[De Novo renal mass on kidney grafts.] / Tumores de novo en trasplante renal.

OBJECTIVE: Cancer is the 3rd cause of death in the Spanish kidney transplant population. The risk of developing a tumour is multifactorial. Improvements in follow-up and increased graft survival have led to an increase in the incidence of de novo tumours in these patients. MATERIAL AND METHODS: We have conducted a systematic review of articles published in online medical databases related to de novo tumours in kidney transplant recipients. We have evaluated the incidence of de novo neoplasms in patients who under went a kidney transplant at the Hospital Universitario de Cruces from January 2011 to December 2018. RESULTS AND DISCUSSION: Different characteristics have been described within the transplanted population that could promote the development of tumours. The alteration of the antitumor response, the altered ability to respond to infections, drug´s carcinogenic effect, and agreater susceptibility ultraviolet rays damage are some of the most repeated. As a consequence, overall risk of cancer increases two to three times in the transplanted population. Overall, in our analysis, the neoplasms that showed the highest incidence were urological (21.98%), followed by haematological (16.63%) and digestive tract (14.58%). CONCLUSION: There is a higher incidence and risk of de novo tumour development in the kidney transplant population, which probably requires optimizing patient follow-up and developing more precise screening strategies that can be modified depending on geographic and individual variations, to reduce the impact on survival that it may have on our patients.

OBJETIVO: Las neoplasias son la 3ª causa de muerte en la población trasplantada renal en España. El riesgo de desarrollar una neoplasia es multifactorial. Con las mejoras en el seguimiento y el aumento de la supervivencia del injerto, se está produciendo un incremento en la incidencia de neoplasias de novo en estos pacientes.MATERIAL Y MÉTODOS: Análisis bibliográfico de las neoplasias de novo en pacientes trasplantados renales mediante la revisión sistemática de artículos publicados en bases de datos médicas online. Recogida y evaluación de la incidencia de neoplasias de novo en pacientesa los que se les realizó un trasplante de riñón en el Hospital Universitario de Cruces desde enero de 2011 hasta diciembre 2018.RESULTADOS Y DISCUSIÓN: Dentro de la población trasplantada se han descrito diferentes vías que podrían promover la aparición de neoplasias. Unas de las hipótesis más repetidas son la alteración de la respuesta antitumoral, la capacidad alterada para contrarrestar infecciones, características cancerígenas de los medicamentos en sí y una mayor susceptibilidad a los efectos dañinos de los rayos ultravioleta. La influencia de todos estos factores se traduce en un incremento de dos a tres veces en la incidencia de neoplasias en esta población. De forma global, en todos los estudios analizados, las neoplasias que mostraron mayor incidencia fueron las urológicas (21,98%), seguidas de las hematológicas (16,63%) y del tracto digestivo (14,58%).CONCLUSIÓN: Se evidencia una mayor incidencia de tumores de novo en la población trasplantada renal, que probablemente requiera una optimización en el seguimiento de los pacientes, desarrollando estrategias de screening más precisas que puedan modificarse en función de las variaciones geográficas e individuales, para disminuir el impacto en la supervivencia que puedan tener estas neoplasias de novo.

Tumores de novo en trasplante renal / New tumors in kidney transplantation

Objetivo: Las neoplasias son la 3ª causade muerte en la población trasplantada renal en España. El riesgo de desarrollar una neoplasia es multifactorial. Con las mejoras en el seguimiento y el aumentode la supervivencia del injerto, se está produciendo unincremento en la incidencia de neoplasias de novo enestos pacientes. Material y métodos: Análisis bibliográfico de lasneoplasias de novo en pacientes trasplantados renalesmediante la revisión sistemática de artículos publicadosen bases de datos médicas online. Recogida y evaluación de la incidencia de neoplasias de novo en pacientes a los que se les realizó un trasplante de riñón en elHospital Universitario de Cruces desde enero de 2011hasta diciembre 2018.Resultados y discusión: Dentro de la poblacióntrasplantada se han descrito diferentes vías que podríanpromover la aparición de neoplasias. Unas de las hipótesis más repetidas son la alteración de la respuesta antitumoral, la capacidad alterada para contrarrestarinfecciones, características cancerígenas de los medicamentos en sí y una mayor susceptibilidad a los efectosdañinos de los rayos ultravioleta. La influencia de todosestos factores se traduce en un incremento de dos a tresveces en la incidencia de neoplasias en esta población.De forma global, en todos los estudios analizados, lasneoplasias que mostraron mayor incidencia fueron lasurológicas (21,98%), seguidas de las hematológicas(16,63%) y del tracto digestivo (14,58%). COonclusión: Se evidencia una mayor incidencia detumores de novo en la población trasplantada renal,que probablemente requiera una optimización en elseguimiento de los pacientes, desarrollando estrategiasde screening más precisas que puedan modificarse enfunción de las variaciones geográficas e individuales,para disminuir el impacto en la supervivencia que puedan tener estas neoplasias de novo.(AU)

