,TNF-α及IFN-γ的表达显著增高,肿瘤细胞增殖加快(P0.01)。拮抗CD40表达后,miR-145高表达,TNF-α及IFN-γ的表达量有下调趋势,但差异无统计学意义。结论:miR-145在肾细胞癌细胞中显著降低,并通过调控CD40的表达,进一步调控细胞因子分泌及细胞增殖,促进肿瘤的发生与发展。     

嗜酸性实性和囊性肾细胞癌2例临床病理观察

目的探讨嗜酸性实性和囊性肾细胞癌的诊断及鉴别诊断。方法分析2例嗜酸性实性和囊性肾细胞癌的临床病理特征及免疫表型,并复习相关文献。结果例1肿瘤以实性区为主,局灶形成囊腔,肿瘤细胞强嗜酸性,有胞质内彩斑、空泡,可见多核化,囊壁被覆鞋钉样排列的强嗜酸性细胞。例2以囊性区(巨囊)为主,局灶实性,囊壁被覆强嗜酸性肿瘤细胞,呈鞋钉样排列,胞质内彩斑及空泡不明显。2例免疫组化表型均为局灶CK20(+)。结论嗜酸性实性和囊性肾细胞癌是新近认识的一种以实性和囊性结构及大的嗜酸性细胞为主型的惰性肾肿瘤,具有独特的病理特征,免疫表型表现为独特的CK20局灶阳性。通过其特征性的组织学形态和独特的免疫表型表现比较容易与其他嗜酸性肾细胞肿瘤鉴别。     

囊性肾癌27例的超声诊断分析

目的:评价超声诊断囊性肾癌的价值。方法:回顾性分析上海交通大学医学院附属瑞金医院2002年1月至2009年6月期间27例囊性肾癌超声表现和手术后病理检查结果。结果:本组27例囊性肾癌患者经超声检出25例,声像图表现为混合回声(16例)、低回声(5例)、稍高回声(3例)及等回声(1例)4种类型,其中混合回声型居多,占64.00%(16/25),且肿瘤最大径在3.60～11.00cm。超声图像表现为后3种回声的肿瘤最大径均≤4.00cm,超声表现往往提示为肾脏实质性占位。所有患者均行彩色多普勒血流显像检查,部分肿瘤在其实性或分隔上可显示彩色血流信号;3例行超声造影,部分分隔和囊壁可见少许微泡灌注,提示此处有微血管存在。结论:超声对囊性肾癌具有较高的诊断价值,因而目前超声仍是囊性肾癌的一种主要诊断手段,结合超声造影﹑增强CT及其他影像学检查对诊断囊性肾癌可以起互补作用,有助于早期诊断、早期治疗。     

Laparoscopic radical partial nephrectomy of a renal tumour: Initial case report

Summary. Advances in laparoscopic surgery have been made with development of improving tools and techniques which have expanded the application of laparoscopy to include successful management of renal neoplasm. Herein, we present a case of an incidentally discovered lower pole renal tumour effectively treated by a laparoscopic ‘radical’ partial nephrectomy.     

Multilocular cystic renal cell carcinoma presenting as a solid mass: radiologic evaluation

Background: Multilocular cystic renal cell carcinomas (MCRCCs) are a recently described variety of renal cell carcinoma with characteristic pathological and clinical features. We found that the radiologic appearances of MCRCCs of smaller size did not fulfill the previously documented criteria of the MCRCCs. This study was conducted to analyze the radiologic characteristics of MCRCCs of smaller sizes. Methods: The radiologic findings of 13 multilocular cystic renal cell carcinomas of diameter ranging from 10–32 mm (average 22 mm) seen in nine patients were analyzed in correlation with pathologic findings. Results: On US, the tumors were predominantly hyperechoic (11 of 13 tumors) with or without small anechoic areas. Precontrast CT showed the lesions to be either hypodense or hyperdense depending on the presence of hemorrhage. Degree of contrast enhancement was usually slight. The mean increase in CT attenuation was 28 ±19 (mean±standard deviation) at dynamic phase and 12±10 at delayed phase. On MR imaging, signal intensities of the tumors were high both on T1- and T2-weighted images (7 of 9 tumors) due to proteinaceous fluid or hemorrhage. Dynamic enhanced MR imaging revealed irregular contrast enhancement within the tumor (5 of 6 tumors). Angiography failed to reveal neovascularity. Conclusion: Although multiple cysts were seen within the tumors pathologically, MCRCCs of smaller sizes appeared solid on radiologic examinations. However, contrast enhancement or neovascularity was very slight.     

