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La nefrectomia parcial ha proporcionado múltiples beneficios principalmente en pacientes con lesiones renales de pequeño tamaño o con enfermedades que puedan afectar el funcionamiento renal a largo plazo, también en pacientes con riñón único funcional, ya sea congènita o por cirugía, enfermedad renal terminal, tumores renales bilaterales o con enfermedades cromosómicas que afecten la función renal.Se presenta el caso de un paciente de 52 años con un tumor de riñón derecho de 10 cm de diámetro en región interpolar, con riñón izquierdo sin función, por proceso obstructivo de estenosis ureteropielica congènita. Se realizó nefrectomia parcial derecha a pesar de la localización y tamaño del tumor renal, obteniendo excelentes resultados oncológicos y funcionales. Con un seguimiento a doce meses de evaluación post-operatoria sin datos de actividad tumoral, presentando una función renal con creatinina 1.6 mg/dl, con evolución satisfactoria. Conclusiones: La nefrectomia parcial es el manejo ideal para tumores renales pequeños que están localizados en la corteza renal y en los extremos polares del riñón o con un riñón contralateral sin función; pero hay el dilema cuando se presentan en pacientes con función renal baja o tumores localizados cerca del hilio renal de más de 5 cm de diámetro, se debe tomar los riesgo de intentar realizar este procedimiento, el abordaje por via laparoscópica es excelente opción con excelentes resultados, con menor riesgo de complicaciones, y menor sangrado que cirugía abierta.
Nephron-sparing surgery (partial nephrectomy) has provided multiple benefits, mainly in patients with small kidney lesions or concomitant diseases that affect overall kidney function in long term, also in patients with a single functional kidney, either congenital or by surgery, end-stage renal disease, bilateral renal tumors or with chromosomal diseases that affects the renal function. The case of a 52-years-old male patient is presented with a 10-cm right kidney tumor in the interpolar region, with not functional left kidney exclusion due to an obstructive process by congenital ureteropyelic stenosis. Right nephron-sparing nephrectomy was performed despite the location and size of the tumor, obtaining excellent oncological and functional results. Follow-up at twelve months of postoperative evolution showed no data of tumor activity, presenting renal function with creatinine of 1.6 mg/dl, with satisfactory evolution. Conclusions: Partial nephrectomy is the standard management for small-volume renal tumors located in the renal cortex and polar areas, or not functional contralateral kidney; but there is the dilemma, when patients appear with impaired renal function or tumors located near the renal hilum by > 5 cm of diameter, the risk of performs this procedure must be taken, the laparoscopic approach is an excellent option. with great results, and minor bleeding than open surgery.
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Abstract Introduction: Identifying the imaging features of renal tumors in pediatric population allows reaching more accurate diagnoses and implementing more appropriate treatments. Objective: To describe the imaging findings of renal tumors in children and to assess the association between imaging findings and histological diagnosis of Wilms tumors versus Non-Wilms tumors, and between imaging features and intraoperative rupture of Wilms tumors, as well as the level of agreement between radiological and histological diagnosis (Wilms vs. Non-Wilms tumor). Materials and methods: Cross-sectional study conducted in 47 children with a pathological diagnosis of kidney tumor and treated between 2012 and 2018 in a pediatric hospital in Bogotá D.C., Colombia. The patients' medical records, as well as their ultrasound, tomography and magnetic resonance studies were reviewed. Two univariate logistic regression analyses were performed to assess the association between imaging findings and histopathological diagnosis and between imaging features and intraoperative rupture of Wilms tumors, calculating the respective Odds Ratio (OR) with a 95% confidence interval. In addition, the level of agreement between radiological and histological diagnosis was determined using the Cohen's kappa coefficient. Results: A significant association was found between histological diagnosis of Wilms tumor and the presence of necrosis, tumor enhancement, pseudocapsule, rupture signs, tumor volume and tumor size (OR: 21.6, 15.17, 14.57, 8.21, 7.93, and 4.37, respectively; p<0.05). An association between having Wilms tumors and a lower frequency of metastases was also found (OR: 0.19; p<0.05). The kappa coefficient between radiological diagnosis of Wilms/non- Wilms tumors and histological diagnosis was 0.78 (CI95%: 0.59-0.96; p<0.05). Additionally, Wilms tumors volumen was significantly associated with the occurrence of rupture (OR: 3.08; p<0.05). Conclusions: There are imaging findings such as necrosis, tumor enhancement and tumor volume that can help predict the histological diagnosis of Wilms tumors, as well as perioperative rupture. In addition, a moderate to very good concordance between radiological diagnosis of Wilms/non-Wilms tumors and histological findings was found.
