Metastatic clear-cell renal carcinoma: an exceptional cause of ileocolonic intussusception in adults

Introduction: Intussusceptions in adults are rare, representing 1% to 5% of intestinal obstructions in this age group. This condition can be caused by benign and malignant lesions acting as lead points, the latter being the most frequent. Furthermore, the diagnosis is challenging due to the non-specific symptoms with variable duration. Case Presentation: A 43-year-old man, with a history of localized clear-cell renal carcinoma (ccRCC) treated 9 years earlier with a right radical nephrectomy, presented with bowel obstruction symptoms. An abdominal computed tomography scan showed an ileocolonic intussusception. Hence, the patient required a right hemicolectomy with ileotransverse anastomosis. The histopathological analysis showed a metastatic ccRC to the terminal ileum causing the intussusception. Discussion: Adult intussusceptions are rare. However, they should be considered in the differential diagnosis of patients with abdominal pain and symptoms of bowel obstruction. Metastases of renal cancer to the small bowel are uncommon and even more so in the form of intussusception. Definitive treatment must be tailored to the patient's condition and underlying cause. (AU)

Mechanism of berberine inhibiting invasion and migration of renal carcinoma cells by down-regulating the expression of METTL3 / 中国药房

OBJECTIVE To investigate the inhibitory effect of berberine （BER） on the invasion and migration of human renal carcinoma cells and its potential mechanism. METHODS Using human renal carcinoma OSRC-2 cell as object， alamarBlue assay was adopted to detect the inhibitory effects of 0 （control group）， 25， 50， 75， 100， 125， 150， 175 and 200 μmol/L BER on the proliferation of OSRC-2 cell after treatment for 24 h and 48 h. After treated with 0（control group）， 50， 100 μmol/L BER for 48 h， the effect of BER on cell cycle was analyzed by flow cytometry. The migration of OSRC-2 cells in 24 h and 36 h was observed by cell scratch test， and the invasion ability of OSRC-2 cells in 24 h was detected by Transwell assay. The protein expression of methyltransferase-like 3 （METTL3） was detected by Western blot after treatment for 48 h， and RNA methylation quantification kit was used to detect the levels of N6-methyladenosine （m6A） in OSRC-2 cells. RESULTS Compared with control group， BER at different concentrations could significantly decrease the survival rate of OSRC-2 cells （P＜0.01）， and showed a dose-dependent and time-dependent manner. After 48 h of BER treatment at 50， 100 μmol/L， the cell was arrested in G0/G1 phase （P＜0.01）. Compared with control group， the migration and invasion abilities of cells in 50， 100 μmol/L BER group were significantly decreased （P＜0.05 or P＜0.01）； the protein expression of METTL3 and the level of m6A in RNA were significantly decreased （P＜0.01）. CONCLUSIONS BER can inhibit level of m6A by down-regulating the expression of METTL3， thereby inhibiting the invasion and metastasis of human renal carcinoma cells.

Mechanism of Tripterygium wilfordii in treating renal cell carcinoma using network pharmacology / 国际生物医学工程杂志

Objective:To explore the mechanism of Tripterygium wilfordii in treating renal cell carcinoma using network pharmacology and experimental validation. Methods:The traditional Chinese medicine systems pharmacology (TCMSP) database and analysis platform was utilized to screen the active ingredients of T. wilfordii and predict the targets using the Swiss database. Renal cell carcinoma related targets were collected from DisGeNET, GeneCards, and OMIM databases, and intersecting targets were obtained through Venny 2.1.0. Protein-protein interaction (PPI) networks were mapped using the STRING database and Cytoscape software, and gene ontology (GO) and kyoto encyclopedia of genes and genomics (KEGG) enrichment analyses were performed. Component-target-pathway networks were constructed using Cytoscape software. To induce the subcutaneous transplantation tumor model of renal cell carcinoma, nude mice were randomly divided into a control group and a treatment group, with 5 mice in each group. In the treatment group, mice were gastrically instilled with 615 mg/ml of T. wilfordii solution (1 845 mg T. wilfordii granules dissolved into 3 ml water) 2.46 g/kg, 10 μl/time, once daily for 21 d. In the control group, mice were gastrically instilled with an equal amount of saline. Tumor volume was measured once every 5 days, and the expression of serine/threonine protein kinase 1 (AKT1), signal transduction and transcription activator 3 (STAT3), tumor necrosis factor (TNF), tumor protein p53 (TP53), JUN, mitogen-activated protein kinase 8 (MAPK8), and MAPK14 was detected by enzyme-linked immunoassay. Results:Twenty-eight active pharmaceutical ingredients and 117 potential targets of T. wilfordii were screened; 13 425 related disease targets were identified; and finally, 113 drug-disease intersecting targets were obtained. In the PPI network, AKT1, STAT3, TNF, TP53, JUN, MAPK8, and MAPK14 were the core targets. GO analysis showed that BP mainly included nuclear receptor activity, ligand-activated transcription factor activity, RNA polymerase-specific DNA-binding transcription factor binding, nuclear steroid receptor activity, and adrenergic receptor activity, etc. CC mainly included the response to hormones, the cellular response to lipids, the positive regulation of cell migration, the response to TNF, the inflammatory response, the cellular response to hormonal stimulation, the response to hypoxia, the response to metal ions, etc. MF involves membrane rafts, membrane microregions, the outer side of the plasma membrane, the lateral side of the membrane, plasma membrane rafts, presynaptic membranes, vesicles, transcriptional regulatory complexes, post-synaptic membranes, synaptic membranes, etc. KEGG analysis showed that T. wilfordii treatment of RCC involves signaling pathways such as lipid and atherosclerosis, advanced glycosylation end product-receptor for advanced glycosylation end products (AGE-RAGE), TNF, Toll-like receptor, phosphatidylinositol 3-kinase-protein kinase B (PI3K-Akt), and MAPK. The experimental validation results showed that the tumor volume was reduced after treatment with tretinoin ( P < 0.05), the expression of TP53 protein was increased ( P < 0.001), and the expression of AKT1, STAT3, TNF, JUN, MAPK8, and MAPK14 proteins were all reduced (all P < 0.001). Conclusions:In this study, the target and signaling pathways of T. wilfordii treatment of renal cell carcinoma were initially predicted, providing a reference basis for further research on its protective mechanism and clinical application.

