Automatic segmentation of kidney tumor based on cascaded multiscale convolutional neural networks / 生物医学工程学杂志

The background of abdominal computed tomography (CT) images is complex, and kidney tumors have different shapes, sizes and unclear edges. Consequently, the segmentation methods applying to the whole CT images are often unable to effectively segment the kidney tumors. To solve these problems, this paper proposes a multi-scale network based on cascaded 3D U-Net and DeepLabV3+ for kidney tumor segmentation, which uses atrous convolution feature pyramid to adaptively control receptive field. Through the fusion of high-level and low-level features, the segmented edges of large tumors and the segmentation accuracies of small tumors are effectively improved. A total of 210 CT data published by Kits2019 were used for five-fold cross validation, and 30 CT volume data collected from Suzhou Science and Technology Town Hospital were independently tested by trained segmentation models. The results of five-fold cross validation experiments showed that the Dice coefficient, sensitivity and precision were 0.796 2 ± 0.274 1, 0.824 5 ± 0.276 3, and 0.805 1 ± 0.284 0, respectively. On the external test set, the Dice coefficient, sensitivity and precision were 0.817 2 ± 0.110 0, 0.829 6 ± 0.150 7, and 0.831 8 ± 0.116 8, respectively. The results show a great improvement in the segmentation accuracy compared with other semantic segmentation methods.

Tumor de Wilms / Wilms' tumor

Resumen El tumor de Wilms es el tumor renal maligno más frecuente de la infancia, representa incluso 7% de las neoplasias a esta edad. El tratamiento que ha mostrado efecto en la supervivencia de estos pacientes es, sin duda alguna, la cirugía, con tasas de éxito de hasta 90% durante los primeros estadios de la enfermedad, esta tasa disminuye tras la progresión de los estadios. Sin embargo, la mayoría de los casos que se encuentran en etapas tempranas se presentan como hallazgos radiográficos o a la exploración física como masa abdominal palpable. Se comunica un caso clínico que muestra la importancia del diagnóstico oportuno en estos pacientes.

Abstract Wilms' tumor is the most frequent malignant kidney tumor of childhood, presented over 7% of neoplasms at this age. The treatment that has demonstrated impact on the survival of these patients is, without a doubt, the surgery, with success rates of up to 90% during the first stages of the disease, decreasing this index after the progression of the stages. However, most cases that are found in the early stages are presented as radiographic findings or physical examination as palpable abdominal mass. So, this paper reports a clinical case, which shows the importance of timely diagnosis in these patients.

Kidney tumor segmentation in ultrasound images using adaptive sub-regional evolution level set models / 生物医学工程学杂志

Kidney tumor is one of the diseases threatening human health. Ultrasound is widely applied in kidney tumor diagnosis due to its high popularization, low price and no radiation. Accurate segmentation of kidney tumor is the basis of precise treatment. Kidney tumors often grow in the middle of cortex, so that segmentation is easy disturbed by nearby organs. Besides, ultrasound images own low contrast and large speckle, leading to difficult segmentation. This paper proposed a novel kidney tumor segmentation method in ultrasound images using adaptive sub-regional evolution level set models (ASLSM). Regions of interest are firstly divided into subareas. Secondly, object function is designed by integrating inside and outside energy and gradient, in which the ratio of these two parts are adjusted adaptively. Thirdly, ASLSM adapts convolution radius and curvature according to centroid principle and similarity inside and outside zero level set. Hausdorff distance (HD) of (8.75 ± 4.21) mm, mean absolute distance (MAD) of (3.26 ± 1.69) mm, dice-coefficient (DICE) of 0.93 ± 0.03 were obtained in the experiment. Compared with traditional ultrasound segmentation method, ASLSM is more accurate in kidney tumor segmentation. ASLSM may offer convenience for doctor to locate and diagnose kidney tumor in the future.

Surgical management of renal neoplasm extending into the inferior veno cava / 中华泌尿外科杂志

Objective To summarize our experience with surgical management of renal neoplasm involving inferoir veno cava.Methods We review the data of 115 patients,including 74 male patients and 41 female patients,with renal neoplasm involving venous system between March 1993 and December 2015.The mean age was 52 years old,ranging 22 to 77 years old.The tumor was found in right side in 77 cases and left side in 38 cases.There were 15 patients (13.0％) with renal vein thrombus,38 (33.1％) with infrahepatic thrombus,29 (25.2％) with low retrohepatic thrombus,20 (17.4％) with high retrohepatic thrombus,and 13 (11.3％) with supradiaphragmatic thrombus.The mean age was 52 years old,ranging 22 to 77 years old.The tumor was found in right side in 77 cases and left side in 38 cases.All patients accepted the radical nephrectomy.Primary outcomes were overall survival (OS),and cancer special survival (CSS) in patients with renal cell carcinoma (RCC) estimated by Kaplan-Meier method.Secondary outcome included operative and oncological features,past-operative complications and hospital mortality.Cox proportional hazard model was used to univariate and multivariate analysis for risk factor impacting on OS of RCC patients.Results Complete resections of renal neoplasm with tumor thrombus were achieved in 113 patients (98.3％),2 patients died intraoperatively due to the dropping of thrombus.Postoperative complication rate was 16.8％.Hospital mortality was 2.6％.Mean follow-up interval was 48 months.OS rates at 5-,and 10-year in RCC patients were 66.5％,and 61.8％,respectively.Metastasis was an independent risk factor affecting on OS (P =0.000).However,the level of thrombus was not an risk factor affecting the prognosis.Conclusions Radical resection of renal tumor and caval thrombus is an effective treatment for prolonging survival in patients with RCC extending into venous system.Retrohepatic caval tumor thrombus below or above the main hepatic vein should be dichotomized and managed respectively with diverse techniques.Metastatic rather than the level of thrombus was a risk factor impacting on RCC patient survival.

