Value of miR-15b-5p combined with ultrasound imaging in early diagnosis of renal cell carcinoma

Renal cancer is one of the most common malignancies, and its incidence is increasing year by year, second only to prostate and bladder cancers. Therefore, early screening is of great significance to prevent and improve the prognosis of patients with renal cancer. Therefore, this study intends to observe the early diagnostic value of miR-15b-5p combined with Colour ultrasound imaging in renal cell carcinoma. In this study, the clinical samples of 76 patients with renal cell carcinoma diagnosed by pathology in our hospital from April 2020 to June 2022 were retrospectively collected as the research objects. Another 100 healthy people who underwent general physical examination in our hospital during the same period were selected to detect the expression level of miR-15b-5 in serum by RT-PCR together with the 76 experimental samples. Colour ultrasound imaging was used to detect the blood flow distribution around and inside the kidney of the patients with renal cancer, and the parameters were measured and compared with the gold standard for statistical analysis. The expression level of miR-15b-5 in renal cell carcinoma group was significantly higher than that in control group. Most of them showed renal hamartoma (40.79%). Benign renal tumors were mainly characterized by type I and II blood flow, while malignant renal tumors were characterized by type III and IV blood flow. Compared with the pathological gold standard, the diagnostic accuracy of ultrasound imaging was founded to be about 81.25%. Further ROC analysis showed that ultrasound imaging combined with miR-15b-5 detection could effectively improve the early screening value of renal cell carcinoma. We observed that miR-15b-5 has a specific expression level in the serum of patients with renal cell carcinoma, and its combination with ultrasound imaging can significantly improve the early detection of renal cell carcinoma. This approach is envisaged to be highly useful for, early diagnosis, intervention and management of patients with renal cell carcinoma

A rare case of multilocular cystic renal neoplasm of low malignant potential diagnosed on intra-operative fine needle aspiration cytology

Multi-locular Cystic Renal Cell Carcinoma (MCRCC) is now considered as Multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) in World health organisation classification (WHO) 2016. It is usually seen in elderly people where it can mimic most of the time as benign cystic lesion. Authors are reporting a case of MCRNLMP in a 70 year male diagnosed intraoperative with the help of Fine Needle Aspiration Cytology (FNAC). Radiological and other clinical findings are in favour of cystic renal lesion. And it is very important to differentiate it from conventional renal cell carcinoma which requires radical nephrectomy. So, radiological finding and FNAC is instrumental in diagnosing this rare case which require different mode of surgical management.

Features of CT imaging and clinicopathological characteristics in multilocular cystic re-nal neoplasm of low malignant potential and cystic nephroma / 中国肿瘤临床

Objective: To explore the clinicopathological features and the diagnostic value of the CT scan in multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) and cystic nephroma (CN). Methods: The clinical data of 12 patients with CN and 20 patients with MCRNLMP, confirmed by pathology at the Renmin Hospital of Wuhan University and Jingzhou Central Hospital from Janu-ary 2000 to March 2019, were retrospectively analyzed. The receiver operating characteristic (ROC) curves were used to analyze the feature of contrast-enhanced CT images of the tumors, and the immunophenotypes of the tumors were observed by immunohisto-chemistry. Results: There were statistically significant differences between MCRNLMP and CN in terms of thickness of the cyst wall and partition, number of soft-tissue enhancing masses, peak intensity of enhancement, and the Bosniak classification (P<0.05). Based on ROC curve analyses, when the thickness of the capsule wall and partition was greater than 2.25mm, the number of enhanced high-density lesions was greater than 1, and the peaking intensity of fortification was above the moderate level in the diagnosis of CRNLMP. The areas under the curve of the three indexes were 0.879, 0.800 and 0.838, which can be used as the best diagnostic criterion for MCRNLMP. Immunophenotyping revealed that MCRNLMP characteristically expressed the renal cell carcinoma (RCC) marker, and CN characteristically expressed the estrogen receptor(ER) and progesterone receptor(PR). Conclusions: The cyst wall and septal thickness, number of soft-tissue enhancing masses, and peak intensity of enhancement show a higher diagnostic value in differentiating MCRN-LMP and CN. The precise diagnosis relies on the pathological and immunohistochemical examination.