Resumen Introducción. Identificar las características por imagen de los tumores renales en la población pediátrica permite realizar diagnósticos más precisos e implementar tratamientos más apropiados. Objetivo. Describir los hallazgos de imagen de tumores renales en niños y evaluar la asociación entre hallazgos imagenológicos y el diagnóstico histopatológico de tumores de Wilms versus tumores no Wilms, y entre las características de imagen y ruptura quirúrgica de tumores Wilms, así como el grado de concordancia entre el diagnóstico radiológico e histológico. Materiales y métodos. Estudio transversal realizado en 47 niños con diagnóstico patológico de tumor renal atendidos entre 2012 y 2018 en un hospital pediátrico de Bogotá D.C., Colombia. Se revisaron las historias clínicas de los pacientes, así como sus estudios de ultrasonografía, tomografía y resonancia magnética. Se realizaron dos análisis de regresión logística univariados para evaluar la asociación entre hallazgos imagenológicos y diagnóstico histopatológico y entre las características imagenológicas de los tumores de Wilms y ruptura quirúrgica, calculando los respectivos odds ratio (OR) con un intervalo de confianza del 95%. Además, se determinó el grado concordancia entre el diagnóstico radiológico e histopatológico mediante el coeficiente de kappa de Cohen. Resultados. Se encontró una asociación significativa entre el diagnóstico histológico de tumor de Wilms y la presencia de necrosis, realce tumoral, pseudocápsula, signos de ruptura, volumen y tamaño del tumor (OR: 21.6, 15.17, 14.57, 8.21, 7.93 y 4.37, respectivamente; p<0.05). También se observó una asociación entre tener tumores de Wilms y menor frecuencia de metástasis (OR:0.19; p<0.05). El coeficiente de Kappa entre el diagnóstico radiológico de los tumores (Wilms/no-Wilms) y el diagnóstico histológico fue 0.78 (IC95%: 0.59-0.96; p<0.05). Además, el volumen de los tumores de Wilms se asoció significativamente con la ocurrencia de ruptura (OR: 3.08; p<0.05). Conclusiones. Hay hallazgos imagenológicos como la necrosis, el realce tumoral y el volumen tumoral que ayudan a predecir el diagnóstico histológico de tumores de Wilms, así como la ruptura perioperatoria. Además, se observó una muy buena concordancia entre el diagnóstico radiológico de tumores Wilms/no Wilms y los hallazgos histológicos.
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Objective:To analyze the MRI characteristics of surgical resected renal angiomyolipoma (AML) smaller than 4 cm.Methods:A total of 112 patients with surgical pathology confirmed renal AML of which the maximum diameter was smaller than 4 cm were analyzed retrospectively in the First Medical Centre, Chinese PLA General Hospital from January 2014 to November 2020, 5 of which were epithelioid angiomyolipoma (EAML) patients. According to the presence or absence of visible fat in lesions on MRI, the lesions were divided into AML with fat group and AML without visible fat (AML wovf) group. The MRI features were evaluated, including maximum diameter, location, growth pattern, shape, beak sign, angular interface with renal parenchyma, pseudo-capsule, hemorrhage, cystic degeneration, coagulative necrosis, flowing void in the tumor, signal intensity and homogeneity on T 2WI and diffusion weighter imaging (DWI), the peak enhanced phase. The differences of maximum diameter of AML with fat and AML wovf were analyzed using Mann-Whitney U test, and the differences of MRI features were analyzed using χ 2 test or Fisher′s exact probability test. Results:There were 123 lesions found in 112 patients, and 96 lesions contained fat and 27 lesions were AML wovf. 82 lesions showed round and round-like shapes, 112 lesions showed exophytic growth pattern, 71 lesions with peak enhancement in corticomedullary phase. And the numbers of lesions with angular interface with renal parenchyma, beak sign, cystic degeneration, pseudo-capsule, hemorrhage were 30, 49, 1, 1, 1, respectively. There was no coagulative necrosis in all lesions. Compared with AML with fat, AML wovf was single lesion. The diameters of AML with fat and AML wovf were 2.5 (1.7, 3.5) and 1.8 (1.4, 2.3) cm respectively, with statistically significant difference ( Z=-2.80, P=0.005). In the AML with fat and AML wovf, 65 and 12 cases were heterogeneous in T 2WI, 44 and 5 lesions showed beak sign, 26 and 4 lesions showed angular interface with renal parenchyma, 57 and 10 cases were heterogeneous in DWI. And there were 5 and 6 lesions showed the endophytic, 44 and 8 lesions showed partly exophytic, 47 and 13 lesions showed exophytic in patterns of tumor growth respectively. The beak sign, homogeneous in T 2WI and DWI, patterns of tumor growth showed statistical differences in AML with fat and AML wovf (all P<0.05), and there was no significant difference in other features ( P>0.05). A total of 5 EAML patients were with 8 lesions. One patient had 4 lesions with fat, other patients had single lesion in which 2 lesions with fat, 2 lesions without visible fat. One lesion without visible fat showed hemorrhage. Conclusions:Surgical resected AML smaller than 4 cm is often exophytic round and round-like, enhanced in corticomedullary phase, showing angular interface with renal parenchyma and beak sign, with rare cystic degeneration, pseudo-capsule, hemorrhage and improbable coagulation necrosis. AML wovf is single smaller lesion which often shows endophytic growth pattern, and beak sign is infrequent. EAML seems to be present in two modes, multiple lesions with fat and AML wovf with hemorrhage.
