Metástasis Pancreática Metacrónica de un Carcinoma de Células Renales. Reporte de un Caso / Metachronic Pancreatic Metastasis of a Renal Cell Carcinoma. Case Report

El carcinoma de células renales (CCR) a nivel mundial presenta una incidencia de 431.288 casos anuales, causando 179.368 muertes en 2020. Sin embargo, a pesar de su incidencia, el desarrollo de metástasis pancreática (MP) de un RCC es un hecho inusual. El objetivo de este manuscrito fue reportar el caso de una paciente con una MP metacrónica de un CCR. Se trata de una paciente de 56 años, sexo femenino, nefrectomizada derecha hace 132 meses por un CCR, en adyuvancia con inmunoterapia. En un control imagenológico de rutina, se le pesquisó una lesión de aspecto tumoral en el cuerpo y cola del páncreas. Se intervino quirúrgicamente, realizándose una pancreatectomía córporo-caudal con preservación esplénica. Evolucionó de forma satisfactoria, sin complicaciones, siendo dada de alta al 4º día de su cirugía. El informe del estudio de la pieza operatoria con estudio inmunohistoquímico concluyó que se trataba de una MP de CCR. La paciente se encuentra en buenas condiciones generales y reinició quimioterapia con anticuerpos monoclonales. El seguimiento frecuente y prolongado de pacientes con antecedentes de CCR, facilita un diagnóstico y tratamiento oportuno de MP facilitando el mejor pronóstico de los pacientes, con tasas más altas de supervivencia.

SUMMARY: Renal cell carcinoma (RCC) worldwide has an incidence of 431,288 cases per year, causing 179,368 deaths in 2020. However, despite its incidence, the development of pancreatic metastasis (MP) from RCC is unusual. The aim of this manuscript was to report the case of a patient with a PM of a RCC. This is a 56-year-old female patient, underwent right nephrectomy 132 months earlier for RCC. While she was in adjuvant immunotherapy, in a routine imaging control, it was found a tumor lesion in the body and the tail of the pancreas. So, she underwent surgery, performing a corpora-caudal pancreatectomy with splenic preservation. Postoperative evolution was correct, without complications, and she was discharged on the 4th day after surgery. The report of the study of the surgical piece with an immunohistochemical study included, conclusive of PM of RCC. Currently, the patient is in good general condition and restarted chemotherapy with monoclonal antibodies. Frequent and prolonged follow-up of patients with a history of RCC facilitates timely diag- nosis and treatment of PM, facilitating the best prognosis for patients, with higher survival rates.

Vertebral metastasis of renal carcinoma at diagnosis: mechanical and clinical evaluation: surgical management / Metástasis vertebral de carcinoma renal en el momento del diagnóstico: evaluación mecánica y clínica: manejo quirúrgico

Renal cell carcinoma accounts for 2-3% of all malignant neoplasms. Metastatic disease of the spine is common and 50% of bone metastases are already present at the time of primary diagnosis. Bone metastases from renal cell carcinoma are difficult to manage, especially vertebral localization.A 48-year-old woman was diagnosed with renal cell carcinoma in the context of low back pain. The patient presented two skeleton metastases at diagnosis (T11 and 5th rib). The patient received neoadjuvant treatment with cabozantinib, followed by removal of the renal tumor. Radiotherapy was administered for the lumbar lesion. In spite of the radiotherapy treatment, increased low back pain limiting mobility and ambulation. MRI showed an occupation of the spinal canal, without neurological lesion. The SINS scale revealed a score of 14 (vertebral instability). The patient's prognosis was greater than 12 months according to the Tokuhashi score. Based on clinical and mechanical criteria, surgical treatment of the vertebral lesion was decided. T11 vertebrectomy was performed, the reconstruction was made with an expandable cage, and T8 a L2 posterior spinal arthrodesis. A partial resection of the fifth rib was performed in order to remove the whole macroscopic tumor. After 3 months, she was diagnosed with a local infection, treated by irrigation, debridement and antibiotherapy, with good evolution. At 1-year follow-up, she has no low back pain or functional limitation. Follow-up chest-abdomen-pelvis computed CT scan showed absence of disease progression, furthermore, the vertebral arthrodesis shows fusion signs. At the time of this report, there are no clinical or radiological data of infection

