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1.
Hinyokika Kiyo ; 65(10): 407-411, 2019 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-31697886

RESUMO

A 69-year-old man was referred to our hospital for a right renal pelvic tumor noted on a computed tomography (CT) scan at another hospital. Urine cytology was negative. Dynamic CT revealed a right renal pelvic tumor and, accidentally, a small left renal tumor enhanced in the arterial phase and washed out in the venous phase. No defect in the urinary tract was found on retrograde urography, and upper urinary cytology was negative. The patient's level of IgG4 was high, but other tumor markers were negative. We judged the right renal pelvic tumor to be an extrapelvic lesion, probably IgG4-related disease. We temporarily followed up the right renal pelvic tumor but performed retroperitoneal left partial nephrectomy for the small left renal tumor. Histopathology led to a diagnosis of clear cell renal cell carcinoma. Follow-up CT showed no change in the right renal pelvic tumor. We diagnosed the right renal tumor as IgG4-related disease and began steroid administration. After one monthof administration, the IgG4 value and the size of the tumor were reduced.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Fibrose Retroperitoneal , Idoso , Carcinoma de Células Renais/complicações , Humanos , Imunoglobulina G , Neoplasias Renais/complicações , Masculino , Nefrectomia , Fibrose Retroperitoneal/complicações
2.
Actas urol. esp ; 43(9): 495-502, nov. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185251

RESUMO

Introducción y objetivos: El objetivo de este estudio es evaluar las tasas de sobrevida global (OS), la sobrevida específica del cáncer (CSS), la sobrevida libre de recaída global (RFS), la sobrevida tiempo libre hasta la recaída local (LRFS) y la sobrevida tiempo libre hasta la recaída a distancia (DRFS), en los pacientes con carcinoma de células renales (CCR) pT3a considerando a la infiltración de grasa (FI) perirrenal y/o sinusal como factores pronósticos. Materiales y métodos: Cohorte retrospectiva de pacientes con CCR pT3a sometidos a cirugía. Los datos se extrajeron de la base de datos LARCG. Se evaluaron variables demográficas, clínicas, patológicas y quirúrgicas. La FI se dividió en 4 grupos (vena, perirrenal, sinusal y ambas grasas). Se realizaron curvas de Kaplan-Meier y regresión de Cox. Resultados: Se incluyeron 293 pacientes. La edad media fue de 61,4 años. La mediana de seguimiento fue de 21 meses (r: 1-194). La CSS, la RFS, el LRFS y el DRFS estimadas a 3 años en el grupo de ambas grasas infiltradas fueron 53,1, 45,1, 58,7 y 51,6 meses, respectivamente, en todos los casos estadísticamente inferiores al resto (p ˂ 0,005). En el análisis multivariable, la infiltración de ambas grasas tuvo un aumento significativo de mortalidad específica, recaída global y local con respecto a infiltración de venas (HR: 4,5, 2,42 y 8,08, respectivamente). El grado de Fuhrman y la infiltración de la pelvis renal fueron predictores independientes de la CSS y la RFS. Conclusiones: La infiltración de ambas grasas renales aumenta el riesgo de recaída global y local en pT3a RCC. Del mismo modo, se asocia con una menor sobrevida específica del cáncer, debiendo considerarse como un factor de mal pronóstico


Introduction and objectives: The objective of this study is to evaluate overall survival (OS), cancer-specific survival (CSS), relapse-free survival, local and distant (LRFS and DRFS, respectively) rates in patients with pT3a renal cell carcinoma (RCC) considering the perirenal and/or sinus fat infiltration (FI) as prognostic factors. Materials and methods: Retrospective cohort of patients with pT3a RCC who underwent radical or partial nephrectomy. The data were extracted from the LARCG (Latin American Renal Cancer Group) database. The demographic, clinical, pathological and surgical variables were evaluated. FI was divided into 4 groups (vein, perirenal, sinus and both fats infiltration). The Kaplan Meier and Cox regression curves were performed. Results: 293 patients were included in the study. The mean age was 61.4 years. The median follow-up was 21 months (r: 1-194). CSS, RFS, LRFS and DRFS estimated at 3 years in the group of both fats’ infiltration were 53.1, 45.1, 58.7 and 51.6 months, respectively, and always statistically lower than the rest (P ˂ 0.005). In the multivariate analysis, the infiltration of both fats significantly increased specific mortality, overall and local relapse with respect to vein infiltration (HR: 4.5, 2.42 and 8.08, respectively). The Fuhrman grade and renal pelvis infiltration were independent predictors of CSS and RFS. Conclusions: Infiltration of both fats increases the risk of overall and local relapse in pT3a RCC. In the same way, it is associated with a lower cancer-specific survival and should be considered as a factor of poor prognosis