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Objective:To explore the mechanism by which microRNA (miRNA) -1303 inhibits the proliferation and migration of renal cell carcinoma 786-O cells through targeted regulation of lysophosphatidic acid receptor 3 (LPAR3) expression.Methods:quantitative real-time polymerase chain reaction (qRT-PCR) was used to detect the relative expression of miR-1303 in renal cancer cell lines (A498, ACHN, 786-O, OS-RC-2) and normal renal tubular epithelial cells HK-2. The miR-1303 mimic and the negative control sequence were transfected into the renal cancer cells with the lowest expression of miR-1303, respectively, as the miR-1303 group and the negative control group. qRT-PCR detected the relative expression of miR-1303 in the two groups of cells. MTT method and Transwell migration experiment were used to detect cell proliferation and migration ability. RegRNA 2.0 predicted the target genes of miR-1303. The dual luciferase reporter gene detected the binding of miR-1303 to the target gene. qRT-PCR and Western blotting detected the relative expression of LPAR3. Measurement data were expressed as mean±standard deviation ( ± s), t-test was used for comparison between two groups, and one-way analysis of variance was used for comparison between multiple groups. Results:The expressions of miR-1303 in renal cancer cell lines A498, ACHN, 786-O, OS-RC-2 and normal renal tubular epithelial cells HK-2 were 0.51±0.04, 0.79±0.02, 0.21±0.04, 0.55±0.07 and 1.00±0.05, the expression of miR-1303 in renal cancer cell lines was lower than that in HK-2 ( P<0.05), and the relative expression in 786-O cells was the lowest ( F=29.50, P<0.01). Compared with the control group, the expression of miR-1303 in the experimental group was significantly increased [(1.00±0.01) vs (7.98±0.88), t=7.95, P<0.01]. The cell absorbance value of the experimental group was significantly lower than that of the control group ( P<0.05). The number of cell migration in the experimental group was significantly lower than that in the control group ( P<0.05). miR-1303 can bind to LPAR3 mRNA in a complementary pair ( P<0.01). Compared with the control group, the expression of LPAR3 mRNA in the 786-O cells of the experimental group was significantly reduced [(1.00±0.01) vs (0.23±0.03), t=23.56, P<0.01]. Conclusion:miR-1303 may inhibit the proliferation and migration ability of renal cancer 786-O cells by down-regulating the expression of LPAR3.
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Introduction:Renal oncocytomas are benign tumours arising from the intercalated cells of the collecting ducts and account for 3% to 7% of primary renal tumours. It was first described by Zippel in 1942. Oncocytomas are mostly asymptomatic and often discovered incidentally. They are often diagnosed postoperatively due to clinical and radiographic challenges in differentiating them from renal cell carcinoma. Presentation of Case:The present study reports two cases of renal oncocytoma in a 61-year-old man who was asymptomatic and a 73-year-old woman who was symptomatic. Relevant clinical and imaging data on the two patients were reviewed. Both patients underwent nephrectomy via flank incisions. Discussion:The typical morphologic features of oncocytoma were observed on histological examination of the excised kidney specimens. The postoperative course of each patient was uneventful and they were discharged 14 and 6-days post-surgery, respectively. In addition, the present study reviews the literature regarding the clinical, radiological and pathological characteristics of renal oncocytoma.Conclusion:Renal oncocytoma though is benign and has an excellent prognosis, the preoperative diagnostic challenges invariable warranted radical nephrectomy.
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Objective: To investigate the expression and biological functions of cold inducible RNA binding protein (CIRBP) in renal cancer. Methods: Bioinformatics analysis of microarray in Gene Expression Omnibus (GEO) and gene sequencing data in The Cancer Genome Atlas (TCGA) was used to analyze the expression of CIRBP mRNA in renal cancer, further the expression level of CIRBP gene in 20 cases of renal cancer tissues and 3 kinds of renal cancer cell lines was identified by real-time fluorescent quantitative PCR. The renal cancer 786-O and CAKI-1 cells were transfected with the CIRBP overexpression plasmids, then the cell proliferation viability was detected by MTT assay and cell clone formation assay. The migration ability of renal cancer cells was detected by Transwell chamer, and the expressions of cell migration-related protein N-cadherin, E-cadherin and protein kinase B (PKB, also known as AKT) pathway-related proteins were detected by Western blotting. Results: The expression level of CIRBP in renal cancer tissues was significantly lower than that in the adjacent normal tissues. The prognosis of patients with high expression of CIRBP mRNA was significantly better than that of the patients with low expression of CIRBP. The proliferation and clone formation of renal cancer 786-O and CAKI-1 cells transfected with CIRBP overexpresion plasmids were significantly inhibited (all P 0.01). The number of renal cancer 786-O and CAKI-1 cells migrated through the membrane in CIRBP overexpression group was less than that in the control group (all P 0.01). In the 786-O and CAKI-1 cells with CIRBP overexpression, the expression level of migration-related protein N-cadherin was significantly decreased, the expession level of E-cadherin was significantly increased, while the expressions of AKT pathwayrelated phospho-AKT (p-AKT) and phospho-glycogen synthasc kinase 3β (p-GSK3β) proteins were decreased significantly (all P 0.05). Conclusion: CIRBP is down-regulated in renal cancer, and inhibits the proliferation and migration of renal cancer cells. CIRBP can be used as a potential clinical diagnosis target and prognostic marker for renal cancer.
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Objective: To assess the role of the arterial based complexity (ABC) scoring system in predicting clinically relevant outcomes of minimally invasive partial nephrectomy (MIPN). Methods: A retrospective review of 161 renal cell carcinoma patients who under-went MIPN at Tianjin Medical University Cancer Institute and Hospital from June 2016 to January 2018 was performed. The ABC score, including grades 1, 2, 3S, and 3H, were based on the patients'enhanced preoperative abdominal CT images. The reproducibility of the ABC scoring system was evaluated, and the relationship between the ABC score and patients'pathological features, surgery-related variables, postoperative complications, and renal function was analyzed. Results: Patients in grades 1, 2, 3S, and 3H in this study ac-counted for 20.5% (33/161), 60.2% (97/161), 11.8% (19/161), and 7.5% (12/161), respectively. The average Kappa value of the physi-cian's score was 0.523, and the average exact match percentage was 70.2%. The ABC score was significantly associated with operative time, warm ischemia time (WIT), estimated blood loss (EBL), and tumor size (P<0.001 for all) and was not associated with postopera-tive hospital stay, postoperative complications, preoperative estimated glomerular filtration rate (eGFR), and eGFR at 3 and 6 months postoperatively (P>0.05 for both). Conclusions: The ABC score is a scoring system with good repeatability and has certain predictive significance for the complexity of MIPN. However, further research is needed for its clinical application.