Mechanism of Pachymic Acid in Inhibiting Invasion and Metastasis of Renal Carcinoma Cells via Regulating MMP/TIMP Balance by Smads / 中国实验方剂学杂志

ObjectiveTo investigate the effect and mechanism of pachymic acid （PA） in Poria on the invasion and metastasis of renal carcinoma cells. MethodThe effect of PA （0， 20， 40， 80， 160 μmol·L-1） on cell viability was detected by cell counting kit-8（CCK-8）， and the dose of PA was selected for subsequent experiments. The effect of PA （0， 20， 40， 80 μmol·L-1） on cell proliferation was evaluated by colony formation assay. The effect of PA （0， 20， 40， 80 μmol·L-1） on cell adhesion ability was observed by cell adhesion assay. The effect of PA （0， 20， 40， and 80 μmol·L-1） on cell invasion and metastasis was investigated by Wound healing assay and Transwell invasion assay. The inhibitory effect of PA （0， 20， 40， 80 μmol·L-1） on cell motility was further observed and verified by high-content imaging technology. The effects of PA （0， 20， 40， 80 μmol·L-1） on the expression of matrix metalloproteinase （MMP）/tissue inhibitor of metalloproteinasas （TIMP） related to invasion and metastasis and Smads were detected by Western blot. ResultCCK-8 results showed that compared with the blank group， the PA groups showed decreased cell viability（P<0.01）， with the half-maximal inhibitory concentration （IC50） of ACHN cells of 70.42 μmol·L-1 at 24 h. Colony formation assay showed that the number of cell clonal groups in the PA groups was reduced compared with that in the blank group（P<0.01）. Cell adhesion assay showed that compared with the blank group， the PA groups displayed reduced cell adhesion（P<0.01）. Wound healing assay showed that the wound healing rate of cells in the PA groups was lower than that in the blank group （P<0.05，P<0.01）. Transwell invasion assay showed that compared with the blank group， the number of transmembrane cells in PA groups was reduced（P<0.01）. High-content imaging showed that the cumulative migration distance of cells in the PA groups was shorter than that in the blank group（P<0.01）. The results of Western blot showed that the protein expression of MMP-2 and MMP-9 in the PA groups decreased （P<0.01）， and TIMP-1 protein expression increased （P<0.01） compared with those in the blank group. In addition， compared with the blank group， the PA groups showed decreased protein expression of Smad2 and Smad3 （P<0.01）. ConclusionPA can inhibit the invasion and metastasis of renal carcinoma cells presumably through regulating the homeostasis of MMP/TIMP by Smad2/3.

Effects of chlorogenic acid on the proliferation, migration and invasion of renal carcinoma A498 and 769-P cells / 现代泌尿外科杂志

【Objective】 To investigate the effects of chlorogenic acid on the proliferation, migration and invasion of renal carcinoma A498 and 769-P cells and the possible molecular mechanism. 【Methods】 Human renal carcinoma A498 and 769-P cells were divided into control group and chlorogenic acid group (2 μL,1 μmol/L) and cultured for 72 h. The cell proliferation, invasion and migration were detected with MTT assay, Transwell assay and scratch test, respectively. The expressions of IL-1β, EPAS-1 and AKT/P65 signaling pathway related proteins were detected with ELISA, qRT-PCR and Western blot, respectively. 【Results】 Chlorogenic acid inhibited the proliferation, invasion and migration of renal carcinoma A498 and 769-P cells, and reduced the IL-1β level in the cell supernatant. Anti-IL-1β reduced the protein and mRNA expressions of EPAS-1, p-AKT and p-P65. Compared with the control group, the chlorogenic acid group had reduced mRNA and protein expressions of EPAS-1, p-AKT and p-P65 (P<0.05). 【Conclusion】 Chlorogenic acid can inhibit the invasion and metastasis of renal carcinoma cells, and its mechanism may be related to inhibiting the secretion of IL-1β, thereby inhibiting the AKT/P65/EPAS-1 pathway.

