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1.
BMJ Case Rep ; 14(4)2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-33863762

RESUMO

Langerhans cell histiocytosis (LCH) is an uncommon group of disorders, which can be either localised or systemic, characterised by abnormal proliferation of monocytes, macrophages and dendritic cells. These disorders represent an aberrant response of myeloid progenitor cells. Bones are the most commonly affected organ but there can be involvement of the skin, lungs, liver and spleen. Renal involvement, however, is rare. LCH is the most commonly seen in children but certain rare forms such as Erdheim-Chester disease can be seen in adults. In this report, we present a case of clear cell renal adenocarcinoma (CCRC) admixed with LCH in a patient with history of smoking and presenting with abdominal pain and heamaturia. Imaging revealed left renal lesion and subsequently left renal nephrectomy was performed with tissue biopsy showing grade 3 clear cell renal cell carcinoma admixed with neoplastic LCH.


Assuntos
Carcinoma de Células Renais , Histiocitose de Células de Langerhans , Neoplasias Renais , Adulto , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/diagnóstico , Histiocitose de Células de Langerhans/complicações , Histiocitose de Células de Langerhans/diagnóstico , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/diagnóstico
2.
Arch Esp Urol ; 74(3): 355-359, 2021 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-33818433

RESUMO

We present a clinical case of an asymptomatic 61-year-old man was found to have a left kidney mass. Ultrasound and CT showed a 6 x 5 cms mass with calcifications. Histologic examination of the radical nephrectomy specimen revealed a chromophobe renal cell carcinoma. The unique feature of this case is the type of calcifications present in a tumor of this category. To our knowledge, were port the first case of chromophobe renal cell carcinoma with peripheral linear calcifications. A literature review onchromophobe renal cell carcinoma with calcifications is performed.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/cirurgia , Humanos , Rim , Neoplasias Renais/complicações , Neoplasias Renais/cirurgia , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Nefrectomia
3.
Medicine (Baltimore) ; 100(10): e25127, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725913

RESUMO

ABSTRACT: Prognostic nutritional index (PNI) could reflect the nutrition and inflammation status in cancer patients. This study aims to identify the prognostic significance of PNI in patients with renal cell carcinoma (RCC).A total of 694 RCC patients from our institution were included in this study. The prognostic correlation between PNI and overall survival (OS) and recurrence-free survival (RFS) was analyzed respectively using Kaplan-Meier method and univariate and multivariate Cox model. Studies about the association between pretreatment or preoperative PNI and prognosis of RCC were systemically reviewed and a meta-analysis method was performed to further evaluate the pooled prognostic value of PNI in RCC.267 (38.47%) RCC patients had low PNI according to the cut off value (49.08). Low PNI was associated with poor OS (P < .001) and RFS (P < .001), respectively. In the multivariate Cox analysis, PNI was identified to be an independent prognostic factor for OS (hazard ratio [HR] = 2.13, 95%CI: 1.25-3.62, P = .005). Compared to other nutritional indexes, this risk correlation of PNI is better than that of geriatric nutritional risk index (GNRI; HR = 1.19; P = .531), while is no better than that of neutrophil-lymphocyte ratio (NLR; 1/HR = 2.56; P < .001) and platelet-lymphocyte ratio (PLR; 1/HR = 2.85; P < .001) respectively. Meanwhile, additional 4785 patients from 6 studies were included into pooled analysis. For RCC patients who underwent surgery, low preoperative PNI was significantly associated with worse OS (pooled HR = 1.57, 95%CI: 1.37-1.80, P < .001) and worse RFS (pooled HR = 1.69, 95%CI: 1.45-1.96, P < .001). Furthermore, low PNI (<41-51) was also significantly associated with poor OS (HR = 1.78, 95%CI: 1.26-2.53 P < .05) and poor RFS (HR = 2.03, 95%CI: 1.40-2.95, P < .05) in advanced cases treated with targeted therapies.The present evidences show that PNI is an independent prognostic factor in RCC. Low PNI is significant associated with poor prognosis of RCC patients.