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Objective@#To detect the values of CT texture features in the preoperative prediction of Fuhrman grade of clear cell renal cell carcinoma (ccRCC).@*Methods@#The CT data of 206 patients with ccRCC admitted to the Third Affiliated Hospital of Soochow University from January 2011 to December 2016 were retrospectively analyzed, and the ccRCC cases were graded using Fuhrman grading system, including 38 cases of Grade Ⅰ, 107 cases of Grade Ⅱ, 50 cases of Grade Ⅲ and 11 cases of Grade Ⅳ. All subjects undergone plain and enhancement CT scans. There were two methods used for the extraction of texture features, including histogram (2 features: Kurtosis and Skewness) and gray-level co-occurrence matrix (6 features: Contrast, Correlation, Energy, Entropy, Homogeneity and Variance). Each texture feature during Grade Ⅰ to Ⅳ was compared using a one-way analysis of variance following the log-ratio transformation, and a Newman-Keuls test was performed for all pairwise comparisons. An independent sample t test was used to find the differences of each texture feature between low (Grade Ⅰ+Ⅱ) and high grade (Grade Ⅲ+Ⅳ) ccRCC. A Spearman Rank test was performed to quantify the correlation of each texture feature with Fuhrman grade in ccRCC. Receiver operating characteristic curve (ROC) was employed to compare the diagnostic performance of the texture features to differentiate the low grade from high grade ccRCC.@*Results@#Six texture features, including Contrast, Correlation, Entropy, Homogeneity, Variance and Kurtosis, were different during Grade Ⅰ to Ⅳ (all P<0.05) with the exception of the two features of Energy and Skewness (all P>0.05). Furthermore, five textures, such as Correlation, Entropy, Homogeneity, Variance and Kurtosis, were not significantly different between Grade Ⅲ and Ⅳ ccRCC. There was no clinical application value for the features of Correlation, Energy, Entropy, Variance and Skewness with the absolute coefficients of<0.3, in contrast, the correlation coefficients were -0.54, 0.39 and 0.32 for the features of Contrast, Homogeneity and Kurtosis, respectively (all P<0.05). Compared with that in the low grade ccRCC, the values of Contrast and Variance reduced in the high grade ccRCC (all P<0.05), while the values of Kurtosis, Correlation and Homogeneity increased significantly in the high grade ccRCC (all P<0.05), and no difference was found for the features of Skewness, Energy and Entropy between the low and high grade ccRCC (all P>0.05). When those features were used to differentiate the high from low grade ccRCC, the Contrast exhibited the biggest area under ROC of 0.806 (P<0.05), followed by the Correlation of 0.641, Homogeneity of 0.687, Kurtosis of 0.668 and Variance of 0.659.@*Conclusion@#CT texture features can preoperatively predict the Fuhrman grade of ccRCC, and the Contrast will likely be the potential imaging biomarker for the clinical application.
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Objective To investigate CT and MRI findings of primary malignant fibrous histiocytoma (MFH)in the kidney. Methods The clinical data and imaging findings of 7 patients with primary renal MFH proved by histopathology were reviewed retrospectively.Results Tumors were unilateral in all patients,in which 5 cases were in the left kidney and 2 cases in the right kidney.The maximum diameter of the lesions ranged from 3.5 to 17.1 cm,with a mean of (8.7±3.9)cm.All the masses showed shallow lobulated or oval, with obscure boundary.On CT plain scan,heterogeneous isodensity/hypodensity were showed in 7 cases,necrosis occured in 7 cases, intratumoral hemorrhage in 2 cases and calcification in 3 cases.MRI also showed heterogeneous signal intensity.No obvious pseudocapsule was found in 6 cases.On dynamic contrast enhancement scan mild-moderate progressive enhancement was showed in corticomedullary and parenchymal phase in all 7 cases.In delay phase slightly decreased enhancement were showed in 5 cases,and similar or slightly higher enhancement corresponding to the parenchymal phase was showed in 2 cases.However,lower enhancement was showed in the tumors on all 3 phases than that in the renal cortex.Besides,the tumors invaded the renal vein (n=1)and the adjacent structure (n=3).Conclusion No specific imaging findings of primary renal MFH are found.The dynamic contrast enhancement might be helpful for its diagnosis to some extent,and clinical data should be integrated with imaging findings together to differentiate renal MFH from other renal neoplasms.The final diagnosis relies on pathology and immunohistochemistry examination.