The efficiency of zero ischemia index in predicting complexity and outcomes of off-clamp nephron-sparing surgery / 中华泌尿外科杂志

Objective To evaluate the efficacy of zero ischemia index (ZⅡ) in predicting the complexity and perioperative outcomes of off-clamp nephron-sparing surgery (NSS).Methods The patients between June 2016 and June 2017 in our institution who underwent off-clamp NSS were prospectively evaluated.ZⅡ was defined as the product of the tumor diameter and depth within renal parenchyma.The ZⅡ ＞6 defined as higher risk while ZⅡ ≤ 6 defined as low risk.The operating time,estimated blood loss,hospital stay,drainage,and complication rate were analyzed.Results There were 35 males and 10 females with average age of 42 y(range 23-76y).Mean tumor size was 2.4 cm (range 0.8-4.2 cm).Mini-flank approach open NSS was performed in 33 cases and laparoscopic NSS was performed in 12 cases.Off-clamp NSS was successfully performed in 44 patients except for renal artery occlusion in 1 case.Mean operative time was (95.0± 17.5) min (range 50-150 min);The average estimated blood loss was (152.4 ± 134.2) ml (range 20-600 ml);Mean postoperative drainage was (97.3 ± 59.7) ml (range 50-300 md);Mean postoperative hospital stay was (6.1 ± 1.3) d (range 5-8 d).Not severe post operative complication was observed.There were 37 patients in low risk group and 8 patients in high risk group.Operating time was significantly longer in high risk group [(118.8 ± 14.6 min) vs.(89.9±13.4) min,P＜0.01].EBL [(375.0±158.1) ml vs.(104.3 ±61.4) ml,P＜0.01] and drainage [(161.2±91.3)ml vs.(83.5 ±40.4)ml,P ＜ 0.01] were also significantly higher in high risk group.But there was no significant difference in hospital stay between two groups.The postoperative pathology indicated that 35 cases of clear cell carcinomas,2 cases of chromophobe renal cell carcinomas,one case of papillary carcinoma and seven cases of angiomyolipomas.Conclusions The ZⅡ is a novel and effective measurable criterion which can help predict the risk of perioperative outcomes of off-clamp NSS.ZⅡ =6 is established as a preliminary threshold for patient selection of off-clamp NSS.

Detection of Na+/H+exchanger regulatory factor 3 protein expression in renal carcinoma and its correlation with malignant biological behavior / 中国医师进修杂志

Objective To study the detection of Na+/H+exchanger regulatory factor 3(NHERF3) protein expression in renal carcinoma and its correlation with malignant biological behavior. Methods Renal clear cell carcinoma and their adjacent tissues of forty- eight patients were collected. Immunohistochemical method was used to detect the positive expression of NHERF3 protein,and specific expression was detected by Western-blot.Patients were further divided into high NHERF3 group and low NHERF3 group according to median expression of NHERF3 protein,and each group had 24 cases.The expressions of proliferation,invasion and autophagy genes in tumor tissues were detected by fluorescent quantitative PCR.Results The positive rate of NHERF3 protein and the expression of NHERF3 protein in renal carcinoma tissue was significantly lower than that in paracancerous tissue(P<0.05).Expressions of proliferation genes such as k-Ras,c-Myc,TRPC1 mRNA in low NHERF3 group were higher than those in high NHERF3 group:141.74 ± 18.95 vs. 100.00 ± 0.00, 135.88 ± 16.32 vs. 100.00 ± 0.00, 137.21 ± 16.98 vs.100.00 ± 0.00;MIIP,FOXO1 mRNA levels were lower than those in high NHERF3 group: 43.19 ± 5.88 vs. 100.00 ± 0.00, 38.76 ± 4.51 vs. 100.00 ± 0.00; expressions of invasion genes such as CD74, Fascin, MACC1, TRPM8 mRNA were significantly higher than those in high NHERF3 group:152.18 ± 17.64 vs. 100.00 ± 0.00, 146.29 ± 17.63 vs. 100.00 ± 0.00, 139.76 ± 15.82 vs. 100.00 ± 0.00,150.47 ± 17.95 vs.100.00 ± 0.00;expressions of autophagy genes such as Beclin-1,LC3 mRNA were significantly lower than those in high NHERF3 group: 63.21 ± 7.09 vs. 100.00 ± 0.00, 56.28 ± 7.15 vs. 100.00 ± 0.00; EZH2 mRNA level was higher than that in high NHERF3 group:159.47 ± 17.82 vs.100.00 ± 0.00,and there were significant differences(P<0.05).Conclusions The positive rate of NHERF3 protein expression and the amount of protein expression in renal carcinoma tissue is increased, and the specific expression is closely related to tumor proliferation, invasion and activity of autophagy.

