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Objective To investigate the clinicopathological features and prognosis of chromophobe renal cell carcinoma(ChRCC). Methods The clinical and pathological data of 126 patients with ChRCC treated in Cancer Hospital of Chinese Academy of Medical Sciences were retrospectively analyzed. Results The patients included 64 males and 62 females,with the age of 22-80 years(median of 52 years).The tumor was located on the right side in 70 cases and on the left side in 56 cases.Ultrasound,CT or magnetic resonance imaging(MRI)were performed.Of the 110 cases receiving ultrasound examination,63,23,13,10,and 1 cases showed hypoecho,hyperecho,isoecho,uneven or mixed echo,and dark hypoecho,respectively.Color Doppler flow imaging showed no blood flow signal in 42 cases and low blood flow signal in 60 cases out of 68 cases with blood flow signal.Among the 54 cases receiving CT,50 cases showed equal density or low density and 4 cases showed high density with clear boundary.The enhanced scanning showed mild to moderate uniform or non-uniform reinforcement,mostly below the renal parenchyma,and still showed reinforcement in the delayed period.Among the 97 cases receiving MRI,96 cases showed hypo-or isointense signals and 1 case showed hyperintense signal in T1 weighted images;71 cases showed hyper-or isointense signals and 26 cases showed hypo-or isointense signals in T2 weighted images;93 cases showed hyperintense signals with obvious limited diffusion and 4 cases showed unobvious limited diffusion in diffusion weighted images.Mild to moderate uniform or non-uniform reinforcement was observed in most of the enhanced scans.All the 126 patients underwent surgical treatment,including 64 cases of nephron sparing surgery and 62 cases of radical surgery.Pathological examinations confirmed ChRCC for all the patients,including 91 cases of T1N0M0,15 cases of T2N0M0,and 20 cases of T3N0M0.The immunohistochemical assay demonstrated the positive expression rate of 48.2%(54/112)for CD10,92.3%(96/104)for CD117,8.0%(9/112)for vimentin,85.6%(95/111)for CK7,and 97.6%(83/85)for colloidal iron.Conclusions ChRCC is less common,with low level of malignancy and good prognosis.Since the clinical symptoms of ChRCC are not typical,MRI is an important means of imaging differential diagnosis,and the disease can be confirmed depending on pathological diagnosis.Surgery is the preferred treatment method,and currently there is no standard treatment regimen for metastatic patients.
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Carcinoma, Renal Cell/diagnostic imaging , Diagnosis, Differential , Immunohistochemistry , Kidney Neoplasms/surgery , Retrospective StudiesABSTRACT
Objective To analyze the clinicopathological features and prognostic factors of common subtypes of non-transparent renal cell carcinoma.Methods Retrospective analysis of 115 patients with pathologically confirmed non-transparent renal cell carcinoma from January 2003 to December 2017,including 67 males and 48 females,with a male to female ratio of 1.4∶ 1.The average age is (51.2 ± 13.4)years old.71 cases were asymptomatic renal cancer,44 cases had clinical symptoms,including 10 cases of gross hematuria,28 cases of low back pain,4 cases of hematuria with low back pain,and 2 cases of abdominal mass.There were 49 open surgery and 66 laparoscopic surgery.58 patients underwent radical nephrectomy and 57 underwent partial nephrectomy.Of the 115 patients,17 (14.9％) had abnormal hemoglobin (Hb),22 (19.1％) had abnormal platelet (PLT) count,18 (15.7％) had abnormal alkaline phosphatase,and abnormal lactate dehydrogenase 16 cases (13.9％).The Kaplan-Meier survival analysis method was used to calculate the survival rate of patients,and the Cox proportional regression risk model was used to analyze the prognostic factors.Results The postoperative pathological stage was 57 cases in T1a stage,38 cases in T1b stage,12 cases in T2a stage,8 cases in T2b stage,2 cases of regional lymph node positive,and 113 cases negative;no distant metastasis.Pathological types:42 cases of renal chromophobe cell carcinoma,37 cases of papillary renal cell carcinoma type Ⅰ,36 cases of type Ⅱ.The average follow-up time was 38.6 months,and the rate of loss of follow-up was 3.5％ (4/115).The 1,3,and 5 year overall survival rates of 115 patients with common subtypes of non-transparent renal cell carcinoma were 99.1％,95.8％,and 81.1％,respectively.Multivariate Cox regression analysis found that the pathological type (OR =4.625,P =0.014),four indicators ≥ 3 abnormalities (OR =30.853,P =0.024),lymph node metastasis (OR =35.663,P =0.006) were the group.An independent factor in the survival time of patients with common subtypes of non-transparent renal cell carcinoma.Conclusions Compared with papillary renal cell carcinoma type Ⅰ and renal chromophobe cell carcinoma,papillary renal cell carcinoma type Ⅱ has a higher degree of malignancy and a poor prognosis.The pathological types of the common subtypes of nontransparent renal cell carcinoma,four indicators (Hb,PLT count,alkaline phosphatase,and lactate dehydrogenase) ≥3 abnormalities and lymph node metastasis are independent prognostic factors for overall survival.