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Prognóstico , Carcinoma de Células Renais/diagnóstico , Taxa de Sobrevida , Estudos de Coortes , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/complicações , Estudos Retrospectivos , Estimativa de Kaplan-Meier , Análise Multivariada , Nefrectomia/métodos , Análise de Variância
3.
BMJ Case Rep ; 12(10)2019 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-31586963

RESUMO

Xanthogranulomatous pyelonephritis is associated with obstruction, stones and infection. CT is the mainstay of diagnosis, but appearances can mimic other conditions, including renal cell carcinoma. Nephrectomy is commonly recommended, but conservative treatment with antibiotics has been described after tissue diagnosis. We present a case of xanthogranulomatous pyelonephritis with concomitant renal cell carcinoma, which was an association that was suggested in 1988 and supported by subsequently reported cases. Conservative management of biopsy or cytology proven xanthogranulomatous pyelonephritis is unsafe, as an area of synchronous malignant tumour may be missed: we recommend it only in patients unfit for nephrectomy.


Assuntos
Carcinoma de Células Renais/diagnóstico , Neoplasias Renais/diagnóstico , Pielonefrite Xantogranulomatosa/diagnóstico , Idoso , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Febre/etiologia , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/diagnóstico por imagem , Nefrectomia , Pielonefrite Xantogranulomatosa/complicações , Pielonefrite Xantogranulomatosa/diagnóstico por imagem , Tomografia Computadorizada por Raios X
4.
BMC Cancer ; 19(1): 967, 2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31623580

RESUMO

BACKGROUND: Patients with metastatic renal carcinoma frequently have pre-existing renal impairment and not infrequently develop worsening renal function as a complication of their treatment. The presence of pancreatic metastases in patients with metastatic renal carcinoma, often confers a more favourable prognosis and as a consequence this patient group may be exposed to such treatments for more prolonged periods of time. However, the development of renal failure may also be a consequence of the cancer itself rather than its treatment. CASE PRESENTATION: We present an 84-year-old patient receiving the tyrosine kinase inhibitor (TKI) pazopanib for metastatic renal carcinoma who developed oxalate nephropathy as a consequence of pancreatic exocrine insufficiency resulting from pancreatic metastases. CONCLUSIONS: This case demonstrates the importance of investigating unexpected toxicities and highlights the potential consequences of pancreatic insufficiency and its sequelae in patients with pancreatic metastases.


Assuntos
Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/patologia , Insuficiência Pancreática Exócrina/complicações , Falência Renal Crônica/etiologia , Neoplasias Renais/complicações , Neoplasias Renais/patologia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/secundário , Acetatos/uso terapêutico , Idoso de 80 Anos ou mais , Compostos de Cálcio/uso terapêutico , Carcinoma de Células Renais/tratamento farmacológico , Fármacos Gastrointestinais/uso terapêutico , Humanos , Falência Renal Crônica/terapia , Neoplasias Renais/tratamento farmacológico , Masculino , Oxalatos/urina , Neoplasias Pancreáticas/tratamento farmacológico , Pancrelipase/uso terapêutico , Inibidores de Proteínas Quinases/efeitos adversos , Inibidores de Proteínas Quinases/uso terapêutico , Pirimidinas/efeitos adversos , Pirimidinas/uso terapêutico , Diálise Renal , Sulfonamidas/efeitos adversos , Sulfonamidas/uso terapêutico , Resultado do Tratamento
6.
Arch Esp Urol ; 72(8): 744-749, 2019 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31579032