Renal rhabdoid synovial sarcoma: report of a case with literature review / 临床与实验病理学杂志

Purpose To report a rare case of renal rhabdoid synovial sarcoma and review the literature,in order to improve the realization for this disease and reduce misdiagnosis.Method The clinicopathological data of 1 case rhabdoid renal synovial sarcoma were retrospectively analyzed.The tumors were examined by immunohistochemical of EnVision two-step staining and FISH,the related literatures were reviewed.Result A 31-year-old male patient accepted the right kidney radical operation in November 2014 after imaging examination of right kidney tumor.Microscopically,the tumor cells showed short spindle cells with rich cytoplasm and eosinophilic bodies in the cytoplasm.The pathological diagnosis is the renal rhabdoid tumor for this time.The patient was found a tumor between the liver and the diaphragm by imaging examination in October 2015.The second operation was carried out successfully.Microscopically,the tumor cells were spindle with little cytoplasm and without eosinophilic bodies in the cytoplasm.It was a typical synovial sarcoma in morphology for this time.Immunohistochemical staining showed positive for vimentin,EMA,CD56,and TLE1,SS18SSX fusion gene was disclosed in the primary and recurrent tumor cells,it was therefore corrected as rhabdoid synovial sarcoma for the primary tumor.Conclusion Renal rhabdoid synovial sarcoma is rare.Renal primary rhabdoid synovial sarcoma is easily misdiagnosed as renal rhabdoid tumor.The renal rhabdoid synovial sarcoma has broadened the differential diagnosis of renal rhabdoid tumors spectrum.Even for a tumor with typical rhabdoid morphology,molecular biology method for differential diagnosis is needed.SS18-SSX fusion gene is the basis for diagnosis of synovial sarcoma.

The efficiency of using dual laser system zero in off clamp nephron-sparing surgery / 中华泌尿外科杂志

Objective To evaluate the efficacy of using dual laser system in off clamp nephronsparing surgery.Methods We used dual laser system in the patients who underwent off-clamp NSS between Jan 2016 and Apr 2016 in our institution.There were 16 males and 8 females with average age of 49 years.Mean tumor size was 1.9 cm (range 0.8-3.2 cm).The mean R.E.N.A.L.score was 3.8 (range 3-6).The mean Zhongshan score was 3.5(range 3-5).The mean ZⅡ(zero ischemia index)was 1.6(range 1-4).The Evolve Dual (980 nm/1 470 nm) laser system set at 60 W in continuous mode was used.Results Offclamp NSS was successfully performed in 22 patients except for renal artery occlusion in 2 case.Mean operative time was 74 min(range 50-100 min);The average estimated blood loss was 52.9 ml(range 10-200 ml);Mean postoperative drainage was 65.4 ml(range 20-150ml);Mean postoperative hospital stay was 5.2 days (range:4-7days).No severe post-operative complication was found.The mean pre-and postoperative serum creatinine levels were 76.2 μmol/L(range:48-112μ mol/L) and 81.5μ mol/L(range:54-122 μ mol/L) with no significant difference(P ＞0.05).The postoperative pathology indicated that 20 cases of clear cell carcinomas,3 cases of chromophobe renal cell carcinomas,one case of papillary carcinoma.Conclusions Dual laser system can be used in off clamp nephron-sparing surgery safely and effectively.

A Rare Highly Aggressive Tumor of the Kidney: The Pure Epithelioid Angiomyolipoma.

Aims: The authors presents a case of pure Renal epithelioid angiomyolipoma (EAML) and discuss the clinicopathological characteristics and the diagnosis problems of this entity. Case Presentation: A 51 year-old man presented with a persistant pain in the left lumbar region. Imaging revealed a left kidney tumor that was hemorrhagic and necrotic on gross examination. At histology, proliferation of 99% of atypical epithelioid cells, staining for HMB-45 and Melan A was observed. Our patient had lung and right adrenal metastasis six months after surgery and succumbed one year later. Conclusion: In summary, the pure form of EAML is extremely rare. When diagnosed, the risk of tumor progression is high, especially if other histological predictive parameters of progression are observed. In that case, active treatment should be undergone and patients should be closely monitored.