Assuntos
Carcinoma de Células Renais/mortalidade , Inflamação/diagnóstico , Neoplasias Renais/mortalidade , Recidiva Local de Neoplasia/epidemiologia , Avaliação Nutricional , Adulto , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/imunologia , Carcinoma de Células Renais/cirurgia , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Inflamação/imunologia , Neoplasias Renais/complicações , Neoplasias Renais/imunologia , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/imunologia , Nefrectomia , Estado Nutricional/imunologia , Período Pré-Operatório , Prognóstico , Valores de Referência , Estudos Retrospectivos , Medição de Risco/métodos , Adulto Jovem
4.
Medicine (Baltimore) ; 100(3): e24037, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546003

RESUMO

RATIONALE: Gallbladder polyps are common in the general population, but gallbladder metastasis of renal cell carcinoma (RCC) is very rare. In a patient with RCC diagnosed with a small gallbladder polyp that does not meet the traditional size criteria, the surgeon faces a dilemma of whether cholecystectomy should be performed given the possibility of metastasis. PATIENT CONCERNS: A 55-year-old man who had received a left nephrectomy for RCC presented with a gallbladder polyp that was noted at the time of the nephrectomy. Imaging showed the maximum diameter of the polyp had increased from 5 mm to 24 mm in the 40 months after the initial diagnosis. DIAGNOSIS: Pathological and immunohistology findings confirmed the gallbladder polyp as a metastasis of clear-cell RCC. INTERVENTIONS: : We performed a laparoscopic cholecystectomy. OUTCOMES: Even though the synchronous solitary gallbladder metastasis was left untreated and a cholecystectomy was not performed over the 40 months, no metastasis occurred in other sites. The patient is free from disease 10 months after the cholecystectomy. LESSONS: Solitary gallbladder metastasis of RCC may have more favorable outcomes than typical metastases. Although gallbladder metastasis of RCC occur rarely, it can occur, and any changes in gallbladder polyps in RCC patients should be managed under a strong suspicion of metastasis.


Assuntos
Carcinoma de Células Renais/secundário , Doenças da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/secundário , Neoplasias Renais/patologia , Pólipos/patologia , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/cirurgia , Colecistectomia/métodos , Vesícula Biliar/patologia , Vesícula Biliar/cirurgia , Doenças da Vesícula Biliar/etiologia , Doenças da Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/complicações , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/cirurgia , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Pólipos/etiologia , Pólipos/cirurgia
5.
Anticancer Res ; 41(1): 335-340, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33419828

RESUMO

BACKGROUND/AIM: Large or bilateral multiple renal cell carcinoma (RCC) without/with tumor thrombus (TT) in the renal vein (RV) or inferior vena cava (IVC) poses a challenge to the surgeon due to the potential for massive hemorrhage, tumor thromboemboli and dialysis, and the situation is more critical due to Covid-19 pandemic. We report our experience and measures in dealing with challenging cases of large or multiple RCCs without/with TT during the ongoing Covid-19 pandemic. PATIENTS AND METHODS: Between 4/2020-10/2020, five patients underwent RCC resection with/without TT. Patients 1 and 2 had RCCs/TT in RV; Patient 3 had RCC/TT supradiaphragmatic below right atrium; Patient-4 had a 26 cm RCC; Patient-5 had multiple RCCS as part of Birt-Hogg-Dube syndrome. RESULTS: Patients were preoperatively tested negative for Covid-19. Operation times were 105, 85, 255, 200 and 247 minutes for Patients 1-5. Estimated blood loss was: 100, 50, 3,900,100 and 50 ml, respectively. Patient 3 underwent RCC resection en bloc with IVC/TT. Patients 1 and 2 underwent resections of RCC/TT in RV. Patient 4 underwent a 26 cm RCC resection. Patient 5 underwent laparoscopic bilateral radical nephrectomies. No immediate postoperative complications were reported. CONCLUSION: We successfully managed 5 challenging cases of RCCs despite the recommendations imposed by hospitals due to Covid-19 pandemic, with favorable outcomes.