El carcinoma de células renales representa el 2-3% de todas las neoplasias malignas. La enfermedad metastásica de la columna vertebral es frecuente y el 50% de las metástasis óseas ya están presentes en el momento del diagnóstico. Las metástasis óseas del carcinoma de células renales son difíciles de manejar, especialmente en localización vertebral.Una mujer de 48 años fue diagnosticada de carcinoma de células renales en el contexto de un dolor lumbar. La paciente presentaba dos metástasis óseas en el momento del diagnóstico (T11 y 5ª costilla). Inicialmente recibió tratamiento neoadyuvante con cabozantinib, seguido de la extirpación quirúrgica del tumor renal. Se administró radioterapia para la lesión lumbar. A pesar del tratamiento radioterápico, aumentó el dolor lumbar con limitación para la movilidad y la deambulación. La RM mostró una ocupación del canal espinal, sin lesión neurológica. La escala SINS reveló una puntuación de 14 (inestabilidad vertebral). El pronóstico de la paciente era superior a 12 meses según la puntuación de Tokuhashi. Basándose en criterios clínicos y mecánicos, se decidió el tratamiento quirúrgico de la lesión vertebral. Se realizó una vertebrectomía de T11, para la reconstrucción se usó una caja extensible, junto con una artrodesis vertebral T8-L2. Se realizó una resección parcial de la quinta costilla para eliminar todo el tumor macroscópico. A los 3 meses de la cirugía la paciente fue diagnosticada de infección local, tratada mediante irrigación, desbridamiento y antibioterapia, con buena evolución. Al año de seguimiento, no presenta dolor lumbar ni limitación funcional. La tomografía computarizada de tórax-abdomen-pelvis de seguimiento mostró ausencia de progresión de la enfermedad, además, la artrodesis vertebral muestra signos de fusión. En el momento de este informe, no hay datos clínicos ni radiológicos de infección.

Diagnosis and Treatment of 126 Cases of Chromophobe Renal Cell Carcinoma / 中国医学科学院学报

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.

Role of preoperative MR volumetry in patients with renal cell carcinoma for prediction of postoperative renal function after radical nephrectomy and nephron sparing surgery

ABSTRACT Purpose Preoperative computed tomography or magnetic resonance (MR) imaging are commonly used for radiological evaluation of renal cell carcinoma (RCC) before radical nephrectomy or nephron sparing surgery(NSS). This study aimed to assess the role of MRI for predicting postoperative renal function by preoperative estimation of renal parenchymal volume and correlation with glomerular filtration rate (GFR). Materials and Methods A prospective observational study was conducted from February 2015 to October 2016 at a tertiary care hospital in northern India. MR imaging was done on 3 Tesla MR scanner (Signa Hdxt General Electrics, Milwaukee, USA). MR volumetry was used to estimate the renal parenchymal volume. GFR was measured in all patients using Tc99m Diethyl-triamine-penta-acetic acid using Russell's algorithm. Such measurement was done preoperatively, and postoperatively 3 months after surgery. Results 30 patients with suspected RCC underwent NSS (n=10) and radical nephrectomy (n=20). Median tumour volume was 175.7cc (range: 4.8 to 631.8cc). The median volume of the residual parenchyma on the affected side was 84.25±41.97cc while that on the unaffected side was 112.25±26.35cc. There was good correlation among the unaffected kidney volume and postoperative GFR for the radical nephrectomy group (r=0.83) as well as unaffected kidney volume, total residual kidney volume and residual volume of affected kidney with postoperative GFR for the NSS group (r=0.71, r=0.73, r=0.79 respectively; P <0.05). Conclusion Preoperative residual parenchymal volume on MR renal volumetry correlates well with postoperative GFR in patients with RCC undergoing radical nephrectomy or NSS.

Diagnostic accuracy of contrast-enhanced ultrasound for detecting bland thrombus from inferior vena cava tumor thrombus in patients with renal cell carcinoma