ROS receptor tyrosine kinase: a new potential target for anticancer drugs

ROS kinase is one of the last two remaining orphan receptor tyrosine kinases with an as yet unidentified ligand. The normal functions of human ROS kinase in different body tissues have not been fully identified so far. However, the ectopic expression, as well as the production of variable mutant forms of ROS kinase has been reported in a number of cancers, such as glioblastoma multiforme, and non‐small cell lung cancer, suggesting a role for ROS kinase in deriving such tumors. It is thought also that c‐ROS gene may have a role in some cardiovascular diseases, and the fact that homozygous male mice targeted against c‐ROS gene are healthy but infertile, has inspired researchers to think about ROS inhibition as a method for development of new male contraceptives. The recent discovery of new selective and potent inhibitors for ROS kinase, along with the development of new specific diagnostic methods for the detection of ROS fusion proteins, raises the importance of using these selective inhibitors for targeting ROS mutations as a new method for treatment of cancers harboring such genes. This review focuses on the ectopic expression of ROS and its fusion proteins in different cancer types and highlights the importance of targeting these proteins for treatment of substantial cancers. It describes also the recent advances in the field of ROS kinase inhibition, and the potential clinical applications of ROS kinase inhibitors. © 2010 Wiley Periodicals, Inc. Med Res Rev 31: 794‐818, 2011     

Metastatic renal cell carcinoma presenting as a duodenal mass

We report a case of renal cell carcinoma metastasis to the duodenum.     

色素性微囊肾嫌色细胞癌临床病理观察

目的 探讨色素性微囊肾嫌色细胞癌的临床病理特点、诊断及鉴别诊断.方法 对1例色素性微囊肾嫌色细胞癌的临床资料、组织学形态及免疫组化结果进行分析,并复习相关文献.结果 肿瘤界限清楚,无明显包膜;切面灰白、灰黄至棕黄色.镜下瘤细胞排列呈微囊及腺样结构,可见色素沉着,肿瘤间质内可见钙化灶.免疫组化:瘤细胞CAM2.5、AE1/AE3、CK7、EMA、E-cadherin和CD117(+),S-100、HMB45和vimentin(-).结论 色素性微囊肾嫌色细胞癌是一种少见的肿瘤,最重要的特征是具有相对良性的生物学行为,远处转移很少见.     

肾癌组织中TβRⅡ基因甲基化状态的检测及其临床意义

目的探讨转化生长因子β受体Ⅱ(TβRⅡ)在肾透明细胞癌(RCCC)中的甲基化状态及其临床意义。方法应用甲基化特异性PCR(MSP)技术检测43例肾透明细胞癌组织,43例正常组织中TβRⅡ基因的甲基化状况;应用免疫组织化学P-V法检测40例肾透明细胞癌组织,28例正常组织中TβRⅡ基因的蛋白表达情况。结果 RCCC组织中TβRⅡ基因的甲基化率为58.1%(25/43),显著高于正常组织34.9%(15/43),差异有统计学意义(P0.05);肾透明细胞癌中TβRⅡ基因的甲基化率与患者年龄、性别、肿瘤的大小和肿瘤分化程度无显著相关性(P0.05)。TβRⅡ在RCCC组织中的免疫组化结果显示,基因蛋白表达在RCCC组显著低于正常组(P0.05),且其蛋白表达与肿瘤的大小和肿瘤分化程度相关(P0.05)。结论 TβRⅡ基因启动子甲基化可能与RCCC的发生有关。     