Formas actuales de presentación del tumor renal

El objetivo del trabajo es describir las características epidemiológicas de la población con tumores renales en nuestra institución, la estrategia de diagnóstico y tratamiento y los hallazgos anatomo-patológicos. Se realizó una recolección prospectiva de datos epidemiológicos, de diagnóstico y tratamiento, así como también de los resultados patológicos en un período de 4.5 años, desde enero de 2010 a junio de 2014. En ese lapso 819 casos (796 pacientes) fueron tratados por masa renal. La edad media: 60.7 años (DE 13.1), 553 (69.5%) fueron hombres. El 29% (230) presentó obesidad (IMC ≥ 30). El diagnóstico fue incidental en 653 casos (79.7%). Un 48.8% (388 pacientes) presentó uno o más factores de riesgo, siendo el tabaquismo el más frecuente (34%). En 238 pacientes (29.9%) se presentó más de una comorbilidad. El 18% presentó creatinina preoperatoria ≥ a 1.3 mg/dl. El 45% de las lesiones fueron ≤ a 4 cm (cT1a). El 10.8% (86) de los pacientes presentaron metástasis al diagnóstico. El 93.5% de las lesiones fueron resecadas y el 6.5% fueron vigiladas activamente (no resecadas). Se utilizó la nefrectomía radical en el 51.5% y cirugía renal conservadora en el 48.5% de los pacientes operados. El abordaje laparoscópico fue utilizado en el 56.2%. El tumor renal se caracteriza en la actualidad por un diagnóstico incidental en estadios patológicos iniciales. La cirugía renal conservadora es la primera opción en casi la mitad de los pacientes. La vigilancia activa ha sido utilizada en un porcentaje mayor a lo comunicado en la literatura.

The aim of this paper is to describe the epidemiological characteristics, clinical management and pathologic patterns in a population with renal tumors in our institution. Prospective data collection was performed over a period of 4.5 years, from January 2010 to June 2014. A total of 819 cases (796 patients) were treated for renal mass during this period. The mean age was 60.7 years (SD 13.1). There were 553 (69.5%) males (male to female ratio: 2.2: 1). Twenty nine per cent (230 patients) were obese (BMI ≥ 30). The diagnosis was incidental in 653 cases (79.7%), 48.8% presented one or more risk factors, being smoking the most frequent (34%). In 238 patients (29.9%) there was more than one comorbidity; 18% had preoperative creatinine ≥ 1.3 mg/dl. Lesions were ≤ 4 cm (cT1a) in 45% of the patients, and 10.8% (86) had metastases at diagnosis. The lesions were resected in 93.5% and actively monitored in 6.5% (not resected). In surgery treated patients, radical nephrectomy was performed in 51.5% of cases, and nephron sparing surgery in 48.5% of them. The laparoscopic approach was used in 56.2%. The pattern of presentation of renal masses is characterized by incidental diagnosis in early disease stages. Nephron sparing surgery is the first choice in nearly half of patients. Active surveillance has been used in a greater percentage than previously reported.

Renal myxoma: a case report / Mixoma renal: relato de caso

Myxomas are rare tumors that can appear in many anatomical locations. There are only 14 cases of renal involvement documented in the literature. This article reports a case of renal myxoma in an elderly woman with recurrent cystitis. After five years of follow-up, the computed tomography (CT) revealed a large solid tumor mass in the left kidney. Tumor resection was performed preserving the affected kidney with histopathological diagnosis of renal myxoma. The objective of this study is to report a rare case of renal myxoma, emphasizing the importance of the differential diagnosis from other benign and malignant mesenchymal tumors.

Mixomas são tumores raros que podem ser encontrados em muitas localizações anatômicas. Na literatura, há apenas 14 casos de acometimento renal. Neste artigo, é relatado um caso de mixoma renal em mulher idosa com cistites de repetição. Após cinco anos de acompanhamento, a tomografia computadorizada (TC) evidenciou grande massa tumoral sólida em rim esquerdo. Realizou-se exérese do tumor preservando o restante do rim afetado com diagnóstico histopatológico de mixoma renal. O objetivo deste trabalho é relatar um caso raro de mixoma renal, enfatizando a importância do diagnóstico diferencial de outros tumores mesenquimais benignos e malignos.

The diagnosis and treatment of two cases of renal neoplasm with calcification / 基础医学与临床

Objective To investigate the diagnosis and treatment of renal neoplasm with calcification .Methods Retrospectively summarized the clinical data of the 2 patients with calcific renal neoplasm admitted in our hospital from the May to July in 2014, then analyzed and discussed the clinical manifestations , diagnosis and treatment com-bined with the literatures .Results The two cases were both suspected of renal malignant tumor preoperatively .The case 1 was a 32-year-old male , laparoscopic partial resection of the left kidney was performed , and the postoperative pathology was clear cell carcinoma (Fuhrman levelⅠ).The case 2 was a 18-year-old male, partial resection of the right kidney was performed because of the tumor size , and the postoperative pathology was adult nephroblastoma . Conclusions The calcific renal neoplasm is a rare disease , the property determination depends on postoperative pa-thology, and as to the choice of surgical method , the patients'age, the tumor size and the tumor location should be taken into consideration , and intraoperative frozen should be performed when necessary .

