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OBJECTIVE@#To summarize the clinicoradiological characteristics of clinical T1 renal cell carcinoma patients and to investigate the risk factors of renal sinus invasion in cT1 renal cell carcinoma patients undergoing nephrectomy.@*METHODS@#A retrospective study was conducted in cT1 renal cell carcinoma patients from January 2016 to August 2019 in Department of Urology, Peking University Third Hospital, who underwent partial or radical nephrectomy by analyzing clinicopathological and radiological data. The influencing factors of renal sinus invasion for cT1 renal cell carcinoma were determined by χ2 test, Mann-Whitney U test and Logistic regression analysis.@*RESULTS@#A total of 507 patients were enrolled, including 354 males (69.8%) and 153 females (30.2%). The median age was 59 years and the median body mass index (BMI) was 25.5 kg/m2. Eighteen patients (3.6%) had gross hematuria preoperatively. The median tumor diameter was 3.5 cm. Three hundred twenty-two patients (63.5%) were staged clinical T1a and 165 cases (36.5%) were staged clinical T1b. The median R.E.N.A.L. score was 8. Three hundred fifty-nine patients (70.8%) had regular tumor border and 148 (29.2%) irregular. All the patients underwent surgical treatment, including 186 (36.7%) partial nephrectomy and 321 (63.3%) radical nephrectomy. Postoperative pathology showed seventy-five patients (14.8%) had renal sinus invasion, including 18 in cT1a (5.6%) and 57 in cT1b (30.8%). Univariate analysis showed that age (P=0.020), R.E.N.A.L. score (R value, E value, N value, P < 0.001) and tumor border (P < 0.001) were associated risk factors for cT1 renal cell carcinoma with renal sinus invasion. On multivariate binary Logistic analysis, R.E.N.A.L. score (P≤0.020) and irregular tumor border (P=0.001) were independent risk factors.@*CONCLUSION@#For cT1 renal cell carcinoma patients undergoing nephrectomy, about 15% had renal sinus invasion postoperatively. High R.E.N.A.L. score and irre-gular tumor border help predicting cT1 renal cell carcinoma renal sinus invasion.
Subject(s)
Female , Humans , Male , Middle Aged , Carcinoma, Renal Cell/surgery , Kidney Neoplasms/surgery , Neoplasm Staging , Nephrectomy , Retrospective Studies , Risk FactorsABSTRACT
Objective To describe our renal sinus anatomy based tension-free reconstruction technique step by step and report perioperative data and long-term outcomes of patients undergoing robotassisted nephron-sparing surgery for hilar tumors.Methods From June 2013 to December 2016,data of 286 consecutive patients with hilar tumor who underwent RAPN in single center were retrospectively reviewed.There were 202 males and 84 females,aged (56.2 ± 9.2) years.The body mass index was (26.8 ± 3.5) kg/m2.The median diameter of tumor was 2.6 cm(0.8-6.0 cm),and R.E.N.A.L.score was 8.2 ± 1.8.The anatomy-based "Garland" technique specialized in protecting the large hilar vessels and minimizing the tension of trans/retroperitoneal defect suturing approach for anterior/posterior lip hilar tumor respectively.Patient's perioperative complications and long-term follow-up including renal function and oncological outcomes were analyzed.Results "Garland technique" was successfully applied in 284 patients,the warm ischemia time (WIT) was (18.2 ±4.1) min.Median estimated blood loss (EBL) for RAPN was 100 ml (range:10-600 ml).Median operative time was 120 min (range:60-230 min).No patient was converted to open surgery.Postoperative hospital stay was 4.0 d (range:2.0-9.0 d).Three patients (1.1％) had positive surgical margins.Of all the pathological results,260 cases (91.5％)were clear renal cell carcinoma,8 cases (2.8％)were chromophobe renal carcinoma,7 cases (2.5％)were papillary type renal cell carcinoma,5 cases(1.8％) were oncocytoma,3 cases (1.1％)were angiomyolipoma,one case (0.3％) was mucinous tubular and spindle cell carcinoma.Two patients underwent blood transfusion.Three patients(1.0％) had local recurrence.284 patients were alive at a median follow-up of 36 months (range:12-54 months).Conclusions "Garland technique" is safe and feasible for hilar tumor resection and reconstruction with less surgical complications.Large renal vessel injury was avoided and tension of wound closure was minimized.The trans/retroperitoneal approaches are capable for anterior/posterior hilar tumor.Patients with hilar tumor could benefit from robotic surgery with a well preserved renal function and good oncological outcomes.