RESUMO

OBJECTIVE: To perform a literature review on the use of cavoscopy during surgery for renal cell carcinoma with vena cava thrombus (RCCVCT), according to the criteria of Evidence-Based Medicine. MATERIAL AND METHODS: We performed a Pubmed search for studies published with the following keywords: "renal tumor thrombus", "renal tumor cavoscopy" and "cystoscopy thrombus", without time limit and in English. With these criteria, 5 articles were identified with a total of 41 patients. All studies found are case series and expert opinions, so the degree of evidence in the use of cavoscopy in RCCVCT is low. RESULTS: RCCVCT surgery is a complex technique, which can reach over 50% 5-year survival, when a complete oncological resection is achieved. One of the keys for surgical success is complete resection of tumor thrombus, having used different techniques for its verification. One of them is cavoscopy, which consists on the introduction of a flexible cystoscope through the cavotomy incision after thrombectomy, checking the lumen of the vena cava with saline serum irrigation. In two series of clinical cases, cavoscopy detected thrombus persistence in 22% and 43% of patients respectively, allowing resection. The entire resected thrombus showed malignancy in several cases. CONCLUSION: Cavoscopy is a technique that improves detection of tumor remnants after thrombectomy in comparison to indirect review methods. Although oncological impact of caval thrombus is controversial, the use of cavoscopy allows a more complete resection of the thrombus, and it may offer a possible increase in the recurrence-free survival of these patients.


Assuntos
Carcinoma de Células Renais , Cistoscopia , Neoplasias Renais , Células Neoplásicas Circulantes , Nefrectomia , Trombose , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/cirurgia , Cistoscópios , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Trombose/complicações , Trombose/cirurgia , Veia Cava Inferior
7.
Medicine (Baltimore) ; 98(37): e17172, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517871

RESUMO

The aim of the study was to report the experience and outcomes of Xp11.2 translocation renal cell carcinoma (tRCC) patients with tumor thrombus undergoing radical nephrectomy and thrombectomy.Between January 2017 and December 2017, 66 consecutive patients with RCC and venous thrombus involvement received surgical treatment at Peking University Third Hospital. Of which, 5 patients were confirmed of Xp11.2 tRCC, 61 patients were diagnosed of non-tRCC subtypes including 45 ccRCCs, 10 pRCCs, and 6 other subtypes. Demographic, clinical, operation, pathological and follow-up data were extracted for analysis. Prognostic factors were identified by Cox regression analysis.All the patients received radical nephrectomy and thrombectomy successfully. During a median follow-up of 18 months, 5 patients in non-tRCC group and 1 patient in tRCC group died of disease progression. Survival analysis revealed that Xp11.2 tRCC patients experienced shorter DFS than non-tRCC patients, however, there is no significant difference in OS between two groups. Xp11.2 tRCC histological subtype and presence of metastasis at diagnosis were identified as independent negative factors of DFS by multivariate analysis.Radical nephrectomy with thrombectomy provides an acceptable efficacy for tRCC patients with tumor thrombus extending into the venous system. In addition, multimodality treatment should be considered for advanced Xp11.2 RCCs as this subtype was a negative prognostic factor of DFS.


Assuntos
Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/cirurgia , Neoplasias Renais/complicações , Neoplasias Renais/cirurgia , Trombose Venosa/complicações , Trombose Venosa/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/genética , Carcinoma de Células Renais/mortalidade , Feminino , Seguimentos , Humanos , Neoplasias Renais/genética , Neoplasias Renais/mortalidade , Masculino , Pessoa de Meia-Idade , Nefrectomia , Análise de Sobrevida , Trombectomia , Trombose Venosa/mortalidade , Adulto Jovem
8.
Am J Case Rep ; 20: 1434-1439, 2019 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-31563918

RESUMO

BACKGROUND Blood pressure (BP) is not routinely screened in children in clinical practice. Renal cell carcinoma (RCC) is a rare cause of renal hypertension and accounts for less than 0.3% of all childhood tumors. The clinical manifestation of hypertension in children requires a high index of suspicion, as does RCC, which can have many different manifestations. CASE REPORT We report the case of a 10-year-old girl with 1-year history of persistent symptoms of recurrent episodes of headache and excessive sweating and a 6-months history of weight loss and loss of appetite. She was repeatedly managed as having malaria in the center where she was referred, without recovery. Persistent high BP was discovered in our center, which ranged between 180/120 and 200/120 mmHg. This was not controlled by 3 different classes of drugs. Abdominal ultrasonography showed a right kidney with a well circumscribed lower pole mass with internal echoes, compressing the pelvicalyceal system. Abdominal computed tomography revealed a huge, circumscribed, expansile, isodense mass arising from the renal cortex in the lower pole of the right kidney. Intraoperative findings included a mass seen at the lower pole of the right kidney with histology diagnosis of RCC. Other laboratory tests were normal. To date, the patient remains normotensive and symptom-free after nephrectomy. CONCLUSIONS The nonspecific clinical manifestation found in this case show the need for hypertension screening in children. The resolution of symptoms after nephrectomy confirms RCC as the underlying cause of symptoms, making this case a unique presentation.


Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Erros de Diagnóstico , Hipertensão/etiologia , Neoplasias Renais/diagnóstico por imagem , Anti-Hipertensivos/efeitos adversos , Carcinoma de Células Renais/complicações , Criança , Resistência a Múltiplos Medicamentos , Feminino , Humanos , Hipertensão/tratamento farmacológico , Neoplasias Renais/complicações , Malária , Tomografia Computadorizada por Raios X
9.
J Card Surg ; 34(10): 1018-1023, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31376225

RESUMO

BACKGROUND: Renal cell carcinoma (RCC) with tumor thrombus extending into the inferior vena cava (IVC) occurs in 4%-10% of cases. Within this subset, pulmonary tumor embolism (PTE) appears in approximately 0.9%-2.4% of cases. We wanted to review our experience in managing patients with RCC with IVC involvement and a preoperative diagnosis of PTE. METHODS: A total of seven patients presented at our center between January, 2005 and January, 2015 with RCC, IVC involvement, and PTE (diagnosed either by chest computerized tomography angiography or preoperative transesophageal echocardiogram). Each patient underwent a radical nephrectomy and tumor thrombectomy using an organ transplant-based approach. RESULTS: Surgical removal of the PTE was performed in three patients (tumor embolectomy in two cases, right lower lobe resection in one case); the PTEs in four patients were considered to be too small to undergo surgical resection. PTE pathology found neoplastic cells in each patient that had surgical removal. No postoperative complications were observed in any of the seven patients. All four patients who were metastasis-free preoperatively (with 2/4 having tumor embolectomy performed) developed distant metastasis; median time-to-developing metastatic disease was 6.5 months. With a median follow-up of 19 months, three deaths because the disease have occurred. CONCLUSION: Although RCC with IVC tumor thrombus complicated by PTE may not be catastrophic in most cases, it appears to be associated with an increased risk of developing metastatic disease. In addition, as the PTEs appear to contain neoplastic cells, pulmonary artery embolectomy at the time of nephrectomy should be performed whenever possible.


Assuntos
Carcinoma de Células Renais/complicações , Embolectomia/métodos , Neoplasias Renais/complicações , Embolia Pulmonar/etiologia , Trombectomia/métodos , Veia Cava Inferior , Trombose Venosa/etiologia , Adulto , Idoso , Carcinoma de Células Renais/diagnóstico , Feminino , Seguimentos , Humanos , Neoplasias Renais/diagnóstico , Masculino , Pessoa de Meia-Idade , Células Neoplásicas Circulantes , Nefrectomia , Período Perioperatório , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Trombose Venosa/diagnóstico , Trombose Venosa/cirurgia
10.
Urologia ; 86(3): 156-160, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31431168

RESUMO

Digital ischemia has been rarely associated, as a paraneoplastic syndrome, with renal cancer. Since it can severely compromise the patients' quality of life, early recognition is important, in order to optimally address it with currently available treatment options, such as tyrosine inhibitors. Digital ischemia may occur in the general population and it can be the result of other non-cancerous diseases; accordingly, a thorough and aggressive work-up is mandatory, together with appropriate therapeutic steps such as tyrosine kinase inhibitors, vasodilators, and antiaggregants. Herein, we report a 78-year-old male patient with a history of clear-cell renal-cell cancer, who presented in the emergency department with critical ischemia in the upper limbs.