Assuntos
/complicações , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/diagnóstico , Neoplasias Renais/complicações , Neoplasias Renais/diagnóstico , Trombose/diagnóstico , Trombose/etiologia , Idoso , Biópsia , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Células Neoplásicas Circulantes , Nefrectomia , Veias Renais/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
Am J Clin Oncol ; 44(4): 137-142, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33512910

RESUMO

BACKGROUND: Fatigue is one of the most common adverse events of systemic therapy in patients with metastatic renal cell carcinoma (RCC). The aim of multicenter randomized phase 2 study was to determine the efficacy and safety of testosterone in patients with fatigue developed during targeted therapy. PATIENTS AND METHODS: Male patients with metastatic clear-cell RCC, normal prostate-specific antigen level, low testosterone level, and no evidence of hypothyroidism receiving first-line sunitinib or pazopanib with fatigue were randomly assigned (1:1) to either testosterone undecanoate (1000 mg) and targeted therapy or targeted therapy alone. The primary endpoint was the mean change of fatigue from baseline to 28 days according to the Functional Assessment of Chronic Illness Therapy-Fatigue scale. Secondary endpoints were safety, Functional Assessment of Cancer Therapy-Kidney Symptom Index 19, testosterone serum concentrations, red blood cell count, and hemoglobin level. RESULTS: Sixty patients were assigned to receive testosterone and targeted therapy (N=30) or targeted therapy alone (N=30). As of the data cutoff on December 30, 2019, median follow-up was 18.2 months. The study achieved its primary endpoint based on the significant differences at day 28 favoring testosterone over targeted therapy alone regarding the decreased level of fatigue (difference between groups, 22.5 points; 95% confidence interval, 18.4-26.6; P=0.012). Significant changes in scores demonstrating the enhanced quality of life with testosterone compared with targeted therapy were also observed for Functional Assessment of Cancer Therapy-Kidney Symptom Index 19 disease-related symptoms (P=0.01). There were nonsignificant differences in red blood cell count and hemoglobin level between the 2 groups (all P>0.05). CONCLUSION: Male patients with metastatic RCC and hypogonadism receiving testosterone had less fatigue and better symptom control during targeted therapy.


Assuntos
Carcinoma de Células Renais/secundário , Fadiga/tratamento farmacológico , Neoplasias Renais/tratamento farmacológico , Testosterona/análogos & derivados , Idoso , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/tratamento farmacológico , Fadiga/etiologia , Fadiga/psicologia , Seguimentos , Humanos , Hipogonadismo/complicações , Hipogonadismo/tratamento farmacológico , Neoplasias Renais/complicações , Masculino , Pessoa de Meia-Idade , Pirimidinas/efeitos adversos , Pirimidinas/uso terapêutico , Qualidade de Vida , Sulfonamidas/efeitos adversos , Sulfonamidas/uso terapêutico , Sunitinibe/efeitos adversos , Sunitinibe/uso terapêutico , Testosterona/efeitos adversos , Testosterona/uso terapêutico
7.
Clin Nucl Med ; 46(1): e65-e67, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33181733

RESUMO

A 46-year-old man with end-stage renal disease and renal cell carcinoma underwent F-FDG PET/CT for initial staging followed by F-PSMA-1007 PET/CT. Unlike F-FDG, which undergoes renal clearance, F-PSMA-1007 undergoes hepatobiliary clearance and thus generates superior quality images. F-PSMA-1007 PET/CT showed intense tracer-avid left renal mass lesion (FDG nonavid); lytic bone lesions (FDG avid) and single liver lesion (FDG nonavid). This case highlights the superiority of F-PSMA-1007 over F-FDG PET/CT in identifying primary lesion as well as metastatic sites in case of renal cell carcinoma even in the presence of end-stage renal disease.


Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/patologia , Falência Renal Crônica/complicações , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Niacinamida/análogos & derivados , Oligopeptídeos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Carcinoma de Células Renais/complicações , Feminino , Radioisótopos de Flúor , Humanos , Neoplasias Renais/complicações , Pessoa de Meia-Idade , Estadiamento de Neoplasias
9.
Anticancer Res ; 40(11): 6525-6530, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33109593

RESUMO

BACKGROUND/AIM: End-stage kidney disease is characterized by chronic inflammation and frequent development of cancer. The level of circulating vitamin D is generally low in patients with end-stage renal disease (ESRD). Experimental studies have implicated the role of dysfunctional vitamin D metabolism in tumorigenesis. PATIENTS AND METHODS: We analyzed the expression of vitamin D receptor (VDR), cytochrome P450 family 27 subfamily B member 1 (CYP27B1) and cytochrome P450 family 24 subfamily A member 1 (CYP24A1), the key genes involved in vitamin D signaling, in kidneys from patients with ESRD, tissue microarrays containing ESRD-associated renal cell tumors, as well as in their precursor lesions by immunohistochemistry. RESULTS: Kidneys from patients with ESRD showed strong structural rearrangement with only few tubules and epithelial cell groups embedded in fibrotic-inflammatory stroma. Only an estimated 1-3% of the epithelial cells showed positive staining with antibodies to VDR, CYP27B1 and CYP24A1, which contrasted with the 100%, 40-50% and 40-50% of positively stained cells, respectively, found in normal kidneys. Down-regulation of the vitamin D signaling proteins was found in patients with renal cancer, with the exception of tumors and their precursors occurring exclusively in ESRD. CONCLUSION: The significantly reduced activity of CYP27B1 in kidney from patients with ESRD explains the low level of circulating vitamin D. We suggest that the lack of anti-tumorigenic effect of vitamin D is a crucial factor in the frequent development of unique types of renal cell cancer in in patients with ESRD.


Assuntos
25-Hidroxivitamina D3 1-alfa-Hidroxilase/genética , Carcinoma de Células Renais/genética , Falência Renal Crônica/genética , Receptores de Calcitriol/genética , Vitamina D3 24-Hidroxilase/genética , Carcinoma de Células Renais/sangue , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/patologia , Feminino , Regulação Neoplásica da Expressão Gênica/genética , Humanos , Rim/metabolismo , Rim/patologia , Falência Renal Crônica/sangue , Falência Renal Crônica/complicações , Falência Renal Crônica/patologia , Túbulos Renais/metabolismo , Túbulos Renais/patologia , Masculino , Redes e Vias Metabólicas/genética , Vitamina D/sangue
10.
Am Surg ; 86(8): 1005-1009, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32997953

RESUMO

INTRODUCTION: Interteam performance and Clavien-Dindo (C-D) complications in renal cell carcinoma with inferior vena cava thrombectomy (RCC-IVCT) have not been reported. We aimed to describe complications by the degree of complexity and surgical teams in a collaborative effort between a National Cancer Institute-designated Comprehensive Cancer Center and a Quaternary Care Teaching Hospital. METHODS: Between January 2011 and May 2019, 73 consecutive RCC-IVCT were included. C-D grades III or higher were captured. Teams involved were urologic-oncology, vascular, hepatobiliary/transplant, and cardiothoracic. The Mayo Clinic tumor thrombus classification was used. RESULTS: Overall complication rate was 42% (n = 31). Nineteen percent had grade III, 18% had grade IV, and 6% had grade V complications. Patients with level IV thrombus had the highest in-hospital mortality rate (75%). Thrombus level did not show a correlation to complication rates (14% level I, 45% level II, 32% level III, 42% level IV). A positive correlation found between the number of teams involved and complication rates (35% with 2-team, 59% with 3-team, P = .059). Thromboembolic events (6% vs 24%, P = .02) and disposition other than home (22% vs 48%, P = .01) were statistically lower for the 2-team groups. Two-team in-hospital mortality was 1/51 (2%) versus 3-team (3/22,14%, (P = .07). No statistical differences were found in infections, thromboembolic events, and grades of complications between surgical teams. CONCLUSIONS: Despite similar interteam performance, the consistency of surgeons in high complexity cases could improve outcomes further. Complexity was higher for hepatobiliary/transplant and cardiothoracic teams. A combination of intraoperative events and patient selection (comorbidities and age) contributed to death. Overall, in-hospital mortality was lower than in most reported series.