Large mucinous tubular and spindle cell carcinoma of left kidney: a case report / 中华泌尿外科杂志

In November 2019, we received and treated a patient with MTSCC of the left kidney. The tumor was located at the upper pole of the left kidney, with a size of 23.3 cm×18.0 cm×21.8 cm. She underwent transperitoneal radical nephrectomy. There was no local recurrence or distant metastasis during the follow-up of 3 years and 2 months. MTSCC of the kidney is a rare subtype of renal carcinoma, with slower disease progression, a clear and smooth rim, and fewer invasion or metastasis. Its final diagnosis should depend on pathology examination. Surgical treatment is the only effective intervention for this disease at present.

Lesión granulomatosa en encía insertada-metástasis de carcinoma renal de células claras. Presentación de caso / Granulomatous Lesion in Inserted Gum-Metastasis of Renal Clear Cell Carcinoma. Case Presentation

Resumen: A nivel mundial el carcinoma renal constituye el 3% de todas las formas de cáncer en el cuerpo humano. Su comportamiento biológico es variable dependiendo de la biología de cada individuo; tiende a realizar metástasis a sitios contiguos como glándulas suprarrenales, hígado, pulmón, hueso, ganglios linfáticos sin embargo la presentación a distancia en cavidad bucal es poco frecuente más aún en encía insertada. Las lesiones granulomatosas del periodonto incluyen granulomas piógenos, granulomas de células gigantes entre otros. El objetivo principal de este caso clínico es describir las características clínicas e histopatológicas de las metástasis a cavidad bucal como lesiones granulomatosas. Se presenta el caso de una paciente femenina de 60 años de edad con antecedente de carcinoma renal de células papilares en riñón derecho tratado mediante nefrectomía en el año 2017, en el año 2019 presenta metástasis a pulmón izquierdo y a cavidad bucal. En la actualidad se encuentra bajo protocolo de tratamiento para metástasis de células claras renales.

Abstract: Worldwide, renal carcinoma constitutes 3% of all forms of cancer in the human body. Its biological behavior is variable depending on the biology of each individual; it tends to metastasize to contiguous sites such as adrenal glands, liver, lung, bone, lymph nodes, however, remote presentation in the oral cavity is less frequent, even in inserted gums. Granulomatous lesions of the periodontium include pyogenic granulomas, giant cell granulomas among others. The main objective of this clinical case is to describe the clinical and histopathological characteristics of oral cavity metastases as granulomatous lesions. The case of a 60-year-old female patient with a history of renal cell papillary carcinoma in the right kidney treated by nephrectomy in 2017 is presented, in 2019 she presented metastases to the left lung and oral cavity. It is currently under treatment protocol for renal clear cell metastases.

A case report of mucinous tubular and spindle cell carcinoma of the kidney / 中华泌尿外科杂志

Mucinous tubular and spindle cell carcinoma of the kidney is a rare subtype of renal carcinoma. In July 2019, one case of mucinous tubular and spindle cell carcinoma of the kidney was admitted to our hospital, The laparoscopic partial nephrectomy was performed, and there was no recurrence or metastasis during the follow-up period of 13 months. The disease has no obvious clinical manifestations and its diagnosis depends on pathological and immunohistochemical features. Surgical treatment is the main treatment for this disease, and most patients have a good prognosis.Howerer, the possibility of progression remains in the late stage of the disease.

Técnicas de segmentación y procesamiento para la detección de Carcinomas Renales en imágenes de Tomografía Abdominal / Segmentation and processing techniques for the detection of Renal Carcinomas in Abdominal Tomography images

Una de las campañas más reconocidas en el mundo es la lucha contra el cáncer, siendo el sistema renal uno de los más afectados por esta patología. El carcinoma de células renales (CCR), el más común de cáncer renal en los adultos, representa la sexta causa de muerte por cáncer. Debido al aumento en el uso de las técnicas de diagnóstico por imagen, las lesiones renales pueden ser diagnosticadas en forma incidental aproximadamente en 50% de los casos. Cuba apuesta por el uso de la tecnología en la salud y en la Universidad de las Ciencias Informáticas (UCI) se ha desarrollado un sistema para el almacenamiento, transmisión y visualización de imágenes médicas (XAVIA PACS), el cual se encuentra implantado en varios hospitales del país, pero no cuenta con alternativas para realizar la detección del CCR en imágenes tomográficas, haciendo más lento el diagnóstico, lo que se traduce en menos posibilidades para el paciente. La presente investigación tiene como objetivo realizar un análisis sobre las principales técnicas de segmentación y procesamiento para la detección de carcinomas renales en imágenes de tomografías abdominal, que propicie a los equipos de desarrollo contar con la base teórica necesaria para enfrentar el problema en cuestión. Para ello se realizó un análisis documental sobre trabajos relacionados con la temática y que propician soluciones al problema. Se estudiaron algoritmos y técnicas computacionales efectivas para la segmentación y procesamiento de imágenes abdominales. Como resultado de la investigación se obtuvieron los algoritmos más acordes para el sistema XAVIA PACS y el contexto médico cubano(AU)