ABSTRACT Purpose: To evaluate the role of contrast-enhanced ultrasound (CEUS) in differentiating bland thrombus from tumor thrombus of the inferior vena cava (IVC) in patients with renal cell carcinoma (RCC). Materials and Methods: We retrospectively investigated 30 consecutive patients who underwent robot-assisted radical nephrectomy with IVC thrombectomy and had pathologically confirmed RCC. All patients underwent US and CEUS examination. Two off-line readers observed and recorded thrombus imaging information and enhancement patterns. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value for bland thrombus were assessed. Results: Of the 30 patients, no adverse events occurred during administration of the contrast agent. Early enhancement of the mass within the IVC lumen on CEUS was an indicator of tumor thrombus. Bland thrombus showed no intraluminal flow on CEUS. There were eight (26.7%) patients with bland thrombus, including three level II, two level III, and three level IV. There were three cases with cephalic bland thrombus and five cases with caudal bland thrombus. Three caudal bland thrombi extended to the iliac vein and underwent surgical IVC interruption. Based on no intraluminal flow, for bland thrombus, CEUS had 87.5% sensitivity, 100% specificity, 96.7% accuracy, 100% positive predictive value and 95.6% negative predictive value. Conclusion: Our study demonstrates the potential of CEUS in the differentiation of bland and tumor thrombus of the IVC in patients with RCC. Since CEUS is an effective, inexpensive, and non-invasive method, it could be a reliable tool in the evaluation of IVC thrombus in patients with RCC.

Computed tomography imaging characteristics of clear cell papillary renal cell carcinoma

ABSTRACT Purpose: Clear cell papillary (CCP) renal cell carcinoma (RCC) is a new subtype of RCC that was formally recognized by the International Society of Urological Pathology Vancouver Classification of Renal Neoplasia in 2013. Subsequently, CCP RCC was added to the 2016 World Health Organization Classification of Tumors of the Urinary System and Male Genital Organs. In this study, we retrospectively investigated the computed tomography (CT) findings of pathologically diagnosed CCP RCC. Materials and Methods: This study included 12 patients pathologically diagnosed with CCP RCC at our institution between 2015 and 2017. We reviewed the patient's CT data and analyzed the characteristics. Results: Nine solid masses and 3 cystic masses with a mean tumor size of 22.7±9.2mm were included. Solid masses exhibited slight hyper-density on unenhanced CT with a mean value of 34±6 Hounsfield units (HU), good enhancement in the corticomedullary phase with a mean of 195±34HU, and washout in the nephrogenic phase with a mean of 133±29HU. The walls of cystic masses enhanced gradually during the corticomedullary and nephrogenic phases. Solid and cystic masses were preoperatively diagnosed as clear cell RCC and cystic RCC, respectively. Conclusions: The CT imaging characteristics of CCP RCCs could be categorized into either the solid or cystic type. These masses were diagnosed radiologically as clear cell RCC and cystic RCC, respectively.

A comparative study of ultrasound and cross-sectional imaging for detection of small renal masses: anatomic factors and radiologists experience / Estudo comparativo de ultrassonografia e métodos seccionais para detecção de pequenas lesões renais: fatores anatômicos e experiência do radiologista

ABSTRACT Objective: To evaluate anatomic factors and radiologist's experience in the detection of solid renal masses on ultrasonography. Methods: We searched for solid renal masses diagnosed on cross-sectional imaging from 2007 to 2017 that also had previous ultrasonography from the past 6 months. The following features were evaluated: nodule size, laterality, location and growth pattern, patient body mass index and radiologist's experience in ultrasound. In surgically resected cases, pathologic reports were evaluated. Unpaired t test and χ2 test were used to evaluate differences among subgroups, using R-statistics. Statistical significance was set at p<0.05. Results: The initial search of renal nodules on cross-sectional imaging resulted in 428 lesions and 266 lesions were excluded. Final cohort included 162 lesions and, of those, 108 (67%) were correctly detected on ultrasonography (Group 1) and 54 (33%) were missed (Group 2). Comparison of Groups 1 and 2 were as follows, respectively: body mass index (27.7 versus 27.1; p=0.496), size (2.58cm versus 1.74cm; p=0.003), laterality (54% versus 59% right sided; p=0.832), location (27% versus 22% upper pole; p=0.869), growth pattern (25% versus 28% endophytic; p=0.131) and radiologist's experience (p=0.300). From surgically resected cases, histology available for Group 1 was clear cell (n=11), papillary (n=15), chromophobe (n=2) renal cell carcinoma, oncocytoma (n=1), and, for Group 2, clear cell (n=7), papillary (n=5) renal cell carcinoma, oncocytoma (n=2), angiomyolipoma, chromophobe renal cell carcinoma, and interstitial pyelonephritis (n=1, each). Conclusion: Size was the only significant parameter related to renal nodule detection on ultrasound.