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Purpose To investigate the clinicopathological features, immunophenotype, molecular genetic alteration in multilocular cystic clear cell neoplasm of low malignant potential. Methods 17 cases of multilocular cystic clear cell neoplasm of low malignant potential with complete clinical data, systematic measurement and follow-up were retrospectively studied. Histopathological evaluation and immunophenotyping were examed by HE staining and EnVision two steps methods, chromosome 3p deletion was analyzed by interphase fluorescence in situ hybridization. Results In 17 cases, there were 12 males and 5 females, and the ratio of male and female was 2.4: 1. The prevalence age was at a range of 28-73 years, and the average age is54 years. Mostly of them were found by incidental or physical exmanination. Microscopically, most cysts were lined by a single layer of tumor cells with clear cytoplasm, small nuclear, and no obvious nucleoli. According to WHO/ISUP nuclear grade, they were level I. Clear cell groups similar to cells lined cysts were seen within the fibrous septa. Immunohistochemically, tumor cells were positive for CK(AE1/AE3), CK7, EMA, vimentin, CD10, CAIX, PAX-2, and PAX-8, but negative for CD68. Ki-67 index were less than 10％. The loss of heterozygosity of 3p chromosome was detected in 11 cases and the rate of the loss of heterozygosity was 64.7％. Conclusion Multilocular cystic clear cell neoplasm of low malignant potential is a relatively rare type of renal cell carcinoma with low malignant potential and a good prognosis. It is suggested that tumor cells may be derived from tumor stem cells with pluripotent potential in renal tubules based on the immunophenotypes. Multilocular cystic clear cell renal cell carcinoma and renal clear cell carcinoma is similar in immunophenotype and molecular genetics, which suggesting that it may be a special histologic subtype of renal clear cell carcinoma.
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RESUMEN Introducción: el cáncer renal es una patología que, al igual que otras neoplasias, si se diagnostica tempranamente puede tener un mejor pronóstico. La variabilidad clínica es un factor que puede afectar su diagnóstico. Objetivo: evaluar el nivel de conocimientos y las percepciones de los médicos oncólogos clínicos ecuatorianos sobre el cáncer renal metastásico. Metodología: se realizó un estudio de corte transversal. La información fue recolectada a través de una encuesta diseñada para esta investigación. Resultados: la variabilidad de conocimientos de los profesionales fue baja, la experiencia en su práctica asistencial con medicamentos complejos es amplia, principalmente con sunitinib, la decisión de manejo sistémico del cáncer metastásico se consigue a partir de grupos de pares o multidisciplinarios, pero siempre se priorizan criterios clínicos antes que administrativos. Conclusiones: los oncólogos tienen baja variabilidad en los conocimientos y amplia experiencia en el uso de medicamentos complejos, sin embargo, la situación de acceso a medicamentos de alto costo es un factor presente en la mayoría.
ABSTRACT Introduction: Renal cancer is a pathology that, like other neoplasms, if it is early diagnosed, it can have a better prognosis. The clinical variability is a factor that could affect its diagnosis. Objective: To evaluate the knowledge level and the perceptions about metastatic renal cancer of the Ecuadorian clinical oncologists. Methodology: This was cross-sectional study. The information was collected using a survey designed for this research study. Results: The variability in the knowledge of the professionals was low. Their experience in their care practice with complex medicines was wide, specially with sunitinib. The decision of systemic handling of the metastatic cancer was achieved from peers or multidisciplinary groups but always clinical criterion were prioritized over the administrative ones. Conclusions: The oncologists had low variability in their knowledge and wide experience in the use of complex medicines, however, the situation of access to high cost medicines was a factor present in the majority.
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Purpose To investigate the expression of RSK4 (ribosomal S6 protein kinase 4),CD44 and MMP-9 protein in primary renal cell carcinoma (pRCC) and metastatic renal cell carcinoma (mRCC),and to explore the level of expression as well as the association with clinicopathologic features and clinical outcome.Methods The expression of RSK4,CD44 and MMP-9 in 52 pRCC and 48 mRCC samples was detected by immunohistochemistry and its relationship with clinicopathologic features as well as prognosis was analyzed by statistical methods.Results In the 48 mRCC samples,there were 36 (75％,36/48),33(68.75％,33/48) and 44 (91.7％,44/48) positive for RSK4,CD44 and MMP-9,respectively,while the positive rate in 52 pRCC samples were 23 (44.2％,23/52),18 (34.6％,18/52) and 36 (69.2％,36/52),respectively.Statistical analysis showed that the expression of RSK4,CD44 and MMP-9 in mRCC samples was higher than the pRCC samples (PRsK4 =0.002,PMMP-9 =0.002,PcD44 =0.001).Furthermore,the expression of RSK4,CD44 and MMP-9 in mRCC samples was not correlated with ages,genders,Fuhrman grading and the metastatic sites (P ＞ 0.05).Further analysis showed that there was positive correlation among the three proteins (P =0.008),particularly,the expression of RSK4 and CD44 (P =0.019),MMP-9 and CD44 (P =0.05) were positively correlated,while the expression of RSK4 and MMP-9 (P =1.00) had no significance of correlation.Conclusion The expression of RSK4,CD44 and MMP-9 in mRCC samples is significantly higher than pRCC samples,suggesting that the three may mediate the metastasis of renal cell carcinoma,and its specific mechanism of action remains to be further studied.