One of the most recognized campaigns in the world is the fight against cancer, the kidney system being one of the most affected by this pathology. Renal cell carcinoma (RCC), the most common form of kidney cancer in adults, represents the sixth leading cause of cancer death. Due to the increased use of diagnostic imaging techniques, kidney injuries can be diagnosed incidentally in approximately 50% of cases. Cuba is committed to the use of technology in health and a system for the storage, transmission and display of medical images (XAVIA PACS) has been developed at the University of Computer Sciences (UCI), which is implanted in several hospitals of the country, but it does not have alternatives to detect RCC in tomographic images, slowing down the diagnosis, which translates into fewer possibilities for the patient. The objective of this research is to carry out an analysis on the main segmentation and processing techniques for the detection of renal carcinomas in abdominal tomography images, which provides development teams with the theoretical basis necessary to face the problem in question. For this, a documentary analysis was carried out on works related to the subject and that provide solutions to the problem. Algorithms and effective computational techniques for the segmentation and processing of abdominal images were studied. As a result of the research, the most suitable algorithms for the XAVIA PACS system and the Cuban medical context were obtained(AU)

Metástasis muscular. Presentación de un carcinoma renal / Muscle metastasis as presentation of kidney cancer / Metástase muscular. Relato de caso de carcinoma renal

Resumen: Introducción: el cáncer de riñón frecuentemente se presenta con metástasis sincrónicas. Son excepcionales los casos comunicados en la literatura donde el diagnóstico de la enfermedad surge a partir de una metástasis muscular. Objetivo: el objetivo del trabajo es presentar un caso clínico de metástasis en músculo deltoides izquierdo como primera manifestación de un carcinoma de células claras de riñón. Caso clínico: paciente de 76 años, sexo masculino, que se operó con diagnóstico de tumoración de región delitoidea izquierda cuyo estudio anatomopatológico informó una metástasis muscular de un carcinoma renal de células claras. Se realizó una tomografía axial computarizada que evidenció una tumoración renal derecha, por lo cual se realizó una nefrectomía que confirmó el diagnóstico del tumor primario. Discusión: el diagnóstico de metástasis muscular de un carcinoma de células claras de riñón, cuando es la primera manifestación de la enfermedad, habitualmente se realiza con el estudio de la pieza de resección quirúrgica o bien a través de una biopsia. Si bien el tratamiento de la metástasis en general es paliativo, el control local de la enfermedad solo es posible cuando se realiza una resección quirúrgica con márgenes libres, ya que otros tratamientos oncológicos no han demostrado ser eficaces.

Summary: Introduction: most kidney cancer patients present with synchronous metastatic disease. A review of the literature reveals cases where the diagnosis is based on muscle metastasis are exceptional. Objective: the study aims to present the clinical case of metastasis to the left deltoid muscle as the initial presentation of renal cell carcinoma. Clinical case: 76 year old male patient who was operated upon diagnosis of tumour in the left deltoid region, the biopsy of which revealed muscle metastasis of clear cell renal cell carcinoma (RCC). Computerized axial tomography evidenced a tumorous formation in the right kidney. The patient underwent right-sided nephrectomy that confirmed the primary tumour diagnosis. Discussion: diagnosis of muscle metastasis of clear cell renal cell carcinoma, being it the initial presentation of the disease, is often done by analysing the surgical resection piece or by means of a biopsy. Despite treatment of metastasis is usually palliative, local control of the disease is only possible when tumour-free margins surgical resection is done, since other oncologic treatments have not proved effective.

Resumo: Introdução: o câncer renal frequentemente se apresenta com metástases sincrônicas. São excepcionais os casos relatados na literatura em que o diagnóstico da doença decorre de uma metástase muscular. Objetivo: o objetivo do trabalho é apresentar um caso clínico de metástase no músculo deltóide esquerdo como primeira manifestação de um carcinoma de células claras do rim. Caso clínico: paciente do sexo masculino, 76 anos, submetido à cirurgia com diagnóstico de tumor na região do deltóide esquerdo, cujo estudo anatomopatológico relatou metástase muscular de carcinoma renal de células claras. Foi realizada tomografia axial computadorizada que revelou tumor renal direito, sendo realizada nefrectomia que confirmou o diagnóstico do tumor primário. Discussão: o diagnóstico da metástase muscular do carcinoma de células claras do rim, quando é a primeira manifestação da doença, geralmente é feito com o estudo da peça de ressecção cirúrgica ou por meio de biópsia. Embora o tratamento das metástases em geral seja paliativo, o controle local da doença só é possível quando a ressecção cirúrgica é realizada com margens livres de patologia, uma vez que outros tratamentos oncológicos não têm se mostrado eficazes.

Metástasis pancreática metacrónica de carcinoma renal / Metachronous pancreatic metastasis from renal cell carcinoma

RESUMEN Las metástasis pancreáticas por carcinoma renal de células claras son excepcionales; en general, se presentan como tumores asintomáticos de diagnóstico incidental. Caso clínico: hombre de 61 años, nefrectomizado hace 10 años; durante el seguimiento se detecta una masa pancreática distal de 3 cm, hipervascular. Se realiza pancreatectomía corporocaudal laparoscópica, confirmándose la presencia de una metástasis de carcinoma renal. Las metástasis pancreáticas del carcinoma renal suelen apare cer en forma asintomática y metacrónica. La resección quirúrgica logra buenos resultados oncológicos y debe intentarse siempre que sea posible. En este caso destacamos que se pudo realizar una exéresis radical mediante abordaje mínimamente invasivo.