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Castleman's disease is an uncommon disorder characterized by benign proliferation of the lymphoid tissue that occurs most commonly in the mediastinum. Although unusual locations and manifestations have been reported, involvement of the renal parenchyma and sinus, and moreover, manifestations as cardiac tamponade are extremely rare. Here, we present a rare case of Castleman's disease in the renal parenchyma and sinus that also accompanied cardiac tamponade.
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Humans , Male , Middle Aged , Cardiac Tamponade/diagnosis , Diagnosis, Differential , Diagnostic Imaging , Castleman Disease/diagnosis , Kidney Diseases/diagnosis , NephrectomyABSTRACT
Castleman's disease is a rare benign lymphoproliferative disorder that frequently affects lymph nodes of the mediastinal thorax and the neck. It very rarely affects the renal sinus. We report a case of Castleman's disease arising in the renal sinus in a 64-year-old man. The patient visited the hospital with the chief complaint of hematuria. Abdominal computed tomography revealed a homogeneous mass in the sinus of the left kidney, radiologically interpreted as a malignant urothelial tumor. Subsequently, nephroureterectomy was performed, after which microscopic examination of the specimen revealed a diffuse lymphoproliferative lesion with reactive lymphoid follicles of various sizes and prominent plasma cell infiltration of interfollicular spaces, highlighted by immunohistochemical staining for CD138. The lesion was diagnosed as Castleman's disease of the plasma cell type. Although preoperative diagnosis of Castleman's disease is difficult and the incidence is exceedingly rare, it should be considered in the differential diagnosis of renal sinus tumors.
Subject(s)
Humans , Middle Aged , Diagnosis, Differential , Castleman Disease , Hematuria , Incidence , Kidney , Lymph Nodes , Lymphoproliferative Disorders , Neck , Plasma Cells , ThoraxABSTRACT
Objectlve To discuss the characters and management of renal sinus tumors. Methods The clinical data of 3 tumors occurring in tenal sinus were reviewed.The first patient was a 33-year-old man with the chief complaint of lumbago in the right side for 6 months.B-ultrasound showed low echo in the right pelvis and CT scan showed that a mass measured about 3.5 cm in diameter in the right kidney collective system.Intravenous urography showed the upper collective system was tompressed.He was diagnosed for renal sinus tumor.The second case was a 34-year-old woman with the chief complaint of sudden lumbago in the right for 3 d.Color ultrasonography found hyperechoic in the right kidney.CT scan showed a mass measured 8 cm×6 cm × 8 cm in the right renal sinus,its CT value was about-70 HU.Intravenous urography showed the lower collective system was compressed.She was diagnosed for renal angiomyolipoma of right kidney.The third case was a 55+year-old woman with the chief complaint of lumbago for 1 year.B ultrasound showed hyperechoic in the leftrenal hilum.CT scan showed a nlass of 8 cm×5 cm×5 am in the left renal sinus with CT value of 50 HU.Intravenous urography showed the collective system of the left kidney was compressed.Mag-netic resonance imaging showed high signal on T1 WI and T2WI but low signal in fat suppression ima-ging.She was diagnosed for lipoma of the left renal sinus. Results All the 3 cases had undergone surgical approaches.The first case underwent surgical exploration of renal sinus tumor.Fast pathologic diagnosis was benign tumor,only the tumor was resected.Postoperative pathology confirmed the diagnosis of angioleiomyoma.There was no recurrence during follow-up of 3 years.The second case was scheduled for tumor enucleating,but nephrectomy was perform because of serious bleeding and damaged renal pelvis.Pathological report was angiomyolipoma.The third case was scheduled for lipoma enucleating but nephrectomy was performed because of tumor encapsulated renal pedicle vascular.Pathological report was lipoma.During the follow-up for 4 years there was no relapse. ConclusionsTumors occurred in renal sinus are rare, most of which are benign.CT scan, MRI and intravenous urography are the best imaging examination methods for differential diagnosis.Surgical operation is the major approach, while for the tumor radical nephrectomy less than 4 cm watchful waiting could be a choice.Tumor resection with nephron sparing is feasible while tumor is larger than 4 cm.Radical nephrectomy should performed for the malignant tumor.