Objetive: Cancer is the 3rd cause ofdeath in the Spanish kidney transplant population. Therisk of developing a tumour is multifactorial. Improvements in follow-up and increased graft survival have ledto an increase in the incidence of de novo tumours inthese patients.Material and methods: We have conducted a systematic review of articles published in online medicaldatabases related to de novo tumours in kidney transplant recipients. We have evaluated the incidence ofde novo neoplasms in patients who underwent a kidneytransplant at the Hospital Universitario de Cruces fromJanuary 2011 to December 2018. Results and discussion: Different characteristicshave been described within the transplanted populationthat could promote the development of tumours. The alteration of the antitumor response, the altered ability torespond to infections, drug ́s carcinogenic effect, and agreater susceptibility ultraviolet rays damage are someof the most repeated. As a consequence, overall riskof cancer increases two to three times in the transplanted population. Overall, in our analysis, the neoplasmsthat showed the highest incidence were urological(21.98%), followed by haematological (16.63%) anddigestive tract (14.58%).Conclusion: There is a higher incidence and riskof de novo tumour development in the kidney transplantpopulation, which probably requires optimizing patientfollow-up and developing more precise screening strategies that can be modified depending on geographicand individual variations, to reduce the impact on survival that it may have on our patients.(AU)

SARS-CoV-2-Associated Obliterative Arteritis Causing Massive Testicular Infarction.

A 26-year-old man with symptomatic SARS-CoV-2 infection developed a sudden-onset acute testicular pain. The echo-doppler images showed massive testicular infarction, so orchiectomy was performed. On gross examination, the surgical specimen showed complete testicular necrosis and diffuse thickening of the testicular coverings. Under the microscope, a severe obliterative arteritis was evidenced. SARS-CoV-2 spike antibody was detected by immunohistochemistry in the arterial endothelium. Electron microscopy displayed intracytoplasmic spiky viral particles in endothelial cells. The patient was treated with corticoids and was asymptomatic at last contact.

Oligometastatic Prostate Adenocarcinoma. Clinical-Pathologic Study of a Histologically Under-Recognized Prostate Cancer.

The clinical parameters and the histological and immunohistochemical findings of a prospective protocolized series of 27 prostate carcinoma patients with oligometastatic disease followed homogeneously were analyzed. Lymph nodes (81.5%) and bones (18.5%) were the only metastatic sites. Local control after metastatic directed treatment was achieved in 22 (81.5%) patients. A total of 8 (29.6%) patients developed castration-resistant prostate cancer. Seventeen (63%) patients presented with non-organ confined disease. The Gleason index 8-10 was the most frequently observed (12 cases, 44.4%) combined grade. Positive immunostainings were detected with androgen receptor (100%), PGP 9.5 (74%), ERG (40.7%), chromogranin A (29.6%), and synaptophysin (18.5%) antibodies. The Ki-67 index value > 5% was observed in 15% of the cases. L1CAM immunostaining was negative in all cases. Fisher exact test showed that successful local control of metastases was associated to mild inflammation, organ confined disease, Ki-67 index < 5%, and Gleason index 3 + 3. A castration resistant status was associated with severe inflammation, atrophy, a Gleason index higher than 3 + 3, Ki-67 index ≥ 5%, and positive PGP 9.5, chromogranin A, and synaptophysin immunostainings. In conclusion, oligometastatic prostate adenocarcinoma does not have a specific clinical-pathologic profile. However, some histologic and immunohistochemical parameters of routine use may help with making therapeutic decisions.

Urinary microRNAs: Looking for a New Tool in Diagnosis, Prognosis, and Monitoring of Renal Cancer.

