Clinico-pathological prognostic factors of renal cell carcinoma: a 15-year review from a single center in Greece

To investigate the prognostic significance of certain clinical and pathological factors of renal cell cancer. One hundred and fourteen patients who underwent radical nephrectomy between 1996 and 2011 in our hospital were examined. Parameters including age, gender, mode of presentation, hematological and pathological parameters were evaluated for their role as predictors of disease-free and overall survival. Median follow-up was 69 months. Predominant histological type, pathological stage, and nuclear grade were clear cell carcinoma, pT1, and Fuhrman II, respectively. Five-year overall and disease-free survival were 86% and 82%, respectively. Only nuclear grade [P = 0.02] and preoperative anemia [P < 0.01] were correlated with overall survival, while pathological stage, nuclear grade, anemia, and neutrophil-to-lymphocyte ratio of 2.7 or greater were associated with disease-free survival [P = 0.02, P = 0.038, P < 0.01, P = 0.049, respectively]. In the multivariate setting, anemia [P = 0.04] and pathological stage [P = 0.026] were the only independent statistically significant predictors of disease-free survival, while anemia [P = 0.018] and neutrophil to lymphocyte ratio [P = 0.034] were the only factors correlated with overall survival. Due to the wide application of various imaging studies, patients with kidney cancer are diagnosed more often with localized disease and favorable pathological features. Fuhrman nuclear grade, pathological stage, preoperative anemia, and neutrophil to lymphocyte ratio are strongly associated with survival. In localized disease, such information could be used to guide the intensity of follow-up and identify high-risk patients who can be targeted for adjuvant therapy trials

Hematuria Secondary to an Internal Iliac Artery Aneurysm

We report a case of macroscopic hematuria secondary to an aneurysm of the internal iliac artery. An 84-year-old male presented to our department with a 12-hour history of painless gross hematuria. Cystoscopy showed decreased expansion suggesting compression from outside the bladder. At the point of compression, increased vascularization was noted in the bladder mucosa without evidence of active bleeding. No trace of blood was identified coming from the ureteric orifices, the bladder neck, or the prostate. There was no evidence of intra-vesicular masses or other inflammatory changes. The abdominal computed tomography scan revealed left-sided hydronephrosis and an abdominal aortic aneurysm involving the aortic bifurcation and both internal iliac arteries. There was no evidence of rupture. An aneurysm of the internal iliac artery is a rare cause of macroscopic hematuria that can be fatal. Awareness of this as a possible cause of hematuria may assist in immediate diagnosis and appropriate treatment.