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Objective To investigate the MSCT(multi-slice computed tomography) manifestation of different kinds of malignant tumor in Renal Sinus.Methods MSCT data of 31 patients with diferent kinds of malignent tumor in Renal Sinus were analyzed retrospectively.Results In our series,15 cases were renal pelvic carcinoma,and central mass in renal sinus with light or middle ehancement were revealed in their MSCT investigation,as well as pelvic filling defect and hydronephrosis to some extent were found in secretory phase of enhanced MSCT.10 cases were renal cell carcinoma with renal sinus invasion,and their MSCT muti-planar reconstruction showed the mass mainly located in renal parenchymal,with dramatical and heterogenous CT enhancement mostly,besides local oppression & latral destruction of pelvic wall were caused by renal pelvic invasion.2 cases leiomyosaocoma in renal sinus were big and had a sharp edge,after adminisration they demonstrated dramatical and heterogenous CT enhancement.3 cases were lymphnode metastasis located in renal sinus or renal gate,appeared as nodular lesion with CT enhancement,and hydronephrosis could be exsisted if renal pelvic were obstructed.1 case were retroperitoneal lymphoma,MSCT muti-planar recon-struction revealed a large retroperitoneal mass derectly invaded into renal sinus,with light or middle homogenous ehancement.Conclusion MSCT has advantages of high speed scan,excellent discrimination,and aplenty post-process technique,and is of diagonotic value to malignant tumor in renal sinus.
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Objective To evaluate the effect of incision of the intrarenal sinus plus postrenal low pole segmental incision for removal of calculus on the renal hemodynamics. Methods The hemodynamic changes of intrarenal and incisional sites in 98 cases with complex calculi were consecutively monitored by color Doppler ultrasonograph before operation and also 1 month,3 months,6 months after operation.The ratio(S/D) of the peak flow-rate in systole(S),the flow-rate at the end of diastole(D),and the resistant index(RI) of the intrarenal chief renal arteries and intersegmental arteries and interlobar arteries were analyzed.The signals of blood stream in segmental incision were divided into four classes(Ⅰ to Ⅳ) and were observed. Results The changes of the intrarenal hemodynamics were related to the degrees of hydronephrosis(P0.05),but it caused the blood stream to be obstructed in the area of incision where the signals of blood stream showed classes Ⅲ to Ⅳ.The patients generally recovered after 3 to 6 months,and the time of recovery was associated with the degrees of hydronephrosis Conclusions It is concluded that the incision of the intrarenal sinus plus postrenal low pole segmental incision for removal of calculus is an effective and safe method for treat-ment of complex renal calculus.
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We report a case of renal hemangiopericytoma occurring in renal sinus and expanding to the renal hilum. This unusual presentation caused misinterpretation of this tumor as transitional cell carcinoma of the renal pelvis clinically. The patient who was a 30-year-old woman had a relatively well demarcated solid tumor, 8 x 6 cm, in the renal sinus of the left kidney.