RESUMO Objetivo: Avaliar os fatores anatômicos e a experiência do radiologista na detecção de massas renais sólidas na ultrassonografia. Métodos: Buscamos massas renais sólidas diagnosticadas em imagens seccionais, de 2007 a 2017, que também tivessem ultrassonografia prévia nos últimos 6 meses. As seguintes características foram avaliadas: tamanho do nódulo, lateralidade, localização e padrão de crescimento, índice de massa corporal do paciente e experiência do radiologista em ultrassonografia. Nos casos com ressecção cirúrgica, os laudos de patologia foram analisados. O teste t não pareado e o teste χ2 foram utilizados para avaliar as diferenças entre os subgrupos, usando R-statistics. A significância estatística foi estabelecida em p<0,05. Resultados: A pesquisa inicial de nódulos renais achados em imagens seccionais resultou em 428 lesões, com 266 exclusões. A coorte final incluiu 162 lesões e, destas, 108 (67%) foram detectadas corretamente na ultrassonografia (Grupo 1), e 54 (33%) não foram identificadas (Grupo 2). A comparação dos Grupos 1 e 2 mostrou índice de massa corporal (27,7 versus 27,1; p=0,496), tamanho (2,58cm versus 1,74cm; p=0,003), lateralidade (54% versus 59% no lado direito; p=0,832), localização (27% versus 22% no polo superior; p=0,869), padrão de crescimento (25% versus 28% endofítico; p=0,131) e experiência do radiologista (p=0,300). A histologia disponível para o Grupo 1 foi carcinoma renal de células claras (n=11), papilar (n=15), cromófobo (n=2), oncocitoma (n=1), e, para o Grupo 2, carcinoma renal de células claras (n=7), papilar (n=5), oncocitoma (n=2), angiomiolipoma, cromófobo e pielonefrite intersticial (n=1, cada). Conclusão: O tamanho foi o único parâmetro significativo relacionado à detecção de nódulos renais no ultrassom.

Untargeted contrast-enhanced ultrasound versus contrast-enhanced computed tomography: a differential diagnostic performance (DDP) study for kidney lesions

OBJECTIVES: Histopathology is the 'gold standard' for diagnosing renal cell carcinoma but is limited by sample size. Contrast-enhanced ultrasound can differentiate malignant and benign lesions, but the Chinese guidelines on the management of renal cell carcinoma do not include this method. The purpose of this study was to compare the diagnostic parameters of contrast-enhanced ultrasound against those of contrast-enhanced computed tomography for detecting kidney lesions, with histopathology considered the reference standard. METHODS: Patients with suspected kidney lesions from prior grayscale ultrasonography and computed tomography were included in the analysis (n=191). The contrast-enhanced ultrasound, contrast-enhanced computed tomography, and histopathology data were collected and analyzed. A solid, enhanced mass was considered a malignant lesion, and an unenhanced mass or cyst was considered a benign lesion. The Bosniak criteria were used to characterize the lesions. RESULTS: Contrast-enhanced ultrasound and contrast-enhanced computed tomography both detected that 151 patients had malignant tumors and 40 patients had benign tumors. No significant differences in the tumors and their subtypes were reported between contrast-enhanced ultrasound and histopathology (p=0.804). Chromophobe renal cell carcinoma was detected through contrast-enhanced computed tomography (n=1), but no such finding was reported by contrast-enhanced ultrasound. A total of 35 cases of papillary renal cell carcinoma were reported through contrast-enhanced ultrasound while 32 were reported through histopathology. CONCLUSIONS: Contrast-enhanced ultrasound might be safe and as accurate as histopathology in diagnosing kidney lesions, especially renal cell carcinoma. Additionally, this study provides additional information over histopathology and has an excellent safety profile. Level of evidence: III.

Role of the three-dimensional printing technology in complex laparoscopic renal surgery: a renal tumor in a horseshoe kidney

ABSTRACT Purpose: To report our initial experience using a patient-specific 3D-printed renal tumor model for the surgical planning of a complex heminephrectomy in a horseshoe kidney. Materials and Methods: We selected a clinical case for a complex laparoscopic surgery consisting in a 53 year-old male presenting a local recurrence of a renal tumor in a horseshoe kidney with aberrant vascularisation previously treated with a laparoscopic partial nephrectomy. He is now proposed for a laparoscopic left heminephrectomy. Along with conventional imaging, a real-size 3D-printed renal model was used to plan de surgical approach. The perioperative experience of the surgical team was recorded. Results: The surgical team found the patient-specific 3D printed model useful for a better understanding of the anatomy and an easier surgical planning. Conclusion: The use of patient-specific 3D-printed renal models seem to be helpful for the surgical planning in complex renal tumors.