PURPOSE OF REVIEW: Renal cell carcinoma (RCC) is the third most common urologic malignancy. First symptoms are usually unspecific and belated causing the stages to be high when diagnosed. As compensation, incidental detection of RCC by abdominal imaging techniques for other medical purposes is a reality that favours a decrease in the stage of new diagnosed tumours. Therefore, identifying novel predictive biomarkers for diagnosis, progression and prognosis of RCC is fundamental. RECENT FINDINGS: To date, several studies have demonstrated that microRNAs (miRNAs) play a role in the particular scenario of urologic tumors, and alterations at miRNA level are involved in the initiation, progression and metastases formation of renal cancer. In the present review, we have summarized the up­to­date preliminary clinical works on the role of urinary miRNA profiling in RCC, including an evaluation of its value as a potential biomarker for diagnosis, prognosis and follow up of RCC patients.

Outcomes after a first and/or second salvage treatment in patients with oligometastatic prostate cancer recurrence detected by (18-F) choline PET-CT.

OBJECTIVE: The primary objective of this study was to assess clinical outcomes in patients with oligometastatic prostate cancer recurrence after single or repeated salvage radiation treatment. METHODS: Forty-nine consecutive prostate cancer patients diagnosed with oligometastatic recurrence on Ch-PET have been prospectively treated. Seven (23%) patients had castrate-resistant disease. Clinical outcomes were assessed using the Kaplan-Meier method. Potential prognostic factors were examined using univariate proportional hazards regression. RESULTS: The treatments administered to the initial oligorecurrence sites were intensity-modulated radiotherapy (IMRT) ± ADT (26 patients; 53%) and stereotactic ablative radiotherapy (SABR) ± ADT (23 patients; 47%). With a median follow-up of 24 months (range 6-39), 24 patients developed a biochemical failure. Twenty out of the 24 relapsed patients underwent a second Ch-PET/CT. Seven patients presented poly-metastatic relapse and 10 oligometastatic diseases. Six of 10 patients with a second oligorecurrence were treated again with SABR. Overall, 102 lesions were treated. Local control was detected in 45 (91.8%) patients. No relevant (grade ≥ 2) toxicity was reported, and there was no grade 3 toxicity. On univariate analysis, none of the variables were significantly predicted for clinical disease-free survival. At last follow-up visit, 24 patients (40%) were free from biochemical failure and 37 (71%) patients were free from clinical disease. The 2-year OS and PCSS were 91.8% and 95.9% respectively. CONCLUSION: Salvage IMRT or SBRT of oligometastatic prostate cancer recurrence is associated with a prolonged cDFS. This may result in a longer time to develop castrate-resistant disease and a longer time without systemic therapies.

Surgical Treatment of Completely Endophytic Renal Tumor: a Systematic Review.

PURPOSE OF REVIEW: An endophytic renal tumor represents a special surgical challenge in terms of location and safe removal. For this reason we wanted to review the existing literature on this subject. RECENT FINDINGS: In high-activity robotic centers, robot-assisted partial nephrectomy (RAPN) is a safe and efficacious surgical approach for completely endophytic renal tumors. As research innovation, the application of the radio-guided occult lesion localization technique (ROLL) facilitates the location and complete excision of the tumor during surgery. There are few studies that specifically report the experience with completely endophytic renal tumors. The endophytic tumor is usually smaller than exophytic. Frequently it represents a high complexity value in the different Score systems reported in the last decade. This surgery should be performed by experienced urologists regardless of the surgical approach they prefer (open, laparoscopic, or robotic). It is necessary to develop new techniques for intraoperative easy localization and intraoperative evaluation of surgical margins.

Valor pronóstico de la biopsia renal preimplante en donantes fallecidos de edad avanzada en la función renal al año del trasplante / Prognostic utility of preimplantation kidney biopsy from deceased older donors in first year post-transplant renal function