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Objective@#To explore the clinical features of chromophobe renal cell carcinoma(chRCC) in order to improve its diagnosis and treatment.@*Methods@#Clinical data of 8 patients with chRCC treated from July 2012 to February 2019 in the Second People′s Hospital of Lianyungang were retrospectively analyzed. There were 3 males and 5 females. Their age ranged from 34 to 71 years, with a mean age of (52.1 ± 11.2) years. All tumors were located unilaterally, with 3 cases in left kidney and 5 cases in right kidney. Five patients were asymptomatic and back pain occurred in other 3 patients. The maximum diameter of the tumor was 2.0 to 8.5 cm and the mean value was (5.6 ± 2.2) cm. Ultrasonography and CT scan were performed on all patients. Ultrasonography was mainly characterized by low echo renal mass with intact capsule and low blood flow signals. The CT appearances were typically well circumscribed and homogeneous solid mass, with mild enhanced. One case had calcification, 1 case had necrosis and cystic degeneration, and 1 case had central scar 1 case had significant enhancement. All patients underwent surgery. Five cases underwent retroperitoneal laparoscopic radical nephrectomy, 2 cases underwent open radical nephrectomy and 1 case underwent retroperitoneal laparoscopic partial nephrectomy.@*Results@#Postoperative pathologic findings confirmed the diagnosis of chRCC. The cross section of the tumors was grossly homogeneous, gray and yellow or gray and red. Immunohistochemical assay was positive of CK7 and CD117. The pathologic TNM stage of chRCC was as follows: pT1aN0M0 in 2 cases, pT1bN0M0 in 2 cases, pT1bN0M1(with bone metastasis) in 1 case and pT2N0M0 in 3 cases. All cases were followed-up. The follow-up time was 3 to 79 months, and the mean time was (26.8 ± 24.1) months. One case with bone metastasis was treated with apatinib and had pulmonary metastasis 9 months after operation and died 19 months after operation. One case had pulmonary metastasis 24 months after operation and survived up to March 2019 refusing to accept targeted therapy. Other 6 patients were followed-up without local recurrence and metastasis.@*Conclusions@#chRCC is rare and its diagnosis mainly depends on pathology without obvious clinical and preoperative imaging presentation. Nephrectomy is the common treatment for chRCC and should follow the treatment principles of renal cell carcinoma, with a favorable prognosis owing to a relatively indolent clinical behavior.