Transesophageal echocardiography-guided thrombectomy of level iv renal cell carcinoma without cardiopulmonary bypass

Abstract Advanced renal cell carcinoma accompanied by tumor thrombus in the venous system is present in up to 10% of cases. Extension of tumor thrombus above the diaphragm or into the right atrium represents level IV disease. Level IV tumors are typically treated with sterno-laparotomy approach with or without deep hypothermic circulatory arrest and veno-venous bypass. In this case report, the surgical technique for the resection of advanced RCC were described, with the concomitant use of transesophageal echocardiography for thrombus extraction without the veno-venous or cardiopulmonary bypass.

Metástasis poco frecuente del carcinoma renal de células claras / Unusual metastasis of clear cell renal cell carcinoma

El ligamento falciforme es una reflexión peritoneal abdominal relacionada con la superficie anterior del hígado, que en su borde inferior libre contiene el ligamento redondo (LR); las lesiones únicas en este son infrecuentes. Presentamos un caso de metástasis única en el ligamento redondo en un paciente con antecedente de carcinoma renal de células claras. Realizamos una búsqueda bibliográfica para identificar casos similares. Nuestro paciente es un varón de 71 años con antecedente de carcinoma renal de células tratado con nefrectomía radical izquierda laparoscópica (estadio pT3a). En tomografía computarizada (TC) control a los 5 años se evidencia lesión focal en la periferia del segmento IVa, ante la sospecha de malignidad, se realiza laparotomía exploradora revisando toda la cavidad abdominal sin evidenciar otros implantes peritoneales. Se halla un nódulo de 1 cm en el ligamento redondo y se realiza su exéresis completa, con diagnóstico anatomopatológico de metástasis de células claras. El LR generalmente está afectado en casos de carcinomatosis peritoneal y solo existen dos casos publicados de metástasis únicas.

The falciform ligament is a peritoneal reflection that attaches the liver to the anterior abdominal wall; its lower edge contains the round ligament (RL). Single lesions in the RL are rare and usually correspond to perivascular epithelioid cell tumors. We present a case report of a single metastasis in the RL in a patient with clear cell renal cell carcinoma who underwent surgery five years ago. We conducted a literature review to identify similar cases and we found two case reports of single metastasis in the RL. Our patient was a 71-year-old man with a history of renal cell carcinoma who underwent left laparoscopic radical nephrectomy (stage pT3a), laparoscopic right adrenalectomy and total thyroidectomy due to multinodular goiter. The pathological examination revealed metastases of renal cell carcinoma. A computed tomography (CT) scan performed at 5-year follow-up showed a focal lesion in segment IVa with no FDG uptake in the PET scan, but as malignancy was suspected, the patient underwent exploratory laparatomy with no evidence of peritoneal implants. A 1-cm node was found in the round ligament that was completely resected. The pathological examination revealed metastatic clear cell renal cell carcinoma. The RL is involved in cases of peritoneal carcinomatosis and only two cases of single metastasis have been reported: in one patient with papillary renal cell carcinoma pT1aN0 and another one with left breast adenocarcinoma.

Localized chromophobe renal cell carcinoma: preoperative imaging judgment and laparoscopic simple enucleation for treatment

ABSTRACT Objective: To evaluate the preoperative imaging manifestation and therapeutic effect of laparoscopic simple enucleation (SE) for localized chromophobe renal cell carcinoma (chRCC). Materials and Methods: Clinical data of 36 patients who underwent laparoscopic SE of localized chRCC at our institute were retrospectively analyzed. All patients underwent preoperative renal protocol CT (unenhanced, arterial, venous, and delayed images). CT scan characteristics were evaluated. After intraoperative occlusion of the renal artery, the tumor was free bluntly along the pseudocapsule and enucleated totally. The patients were followed up regularly after the operation. Results: Mean tumor diameter was 3.9±1.0 cm, 80% of tumors were homogeneous and all the tumors had complete pseudocapsule. The attenuation values were slightly lower than normal renal cortex and degree of enhancement of the tumors were significantly lower than normal renal cortex. Mean operation time was 104.3±18.2 min. Mean warm ischemia time (WIT) was 21.3±3.5 min. Mean blood loss was 78.6±25.4 mL. No positive surgical margin was identified. Mean postoperative hospital stay was 5.3±1.5 d. Hematuria occurred in 3 patients and all disappeared within 3 days. After a mean follow-up of 32.1±20.6 months, no patient had local recurrence or metastatic progression. Conclusion: Localized chRCCs have a great propensity for homogeneity and complete pseudocapsule. The attenuation values were slightly lower than normal renal cortex and small degree of enhancement. Laparoscopic SE is a safe and effective treatment for localized chRCC. The oncological results were satisfactory.