Papillary renal cell carcinoma:clinicopathologic analysis of 32 cases with literature review / 临床与实验病理学杂志

Purpose To analyze the clinicopathologic and immunohistochemical features, differential diagnosis and prognosis of papil-lary renal cell carcinoma (PRCC). Methods Thirty-two cases of PRCC diagnosed were reviewed. A retrospective study was per-formed including reviewing the clinical documents, pathological sections and immunohistochemical stainning and follow-up was made of 32 cases of PRCC. Twenty-one patients were treated with radical nephrectomy, eleven patients were treated with partial nephrectomy. Results Among 770 cases of renal epithelial tumors 32(4. 2%) cases of PRCC were detected. Histologically, the PRCC were charac-terized by varying proportions of papillary and tubular architecture covered by single or multiple layer of tumor cells with scanty or volu-minous basophilic or eosinophilic cytoplasm. Foam cells and psammoma bodies were seen in some papillary cores and stroma, and the cytoplasm of some tumor cells contained hemosiderin. Of these 32 patients, 18 and 14 were diagnosed type-Ⅰand type-IIPRCC, re-spectively. Type-I, with small cuboid cell and pale cytoplasm, 16 of them were low in Fuhrman grading, Type-II, with large colunmar cells, rich in eosinophilic cytoplasm, 12 of them were high in Fuhrman grading. Immunohistochemically, the PRCC showed positive immunostaining for vimentin, EMA, CK(AE1/AE3), CK7, CD10 and AMACR. All the tumors studied were negative for CK (34βE12) and TFE-3. Follow-up data were available for 31 cases, 4 patients died of cancer specific causes, 1 with type-Ⅰand 3 with type-II tumors after surgery. The other 27 patients were alive without recurrence or metastasis. High Fuhrman grading, intravascular tumor emboli, lymph node metastasis and high clinical stage were prognostic indicators in PRCC. Conclusions PRCC with unique pathological features is not a common subtype of renal cell carcinoma in China. The presence of higher nuclear grade, sarcomatoid ele-ments or clear cell carcinoma structure may indicate an aggressive biologic behavior and poor prognosis. Close attention to the cytologic and growth pattern characteristics will allow us to arrive at the proper diagnosis in most cases, although sometimes immunohistochemis-try and rarely molecular genetic evaluation may be needed.

Clinicopathological features of multilocular cystic renal cell carcinoma:a series of 32 cases / 临床与实验病理学杂志

Purpose To investigate the clinicopathological features of multilocular cystic renal cell carcinoma ( MCRCC) , and to im-prove the understanding of this disease. Methods Thirty-two of MCRCC were studied by clinic data, pathological features and immu-nophenotype. All the thirty-two cases were followed up. Results In this study, thirty-two patients were diagnosed as MCRCC with a male-to-female ratio of 2.2 : 1, thirteen of whom had the tumor in the left kidney, eighteen in the right kidney, another in the double kidneys. The mean of tumor diameter was 4.6 cm (1.0~8.0 cm). Eleven patients underwent radical nephrectomy while the other 21 patients received nephron sparing surgery. Microscopically, all the cases were multiocular, lined in the cyst wall by a single layer of tumor cells with the clear or pale cytoplasm and Fuhrman grade 1 nuclei. Occasionally, the lining consisted of several layers of tumor cells or a few small papillae were present. The linings of the cyst wall were rich in thin-wall blood vessels. Immunohistochemically, the tumor cells were positive for CK(32/32), CK7(25/32), EMA(32/32), CD10(23/32) and vimentin(20/32), while negative for CD68. Conclusions MCRCC is characteristic by low grade nuclei, lacking solid nodules, and in the cyst wall, and has a favourable prognosis. The rich in thin-wall blood vessels and the lining cells with the clear or pale cytoplasm are diagnosis clues.