ABSTRACT Pancreatic metastases from clear cell renal carcinoma are very rare, and generally present as incidental asymptomatic tumors. Case report: a 61-year-old male patient with a history of nephrectomy 10 years before presented a 3-cm hypervascular mass in the distal pancreas during follow-up. A laparoscopic distal pancreatectomy was performed, confirming the presence of metastasis from a renal cell carci noma. Pancreatic metastases from renal cell carcinoma are usually metachronous and asymptomatic. Surgical resection is associated with favorable oncological results and, if possible, should be attempted. In our case, a successful oncological resection could be performed through a minimally invasive ap proach.

Computed Tomography Imaging Features of IgG4-related Nephropathy / 中国医学科学院学报

Objective To investigate the computed tomography(CT)imaging features of IgG4-related kidney disease(IgG4-RKD).Methods The clinicopathological and imaging data of 36 IgG4-RKD patients(including 26 cases of renal parenchyma,10 cases of renal pelvis,24 cases of double kidney or multiple lesions,and 12 cases of single focus)were retrospectively analyzed.Results IgG4-RKD had specific clinicopathological and imaging features.Although the kidney or renal pelvis was involved,there were no common clinical manifestations of malignant tumors such as hydronephrosis and hematuria.The boundary was clear and complete,and it had typical characteristics of continuous progressive enhancement.The peak value was mostly in the solid and excretory phase,and there were no imaging manifestations such as liquefaction,necrosis,cystic degeneration,and calcification.Even if the renal pelvis was obviously involved and the focus was large,there was no invasion of the peripheral renal parenchyma,the shape of the renal pelvis still existed,the wall was smooth,and there was no enlarged peripheral lymph nodes.Conclusions CT images of IgG4-RKD are similar to those of renal malignant tumors.Based on clinicopathological features,CT findings,and blood IgG4-related tests,a definite diagnosis can be made and unnecessary operation can be avoided.

lncRNALUCAT1 facilitates the proliferation and metastasis of clear cell renal cell carcinoma 786-O cells via regulating miR-199a-5p/HIF-1α axis / 中国肿瘤生物治疗杂志

@# Objective: To investigate the effect of long non-coding RNA (lncRNA) lung cancer associated transcript 1 (LUCAT1) on proliferation and migration of clear cell renal cell carcinoma (ccRCC) 786-O cells and the underlying mechanism. Methods: A total of 40 pairs of pathologically confirmed tumor tissues and corresponding adjacent normal tissues from ccRCC patients, who underwent surgical resection in the Department of Urology, the First People's Hospital of Yichang during June 2013 and June 2017, were selected for this study. ccRCC cell lines (786-O, ACHN, UM-RC-2) and normal renal epithelial KiMA cells were also used in this study. qPCR was used to detect the mRNA expressions of LUCAT1, miR-199a-5p and hypoxia inducible fator 1α (HIF-1α) in above mentioned tissues and cell lines; CCK-8 assay was used to evaluate the proliferation of 786-O cells; Transwell assay was used to evaluate the migration of 786-O cells; Dual luciferase reporter gene assay was performed to validate the relationship between LUCAT1 and miR-199a-5p; and Western blotting was conducted to detect the effect of LUCAT1 and miR-199a-5p on the protein expression of HIF-1α. Results: LUCAT1 was significantly up-regulated in ccRCC tissues and cell lines (all P<0.01), and its knockdown significantly inhibited the proliferation and migration of 786-O cells (all P<0.01). miR-199a-5p was low-expressed in ccRCC tissues and cell lines (all P<0.01), StarBase analysis showed that LUCAT1 contained a conserved target site for miR-199a-5p. miR-199a-5p exerted significant suppression on the luciferase activity of LUCAT1-Wt (P<0.01), and LUCAT1 knockdown significantly reduced miR-199a-5p expression (P< 0.01). LUCAT1 was low-expressed in 786-O cells transfected with miR-199a-5p mimics, however, it was attenuated after co-transfection with LUCAT1. The mRNA and protein expressions of HIF-1α in 786-O cells transfected with miR-199a-5p mimics were up-regulated, which was then reversed by LUCAT1 over-expression (P<0.05 or P<0.01). miR-199a-5p over-expression suppressed the proliferation and migration of 786-O cells, which was partially attenuated by LUCAT1 transfection (P<0.05 or P<0.01). Conclusion: LUCAT1 exerts oncogenic function in ccRCC via regulating miR-199a-5p/HIF-1α axis.·

Síndrome de Stauffer como manifestación de carcinoma renal de células claras / Stauffer's syndrome as manifestation of clear cell renal carcinoma