Influencia del estadio tumoral inicial en la sobrevida de pacientes con adenocarcinoma renal / Initial tumor stage influence on survival of patients with renal adenocarcinoma

Introducción: el adenocarcinoma renal representa hasta el 80 por ciento de los tumores sólidos de este órgano, además de ser el de peor pronóstico. Objetivo: analizar la influencia del estadio tumoral inicial en la sobrevida de pacientes con adenocarcinoma renal. Métodos: se realizó un estudio descriptivo en una muestra de 69 pacientes con diagnóstico de adenocarcinoma renal, atendidos en el Hospital Militar Central Dr. Luis Díaz Soto de enero de 2005 a diciembre de 2014. Las variables estudiadas fueron: edad, sexo, signos y síntomas, exámenes imaginológicos utilizados, estadio tumoral, modalidades terapéuticas empleadas, complicaciones presentadas y la sobrevida posterior al tratamiento. Resultados: prevaleció el grupo de edades de 60-69 años con 46 pacientes (66,7 por ciento) y del sexo masculino con 42 para un 61 por ciento. Predominó el diagnóstico incidental en 52 pacientes (75,4 por ciento). El ultrasonido se empleó en la totalidad de los casos y fue positivo en el 98,6 por ciento. Preponderaron las lesiones en el estadio I en 32 pacientes (46,3 por ciento). La modalidad terapéutica más empleada fue el tratamiento quirúrgico en 65 pacientes (94,2 por ciento), al ser la nefrectomía total por vía lumbar la más practicada con 44 pacientes (63,8 por ciento). La sobrevida a los 5 años fue del 93,7 por ciento. Conclusiones: El diagnóstico del adenocarcinoma renal en estadios iniciales, posibilitó mejor pronóstico y mayor sobrevida de los pacientes. Existió relación directa entre los factores pronósticos, clínicos y tumorales, con la evolución y la mortalidad por adenocarcinoma renal(AU)

Introduction: the renal adenocarcinoma represents until 80 percent of the solid tumors of this organ, besides being that of worse prognosis. Objective: to analyze the influence of the initial tumoral stage in the survival of patient with renal adenocarcinoma. Methods: A descriptive was carried in to sample of 69 patients with diagnosis of renal adenocarcinoma, assisted in the Central Military Hospital Dr. Luis Díaz Soto from January of 2005 to December of 2014. The studied variables were: age, sex, signs and symptoms, imaginologic exams used, tumoral stage, therapeutic modalities employed, complications and the survival later to the treatment. Results: the group of 60-69 year-old ages prevailed with 46 patients (66.7 percent) and of the masculine sex with 42 for 61 percent. The incidental diagnosis prevailed in 52 patients (75.4 percent). The ultrasound was used in the entirety of the cases and it was positive in 98.6 percent. Prevailed the lesions in the I stage in 32 patients (4.3 percent). The therapeutic modality more employed was the surgical treatment in 65 patients (94.2 percent), being the total nephrectomy for lumbar via were practiced in 44 patients (63.8 percent). The survival to the 5 years was of the one 93.7 percent. Conclusions: The diagnosis of the renal adenocarcinoma, in initial stages, facilitates a better prognosis and a bigger survival of the patients. Direct relationship exists among the prognostic factors, clinical and tumoral, with the evolution and the mortality for renal(AU)

Carcinoma de los ductos colectores de bellini: presentación de un caso clínico y revisión del diagnóstico diferencial / Collecting (bellini) duct carcinoma: a case presentation