Assuntos
Carcinoma de Células Renais/complicações , Neoplasias Renais/complicações , Equipe de Assistência ao Paciente , Trombectomia , Veia Cava Inferior/cirurgia , Trombose Venosa/cirurgia , Adulto , Idoso , Institutos de Câncer , Florida , Mortalidade Hospitalar , Hospitais de Ensino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento , Trombose Venosa/etiologia
11.
Nat Commun ; 11(1): 4333, 2020 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-32859933

RESUMO

Diarrhoea is one of the most burdensome and common adverse events of chemotherapeutics, and has no standardised therapy to date. Increasing evidence suggests that the gut microbiome can influence the development of chemotherapy-induced diarrhoea. Here we report findings from a randomised clinical trial of faecal microbiota transplantation (FMT) to treat diarrhoea induced by tyrosine kinase inhibitors (TKI) in patients with metastatic renal cell carcinoma (ClinicalTrials.gov number: NCT04040712). The primary outcome is the resolution of diarrhoea four weeks after the end of treatments. Twenty patients are randomised to receive FMT from healthy donors or placebo FMT (vehicle only). Donor FMT is more effective than placebo FMT in treating TKI-induced diarrhoea, and a successful engraftment is observed in subjects receiving donor faeces. No serious adverse events are observed in both treatment arms. The trial meets pre-specified endpoints. Our findings suggest that the therapeutic manipulation of gut microbiota may become a promising treatment option to manage TKI-dependent diarrhoea.


Assuntos
Carcinoma de Células Renais/complicações , Diarreia/terapia , Inibidores Enzimáticos/metabolismo , Transplante de Microbiota Fecal/métodos , Neoplasias Renais/complicações , Tirosina/metabolismo , Idoso , Método Duplo-Cego , Tratamento Farmacológico , Disbiose , Fezes , Feminino , Microbioma Gastrointestinal , Humanos , Masculino , Pessoa de Meia-Idade , Doadores de Tecidos
12.
Clin Nucl Med ; 45(8): e381-e382, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32520508

RESUMO

Within a few months, coronavirus disease 2019 (COVID-19) has become a pandemic with more than 2 million patients infected and a high mortality rate. Early detection of COVID-19 in oncologic patients is crucial in order to rapidly apply isolation measures and avoid nosocomial spread. However, early diagnosis may be challenging, especially in cancer patients under treatment with immunotherapy as drug-induced pneumonitis can present similar clinical and radiological features. We describe the findings of a SARS-CoV-2 infection on PET/CT with F-FDG in a 51-year-old man with metastatic renal cell carcinoma under treatment with nivolumab.


Assuntos
Betacoronavirus , Carcinoma de Células Renais/tratamento farmacológico , Infecções por Coronavirus/diagnóstico por imagem , Imunoterapia/efeitos adversos , Neoplasias Renais/tratamento farmacológico , Nivolumabe/efeitos adversos , Pneumonia Viral/diagnóstico por imagem , Pneumonia/diagnóstico por imagem , Carcinoma de Células Renais/complicações , Infecções por Coronavirus/complicações , Diagnóstico Diferencial , Fluordesoxiglucose F18 , Humanos , Neoplasias Renais/complicações , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons
13.
J Urol ; 204(6): 1166-1172, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32567459