Tumor renal sobre único riñón funcionante / Renal tumor on single functioning kidney

Se presenta caso de mujer adulta con diagnóstico de tumor renal que asentaba sobre único riñón funcionante, por lo que es sometida a resección quirúrgica parcial. Consulta luego de 6 años de evolución por litiasis renal y sin signos de insuficiencia renal.

We present the case of an adult woman with a renal tumor in a single functioning kidney, that underwent a partial surgical resection. She consulted after 6 years of evolution for kidney stones, not having any signs of kidney failure.

Composite epithelial kidney tumor comprising of adeno and neuroendocrine carcinomatous components: An unusual variant of renal cell carcinoma.

Renal cell carcinomas accounts for an approximately 2% of human malignancies with atleast ten different histological subtypes recognized by the World Health Organization (WHO) 2004 classification. Composite carcinomas with dual divergent epithelial differentiation in kidneys are extremely uncommon. We report an unusual case of a 37-year-old female who presented with symptoms related to renal tumor for the last three years. Computed tomography scan revealed a large heterogenously contrast enhancing left kidney mass comprising of two distinct histological components of low grade adenocarcinomatous and carcinoid-like low grade neuroendocrine carcinomas with presence of hilar lymph nodal metastases of both the components. The component of adenocarcinoma was immunoreactive to E-cadherin, cytokeratins 7 and 19 with negativity for cluster of differentiation 10, cytokeratin 20, CD117, and vimentin; while the neuroendocrine component was immunoreactive for vimentin, chromogranin and synaptophysin with negativity for CD10, CD117, and cytokeratins 7, 19 and 20. MIB-1 labeling index in the both the components was 2-3%. The present case is the first of its kind to be reported in the kidney and emphasizes the diversity potential of kidney tumors.

Tubulocystic carcinoma of kidney associated with papillary renal cell carcinoma.

Tubulocystic renal cell carcinoma (TCRCC) is a rare variant of renal cell carcinoma, which has distinct histology but there is some controversy about its association with papillary renal cell carcinoma (PRCC) and cell of origin in literature. We report an 18-year-old girl with the rare TCRCC of kidney associated with PRCC with metastases to the para-aortic nodes. The patient presented with hematuria and a right renal mass with enlarged regional nodes for which a radical nephrectomy with retroperitoneal lymph node dissection was done. On gross examination, a solid cystic lesion involving the lower pole and middle pole of the kidney measuring 12x9x9 cm was seen along with an additional cystic lesion in upper pole of kidney. Microscopically the main tumor showed the typical histology of a tubulocystic carcinoma with multiple cysts filled with secretions lined by variably flattened epithelium with hobnailing of cells. The mass in the upper pole was a high-grade PRCC and the nodal metastases had morphology similar to this component. To conclude, at least a small but definite subset of TCRCC is associated with PRCC, and cases associated with PRCC do seem to have a higher propensity for nodal metastasis as in the case we report.

Adenocarcinoma de células claras multiquístico del riñón: presentación de serie clínica anatomopatológica y revisión de la literatura / Multicystic clear cell carcinoma of kidney: clinical series presentation and literature review

El carcinoma multiquístico de células claras del riñón es una variedad infrecuente del carcinoma de células claras, representa un 6 por ciento de los tumores quísticos del riñón y se caracteriza por tener un excelente pronóstico de sobrevida luego de la resección quirúrgica completa. Objetivos: Analizar la frecuencia y aspectos morfológicos del adenocarcinoma multiquístico de células claras del riñón. Material y método: Análisis de 217 nefrectomías por tumor renal desde 1990 hasta el año 2005 porun protocolo preestablecido. Resultados: El carcinoma multiquístico de células claras del riñón correspondió al 5,5 por ciento del total de tumores y al 6,7 por ciento del total de carcinomas de células claras, la mayoría de los tumores se encontraban en el estadio T1a de la TNM con un grado nuclear de Furhman de 1 ó 2. La sobrevida libre de enfermedad a 16 años de seguimiento es del 100 por ciento.Conclusiones: El carcinoma multiquístico de células claras del riñón, es una entidad poco frecuente, de excelente comportamiento biológico y pronóstico, que debe ser considerado dentro de los diagnósticos diferenciales de los tumores quísticos del riñón.

