ABSTRACT
Objective To discuss the characteristics of renal cell carcinoma with regional lymph node metastasis at diagnosis. Methods The data of 19 patients diagnosed with renal cell carcinoma with regional lymph node metastases at diagnosis from January 2004 to December 2008 were reviewed.The median age was 57 years (29-77).The study group included 15 males and four females.The primary tumor was located in the left kidney in 12 patients and fight in seven patients.The median maximam diameter of retroperitoneal lymph nodes was 2.8 cm(1.5-5.0).The lymph nodes in four patients were not detected by the preoperative image examination,but were confirmed by intraoperative exploration.Eleven cases had enlarged retroperitoneal lymph nodes resected and eight had regional lymph nodes dissected. Results The patients with regional lymph node metastases at diagnosis of renal celI carcinoma accounted for 1.6% (19/1213) of the total renal cell carcinoma cases.With a median follow-up of 34 months,six patients were survival without progression,and seven were survival with progression.giving a 5-year survival rate of 68.4%.The survival and recurrence rates after surgery were not significantly different by Fisher test(P=0.644 and 0.319 respectively) between the patients who underwent retroperitoneal regional lymph node dissection and those who underwent enlarged lymph node resection. Condmiom Renal cell carcinoma with regional lymph node metastasis at diagnosis is uncommon.Some patients may achieve long-term tumor-free survival through regional lymph node dissection or enlarged Iymph nodes resection.
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Objective To compare contrast-enhanced ultrasound(CEUS)and contrast-enhaneed computed tomography(CECT)on the diagnosis of renal cell carcinoma(RCC). Methods CEUS and CECT were performed on 117 patients(87 men and 30 women)with 124 renal lesions(single nodule in 110 and two nodules in 7)from 2004 to 2008.Among them,there were 63 patients with 65 lesions diagnosed as RCC confirmed by pathology.The tumor enhancement pattern,extent,and dynamic change of CEUS and CECT were compared.The diagnostic efficacy of CEUS and the agreement of CECT and CEUS in diagnosing RCC were analyzed. Results The rate of displaying hypervascular performance on cortical phase,and pseudocapsule enhancement of the RCC lesions by CEUS and CECT were 87.7%(57/65)and 63.1%(41/65),89.2%(58/65)and 69.2%(45/65)(P<0.05).The rate of displaying heterogeneous enhancement were 72.3%(47/65)and 56.9%(37/65)(P>0.05)Using the diagnosis of CECT as reference diagnostic criteria,the sensitivity,specificity,positive predietive value,negative predictive value,and accuracy of CEUS in diagnosing RCC were 89.1%(57/64),91.7%(55/60),91.9%(57/62),88.7%(55/62)and 90.3%(112/124).The agreement of CECT and CEUS in diagnosing RCC was high(κ=0.806). Conclusions CEUS and CECT have the coordinate efficacy in diagnosing RCC.
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Objective To investigate the effect of tissue factor pathway inhibitor-2(TFPI-2)on invasiveness and apoptosis of renal cell carcinoma,to analysis the relationship between promoter methylation and expression of TFPI-2.Methods Immunohistochemistry,Western blot and real-time RT-PCR were performed to detect the expression of TFPI-2 in 37 renal cell carcinoma tissues and 11 normal kidney tissues.TUNEL was used tO study the apoptosis status of renal cell carcinoma.Real-time methylation specific PCR was performed to analysis the methylation status of TFPI-2 gene promoter.Results The optical density of Western-blot strip in renal cell carcinoma and normal kidnev was 0.92±0.36,1.6l±0.13.The relative expression of TFPI-2 mRNA in renal cell carcinoma and normal kidney was 0.0019±0.0011,0.0065±0.0008.Compared with normal kidney,lower expression of TFPI-2 was detected in renal cell carcinoma.The correlation between expression of TFPI-2 and stage of renal cell carcinoma was negative.Apoptosis index of renal cell carcinoma specimens was 2.41%(TFPI-2 expression:grade 1),3.90%(TFPI-2 expression:grade 2),6.78%(TFPI-2 expression:grade 3),9.57%(TFPI-2 expression:grade 4).The expression of TFPI-2 was positively correlated with the apoptosis index of renal cell carcinoma.The relative expression of TFPI-2 mRNA in methylated and unmethylated tumors was 0.0015±0.0011,0.0024±0.0009.The optical densitv of Western-blot strip in methylated and unmethylated tumors was 0.82±0.35,1.04±0.34.Expressions of TFPI-2 mRNA and protein were significantly lower in methylated tumors than those in unmethylated tumors.Conclusions The expression of TFPI-2 is negatively correlated with the invasiveness of renal cell carcinoma.Overexpression of TFPI-2 may induce tumor cell apoptosis in renal cell carcinoma.Lower expression of TFPI-2 in renal cell carcinoma is partially due to hypermethylation of gene promoter.