Cloning of Alpha gene segments from t(6;11) translocation renal cell carcinoma and analysis of their promoter activities / 中国肿瘤临床

To construct recombinant reporter plasmids containing different Alpha gene segments and Alpha1-TFEB fusion gene and to evaluate the promoter activity of the Alpha gene. Methods:Promoter regions of the Alpha gene were predicted using a software Primer 0.5. Five Alpha gene segments with different lengths and a normal TFEB gene promoter (pTFEB) were amplified via polymerase chain reaction, and recombinant reporter plasmids containing different Alpha gene segments and a normal TFEB gene pro-moter were constructed. Liposome transfection was used to transfect these vectors into the human embryo kidney 293T cells. The pro-moter activity of the Alpha gene was evaluated via luciferase assay. Meanwhile, the recombinant Alpha1-TFEB plasmid was construct-ed and transfected into the 293T cells. The TFEB expression of the recombinant Alpha1-TFEB plasmid was then detected via Western blot. Results: Recombinant reporter plasmids containing different Alpha gene segments and pTFEB were constructed successfully. Compared with the luciferase activity of pGL3-Basic, that of the groups with Alpha1, Alpha2, Alpha3, Alpha4 and Alpha5 significantly increased (P<0.01). The luciferase activity also increased significantly in the groups with Alpha1, Alpha2 and Alpha5 compared with that of the pTFEB group (P<0.01). The TFEB expression of the pGL3-Enhancer-Alpha1-TFEB was significantly higher compared with that of the pGL3-Enhancer group. Conclusion:In t(6;11) translocation RCC, the Alpha gene has a strong promoter activity and it en-hances TFEB expression. The strongest promoter activity region is in Alpha5 with a sequence from 643 bp to 693 bp.

Quiste hidatídico renal: reporte de un caso / Renal hydatid cyst: case report

INTRODUCCIÓN: La hidatidosis es una parasitosis endémica en Chile. Los órganos más frecuentemente afectados son hígado y pulmón. Otras localizaciones, tales como la renal son infrecuentes e implican dificultades diagnósticas. PRESENTACIÓN DEL CASO: Mujer de 25 años, sin antecedentes mórbidos, que consulta por dolor lumbar de un mes de evolución, hematuria autolimitada y distensión abdominal, sin hallazgos patológicos al examen físico En sus estudios de laboratorio realizados en Hospital Base de Puerto Montt, Chile, destaca leucocitosis de 13.500 células/mm3 con eosinofilia relativa de 31,4 por ciento, Velocidad de Eritrosedimentación de 74 mm/h y función renal normal. Se solicita ecotomografía abdominal, en la cual se encuentra un quiste renal izquierdo complejo, hallazgo complementado con Tomografía Axial Computada abdomino-pélvico, la cual confirma quiste renal izquierdo de 13 centímetros de diámetro sin aspecto tumoral y quiste en fosa ilíaca izquierda en posición paravesical e hígado sin lesiones. Adicionalmente se realiza radiografía de tórax, la que resulta de aspecto normal. Se realiza Test para Hidatidosis que resulta positivo. Posteriormente, ante la sospecha de hidatidosis renal, se inicia tratamiento con Albendazol 400 mg al día durante 45 días y posteriormente quistectomía renal, evolucionando de forma satisfactoria. Se decide diferir cirugía de quiste paravesical. DISCUSIÓN: La localización renal de un quiste hidatídico es infrecuente y corresponde a menos del 2 por ciento de los casos, el diagnóstico de un quiste complejo renal debe considerar como diagnóstico diferencial la posibilidad de un quiste hidatídico.

INTRODUCTION: Hydatidosis is an endemic parasitic disease in Chile. The main organs affected are the liver and lungs. Other locations, such as the kidneys, are infrequent and involve diagnostic difficulties. CASE REPORT: A 25 year old woman with no previous history of morbid diseases consulting for a one month evolution of lumbar pain, self-limited hematuria and abdominal distension, with no abnormaities on physical examination. In her laboratory studies there was leukocytosis of 13,500 cells/mm3 with relative eosinophilia of 31.4 percent erythrocyte sedimentation rate (ESR) of 74 mm/h and normal renal function. Abdominal ultrasound found a complex left renal cyst, which was complemented with an abdomen and pelvis computerized axial tomography (CT), which confirmed a 13-centimeter left renal cyst without tumor-like appearance. Additionally, chest x-ray shows normal appearance. Enzyme-linked immunosorbent assay (ELISA) for hydatidosis is performed, which results positive. Subsequently, and based on the renal hydatid disease suspicion, she was treated with Albendazole 400 mg per day for 45 days followed by renal cystectomy, evolving satisfactorily. It was decided to defer paravesical cyst surgery. DISCUSSION: Renal hydatid cysts are rare and correspond to less than 2 percent of all cases. The diagnosis of kidney cyst should consider the hydatid cyst as a differential diagnosis.