Collecting (Bellini) duct carcinoma (CDC) is a rare and very aggressive variant of renal cell carcinoma. Objectives: To describe the radiological findings of a CDC case and to determine its differential diagnosis. Basic procedures: Review the published works regarding this tumor and compare the radiological findings of our case with those of other described cases. Most important findings: CDCs are well-defined tumors with a high hemorrhagic component, limited internal enhancement and nodal metastases. In the differential diagnosis, if the lesion presents an exophytic growth it should include papillary carcinoma, mainly the sarcomatoid variant and the complex benign lesions (complex cysts or hydatids). However, if the lesion combines an infiltrating pattern, other lesions such as medullary carcinoma or lymphoma will be taken into account. Main conclusions: In the presence of solid-cystic hypovascular lesions and regional lymphadenopathy, CDC must be included in the differential diagnosis.

El carcinoma de las células colectoras de Bellini (CCB), es una variante rara y muy agresiva del carcinoma de células renales. Objetivos: Describir los hallazgos radiológicos de un caso de CCB y determinar su diagnóstico diferencial. Procedimientos básicos: Revisión de los trabajos publicados sobre este tumor y comparar los hallazgos radiológicos de nuestro caso con los de otros casos descritos. Hallazgos más importantes: Los CCB son tumores bien delimitados con alto componente hemorrágico, escaso realce interno y metástasis ganglionares. En el diagnóstico diferencial si la lesión presenta un crecimiento exofítico debería incluirse el carcinoma papilar, fundamentalmente la variante sarcomatoide y las lesiones benignas complejas (quistes complejos o hidatídicos). En cambio, si la lesión asocia un patrón infiltrante se tendrán en cuenta otras lesiones como el carcinoma medular o el linfoma. Conclusiones principales: En presencia de lesiones sólido-quísticas hipovasculares y adenopatías regionales debe incluirse el CCB en el diagnóstico diferencial.

Angiomiolipoma renal atípico versus carcinoma de células renales: dilema diagnóstico. Hallazgos útiles por tomografía computada para la discriminación de estos tumores / Atypical renal angiomyolipoma versus carcinoma renal cell: diagnosis dilemma. Findings by computed tomography for the discrimination of these tumors

Objetivo: Diferenciar el angiomiolipoma atípico del carcinoma de células renales del mismo tamaño mediante hallazgos tomográficos. Materiales y métodos: Se realizó un estudio retrospectivo con 68 pacientes (17 con angio-miolipomas atípicos y 51 con carcinoma de células renales) nefrectomizados por diagnóstico presuntivo preoperatorio, mediante tomografía computada trifásica (fases sin contraste, corticomedular y excretora temprana), de carcinoma de células renales menor de 45mm. Dos radiólogos que desconocían el diagnóstico definitivo evaluaron retrospectivamente las características generales del tumor, su atenuación en fase sin contraste y las características de su realce. Se realizó un análisis estadístico con software R, aplicándose el modelo logit para diferenciar el angiomiolipoma atípico del carcinoma de células renales a partir de los hallazgos tomográficos de masa renal, incluidos en el modelo final el contorno, la atenuación en fase sin contraste y el patrón de realce con el tiempo. Resultados: Los hallazgos de angiomiolipoma atípico que resultaron significativos fueron atenuación tumoral en fase sin contraste hiperdensa y patrón de realce con tiempo prolongado con chance de ocurrencia de 10,49 (p=0,0381) y 36,71 (p=0,0009), respectivamente. En los pacientes, según el valor de cada hallazgo incluido en el modelo, se calculó probabilidad, sensibilidad (0,2941) y especificidad (0,9804). La curva característica operativa del receptor (ROC) determinó un punto de corte óptimo (0,9694) para discriminar el angiomiolipoma atípico, por lo que se confirmó su presencia. Conclusión: La tomografía computada helicoidal trifásica es útil para diferenciar el angiomiolipoma atípico del carcinoma de células renales, siendo la atenuación hiperdensa sin contraste del tumor y su patrón de realce prolongado los hallazgos tomográficos más valiosos.