Resumen: La incidencia de carcinoma renal de células claras representa cerca de 2% de todas las neoplasias malignas. La tríada clásica de hematuria, dolor abdominal y masa palpable se estima en 10% de los casos. Stauffer describió en 1961 el primer caso llamado síndrome de disfunción hepato-nefrogénica no metastásica, este padecimiento puede encontrarse en 3 a 20% de los casos. La afectación de las enzimas hepáticas puede estar en relación con la infiltración metastásica del hígado o, bien, por disfunción no metastásica. Es una manifestación poco frecuente en cáncer renal. Ante el hallazgo de enzimas hepáticas y fosfatasa alcalina elevadas y al descartar alteración hepática anatómica y funcional, debe sospecharse el síndrome de Stauffer, lo que puede hacer la diferencia entre que éste pase inadvertido o establecer el diagnóstico de manera oportuna. Se comunica una manifestación poco frecuente de síndrome paraneoplásico en cáncer renal de células claras.

Abstract: The incidence of clear cell renal carcinoma corresponds to about 2% of all malignant neoplasms. The classic triad of hematuria, abdominal pain and palpable mass is estimated in 10% of cases. Stauffer described in 1961 the first case called nonmetastatic hepatophrenic dysfunction syndrome, this condition can be found in 3 to 20% of cases. The involvement of liver enzymes may be related to metastatic liver infiltration or also due to non-metastatic dysfunction. It is a rare manifestation in renal cancer. Before the finding of elevated liver enzymes and alkaline phosphatase, ruling out both anatomic and functional hepatic impairment, Stauffer syndrome should be suspected, being able to make the difference between going unnoticed or being a timely finding. This paper reports a little frequent manifestation of paraneoplastic syndrome of clear cell renal carcinoma.

Carcinoma renal de células claras: a propósito de un caso y revisión de la literatura / Renal clear cell carcinoma: case report and review of the literature

El carcinoma de células renales (CCR) es la lesión sólida más frecuente en el riñón y representa aproximadamente el 90% de los tumores renales malignos. Hay un predominio 1,5:1 de varones sobre las mujeres y su incidencia máxima tiene lugar entre los 60 y 70 años de edad. Este tipo de cáncer representa el 2%-3% de todos los cánceres y su incidencia máxima ocurre en los países occidentales. Se reporta un caso poco frecuente de CCR en una paciente femenina de 35 años de edad con una hematuria total, sin dolor, de 2 días de duración. El TAC abdomino-pélvico reveló una lesión ocupante de espacio de 15 x 12 x 10 cm aproximadamente, de aspecto neoproliferativo, con características heterogéneas de hipo e hiperdensidad, de 40 uH, neovascularización y realce al contraste, que compromete cáliz medio e inferior de riñón izquierdo, extensivo hasta pelvis renal. Se practicó nefrectomía radical izquierda. El estudio histopatológico reporta un carcinoma de células claras bien diferenciado de bajo grado, con márgenes libres y ganglios linfáticos sin MT. Paciente quien evoluciona satisfactoriamente en planificación de terapia adyuvante. Por el hecho de ser una presentación en un adulto joven, lo ideal es que el urólogo este en la capacidad de realizar el diagnóstico a la brevedad posible(AU)

Renal cell cancer (RCC) is the most common solid lesion in the kidney and accounts for approximately 90% of malignant renal tumors. There is a 1.5:1 male predominance and the highest incidence occurs between 60 and 70 years of age. RCC represents 2%-3% of all cancers and its highest incidence occurs in western countries. We report a rare case of a female patient of 35 years of age who has had pain free hematuria for two days. A contrasted abdominal/pelvic CT revealed a lesion of approximately 15 x 12 x 10 cm with neoproliferative appearance and heterogeneous features of hypo and hyperdensity of 40 uH, with neovascularization and contrast enhancement, compromising the middle and lower calyx of the left kidney extensive to renal pelvis. A left radical nephrectomy was performed. Histopathological study revealed a well-differentiated low grade clear cell carcinoma, with free margins and lymph nodes without metastasis. The patient has a satisfactory evolution and is awaiting adjuvant treatment. Due to the fact that the patient is a young adult, the urologist should be able to make the diagnosis as soon as possible(AU)

miR-19a-3p targets cell adhersion molecule 2 to inhibit proliferation and metastasis of renal carcinoma 7867-O cells via blockingAKT pathway / 中国肿瘤生物治疗杂志