RESUMO

PURPOSE: The controlling nutritional status (CONUT) score, consisting of albumin, lymphocytes and total cholesterol, is a validated, objective tool for nutritional assessment. Patients with advanced cancer frequently have malnutrition in association with cachexia and chronic inflammation. We explored the prognostic significance of the CONUT score in patients with advanced renal cell carcinoma receiving nivolumab. MATERIALS AND METHODS: This retrospective study included 60 patients with stage IV renal cell carcinoma treated with nivolumab after failure of prior tyrosine kinase inhibitors at 2 cancer centers between 2016 and 2019. Associations of the CONUT score with progression-free survival, cancer specific survival and tumor shrinkage rate were assessed. RESULTS: The median (range) CONUT score was 2 (0-10). During followup periods 29 and 14 patients exhibited disease progression and died of cancer, respectively. Both progression-free survival and cancer specific survival were significantly stratified by CONUT scores of 0 to 1, 2 to 4 and 5 or more (p=0.002). A CONUT score of 5 or more (versus score 0 to 1) was independently associated with unfavorable progression-free survival (HR 5.18, p=0.003) and cancer specific survival (HR 15.34, p=0.014), as was the absence of prior nephrectomy (HR 4.23, p=0.004 and HR 6.57, p=0.001, respectively). C-indices of the CONUT score for predicting progression-free survival and cancer specific survival were 0.694 and 0.737, respectively. The CONUT score was significantly associated with the best response to nivolumab with the median tumor shrinkage rate of -23%, +8% and +24% for CONUT scores of 0 to 1, 2 to 4 and 5 or more, respectively (p=0.021). CONCLUSIONS: The CONUT score may be useful to predict the clinical outcomes and therapeutic response in patients with advanced renal cell carcinoma receiving nivolumab.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Caquexia/diagnóstico , Carcinoma de Células Renais/terapia , Neoplasias Renais/terapia , Nivolumabe/uso terapêutico , Avaliação Nutricional , Idoso , Antineoplásicos Imunológicos/farmacologia , Caquexia/sangue , Caquexia/etiologia , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/patologia , Quimioterapia Adjuvante/métodos , Colesterol/sangue , Resistencia a Medicamentos Antineoplásicos , Feminino , Seguimentos , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Nefrectomia , Nivolumabe/farmacologia , Estado Nutricional/fisiologia , Prognóstico , Intervalo Livre de Progressão , Inibidores de Proteínas Quinases/farmacologia , Inibidores de Proteínas Quinases/uso terapêutico , Estudos Retrospectivos , Albumina Sérica Humana/análise
14.
Khirurgiia (Mosk) ; (6): 118-120, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32573543

RESUMO

Small bowel tumor causes gastrointestinal bleeding in 1-4% of cases. Gastrointestinal bleeding from metastases of renal cell carcinoma is a rare and little-known manifestation of this disease. We report a rare clinical case of a solitary metastasis of clear cell renal cell carcinoma into small bowel in 5 years after nephrectomy. The first symptom was intestinal bleeding. This example emphasizes the need for more thorough examination of patients with symptoms of latent and anamnestic blood loss.


Assuntos
Carcinoma de Células Renais/secundário , Hemorragia Gastrointestinal/etiologia , Neoplasias Intestinais/secundário , Neoplasias Renais/patologia , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Intestinais/complicações , Intestino Delgado , Neoplasias Renais/cirurgia , Nefrectomia
15.
Medicine (Baltimore) ; 99(19): e20071, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384474

RESUMO

Renal cell carcinoma (RCC) is known to be more prevalent in autosomal dominant polycystic kidney disease (ADPKD) patients than in the general population. However, little is known about genetic alterations or changes in signaling pathways in RCC in patients with ADPKD.In the current report, whole-exome and transcriptome sequencing was performed for paired samples of tumor tissue, cyst tissue, and peripheral blood (triple set) from a patient diagnosed with ADPKD and RCC.A 68-year-old man with ADPKD underwent left partial nephrectomy and was diagnosed with RCC. DNA and RNA were extracted from the triple set of the patient. A nonsense mutation in PKD2 (p.Arg742X), which is well known as a pathogenic variant in ADPKD, was identified in the paired triple set. In the tumor sample, a somatic missense mutation of VHL (p.S65L) was found, which is known as a pathogenic mutation in Von Hippel-Lindau syndrome and RCC. Furthermore, loss of chromosome 3p, where VHL is located, was detected. Upregulated VEGFA was found in the analysis of RCC mRNA, which might be caused by the loss of VHL and accelerate angiogenesis in RCC.Proliferation was also expected to be activated by the MAPK signaling pathway, including NRAS and MAPK1 expression.