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Objective To identify the imaging performance and differences between type] and type Ⅱ papillary renal cell carcinoma (PRCC).Methods Data of 21 lesions of type Ⅰ,27 lesions of type Ⅱ (1 patient had 2 lesions) in 47 patients was retrospectively analyxed.All patients with pathologically proven PRCC were examined by contrast CT or MRI preoperatively.The morphological features,outside invasion signs and performance on contrast-enhanced CT were compared by qualitative and quantitative studies.The maximum diameter of tumors and CT values,△CT values in corticomedullary and nephrographic phase were analyzed by two-sample t-test,classified variable were compared by the Pearson X2 test or the Fisher exact test.Results On morphological behaviors,type Ⅱ PRCC were significantly larger than type Ⅰ PRCC (t =-2.604,P =0.013),more heterogeneous (X2 =14.928,P =0.000),greater probability to show cystic degeneration or necrosis (X2 =5.598,P =0.018) with more severity (X2 =4.769,P =0.029).There was no significant difference in hemorrhage and calcification between the two types observed by contrast-enhanced CT.Respectively,66.7 ％ of type Ⅱ PRCC and 23.8％ of type Ⅰ PRCC had papillary nodule,with obviously significant difference (X2 =8.694,P =0.003).In outside invasion signs,except for margins,type Ⅱ had more easily invaded peripheral fat,renal sinus and distant metastasis compared with type Ⅰ (P＜0.05).On contrast enhanced CT,there were significant differences in CT values and △CT values in corticomedullary phase between the two types (t =-2.674,P =0.012;t =-3.109,P =0.005).And there were no significant difference in unenhanced and nephrographic phase.Conclusions There were certain difference in morphological features,outside invasion signs and enhancement degree between type Ⅰ and type Ⅱ PRCC,and part of type Ⅱ PRCC had aggressive biological behaviors with worse prognosis.
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Objective To evaluate the feasibility and clinical efficacy of intraperitoneal laparoscopic partial nephrectomy for T1a peripheral renal neoplasms. Methods Intraperitoneal laparoscopic partial nephrectomy was performed without renal artery occlusion for T1a peripheral peripheral renal neoplasms. The operative time, bleeding volume and complications were observed and the clinical experience was summarized. Results From October 2014 to January 2017 ,there were 10 patients:7 males and 3 females. All patients had T1a peripheral renal tumors. 10 patients underwent operation successfully ,of which 1 case developed temporarily blocked renal artery in the surgery due to hemorrhage. There was no referral during surgeries. The operative duration was 108 to 210 min,with a median of 135 min. The estimated blood loss was 100 to 750 mL,with a median of 320 mL. Followed up duration was 2 to 24 months (median 12 months),there were not postoperative renal secondary bleeding , leakage and other complications. No recurrence of tumor was found. Conclusion It is feasible and safe to exercise intraperitoneal laparoscopic partial nephrectomy without renal artery occlusion in the treatment of T 1a peripheral renal tumors,which can protect renal function to the greatest extent.
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Objective To investigate the feasibility and advantages of five skills summarized by relative motion theory in reducing difficulty of suturing the kidney during retroperitoneal laparoscopic partial nephrectomy. Methods We retrospectively analyzed the clinical data of 89 patientsundergoing retroperitoneal laparoscopic partial nephrectomy in the Department of Urology of Changhii Hospital, Second Military Medical University between Jan. 2014 and May 2016. There were 42 cases in the control group and 47 cases in the skill group. Five skills including “move, add, push, pull, and shitt” were strictly applied to reconstruct the kidney in the skill group, but not fully used in the control group. Warm ischemic time, operation time, intra-operative blood loss, renal function and complications were compared between the two groups during and after operation. Results The operations were successfully completed in all the 89 cases. The average warm ischemic time was (22. 4 ± 4. 9) min and the operation time was (96. 0±11. 6) min in the skill group; while those in the control group were (24. 5 ± 4. 8) min and (102. 0 ± 13. 7) min, respectively, and the differences between the two groups were statistically significant (P<0. 05). There were no significant differences in the intra-operative blood loss, blood transfusion or artery injury between the two groups. No complications such as urine leakage or post-operative bleeding were observed in either groups. Conclusion The five skills summarized by relative motion theory are clinically feasible and safe in retroperitoneal laparoscopic partial nephrectomy, and can shorten operation time and renal warm ischemic time.
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Objective@#To investigate the expression of LIM and SH3 protein 1 (LASP1) in renal cell carcinoma and its significance in the invasion and migration of renal clear cell carcinoma 786-O cell line.@*Methods@#The expression level of LASP1 in 41 cases of renal cell carcinoma tissues and normal renal tissues was analyzed by immunohistochemistry. The relationship between the expression level of LASP1 and clinical characteristics was further analyzed. Expression of LASP1 in 10 cases of tumor tissues with or without lymph node metastasis was analyzed by Western blot. Furthermore, small interfering RNA (siRNA) targeting LASP1 was constructed and transfected into 786-O cells to downregulate LASP1 expression. The interference effect of LASP1 siRNA on LASP1 protein and the expression of related proteins in epithelial mesenchymal transition (EMT) pathway were detected by Western blot. The effects of LASP1 knockdown on cell proliferation, migration and invasion and gene expression were then assessed using CCK8 assay, transwell cell migration system and western blot analysis, respectively.@*Results@#The positive rate of LASP1 expression in renal clear cell carcinoma tissues was 90.2% (37/41), which was significantly higher than that in the adjacent tissues (29.3%, P=0.002). The expression of LASP1 in renal cell carcinoma was positively correlated with lymph node metastasis and TNM stage of renal cell carcinoma (P<0.05). The results of Western blot showed that LASP1 (0.696±0.053) was highly expressed in renal cell carcinoma (1.459±0.628), especially in cases with lymph node metastasis (2.692±0.186, P<0.05). The LASP1 siRNA remarkably down-regulated the expression of LASP1 protein in 786-O cells. The abilities of proliferation, invasion and migration of 786-O cells were decreased significantly in the LASP1 siRNA groups.The relative expression of E-cadherin protein in the siRNA group (0.848±0.020) was significantly higher than those in the siRNA-NC group (0.671±0.018) and control group (0.691±0.037, P<0.05). The relative expression of N-cadherin protein in the siRNA group (0.449±0.047) was significantly lower than those in the siRNA-NC group (0.613±0.018) and control group (0.633±0.045, P<0.05). The relative expression of vimentin protein in the siRNA group (0.477±0.029) was significantly lower than those in the siRNA-NC group (0.598±0.069) and control group (0.633±0.045, P<0.05 for both).@*Conclusions@#LASP1 is highly expressed in renal clear cell carcinoma, which is closely related to the development of the cancer. The effects of LASP1 on the invasion and migration of 786-O cells and lymph node metastasis may be related to the EMT.