@# Objective: To explore the mechanism of miR-19a-3p regulating cell adhesion molecule 2 (CADM2) to inhibit the proliferation and metastasis of renal carcinoma cells via the AKT signaling pathway. Methods: A total of 42 patients with renal cancer admitted to Department of Nephrology, the First Affiliated Hospital of Suzhou University from April 2012 to November 2017 were enrolled to collect samples of surgically resected renal carcinoma tissues and paracancerous tissues. Expression of miR-19a-3p was detected in renal carcinoma tissues and 4 types of renal carcinoma cell lines such as 786-O by quantitative Real-time polymerase chain reaction (qPCR). The effects of miR-19a-3p knockdown on proliferation, invasion and epithelial mesenchymal transition (EMT) of renal carcinoma 786-O cells were evaluated by CCK-8 assay, Transwell assay and immunofluorescence, respectively. Subsequently, dual luciferase reporter assay was used to verify whether CADM2 was a target gene of miR-19a-3p. Furthermore, Wb was applied to detect the regulatory effect of miR-19a-3p onAKT signaling pathway through CADM2. Results: miR-19a-3p expression was significantly up-regulated in renal carcinoma tissues and cell lines (all P<0.01). Knockdown of miR-19a-3p could inhibit proliferation, invasion and EMT process of 786-O cells; furthermore, the results indicated that CADM2 was a direct target of miR-19a-3p and its expression was down-regulated (P <0.05 or P<0.01). Additionally, knockdown of miR-19a-3p obviously suppressed proliferation, migration and EMT process of 786-O cells via up-regulating CADM2 and blocking AKT pathway (all P<0.05 or P<0.01), thus alleviating the occurrence and development of renal carcinoma. Conclusion: The study demonstrates that miR-19a-3p has a high expression level in renal carcinoma tissues; knockdown of miR-19a-3p could significantly inhibit the proliferation, migration and EMT process of renal carcinoma tissues, and its mechanism may be associated with miR-19a-3p/CADM2/AKT axis.

Value of CT signs in predicting Fuhrman grading of clear cell renal carcinoma / 实用放射学杂志

Objective To investigate the predictive value of CT signs in the pathological Fuhrman grading of clear cell renal carcinoma (ccRCC).Methods The clinicopathological features and CT findings of 72 patients with ccRCC which confirmed by operation and pathology were analyzed retrospectively.According to the WHO Fuhrman grading,all patients were divided into low-grade(Fuhrman gradeⅠorⅡ)or high-grade (Fuhrman gradeⅢorⅣ).ChiG square test and t-test were used to compare the clinical data and CT findings between the two groups,including morphological features (site,whether the renal medulla invasion,morphology,growth pattern,border,pseudo-envelope,lobulation sign,interface,perirenal fascia and the same lateral adrenal invasion,renal sinus and perirenal fat invasion,venous invasion,lymphadenopathy, maximum diameter),density (bleeding,necrosis ratio,calcification,fat)and enhancement characteristics (the degree of enhancement, strengthening method).And the pathological Fuhrman grading was the gold standard.The ROC was used to analyze the diagnostic efficacy of CT signs on Fuhrman grading.The Delong test was used to compare the AUC of different CT signs.Results There were significant differences in tumor maximum diameter,the renal medulla invasion,and lobulation sign between the Fuhrman low-grade and high-grade group(χ2/t＝－4.31 7,9.794,7.325,P＜0.05).There were no differences in gender,age,location sign,morphology,growth pattern, border,pseudo-envelope,interface,perirenal fascia and ipsilateral adrenal invasion,renal sinus and perirenal fat invasion,necrosis ratio,degree of enhancement,strengthening method between two groups (P＞0.05). The largest diameter of the tumor,the renal medulla invasion and the lobulation sign were useful for Fuhrman diagnosis.The AUC was 0.778,0.647 and 0.644,respectively.And there were significant differences between the maximum diameter and the renal medulla invasion or lobulation sign (P＜0.05).Conclusion The maximum diameter,medulla and lobular sign can predict the Fuhrman grading of ccRCC,and the maximum diameter prediction is the most accurate.

Experience in diagnosis and treatment of non-hereditary bilateral synchronous renal carcinoma / 中华泌尿外科杂志