Assuntos
Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/genética , Neoplasias Renais/complicações , Neoplasias Renais/genética , Mutação , Rim Policístico Autossômico Dominante/complicações , Rim Policístico Autossômico Dominante/genética , Idoso , Humanos , Masculino
16.
Medicine (Baltimore) ; 99(16): e19838, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32312006

RESUMO

Renal cell carcinoma (RCC) has been traditionally thought to be radioresistant. This retrospective cohort study aims to assess the outcomes of patients with spinal metastases from RCC treated with conventionally-fractionated external beam radiation therapy (cEBRT) in our institution.Patients diagnosed with histologically or radiologically-proven RCC who received palliative cEBRT to spinal metastases, using 3-dimensional conformal technique between 2009 and 2018 were reviewed. Local progression-free survival (PFS), overall survival (OS) and common terminology criteria for adverse events version 4.0-graded toxicity were assessed. Univariable and multivariable Cox proportional hazards regression analyses were performed to evaluate for predictors associated with survivals.Thirty-five eligible patients with forty spinal segments were identified, with a median follow-up of 7 months (range, 0-47). The median equivalent dose in 2 Gy fractions (EQD2) was 32.5 Gy 10 (range, 12-39). Thirty-seven percent of patients underwent surgical intervention. At the time of last follow-up, all but 1 patient had died. Seven patients developed local progression, with the median time to local progression of 10.2 months. The median local PFS and OS were 3.3 and 4.8 months. There was no grade 3 or higher toxicity. A higher radiation dose (equivalent dose to 2 Gy fraction <32.5 Gy 10 vs ≥32.5Gy 10) (hazard ratio [HR], 0.47; 95% confidence interval [CI], 0.17-3.18; P-value (P) = .68) and spinal surgery (HR, 2.35; 95% CI, 0.53-10.29; P = .26) were not significantly associated with local PFS on univariable analysis. Multivariable analysis showed that higher Tokuhashi score (HR, 0.41; 95% CI, 0.19-0.88; P = .02), lower number of spinal segments irradiated (HR, 1.18; 95% CI, 1.01-1.37; P = .04) and use of targeted therapy (HR, 0.41; 95% CI, 0.18-0.96; P = .04) were independent predictors for improved OS.For an unselected group of patients with RCC, there is no significant association between higher radiation dose and improved local control following cEBRT. This may be due to their short survivals. With the use of more effective systemic therapy, including targeted therapy and immunotherapy, survival will likely be prolonged. A tailored-approach is needed to identify patients with good prognosis who may still benefit from aggressive local treatments.


Assuntos
Carcinoma de Células Renais/complicações , Radiocirurgia/métodos , Neoplasias da Coluna Vertebral/radioterapia , Neoplasias da Coluna Vertebral/secundário , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imunoterapia/métodos , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Terapia de Alvo Molecular/métodos , Intervalo Livre de Progressão , Radiocirurgia/efeitos adversos , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/cirurgia , Coluna Vertebral/patologia , Coluna Vertebral/efeitos da radiação , Resultado do Tratamento
17.
Anticancer Res ; 40(3): 1527-1534, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32132053

RESUMO

We report a case of rapid evolution of polycystic liver disease in a 76-year-old patient with metastatic renal cell carcinoma who underwent treatment with numerous antineoplastic agents. The aim was to identify a causative etiology for these hepatic cysts of unclear origin. The cystic lesions of the patient were ultimately innumerable and developed rapidly, more than tripling the total liver volume from complete absence over the course of 24 months. The hepatic lesions continued to grow despite an otherwise moderate tumor response. Prior to patient death, the patient remained relatively asymptomatic from the cyst burden and was without signs of grossly metastatic disease. This rapid development of polycystic liver disease most likely represents a previously unseen medication side-effect of cabozantinib or pazopanib. It is important to identify adverse effects of novel antineoplastic agents in this time of oncological medical discovery.