Antecedentes: La biopsia renal preimplante puede aportar información útil evolutiva postrasplante. Objetivo: Analizar el valor pronóstico de la biopsia renal de donantes de edad avanzada respecto al filtrado glomerular estimado MDRD-4 (FGe) al año del trasplante. Métodos: Estudiamos a 124 receptores de trasplante renal de donantes fallecidos de ≥60 años, con biopsia renal preimplante. Los trasplantes fueron realizados en nuestro centro, entre marzo del 2008 y mayo del 2012. Las biopsias se valoraron según el baremo propuesto por O’Valle et al. y se categorizaron en 3 grupos: 0-3, 4-5, 6-8 puntos. Se descartaron los riñones con una puntuación >8. El 77% de los donantes tenía ≥70 años. Resultados: El FGe medio (DE) del grupo 6-8 al año del trasplante: 38,5 (14,1) mL/min/1,73m2 fue menor que el del grupo 4-5: 46,3 (15,7) (p=0,03) y del grupo 0-3: 49,6 (12,5) (p=0,04). Se registraron 7 (19%) pacientes con FGe<30mL/min/1,73m2 en el grupo 6-8 vs. 8 (14%) en el grupo 4-5 y ninguno en el grupo 0-3 (p=0,17). En el análisis de regresión logística, OR (IC 95%), que valoró los pacientes con FGe<30mL/min/1,73m2 al año del trasplante, la función retrasada del injerto (6,3 [1,9-21,3]) y el rechazo agudo (5,8 [1,1-31]) fueron significativos. La puntuación del daño histológico de las biopsias, grupo 6-8 vs. 0-5, presentó un OR ajustado no significativo de 2,2 (0,7-7,3). Conclusiones: Los riñones con mayor afectación histológica presentaron un menor FGe al año del trasplante. La función renal retrasada del injerto y el rechazo fueron factores de riesgo significativos de un bajo FGe al año del trasplante (AU)

Background: Preimplantation renal biopsy provides potentially valuable information about post-transplant renal function. Objective: To assess the prognostic value of preimplantation kidney biopsy from older donors in determining 1-year post-transplant estimated glomerular filtration rate MDRD-4 (eGFR). Methods: We evaluated a cohort of 124 renal transplant recipients from deceased donors ≥60 years old, performed at our center between March 2008 and May 2012. Biopsies were assessed by applying the score proposed by O’Valle et al. The overall score was stratified into 3 levels: 0-3, 4-5 and 6-8 points. Kidneys scoring > 8 points were discarded. A total of 77% of the donors were ≥70 years. Results: One year post-transplant, mean eGFR (SD) was lower in transplant recipients with 6-8 points (38.5 [14.1] mL/min/1.73m2) than in the group scoring 4-5 points (46.3 [15.7] [p=0.03]) and the group scoring 0-3 (49.6 [12.5] [P=.04]). Seven patients (19%) had eGFR <30mL/min/1.73m2 1 year post-transplant in group 6-8 vs. 8 (14%) in group 4-5 and none in group 0-3. In the logistic regression, OR (95% IC), to determine patients with 1-year post-transplant eGFR (<30mL/min/1.73m2), delayed graft function (6.3 [1.9-21.3]) and acute rejection (5.8 [1.1-31]), were significant. The adjusted OR of biopsy score group 6-8 vs. 0-5, was 2.2 (0.7-7.3). Conclusions: Allografts with higher pathologic score in preimplantation renal biopsy were associated with a worse 1-year post-transplant eGFR. Delayed graft function and acute rejection were significant risk factors for 1-year post-transplant low eGFR (AU)

Prognostic utility of preimplantation kidney biopsy from deceased older donors in first year post-transplant renal function.

BACKGROUND: Preimplantation renal biopsy provides potentially valuable information about post-transplant renal function. OBJECTIVE: To assess the prognostic value of preimplantation kidney biopsy from older donors in determining 1-year post-transplant estimated glomerular filtration rate MDRD-4 (eGFR). METHODS: We evaluated a cohort of 124 renal transplant recipients from deceased donors ≥60 years old, performed at our center between March 2008 and May 2012. Biopsies were assessed by applying the score proposed by O'Valle et al. The overall score was stratified into 3 levels: 0-3, 4-5 and 6-8 points. Kidneys scoring > 8 points were discarded. A total of 77% of the donors were ≥70 years. RESULTS: One year post-transplant, mean eGFR (SD) was lower in transplant recipients with 6-8 points (38.5 [14.1] mL/min/1.73m(2)) than in the group scoring 4-5 points (46.3 [15.7] [p=0.03]) and the group scoring 0-3 (49.6 [12.5] [P=.04]). Seven patients (19%) had eGFR <30mL/min/1.73m(2) 1 year post-transplant in group 6-8 vs. 8 (14%) in group 4-5 and none in group 0-3. In the logistic regression, OR (95% IC), to determine patients with 1-year post-transplant eGFR (<30mL/min/1.73m(2)), delayed graft function (6.3 [1.9-21.3]) and acute rejection (5.8 [1.1-31]), were significant. The adjusted OR of biopsy score group 6-8 vs. 0-5, was 2.2 (0.7-7.3). CONCLUSIONS: Allografts with higher pathologic score in preimplantation renal biopsy were associated with a worse 1-year post-transplant eGFR. Delayed graft function and acute rejection were significant risk factors for 1-year post-transplant low eGFR.