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Objective@#To detect the high mobility group A2 (HMGA2) expression in renal carcinoma, and to explore the relationship with clinicopathological features and its significance for prognosis.@*Methods@#50 renal carcinoma specimens, 50 corresponding adjacent normal kidney tissue samples, and 40 benign renal tumor specimens were used in this study. The expressions of HMGA2 mRNA and protein were detected by RT-PCR, Western blot and immunohistochemical assays, and its relationship with clinicopathological features and prognosis in the renal carcinoma patients was analyzed.@*Results@#The RT-PCR results showed that the relative expression levels of HMGA2 mRNA in the renal carcinoma, benign renal tumor tissues, and adjacent normal renal tissues were 0.84±0.23, 0.19± 0.06 and 0.08±0.04, respectively, and the expression in renal carcinoma tissue was significantly higher than those of the other 2 groups (P<0.01). The Western blot results showed that the relative expression levels of HMGA2 protein in the renal carcinoma, benign renal tumor tissues, and adjacent normal renal tissues were 0.91±0.24, 0.12±0.04 and 0.03±0.01, respectively, and the expression in renal carcinoma tissue was significantly higher than those of the other 2 groups (P<0.01). Immunohistochemical results showed that the expression of HMGA2 protein exhibited brown and tan granular, which mainly distributed in the cell nuclei. Among the 50 cases of renal carcinoma, 34 cases exhibited positive expression, with a positive rate of 68.0%. Among the 40 cases of benign tumor tissues, 3 cases had positive expression, with a positive rate of 7.5%, while among the 50 cases of adjacent normal renal tissues, there was only 1 case exhibiting positive expression of HMGA2 protein, with a positive rate of 2.0%. The protein expression of HMGA2 was significantly higher in the renal carcinoma than in the benign tumors and normal renal tissues (P=0.004). There was no statistically significant difference in the association of HMGA2 protein expressions with age, sex, tumor size and histological type (P>0.05), while significant difference did exist in the association with different statuses of TNM staging and lymph node metastasis (P<0.05). The median time to progression (TTP) in 34 HMGA2 protein-positive patients was (22.36±1.48) months and that of 16 HMGA2 protein-negative patients was (34.55±1.87) months (P<0.05).@*Conclusions@#HMGA2 plays an important role in the tumorigenesis and development of renal carcinoma, and may be used as an important predictor for estimating the prognosis of renal carcinoma. HMGA2 might become a new diagnostic and prognostic marker for renal carcinoma.
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Objective: To screen the differentially expressed proteins in clear cell renal cell carcinoma (ccRCC), and to investigate its clinical significance. Methods: The differentially expressed proteins in 15 cases of ccRCC and their adjacent renal tissues were screened by two-dimensional fluorescence difference in gel electrophoresis combined with mass spectrometry (2-D DIGE-MS). The expression levels of differentially expressed proteins screened by 2-D DIGE-MS in 45 cases of ccRCC and their adjacent tissues were examined by Western blotting. The expression levels of this differentially expressed proteins in 152 specimens of ccRCC and 40 specimens of adjacent tissues were detected by immunohistochemistry. The correlations of this protein expression with the clinicopathologic features and prognosis of ccRCC patients were analyzed. Results: Proteomics screening results showed that the expression level of peroxiredoxin 4 (PRDX4) was significantly different in ccRCC and its adjacent tissues; compared with the adjacent tissues, PRDX4 expression was significantly down-regulated in ccRCC tissues (P 0.05). The patients with lower expression of PRDX4 had high grade of ccRCC (? = -0.211, P = 0.009) and distant metastasis (? = -0.161, P = 0.048). The 5-year survival rates of patients with positive and negative expression of PRDX4 were 75.3% and 62.7% (P = 0.862), respectively. Conclusion: PRDX4, as a differentially expressed protein in ccRCC, may be involved in the formation and development of renal cancer, and its down-regulation is correlated with the increased malignancy of ccRCC.
