Total nephrectomy with nephron-sparing surgery for a giant bilateral renal angiomyolipoma: A case report.

The current report presents the case of a 50-year-old female who presented with a giant bilateral renal angiomyolipoma (AML). After assessing the patient's symptoms, the tumor size and renal function, the patient underwent a total nephrectomy for the right AML, which measured 28×20×14 cm and nephron-sparing surgery was performed without preoperative selective angiographic embolization for a further 3 AMLs in the left kidney, the largest of which had a diameter of 12 cm. The introperative bleeding volume was at an acceptable level and the renal function was stable. No local recurrence was observed and no dialysis was required during follow-up. The strategy of the treatment in this report should be considered when treating similar tumors.

In vitro study on shRNA-mediated reduction of testis developmental related gene 1 expression and its effects on the proliferation, invasion and apoptosis of NTERA-2 cells.

Testis developmental related gene 1 (TDRG1) is a novel human testis-specific gene. TDRG1 is differentially expressed in cancerous tissue compared with normal testicular tissue and demonstrates a unique expression pattern in normal testes; therefore, this gene may be involved in the occurrence and development of testicular germ cell tumors (TGCT). In the present study, the expression level of TDRG1 was downregulated in human TGCT NTERA-2 cells by RNA interference (RNAi) in order to investigate the association between TDRG1 and TGCT. The TDRG1 mRNA and protein expression levels in NTERA-2 cells were significantly inhibited following transfection with specific RNAi plasmids. The ability to proliferate (inhibited by 15.4% at day 3 and 26.1% at day 5; P<0.001) and invade (reduced by 49.1%; P=0.01) in vitro was suppressed in cells in which the expression level of TDRG1 was reduced, and a corresponding increase in the apoptotic potential was observed (the early apoptotic potential and total apoptotic potential were increased by 75%; P=0.019 and 54.8%; P=0.009, respectively). The results of the present study indicated that the biological behavior of NTERA-2 cells is associated with TDRG1 expression levels, and that this gene may be a novel target candidate in the treatment of TGCT.

An invasive mole with bilateral kidney metastases: A case report.

Clinical reports of kidney metastases derived from an invasive mole (IM) are rare. The present study presents the case of a 42-year-old woman who exhibited IM and bilateral kidneys metastases in what may be, to the best of our knowledge, the first report of such a case. Following an induced abortion, the patient initially experienced irregular vaginal bleeding and subsequently presented with left-sided waist and abdominal pain. The patient was admitted to hospital and was clinically diagnosed with gestational trophoblastic neoplasia (GTN), as well as bilateral kidney metastases and a spontaneous rupture of the left kidney. This diagnosis was based on the patient's medical history, which comprised increased levels of human chorionic gonadotropin ß and aberrant results on computed tomography (CT) scans. The patient subsequently received conservative management to prevent renal damage, and a standard etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine chemotherapy regimen for GTN was administered. Following eight cycles of chemotherapy, a follow-up CT examination indicated that the damage in the patient's left kidney could not be corrected with conservative treatments, therefore the left kidney was excised and a laparoscopic hysterectomy was performed. The pathological results were consistent with the clinical diagnosis and allowed further classification of the primary tumor as an IM. The present case demonstrated that it is possible for IM to metastasize to the kidney, and furthermore, that this type of metastatic tumor may be fragile and possess the potential to cause spontaneous kidney rupture.

Gadolinium-enhanced magnetic resonance angiography in renal artery stenosis: comparison with digital subtraction angiography.

OBJECTIVES: To evaluate the accuracy of gadolinium-enhanced magnetic resonance angiography in assessing renal artery stenosis compared to catheter digital subtraction angiography. DESIGN: Retrospective study. SETTING: Singapore General Hospital. PATIENTS: Records of patients who underwent magnetic resonance angiography as well as digital subtraction angiography for assessment of renal artery stenosis from January 2003 to December 2005 were reviewed. RESULTS: There were 27 patients (14 male, 13 female) with a mean age of 62 (range, 44-77) years. There were 10 patients with renal transplants; their native renal arteries were not evaluated. Each of the two experienced interventional and body magnetic resonance radiologists, who were blinded to the results, reviewed the digital subtraction angiography and magnetic resonance angiography images respectively. Digital subtraction angiography was used as the standard of reference. A total of 39 renal arteries from these 27 patients were evaluated. One of the arteries was previously stented and could not be assessed with magnetic resonance angiography due to severe artefacts. Of the remaining 38 renal arteries, two were graded as normal, seven as having mild stenosis (<50%), eight as having moderate stenosis (> or =50% but <75%), and 21 as having severe stenosis (> or =75%). Magnetic resonance angiography and digital subtraction angiography were concordant in 89% of the arteries; magnetic resonance angiography overestimated the degree of stenosis in 8% and underestimated it in 3% of them. In the evaluation of clinically significant renal artery stenosis (> or =50%) with magnetic resonance angiography, the overall sensitivity, specificity, positive predictive value, and negative predictive value were 97%, 67%, 90%, and 86% respectively. The sensitivity and specificity of magnetic resonance angiography in transplant renal artery stenosis was 100%. CONCLUSION. Our experience suggested that gadolinium-enhanced magnetic resonance angiography is a sensitive non-invasive modality useful in the assessment of clinically significant renal artery stenosis.

Imaging findings in acute neck infection due to pyriform sinus fistula.

INTRODUCTION: Pyriform sinus fistula is a congenital branchial pouch abnormality that is often overlooked as a cause of acute neck infection in children. Our aim is to demonstrate the value of various imaging modalities (ultrasound, computed tomography [CT], barium oesophagraphy) in its diagnosis. MATERIALS AND METHODS: The preoperative imaging findings of 5 patients with surgically proven pyriform sinus fistula who presented with acute neck infection between September 2001 and March 2003 were retrospectively reviewed. CT was performed in all patients, 4 patients had barium oesophagraphy and 3 had an ultrasound scan. RESULTS: All 5 patients suffered from upper respiratory tract infection within a week of developing a tender swelling on the left side of the neck. Four patients had a history of recurrent neck infections. CT depicted inflammation of the left perithyroid soft tissue and adjacent left thyroid lobe in every case. In 2 cases, CT demonstrated the presence of a pyriform sinus fistula. Ultrasound, performed in 3 patients, correlated strongly with the CT findings. It also showed gas within a fistula in 1 case. Barium oesophagraphy clearly delineated the fistula in 3 out of 4 cases. CONCLUSION: Ultrasound and CT accurately showed the presence of acute neck infection and could demonstrate the pyriform sinus fistula. Barium oesophagraphy most clearly depicted the presence and course of the fistula. Recurrent left-sided neck infection in a child should alert the physician to the possibility of an underlying pyriform sinus fistula and imaging should be performed to confirm its presence.