Adenocarcinoma renal metastático em uma Codorna Japonesa (Coturnix coturnix japonica) / Metastatic renal adenocarcinoma in a Japanese Quail (Coturnix coturnix japonica)

Uma codorna japonesa (Coturnix coturnix japonica), fêmea, adulta com 2 anos apresentou parada de postura, emagrecimento, aumento de volume abdominal e morte. Ao exame macroscópico, observou-se ascite, pulmão esquerdo difusamente esbranquiçado, massas esbranquiçadas, de aproximadamente 1,0cm de diâmetro, na região caudal do lobo direito do fígado e na serosa da moela; massas de 0,1 a 0,5cm no mesentério e serosa intestinal; e uma massa de 5,0x2,0cm na fossa do sinsacro, que acometia 90 por cento do parênquima renal e estendia-se ao ovário e oviduto. Na avaliação histopatológica da neoformação renal, observou-se proliferação de células epiteliais formando túbulos, que muitas vezes não apresentavam lúmen, sustentados por um estroma fibrovascular escasso associado à necrose multifocal. As células neoplásicas eram cuboidais, núcleos redondos a ovalados, nucléolos evidentes, citoplasma abundante e eosinofílico, pleomorfismo moderado e poucas figuras mitóticas. Metástases foram observadas de forma difusa no ovário, oviduto e pulmão esquerdo; multifocal na serosa do intestino e focal no fígado e camadas muscular e serosa da moela. Na avaliação imuno-histoquímica, as células tumorais foram positivas para a citoqueratina (clones AE1+AE3) e negativas para a citoqueratina 5/6, o CD10 e a fosfatase alcalina placentária. De acordo com a localização, achados morfológicos e o perfil imuno-histoquímico, conclui-se que o presente relato trata-se de um adenocarcinoma renal metastático.

A 2-year-old Japanese quail (Coturnix coturnix japonica), female, which stopped egg production presented: weight loss, increased abdominal volume, and death. Macroscopically, it was observed: ascites, whitish left lung, whitish masses measuring 1.0cm in diameter in the caudal right lobe of the liver and in the gizzard serosa; 0.1-0.5cm masses in the mesentery and intestinal serosa; and a 5.0x2.0cm mass in synsacral area that encompassed 90 percent of the renal parenchyma and part of ovary and oviduct. Histologically, epithelial cells proliferation with formation of tubules, sometimes without lumen supported by mild fibrovascular stroma and multifocal necrosis was observed in the renal mass. The neoplastic cells were cuboidal, with round to oval nuclei, and evident nucleolus, abundant eosinophilic cytoplasm, moderated pleomorphism. Mitotic figures were rare. Metastasis was seen diffuse in ovary, oviduct, left lung, multifocal in intestinal serosa, focal in liver and serosal and muscular layer in gizzard. Immunohistochemically, tumors cells were positive for cytokeratin (clones AE1+AE3) and negative for cytokeratin 5/6, CD10 and placental alkaline phosphatase. According to localization, morphology features and immunohistochemistry evaluation, the present study reports a metastatic renal adenocarcinoma.

The Initial Experience with 3rd Generation Nephron-sparing Cryoablation for Renal Tumor / 대한비뇨기과학회지

PURPOSE: We report here on our initial experience with 3rd generation nephron-sparing renal cryoablation, which is one of the minimal invasive nephron-sparing surgeries. MATERIALS AND METHODS: We enrolled 10 patients who had renal neoplasm identified on computed tomography (CT) and who underwent 3rd generation cryoablation from August 2004 to May 2006. The operative indications were a tumor less than 4cm in diameter, an exophytic mass with malignant potential and those cases like solitary kidney, bilateral tumor or renal insufficiency that needed preservation of renal function. Eight patients underwent minimal incision open cryoablation, and the other two underwent laparoscopic cryoablation. In every case, there were 2-3 cycles of freeze and thawing and we monitored the tumor and ice ball via intraoperative ultrasound. RESULTS: The size of the iceball was maintained more than 1cm apart from the margin of the tumor to secure a safety margin. The average operation time of open cryoablation was 1.7 hr and that of laparoscopic cryoablation was 2.2 hr; the average blood loss was 194cc and 55cc, respectively. The average period of hospitalization after operation was 6.6 days and 3 days, respectively, and there was no complication except for one patient who had postoperative pulmonary effusion. During a mean follow-up of 14.1 months, no patient died and all the patients except one remained without local recurrence. CONCLUSIONS: As a result of our initial experience, renal cryoablation turned out to have an excellent effect of tumor erradication and few complications. Although long term follow-up results are necessary, laparoscopic renal cryoablation is considered a minimal invasive nephron- sparing surgery that could be substituted for laparoscopic partial nephrectomy in the future.