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Objective To explore the clinical features of chromophobe renal cell carcinoma (chRCC) in order to improve its diagnosis and treatment. Methods Clinical data of 8 patients with chRCC treated from July 2012 to February 2019 in the Second People′s Hospital of Lianyungang were retrospectively analyzed. There were 3 males and 5 females. Their age ranged from 34 to 71 years, with a mean age of (52.1 ± 11.2) years. All tumors were located unilaterally, with 3 cases in left kidney and 5 cases in right kidney. Five patients were asymptomatic and back pain occurred in other 3 patients. The maximum diameter of the tumor was 2.0 to 8.5 cm and the mean value was (5.6 ± 2.2) cm. Ultrasonography and CT scan were performed on all patients. Ultrasonography was mainly characterized by low echo renal mass with intact capsule and low blood flow signals. The CT appearances were typically well circumscribed and homogeneous solid mass, with mild enhanced. One case had calcification, 1 case had necrosis and cystic degeneration, and 1 case had central scar 1 case had significant enhancement. All patients underwent surgery. Five cases underwent retroperitoneal laparoscopic radical nephrectomy, 2 cases underwent open radical nephrectomy and 1 case underwent retroperitoneal laparoscopic partial nephrectomy. Results Postoperative pathologic findings confirmed the diagnosis of chRCC. The cross section of the tumors was grossly homogeneous, gray and yellow or gray and red. Immunohistochemical assay was positive of CK7 and CD117. The pathologic TNM stage of chRCC was as follows: pT1aN0M0 in 2 cases, pT1bN0M0 in 2 cases, pT1bN0M1(with bone metastasis) in 1 case and pT2N0M0 in 3 cases. All cases were followed-up. The follow-up time was 3 to 79 months, and the mean time was (26.8 ± 24.1) months. One case with bone metastasis was treated with apatinib and had pulmonary metastasis 9 months after operation and died 19 months after operation. One case had pulmonary metastasis 24 months after operation and survived up to March 2019 refusing to accept targeted therapy. Other 6 patients were followed-up without local recurrence and metastasis. Conclusions chRCC is rare and its diagnosis mainly depends on pathology without obvious clinical and preoperative imaging presentation. Nephrectomy is the common treatment for chRCC and should follow the treatment principles of renal cell carcinoma, with a favorable prognosis owing to a relatively indolent clinical behavior.
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Objective To explore the MSCT manifestations of chromophobe renal cell carcinoma (CRCC)and to improve its accu-racy of preoperative diagnose.Methods Clinical and MSCT finding were retrospectively reviewed in 14 patients with CRCC,which were confirmed by surgical pathology or biopsy.Results (1)On plain scanning,most of the CRCC lesions showed round or oval (86.7%,13/1 5)and isodensity (73.3%,1 1/1 5)mass;and the border of 66.7% (10/1 5)lesions were clear.53.3% (8/1 5)of the lesions were heterogeneous with lamellar cystic low density (8 lesions)and coarse ringed and/or foliated calcifications (4 lesions). (2)On contrast-enhanced sacanning,the CRCC lesions showed mild to moderate (86.7%,13/1 5)and heterogeneous (60%,9/1 5) enhancement,and 73.3% (1 1/1 5)of the lesions were persistent enhanced.(3)According to the pathology,80% (12/1 5)of the le-sions was the typical type,20% (3/1 5)was the eosinophilic type,and 0 was the hybrid type.Conclusion CRCC demonstrates cer-tain characteristics signs at MSCT examination.Lesion mostly shows well-circumscribed round or oval mass in the renal parenchy-ma,mild to moderate,heterogeneous and continuous enhancement on the contrast scanning.The diagnosis of CRCC should be con-sidered especially when the lesion has cystic change and coarse ringed and/or foliated calcifications.