The multicystic carcinoma of clear cells of the kidney is an infrequent variety of the carcinoma of clear cells, represents 6 percent of the cystic tumors of the kidney and is characterized for having an excellent survival after the surgical complete resection. Objective: To analyze the frequency and morphologic aspects of the multicystic adenocarcinoma of clear cells of the kidney. Material and method: Analysis of 217 nefrectomias for renal tumor from 1990 until the year 2005 for a pre-established protocol. Results: The multicystic carcinoma of clear cells of the kidney corresponded to 5.5 percent of the whole of tumors and to 6.7 percent of the whole of carcinomas of clear cells, the majority of the tumours were meetingin the stadium T1a of the TNM with a Furhman’s nuclear grade of 1 or 2. The free survival of disease to 16 years of follow-up is 100 percent. Conclusions: The multicystic carcinoma of clear cells of the kidney, is a slightly frequent entity, of excellent biological behavior and forecast, which it must be considered inside the differential diagnoses of the cystic tumors of the kidney.

Renal Involvement of Chronic Myelogenous Leukemia Presenting as a Kidney Tumor

Renal involvement by leukemic cells is rare in chronic myelogenous leukemia (CML). Herein, this study reports a case of CML associated with renal involvement of leukemic cells, which occurred 1 and 1/2 years after the initial diagnosis. Abdomino-pelvic computed tomography revealed a 4.4 x4.2 cm-sized, low-density solid mass having a thick wall from the mid to lower pole of the left kidney. A peripheral blood analysis revealed blastic transformation of CML. The biopsied renal parenchyme was diffusely infiltrated by sheets of immature myeloid cells, polymorphonuclear leukocytes, and occasional eosinophils. Most of the infiltrating cells were positive for anti-neutrophil elastase, but negative for lymphoid markers. Therefore, differential diagnosis of a kidney tumor during the course of CML, especially in the time of blastic transformation, should be performed.

Esophageal Cancer Metastasis to the Kidney

We report a case of 54-year-old man who presented with a right renal tumor secondary to an esophageal cancer, which was detected during a periodic follow-up computerized tomographic examination. In December 2000, the patient underwent a transhiatal esophagectomy with a cervical esophagogastrostomy and a histological examination showed an infiltrative squamous carcinoma (T3N1M0, stage III). The patient was treated with 6 cycles of adjuvant chemotherapy with 5-FU (500 mg/m2) and cisplatinum (40 mg/m2). Subsequently, a follow-up study revealed no evidence of recurrence until December 2001. In June 2002, he attended a follow-up examination and complained of general weakness and a 3 kg weight loss over a month. CT scan detected a hypodense space occupying lesion in the inferior pole of the right kidney and enlarged aortocaval lymph nodes below the right renal vein. Intravenous pyelography showed a phantom calyx in the inferior pole after a contrast infusion. The cystoscopic examination was negative. He underwent a right nephrectomy and a periaortic lymph node dissection under the impression of a metachronous transitional cell carcinoma. However, a histological examination revealed that the tumor was a metastatic squamous carcinoma with lymph nodes involvement from the previous esophageal squamous carcinoma.

The Diagnostic Value of the Color Doppler Ultrasonic Detection in Distinguishing Malignant and Benign Kidney Tumors / 中国医师杂志

0 55). The Vmax and Vmin of the patients were singnificantly higher than those of healthy people. The RI of healthy subjects was higher than that of the patients. The Vmax and Vmin of the kidney with tumor was singnificantly higher than that of the other normal kidney side. Conclusion The hemodynamic features of the kidney tumors and kidney artery were valuable to the differential diagnosis of the malignant and benign kidney tumors.

Solitary metastasis to the kidney from follicular carcinoma of the thyroid / 대한비뇨기과학회지

We report a case of metastatic renal tumor from the follicular carcinoma of the thyroid. Renal mass was found 7 years after resection of the follicular adenoma of the thyroid. We performed radical nephrectomy and the tumor was proved to be the follicular carcinoma of the thyroid. To search for another distant metastatic foci of thyroid carcinoma, whole body iodine scintigram should be done after the ablation of all thyroid tissue to maximize thyroid stimulating hormone(TSH) stimulation.

Clear Cell Sarcoma of the Kidney: Report of two cases

Clear cell sarcoma is a rare malignant rumor of the kidney which occurs in children and is differentiated from Wilms' tumor by its different clinicopathologic features and natural history. Previous studies indicate that this tumor may be of mesenchymal cell origin; however, this has not been proven conclusively. Further accumulation and study need to be conducted in order to clarify the histogenesis of this tumor. We report two cases of clear cell sarcoma of the kidney which occurred in a 2 and a half-year old and a 2-year old boy. This report places special emphasis on the clinicopathologic characteristics of these two cases including electron microscopic and immunohistochemical findings. Attempts were also made to differentiate the clinicopathologic aspects of clear cell sarcoma from Wilms' tumor and speculate on the histogenesis of this rumor.