Assuntos
Carcinoma de Células Renais/complicações , Cistos/complicações , Neoplasias Renais/complicações , Hepatopatias/complicações , Idoso , Anilidas/administração & dosagem , Anilidas/efeitos adversos , Carcinoma de Células Renais/tratamento farmacológico , Carcinoma de Células Renais/patologia , Cistos/induzido quimicamente , Cistos/etiologia , Cistos/patologia , Humanos , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/patologia , Hepatopatias/etiologia , Hepatopatias/patologia , Masculino , Metástase Neoplásica , Piridinas/administração & dosagem , Piridinas/efeitos adversos , Pirimidinas/administração & dosagem , Pirimidinas/efeitos adversos , Sulfonamidas/administração & dosagem , Sulfonamidas/efeitos adversos
18.
Transplant Proc ; 52(3): 737-739, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32139277

RESUMO

BACKGROUND: The existence of renal cell cancer (RCC) in a donated kidney may cause some confusion for clinicians. We aim to present our clinical experiences with 2 recipients who received an RCC-containing kidney from their living related donors. METHODS: Two male patients received a kidney containing resectable size RCC from their living related donors. The recipients were discharged with well-functioning kidneys and currently are being monitored on standard follow-up protocols, and there is no evidence of RCC in their grafts. RESULTS: The kidneys with resectable sizes of renal cell carcinoma were transplanted to the recipients after nephron-sparing surgery, with no sign of recurrent RCC in the 12-month follow-up period. CONCLUSIONS: In the era of transplantation, the shortage of organ sources is the major barrier for the provision of organs to recipients. To enhance the graft donation pool, kidneys with resectable size RCC might be used in providing grafts to patients with end-stage kidney disease.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Transplante de Rim/métodos , Rim/patologia , Doadores Vivos/provisão & distribução , Adulto , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos
20.
Nat Commun ; 11(1): 739, 2020 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-32029730

RESUMO

Clear cell renal cell carcinoma (ccRCC) is a heterogeneous disease with features that vary by ethnicity. A systematic characterization of the genomic landscape of Chinese ccRCC is lacking, and features of ccRCC associated with tumor thrombus (ccRCC-TT) remain poorly understood. Here, we applied whole-exome sequencing on 110 normal-tumor pairs and 42 normal-tumor-thrombus triples, and transcriptome sequencing on 61 tumor-normal pairs and 30 primary-thrombus pairs from 152 Chinese patients with ccRCC. Our analysis reveals that a mutational signature associated with aristolochic acid (AA) exposure is widespread in Chinese ccRCC. Tumors from patients with ccRCC-TT show a higher mutational burden and genomic instability; in addition, mutations in BAP1 and SETD2 are highly enriched in patients with ccRCC-TT. Moreover, patients with/without TT show distinct molecular characteristics. We reported the integrative genomic sequencing of Chinese ccRCC and identified the features associated with tumor thrombus, which may facilitate ccRCC diagnosis, prognosis and treatment.


Assuntos
Carcinoma de Células Renais/genética , Neoplasias Renais/genética , Trombose/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Ácidos Aristolóquicos/toxicidade , Grupo com Ancestrais do Continente Asiático/genética , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/etiologia , China , Estudos de Coortes , Feminino , Perfilação da Expressão Gênica , Estudos de Associação Genética , Instabilidade Genômica , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/etiologia , Masculino , Pessoa de Meia-Idade , Mutação , Prognóstico , Trombose/complicações , Trombose/etiologia , Sequenciamento Completo do Exoma
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