Objective To investigate the principles of diagnosis and treatment of non-hereditary bilateral synchronous renal cell carcinoma.Methods This retrospective study analyzed 36 cases of non-hereditary bilateral synchronous renal cell carcinoma in our hospital from January 2008 to December 2016,including 30 males and 6 females.A total of 74 renal tumors were found,in which 34 patients had bilateral single kidney tumor and 2 patients had two tumors in one kidney.The diameter of tumors ranged from 1 cm to 11 cm,with an average of (6.8 ±4.1)cm.The patients that underwent nephron-sparing surgery(NSS) got 4-12 points,with an average of (6.1 ±3.4) points in R.E.N.A.L.score and 3-13 points,with an average of (6.9 ± 3.7) points in Zhongshan score.The patients are classified into 4 groups according to operation methods.In group A,16 patients underwent bilateral NSS,which the preoperative creatinine was 63-103 μmol/L with an average of (80.9 ± 11.4) μmol/L.In group B,7 patients underwent one side of NSS before contralateral radical nephrectomy (RN),which preoperative creatinine was 59-87 μmol/L with an average of (75.7 ± 8.9)μmol/L.In group C,7 patients underwent one side of RN before contralateral NSS,preoperative creatinine was 57-107 μmol/L,with an average of (77.6 ± 19.2) μmol/L.In group D,6 patients underwent one side of NSS or RN and spare the contralateral side,2 of which shifted from NSS to RN after finding tumor invaded pelvis and upper ureter during surgery.Of all the 16 patients with bilateral NSS,4 patients underwent surgery on the side where tumor had a higher score in the first phase and then the side where tumor had a lower score in the second phase,11 underwent surgeries in an opposite order.One patient underwent bilateral NSS simultaneously.Group A,B and C are taken into final analysis.Result All the 30 patients underwent surgery successfully.The operation time of NSS ranged from 60 to 110 min with an average of (88.6 ± 23.6) min and RN ranged from 40 to 90 min with an average of (72.3 ± 21.4) min.The warm ischemia time of NSS was 12-40 mins with an average of (29.5 ± 9.7)min.The creatinine of Group A was 62-117 μmol/L with an average of (89.4 ± 15.8) μmol/L and 57-392 μmol/L with an average of (129.6 ±74.9)μmol/L one month after the first and second surgery respectively.The creatinine of Group B was 64-115 μmol/L with an average of (94 ± 14.4) μmol/L and 93-453 μmol/L with an average of (190.4 ± 117.2)μ mol/L one month after the first and second surgery respectively.The creatinine of Group C was 84-113 μmol/L with an average of (90.1 ± 12.1) μ mol/L and 88-156 μmol/L with an average of (121.4 ± 24.8)μmol/L one month after the first and second surgery respectively.One patient in Group B and C developed lung metastases.One patient in Group B occurred oliguria after the second stage of surgery,and gradually improved after one week of hemodialysis.The creatine showed no significant difference among Group A,B and C before operation,after the first and second stage (P ＞ 0.05).Postoperative hospital stay after the first stage surgery was 3-16 days with an average of (6.7 ± 3.4) d,and 3-16 d with an average of (6.2 ± 3.2)d after the second stage,respectively.Conclusions In principle,bilateral renal tumors should be treated with NSS,wbich can protect renal functions as much as possible.Among patients who can undergo bilateral NSS,the first-stage surgery should be operated on the simpler and easier side to preserve the kidney of one side as much as possible to lay a good foundation for the second stage surgery.Among patients who undergo one side of RN and the other side of NSS,NSS is recommended for the first stage,and RN for the contralateral second stage after the renal function of the operated side was restored.

Imaging features of pancreatic metastasis from clear cell renal carcinoma / 中华放射学杂志

Objective To explore the imaging diagnosis in pancreatic metastasis from clear cell renal carcinoma. Methods Twenty three patients with pancreatic metastasis from clear cell renal carcinoma confirmed by pathology were enrolled during 2007 to 2014,and their clinical sources,images and pathologic findings were reviewed. Twenty three patients underwent CT and 8 patients underwent MRI examinations. Metastatic neoplasm in pancreas were found after nephrectomy from 3 years to 17 years (average 9 years), including17 patients were diagnosed in more than 5 years after nephrectomy. Imaging features were observed.Result Metastatic neoplasms were solitary in 5 patients and multiple in 18 patients. The diameters were from 0.2 to 5.0 cm.CT plain scan demonstrated iso-density or slight hypo-density tumors with clear boundary, without calcification, and significant enhancement. MR demonstrated significantly lower signal on T1WI and high or slightly high signal on T2WI in all metastases.After contrast injection,the metastases were enhanced significantly.In 4 cases,the obstruction of the main pancreatic duct was found. Conclusions Pancreatic metastasis from clear cell renal carcinoma mostly were found in more than 5 years after nephrectomy. The images demonstrated that single or multiple tumors with clear boundary and significant enhancement in pancreas.Medical history is the key to imaging diagnosis.

Clinical value of individualized neoadjuvant chemotherapy for renal carcinoma to reduce adverse reaction under the guidance of gene detection / 中国综合临床

Objective To investigate the clinical significance of individualized neoadjuvant chemotherapy for renal carcinoma to reduce side effects under the guidance of gene detection.Methods From January 2011 to March 2014,two hundred and twelve patients with renal carcinoma treated in Cangzhou Central Hospital were enrolled in the study and randomly divided into the gene detection group (102 cases) and non-gene detection group (110 cases).The gene detection group was detected by the real time fluorescence quantitative (RT-PCR) method and the drug sensitivity test was carried out,and the patients were given neoadjuvant chemotherapy based on the results of drug sensitivity test.The patients in the non-gene detection group were treated with the national comprehensive cancer network (NCCN) experience regimen.The incidence of chemotherapy side effects was compared between the two groups.Results The 1 year survival rate of the gene test group was higher than that in the non-gene detection group (87.25％ (89/102) vs.77.27％ (85/ 110),x2 =4.67,P＜0.05),and the 3 year survival rate increased (70.58％ (72/102) vs.64.54％ (71/110),x2 =4.510,P＜ 0.05) as well,the differences were statistically significant (P ＜ 0.05).The incidence of liver injury in the gene detection group was 17.64％ (18/102),which was lower than that in the control group 30％ (33/110),the difference was statistically significant (x2 =4.42,P ＜ 0.05).In the gene detection group,the incidence of leukocyte 3～4 level inhibition was 27.5％ (28/102),which was higher than that in the non-gene detection group 21.8％ (24/110).The difference was statistically significant (x2 =4.940,P ＜ 0.05).Conclusion Genetic polymorphisms detection is a guide to the application of tumor sensitive drugs in the individualized neoadjuvant chemotherapy of renal carcinoma.It can improve the therapeutic effect,and also reduce the occurrence of liver injury caused by side effects of chemotherapy and has high clinical application value.