[Adrenalectomy and radical nephrectomy due to renal carcinoma]. / Surrenalectomia e nefrectomia radicale per carcinoma renale. Considerazioni.

BACKGROUND: Surgery remains the only effective treatment for renal carcinoma. According the current surgical procedure, both the neoplastic kidney with its perirenal tissue and the Gerota fascia with adrenal gland must be removed. In the last years, the utility of routine adrenalectomy for kidney cancer surgery has been questioned and some authors now recommend this procedure just in selected cases. METHODS: In order to provide a contribution to this debate, 350 cases of nephrectomy after renal carcinoma have been reviewed. In all, 185 adrenalectomy have been performed and neoplastic involvement of adrenal gland has been identified just in 9 cases (4.9%), suggesting a rarity of tumor progression to adrenal gland at the time of surgery. RESULTS: Moreover, neoplastic involvement of adrenal gland has been shown in just 3 cases at preoperatively CT scan. CONCLUSIONS: The conclusion is drawn that adrenal gland may be retained in surgery for radical nephrectomy after renal carcinoma. Adrenalectomy may be recommended in doubtful cases, especially in upper pole localization and in large tumours.

Bellini duct (collecting duct) carcinoma of the kidney.

Carcinoma of the collecting ducts, or Bellini carcinoma, is a rare renal tumour and, unlike most renal cell carcinomas, it derives from distal tubules. It displays highly aggressive behaviour and has a poor prognosis. In this study, the authors present three cases which they observed over the past three years.

Renal adenocarcinoma with lung metastasis in an adolescent.

OBJECTIVE: The finding of a renal adenocarcinoma in a young patient is a rare occurrence. We report on a case of renal adenocarcinoma with lung metastases arising in an 18-year-old girl with non-specific symptoms and normal blood chemistry and urinary analysis. RESULTS AND CONCLUSION: We underscore the aggressive nature of the tumour which grew asymptomatically, giving rise to lymph node and pulmonary metastases.

Comparison between ultrasonography and computerized tomography in the identification of small-sized renal carcinomas.

OBJECTIVES: The increased detection of such small-sized carcinomas has brought a number of new problems regarding the surgical approach to be adopted. We review our experience with 34 patients with small-sized renal carcinomas, comparing the US and CT data with histological findings. METHODS: In a series of 150 cases of renal carcinoma, small sized carcinomas were diagnosed in 34 patients. All patients were examined by US and CT. RESULTS AND CONCLUSION: Five patients presented bifocal carcinomas. CT identified 100% of the small-sized carcinomas, failing only to identify the smaller carcinomas measuring less than 1 cm in diameter in the bifocal carcinoma cases, whereas US identified only 78.3% of the cases. The authors, moreover, mention the problem of multifocal tumours as an argument against performing a partial nephrectomy in the presence of two normally functioning kidneys, and believe it is advisable to reserve such conservative surgery for a selected number of cases.

[Multilocular cystic nephroma in children. Description of a case]. / Nefroma cistico multiloculare in età pediatrica. Descrizione di un caso.

In paediatric age there may occur the various types of cystic renal tumor also of different clinical meaning; we can count among them shapes openly or potentially deadly, among which Wilms tumor cystic owing to haemorrhages and tumoral necrosis, congenital mesoblastic cystic nephroma, clear cell carcinoma, cystic, partially differentiated nephroblastoma (CPDN) and benign forms such as multilocular cystic nephroma (MLCN), cystic localized dysplasia of the kidney. In some cases, the differential diagnosis is difficult and it becomes only by histology: particularly the differential diagnosis between MLCN and CPDN, indistinguishable on the basis of the imaging and the macroscopic aspect, it is possible only by histology. It is described a case of multicystic lesion in a baby, male, aged twenty-two months, with an indolent mass of left side, screened by US and TC. The US examination has put into evidence the presence of renal with clean outlines of eight cms, formed by multiple small cysts, divided by thin regular septa . These aspects have been confirmed by TC. The histological examination has diagnosed a multilocular cystic nephroma, without atypias. Therefore, the multilocular cystic lesions of the kidney have to be considered potentially malignant and submitted to surgical treatment.

Small renal-cell carcinomas: clinical and imaging features.

The authors review the clinical, pathological and imaging characteristics of 20 patients with histological confirmation of 23 renal-cell carcinomas measuring < or = 3 cm in size. All lesions were unilateral. All patients were submitted to CT investigations, which identified 20 tumours (86%) and failed to identify 3 small-sized neoplastic nodular formations (0.4, 0.4, 0.8 cm) in patients with double tumour localisation in the same kidney. 15 patients underwent ultrasonography (US) which detected 11 carcinomas out of 17 (65%); of the 6 tumours (in 4 patients) not detected by US, 4 were identified by CT; 2 of these patients were subsequently re-examined by US with identification of the tumour. US failed to detect the 2 small tumours unidentified by CT (the third patient did not undergo US). 17 patients had no renal symptoms, and identification of the tumour was an incidental finding. The increasingly widespread use of US and CT enables a large number of kidneys to be examined and thus permits identification of a greater number of small-sized kidney tumours, allowing early surgical intervention with a greater chance of success. The technical options in surgical therapy may be multiple, though the use of any operation other than nephrectomy tends to be limited by the possible presence of small neoplastic nodular formations in the same kidney, which may not be detectable by US or CT owing to their very small size.