肾癌组织中TβRⅡ基因甲基化状态的检测及其临床意义

目的探讨转化生长因子B受体Ⅱ（TβR Ⅱ）在肾透明细胞癌（RCA2C）中的甲基化状态及其临床意义。方法应用甲基化特异性PCR（MSP）技术检测43例肾透明细胞癌组织,43例正常组织中T13RⅡ基因的甲基化状况;应用免疫组织化学P-V法检测40例肾透明细胞癌组织,28例正常组织中TβRⅡ基因的蛋白表达情况。结果RCCC组织中TβRⅡ基因的甲基化率为58．1％（25／43）,显著高于正常组织34．9％（15／43）,差异有统计学意义（P〈0．05）;肾透明细胞癌中耶RII基因的甲基化率与患者年龄、性别、肿瘤的大小和肿瘤分化程度无显著相关性（P〉0．05）。TβRⅡ在RCCC组织中的免疫组化结果显示,基因蛋白表达在RCCC组显著低于正常组（P〈0．05）,且其蛋白表达与肿瘤的大小和肿瘤分化程度相关（P〈0.05）。结论耶RⅡ基因启动子甲基化可能与RCCC的发生有关。     

肾集合管癌3例临床病理分析

目的探讨肾集合管癌的临床病理特征。方法对3例外科治疗的肾集合管癌进行临床、组织学、免疫组化及超微结构观察，并结合文献复习。结果本病发病年龄35～42岁，临床无特殊症状，影像学检查提示肾细胞癌。病理上肿瘤主要位于肾髓质内，组织学瘤细胞呈管状、管状乳头状结构，胞质透明或颗粒状，核大，核仁清晰，典型的肿瘤细胞呈靴钉样，间质纤维增生，多量淋巴细胞浸润并有肿瘤旁集合管上皮细胞的异型增生。免疫组化显示CK(AE3)、EMA和vimentin( )，CD10、CEA、CK7和CK20(-)。结论肾集合管癌是一种少见的起源于集合管上皮的恶性肿瘤，肿瘤呈管状、乳头状排列，细胞呈靴钉状伴间质的纤维增生和炎细胞反应，确诊本病时应与肾乳头状癌和肾髓质癌鉴别。     

保留肾单位手术治疗T_1期局限性肾癌的围术期护理

目的探讨保留肾单位手术治疗T_1期局限性肾癌的围术期综合护理干预效果。方法选取保留肾单位手术治疗T_1期局限性肾癌的患者82例,采用随机数字表达法分为对照组和观察组,对照组采用常规围术期护理,观察组针对常规护理中的不足进行针对性改进,开展综合护理干预。结果观察组术后肠道功能恢复时间、术后进食时间、术后拔除引流管时间、出院前较术前血肌酐上升幅度均低于观察组(P0.05);2组均未见术后出血、切口感染等严重并发症;观察组术前病理性焦虑以及术后便秘/腹胀、腰背痛、失眠、血压波动的发生率均低于对照组(P0.05)。结论将综合护理干预措施应用于保留肾单位手术治疗T_1期局限性肾癌的围术期护理中,可改善患者胃肠道功能、心理状态等,且不会增加严重并发症发生风险。     

Temsirolimus in patients with advanced renal cell carcinoma: an overview

Treatment of patients with advanced renal cell carcinoma (RCC) has changed dramatically with the advent of targeted therapeutics. Temsirolimus, an inhibitor of mammalian target of rapamycin (mTOR), has proven beneficial in the treatment of advanced RCC with poor prognosis. The rationale for mTOR inhibitors in treatment of RCC, the pharmacokinetics and toxicities of temsirolimus, landmark clinical trials of temsirolimus in advanced RCC, and the indications for its use in the treatment of RCC are reviewed here. The status of temsirolimus in the rapidly evolving therapeutic landscape of advanced RCC is also discussed.