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Purpose To investigate the value of Cyclin D1 and claudin 7 expression in the differential diagnosis of renal epithelial tumors.Methods The expression of Cyclin D1 and claudin7 was detected by immunohistochemical staining with tissue microarray.Totally 309 cases of renal epithelial tumors and 20 cases of normal renal tissues were collected for immunohistochemical staining.Comparative analysis for the values of Cyclin D1 and claudin 7 was performed on the diagnosis and differential diagnosis of renal tumors.Results The positive rates of Cyclin D1 in renal oncocytoma (RO),chromophobe renal cell carcinoma (ChRCC),clear cell renal cell carcinoma (CCRCC),papillary renal cell carcinoma (PRCC),Xp11.2 translocation/TFE3 gene fusion associated renal cell carcinoma (Xp11.2/TFE3) and clear cell tubulopapillary renal cell carcinoma (CCTPRCC) were 86.2％ (50/58),8.2％ (4/49),70.0％ (98/140),8.8％ (3/34),42.9％ (6/14),and 71.4％ (10/14),respectively.The positive rates of RO were significantly different from those of ChRCC and PRCC (x2 =64.72,52.56,P ＜0.000 1).Significant differences in positive rates of CCRCC and ChRCC (x2 =55.87,P ＜ 0.000 1),PRCC and Xp11.2/TFE3 (X2 =4.28,P=0.039),CCTPRCC and ChRCC (x2 =21.69,P ＜0.000 1)were also observed.The positive rates of claudin 7 in RO,ChRCC,CCRCC,PRCC,Xp11.2/TFE3 and CCTPRCC were 20.7％ (12/58),87.8％ (43/49),8.6％ (12/140),50％(17/34),14.3％ (2/14),and 57.1％ (8/14),respectively.There were significant differences in positive ratios of RO and ChRCC (x2 =47.82,P ＜ 0.000 1),CCRCC and CCTPRCC(x2 =26.57,P ＜0.000 1),PRCC and Xp11.2/TFE3 (x2 =5.29,P ＜ 0.05).The sensitivity and specificity of Cyclin D1 +/claudin 7-immunophenotype for RO were 69％ and 95.9％ respectively.The diagnostic sensitivity and specificity of Cyclin D1-/claudin 7 + for ChRCC were 83.7％ and 96.6％.In the identification of CCRCC and CCTPRCC,the sensitivity and specificity of Cyclin D1 +/claudin 7-for CCRCC were 65.7％ and 71.4％,and the diagnostic sensitivity and specificity of Cyelin D1 +/claudin7 + for CCTPRCC were 42.9％ and 95％.Conclusion The differential expression of Cyclin D1 and claudin7 in RO and ChRCC,CCRCC and ChRCC,PRCC and Xp11.2/TFE3 suggests that combined detection of two proteins provides an important assistance for the identification of these renal epithelial tumors.
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INTRODUCCIÓN: El carcinoma papilar de células renales es el segundo tipo más común de los canceres renales, representando el 5-15 por ciento . Los síntomas son inespecíficos. Generalmente, son bien circunscritos, poseen necrosis y degeneración quística. Es más frecuente entre la cuarta y quinta década, con una razón hombre-mujer de 2:1. Se caracteriza por un crecimiento más lento y un mejor pronóstico que otros carcinomas de células renales. CASO CLÍNICO: Masculino de 63 años, con dolor mesogástrico, crónico, severo, irradiado a flanco derecho. Tomografía Axial Computarizada muestra dos masas sólidas en polo superior e inferior de riñón derecho, de 3 cm, con componentes isodensos; a nivel de polo renal izquierdo se reconoce lesión quística simple de 70 mm. Resonancia magnética confirma lesiones descritas. Se realiza nefrectomía radical derecha. Estudio anatomopatológico concluye carcinoma de células renales Papilar bifocal tipo 1. El paciente finalmente presenta evolución satisfactoria. DISCUSIÓN: El carcinoma de células renales papilar posee baja incidencia. Se describen alteraciones cromosómicas como trisomía 7 y pérdidas cromosomales Y. Existen dos variantes, la Tipo 1 con mejor sobrevida, que muestra papilas cubiertas de una sola capa de células, y la Tipo 2 con pseudoestratificación e hipercromasia nuclear. Los estudios imagenológicos no son específicos; se ha sugerido estudios angiográficos en vista de la hipovascularidad de la lesión. El tratamiento definitivo se obtiene por nefrectomía radical dada su tendencia multifocal.(AU)
INTRODUCTION: Papillary renal cell carcinoma is the second most common type of kidney cancers, accounting for 5-15 pertcent. The symptoms are nonspecific. Generally, they are well circumscribed, with necrosis and cystic degeneration. It is most common between the fourth and fifth decade, with a male to female sex ratio of 2: 1. It is characterized by slower growth and a better prognosis than other renal cells carcinomas. CASE REPORT: Male of 63 years with mesogastric, chronic, severe pain radiating to the right flank. Computed Tomography shows two solid masses in the upper and lower pole of the right kidney of 3 cm, with isodense components; a level of left kidney pole a simple cystic lesion of 70 mm is recognized. Magnetic Resonance Imaging confirmed injuries described. Right radical nephrectomy was performed. Pathological study concludes bifocal papillary renal cell carcinoma type 1. The patient eventually presented satisfactory evolution. DISCUSSION: Papillary renal cell carcinoma has low incidence. Chromosomal abnormalities such as trisomy 7 and lost chromosomal Y are described. There are two variants, the Type 1 with better survival, shows covered buds of a single layer of cells, and the Type 2 with pseudostratification and nuclear hyperchromasia. Imaging studies are not specific, so that angiographic studies have been suggested in view of the hipovascularity of the injury. The definitive treatment is obtained by radical nephrectomy because of tendency multifocal.(AU)