[Renal angiomyolipoma: diagnostic approach and therapeutic up-date; report of 11 clinical cases]. / L'angiomiolipoma renale: orientamento diagnostico ed attualità terapeutiche; a proposito di 11 osservazioni cliniche.

Eleven cases of renal angiomyolipoma are reported. In all cases a correct preoperative diagnosis was made, using standards x-radiography, ultrasonography and computerized tomography. Small size AML do not generally require any surgery, while surgical procedures for larger AML vary depending on the size, associated diseases, other complicating factors. As a general rule, surgical treatment should be as conservative as possible.

[Renal-colonic-cutaneous fistula secondary to xanthogranulomatous pyelonephritis]. / Fistola reno-colon-cutanea secondaria a pielonefrite xantogranulomatosa.

The appearance of intestinal fistulas secondary to kidney disease is a rare occurrence. Even rarer are complex fistulas involving several organs or systems [correction of apparati]. In this study, the authors report on a case of reno-colo-cutaneous fistula which set in as a complication of xanthogranulomatous pyelonephritis.

[10 cases of xanthogranulomatous pyelonephritis]. / Considerazioni su 10 casi di pielonefrite xantogranulomatosa.

Xanthogranulomatous pyelonephritis (XGP) is a chronic inflammation of the kidney usually associated with renal stones, recurrent urinary tract infections or endocrine disorders. A correct preoperative diagnosis is rarely made, since no specific clinical or radiological pattern is known. Differential diagnosis must include renal tuberculosis and renal carcinoma. Ten cases of XGP are reported. Clinical findings, radiological and pathological features, biolaboratory abnormalities are discussed.

Thyroid metastases from renal carcinoma.

The identification and diagnosis of thyroid metastases from renal adenocarcinoma are rare in living patients, though more frequent during autopsy. A case is reported in which the identification of thyroid metastases indicated a clear-cell renal carcinoma in a kidney treated 12 years earlier for emptying of multiple cysts.

[Malignant neoplastic pathology in patients given a kidney transplant]. / La patologia neoplastica maligna nel paziente sottoposto a trapianto renale.

The incidence of malignant neoplasms in patients subjected to pharmacological immunosuppression following kidney transplantation is higher than that observed in the control population at large. In our unit, in a study population of 451 patients undergoing a total of 462 kidney transplants over the period from 1968 to 1986, four malignant neoplasms (0.9%) were observed in 3/369 (0.8%) patients treated with azathioprine (1 ovarian papilliferous cystoadenoma, 1 embryonal carcinoma of the testicle and 1 Kaposi's sarcoma) and in 1/93 (1.1%) patients treated with cyclosporin (1 Kaposi's sarcoma). The neoplasm was successfully controlled only in the first case after bilateral extended adnexectomy.

[Hyperparathyroidism in patients having undergone a kidney transplant]. / Iperparatiroidismo in pazienti sottoposti a trapianto renale.

The persistence or onset of hyperparathyroidism following kidney transplant is characterized by an incidence ranging from 2.6 to 70% according to the various statistics available. In a total of 462 kidney transplants performed in our department, hyperparathyroidism was detected in 9 patients. Surgery took the form of parathyroidectomy 8/8 plus autograft in 3 cases, parathyroidectomy 3/4 in 2 cases, 7/8 in 2 cases, and 4/8 in 1 case. Serum calcium values returned to normal in all patients after the operation.

[Spontaneous perirenal extravasation of urine]. / Lo stravaso perirenale spontaneo d'urina.

Perirenal urinary extravasation in the course of violent renal colic appears to occur much more frequently than is reported in the literature. In this study, the authors report on three such cases observed personally in the space of one year and discuss the pathophysiological factors which may give rise to this phenomenon.

[Adenomatoid tumor of the epididymis]. / Il tumore adenomatoide dell'epididimo.

Primary tumors of the epididymis are very rare. The neoplasms most frequently affecting the epididymis are adenomatoid tumors. In this report, the authors describe a case observed personally. Various histogenetic hypotheses and the histological characteristics of the tumor are discussed.

[Adenoma nephrogenic. Morphologic aspects]. / Adenoma nefrogenico. Aspetti morfologici.

Nephrogenic adenoma is a rare lesion of urothelial mucous membrane. At present, the cases described in literature are 85. In this work the Authors study the morphologic aspects and etiopathogenetic theories.

[Primary retroperitoneal tumors (clinical findings in yolk sac tumor, vascular leiomyosarcoma and extraosseous chondrosarcoma)]. / Tumori retroperitoneali primitivi (rilievi clinici sul tumore del sacco vitellino ("yolk-sac tumour"), leiomiosarcoma vascolare e condrosarcoma extrascheletrico).

Primary retroperitoneal tumors (PRT) constitute about 0.02 per cent of all tumors examined in the Department of Pathology of our hospital. We report 3 cases of malignant PRT - yolk-sac tumour, vascular leiomyosarcoma and extraskeletal chondrosarcoma - selected for their histological rarity and clinical features. Recent techniques available for the diagnosis of these neoplasms and surgical treatment are discussed. The role of radio-chemotherapy is also dealt with.