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Objective To analyze the CT and MRI performances of chromophobe cell renal carcinoma,to improve the understanding of the disease.Methods The CT and MRI performances of 16 patients with chromophobe cell renal carcinoma confirmed by post-operation pathology were analyzed retrospectively.Results Among 13 cases examined by CT,8 cases had homogeneous lesion including the homogeneous lesions density of 5 cases higher than that of normal renal parenchyma,and the other 5 cases had inhomogeneous density.After enhanced scan,the uneven essence ingredients were markedly enhanced in homogeneous density and inhomogeneous density cases,and the enhancement degree in arterial phase was lower than that of the renal cortex and higher than that of the renal medulla.Among 8 cases checked by MRI,2 cases had signal homogeneity with long T1 weighted imaging and long T2 weighted imaging signal,of which 5 cases appeared high signal in T1 weighted imaging flat lesions.The enhancement mode were similar with CT.In 5 patients examined by CT and MRI at the same time,their density,signal and the pattern strengthening were similar.Conclusions Chromophobe cell renal carcinoma is a rare malignant renal cell carcinoma,and CT and MRI can reflect the composition and hemodynamic changes.When homogeneity and high density or T1WI appeared high signal,disease was large and necrosis was less,and strengthening belt was appeared in lesions,it is value on diagnosis of chromophobe cell renal carcinoma.
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Objectiye To improve the diagnosis and treatment of chromophobe renal cell carcinoma(CRCC). Methods The clinical dota of 25 patients of CRCC were reviewed.Thirteen were xmales and 12 were females and thirteen on the left and twelve on the right.The mean age was 51 years.Sixteen(64%)patients were asymptomatic.Gross hematuria,low back pain and discomfort and fever occurred in the other 9 patients.Laboratory investigations showed 1 patient had raised alanine aminotransferase and 1 had high erythrocyte sedimentation rate. Results B-ultrasound was mainly characterized by low echo renal mass with intact capsule and low blood flow signals.CT and MR of CRCC were typically well circumscribed,homogeneous(unenhanced CT was 70%,MR was 73%)with no necrosis and hemorrhage,homogenous enhancement(CT was 65%,MR was 67%)and mild enhanced(CT was 65%,MR was 67 %)renal mass.Twenty-two patients with tumors＞4.0 cm had radical nephrectomy and three with tumors≤4.0 cm had partial nephrectomy.The average diameter of tumors was 7.6 cm.The cross-sections of the tumors were grossly homogeneous,pale or dark brown solid.Light microscopy showed that the tumors were composed of trabeculae or sheets with voluminous cells in pale or eosinophilic cytoplasm.Immunohistochemical assay was positive of CK8 and negative of Vimentin.The pathologic TNM stages were 8 with T1a,9 with T1b,6 with T2 and 2 with T3a.Twenty-three patients were followed up.After mean follow-up of 28 months,22 cases were tumor free.One patient had pulmonary metastasis 58 months after operation and had no reaction to interferon-α and chemotherapy and died. Conclusions The majority of CRCC patients are asymptomatic and usually with low-stages.There are some features in CT and MR appearance of CRCC such as well circumscribed and homogenous.Surgical treatment should follow the treatment principles of renal cell carcinoma and carries an excellent prognosis for most localized tumors but there has been no effective measures to treat metastasis disease.The interval between operation and metastasis is relatively long and the time of follow-up should be prolonged in CRCC.
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Objective To improve the capability of diagnosing and treating renal chromophobe cell carcinoma (RCCC) and the recognition of this subtype of renal cell carcinoma (RCC). Methods The clinical data of 15 cases of RCCC (10 men and 5 women) were analyzed.Their age ranged from 47 to 74 years,with a mean of 57 years. Radical nephrectomy was performed in all these cases. Results Postoperative pathological findings confirmed the diagnosis of RCCC.The pathologic TNM stage of RCCC was as follows:pT 1N 0M 0 in 6 cases,pT 2N 0M 0 in 5,pT 3bN 0M 0 in 2,pT 1N 2M 0 in 1 and pT 2N 2M 0 in 1.The pathologic grade of RCCC was G 2 in 10 cases and G 3 in 5.Eleven cases were followed up.During the follow-up of 2 to 31 months (mean, 19 months),1 died of heart attack,1 had local recurrence and 9 were surviving tumor free. Conclusions RCCC is a morphologically distinctive uncommon subtype of RCC.Radical nephrectomy is the first choice for the treatment of RCCC.Compared with other types of RCC at the same stage and of the same grade,RCCC has a better prognosis.