Objective: To compare various computed tomographic features of atypical angiomyolipoma with those of size-matched renal cell carcinoma. Materials and methods: Sixty-eight patients (17 with atypical angiomyolipomas and 51 with carcinoma renal cells) who had undergone nephrectomy by presumptive diagnosis of carcinoma renal cell<45mm on diameter by preoperative triphasic computed tomography (CT) (with unenhanced, corticomedullary, and early excretory phase scanning) were evaluated in a retrospective study. Two reviewers who were unaware of the diagnosis retrospectively recorded tumor attenuation on unenhanced scans, enhancement characteristics and general characteristics of the tumor. Statistical analysis was performed with R software, applying logit model to differentiate atypical angiomyolipoma from renal cell carcinoma from CT findings of renal mass, included in the final model the tumor margin, its attenuation on unenhanced scans and the enhancement pattern over time. Results: For atypical angiomyolipomas the most valuable CT findings were hyperdense attenuation tumour in unenhaced phase scan and prolonged enhancement pattern, with chance of occurrence of 10.49 (p=0.0381) and 36.71 (p=0.0009), respectively. In the patients, as each finding value in the model, probability, sensitivity (0.2941) and specificity (0.9804) was calculated ROC curve was constructed that determined optimal cutoff (0.9694) to discriminate atypical angiomyolipoma, confirming their presence. Conclusion: Triphasic helical CT may be useful in differentiating atypical angiomyolipoma from renal cell carcinoma, with hyperdense tumor attenuation on unenhanced scans and prolonged enhancement pattern being the most valuable CT findings.

Urothelial neoplasm of the bladder in childhood and adolescence: a rare disease

ABSTRACT Purpose: Bladder tumors are rare in children and adolescents. For this reason, the diagnosis is sometimes delayed in pediatric patients. We aimed to describe the diagnosis, treatment, and follow-up methods of bladder urothelial neoplasms in children and adolescents. Materials and Methods: We carried out a retrospective multicenter study involving patients who were treated between 2008 and 2014. Eleven patients aged younger than 18 years were enrolled in the study. In all the patients, a bladder tumor was diagnosed using ultrasonography and was treated through transurethral resection of the bladder (TURBT). Results: Nine of the 11 patients (82%) were admitted with gross hematuria. The average delay in diagnosis was 3 months (range, 0–16 months) until the ultrasonographic diagnosis was performed from the first episodes of macroscopic hematuria. A single exophytic tumor (1–4cm) was present in each patient. The pathology of all patients was reported as superficial urothelial neoplasm: two with papilloma, one with papillary urothelial neoplasm of low malignant potential (PUNLMP), four with low grade pTa, and four with low grade pT1. No recurrence was observed during regular cystoscopic and ultrasonographic follow-up. Conclusions: Regardless of the presence of hematuria, bladder tumors in children are usually not considered because urothelial carcinoma in this population is extremely rare, which causes a delay in diagnosis. Fortunately, the disease has a good prognosis and recurrences are infrequent. Cystoscopy may be unnecessary in the follow-up of children with bladder tumors. We believe that ultrasonography is sufficient in follow-up.

Tumores que invaden la vena cava inferior: revisión pictográfica de los principales hallazgos imagenológicos en tomografía computarizada y resonancia magnética / Tumours that invade the inferior vena cava: an illustrative review of the main imaging features on computed tomography and magnetic resonance

Abstract. The objective of this article is to describe the multiple entities that can affect and invade the inferior vena cava. These can be either benign entities, but with an aggressive behaviour, or malignancies that originate in the organs adjacent to this vascular structure, or in itself as a leiomyosarcoma. The present review shows different examples in Computed Tomography and Magnetic Resonance, with cases of angiomyolipoma, phaeochromocytoma, adrenal cortical carcinoma, renal cell carcinoma, hepatocellular carcinoma, a retroperitoneal sarcoma and a leiomyosarcoma originating in the inferior vena cava. Besides these, there are situations that may lead to diagnostic errors, such as the flow artefacts and pseudolipoma.

El objetivo de este artículo es describir las múltiples entidades que pueden afectar e invadir la vena cava inferior. Entre ellas podemos enumerar tanto entidades benignas, pero con un comportamiento agresivo, como procesos malignos que se originan en órganos adyacentes a esta estructura vascular o en ella misma como el leiomiosarcoma. En la presente revisión se exponen diferentes ejemplos en tomografía computarizada y resonancia magnética con casos de angiomiolipoma, feocromocitoma, carcinoma suprarrenal, carcinoma de células renales, hepatocarcinoma, sarcoma retroperitoneal y leiomiosarcoma originado en la vena cava inferior. Además se exponen situaciones que pueden inducir a errores diagnósticos como los artefactos de flujo y el pseudolipoma.