Superselective renal artery embolization with lipiodol and absolute alcohol emulsion for renal tumor / 介入放射学杂志

Objective To evaluate the efficacy of the renal arterial embolization with lipidol and absolute alcohol emulsion in the treatment of renal tumors. Methods The superselective renal arterial embolization by using coaxial-cathaterization with infusion of lipiodol and absolute alcohol (in proportion of 2 ∶ 1) emulsion was performed in twenty patients with malignant and benign kidney tumors. 4 weeks later, the renal arteriography was taken routinely and repeated embolization was performed in case of necessary; and follow up was carried out periodically. Results The imaging findings showed thorough tumor necrosis and feeding vessel abruption in 18 cases after one session of treatment. The volume of tumors decreased more than a half in 13 patients (82.25%, 13 / 18) associated with a well-distributed lipidol inside the tumors. The second session of treatment was performed in other 2 patients and the clinical symptoms relieved obviously. Conclusions The superselective renal artery embolization with lipidol and absolute alcohol emulsion can permanently embolize all tumor feeding arteries in capillary vessel level with maximum reservation of renal function, providing definitively efficacy and worthwhile to be recommended widely.

Korean Nomogram for the Prediction of Recurrence-free Survival after Definitive Surgery for Renal Cell Carcinoma / 대한비뇨기과학회지

Purpose: This multiinstitutional study was to investigate the accuracy of the Kattan nomograms for the prediction of recurrence after definitive surgery for renal cell carcinoma (RCC) in Korean patients and develop a nomogram revised to complement the shortcomings. Materials and Methods: Clinical and pathological data of 1,866 patients with RCC who had been followed for at least 2 years after surgery in each participating institutes were reviewed as well as evidence of disease recurrence, defined to include local recurrence and distant metastasis. Accuracy of the Kattan nomograms' predictability in tumors 7cm or less was tested by calculating the area under the receiver-operating characteristics curve (AUC) and actuarial recurrence-free survival by Kaplan- Meier method. We used the Cox proportional hazard analysis to identify significant variables and develop prediction nomogram, and internally validated by bootstrapping method. Mean follow-up was 56.5 months (24-184). Results: Recurrence occurred in 12.5% of the patients and correlated with the pathological stage, with 4.3%, 7.9%, 15.0%, 22.6%, 38.4%, 58.3% for stages T1a, T1b, T2, T3a, T3b/c and T4, respectively (p<0.001). The AUC of the Kattan nomograms was 0.276. Factors significantly predictive of recurrence were T stage (p<0.0001), presentation (p=0.006), preoperative hemoglobin (p=0.023) and gender (p=0.032). Actuarial 60-month recurrence- free survival was 87.9% and using the prognostic factors, nomogram predicting 60-month recurrence-free survival was constructed. Conclusions: Korean nomogram complementing the preexisting nomograms for the prediction of recurrence-free survival after definitive surgery for RCC has been constructed, which may be useful in patient prognostication, counseling and follow-up planning.

Laparoscopic,retroperitoneal laparoscopic,and open radical nephrectomy: A comparison of curative effects in 92 cases / 中国微创外科杂志

Objective To evaluate the clinical value of laparoscopic,retroperitoneal laparoscopic,and open radical nephrectomy.Methods Clinical data of 32 cases of laparoscopic radical nephrectomy(Laparoscopic Group),18 cases of retroperitoneal laparoscopic radical nephrectomy(Retroperitoneal Group),and 32 cases of open radical nephrectomy(Open Group) were compared in respect of operation time,length of hospitalization after operation,intraoperative hemorrhage volume,and incidence of postoperative complications.Results With exception of 1 case of conversion to open surgery because of ruptured renal vein in the Laparoscopic Group,the operation was successfully completed in all the cases.Of the Laparoscopic Group,Retroperitoneal Group,and Open Group,the operation time was 100.5?19.2 min,90.3?21.4 min,and 127.2?20.5 min,respectively,the intraoperative hemorrhage volume was 40?15 ml,50?15 ml,and 200?30 ml,respectively,and the length of postoperative hospitalization was 5.2?1.3 d,5.6?1.1 d,and 9.1?1.8 d,respectively.Both the Laparoscopic Group and the Retroperitoneal Group were superior to the Open Group(P