Assuntos
Carcinoma de Células Renais/complicações , Dedos/irrigação sanguínea , Isquemia/etiologia , Neoplasias Renais/complicações , Síndromes Paraneoplásicas/etiologia , Idoso , Humanos , Masculino
11.
Artigo em Chinês | MEDLINE | ID: mdl-31446739

RESUMO

SummaryRenal clear cell carcinoma(RCCC) is the most common type of renal cell carcinoma, but metastasis to the nasal cavity is extremely rare. A case of RCCC to the nasal cavity and paranasal sinuses was reported. The early clinical manifestations of this case were intermittent epistaxis and subsequent massive epistaxis. Imaging examination revealed that there were masses in the nasal cavity and paranasal sinus, accompanied by bleeding and destruction of the skull base. Renal CT examination showed a tumor in the right kidney, and considered the patient suffering from renal cell carcinoma. The patient underwent a nasal side incision to remove the tumor, the patient's pathological return; nasal nephrogenic clear-cell carcinoma.


Assuntos
Adenocarcinoma de Células Claras/complicações , Carcinoma de Células Renais/complicações , Neoplasias Renais/complicações , Cavidade Nasal/patologia , Neoplasias dos Seios Paranasais/secundário , Adenocarcinoma de Células Claras/diagnóstico , Humanos , Seios Paranasais/patologia
13.
J Med Case Rep ; 13(1): 188, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31221202

RESUMO

BACKGROUND: Leser-Trélat syndrome, which manifests as eruptive multiple seborrheic keratoses, is a rare paraneoplastic sign. Hyponatremia in the elderly population is an often overlooked but potentially sinister biochemical abnormality. Cancer-related causes of hyponatremia include syndrome of inappropriate antidiuretic hormone secretion, cerebral or renal salt wasting, and adrenal dysfunction. We report a case of an elderly man who presented with both syndrome of inappropriate antidiuretic hormone secretion and Leser-Trélat syndrome, and was eventually found to have renal malignancy. CASE PRESENTATION: A 74-year-old indigenous Malaysian man with underlying chronic kidney disease presented with recurrent admissions for hyponatremia with parameters indicative of syndrome of inappropriate antidiuretic hormone secretion, constitutional symptoms, and diffuse skin lesions suggestive of multiple seborrheic keratoses. A radiological workup revealed metastatic renal cell carcinoma with evidence of metastasis to the brain, adrenal glands, bone, and lungs. CONCLUSIONS: To the best of our knowledge, renal malignancy presenting as syndrome of inappropriate antidiuretic hormone secretion and Leser-Trélat concurrently is rare. The causes of hyponatremia in the elderly, approach to investigation, and value as a poor prognostic marker in malignancy are highlighted. We also discuss Leser-Trélat syndrome, its pathophysiology, and its possible implications on clinical practice.


Assuntos
Carcinoma de Células Renais/complicações , Síndrome de Secreção Inadequada de HAD/etiologia , Ceratose Seborreica/etiologia , Neoplasias Renais/complicações , Síndromes Paraneoplásicas/etiologia , Idoso , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/secundário , Humanos , Hiponatremia/etiologia , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Masculino
14.
BMC Urol ; 19(1): 49, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174518

RESUMO

BACKGROUND: Conflicting evidence exists regarding the effect of hypertension on the prognosis of metastatic renal cell carcinoma (mRCC) patients treated with tyrosine kinase inhibitors (TKIs). This study aimed to assess the predictive value of TKIs-induced hypertension in patients with mRCC. METHODS: This study was registered in PROSPERO (CRD42019129593). PubMed, Embase, Web of Science and the Cochrane Library database were searched with terms: "renal cell carcinoma", "hypertension", "blood pressure", "tyrosine kinase inhibitor", "sunitinib", "axitinib", "sorafenib" and "pazopanib" until March 21, 2019. Hazard Ratios (HR) and 95% confidence intervals (CI) for progression-free survival (PFS) or overall survival (OS) were extracted and analyzed with Stata 15.0 software. Heterogeneity was assessed using the I2 value. Meta-regression, subgroup analysis and sensitivity analysis were also performed to explore heterogeneity. Publication bias was assessed with funnel plots and precisely assessed by Egger's and Begg's tests. The quality of evidence of outcomes was generated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). RESULTS: A total of 4661 patients from 22 studies were included in the study. The results showed that the increase of blood pressure was an effective predictor for longer PFS (HR = 0.59, 95% CI: 0.48-0.71, p < 0.001; I2 = 77.3%) and OS (HR = 0.57, 95% CI: 0.45-0.70, p < 0.001; I2 = 77.4%) of patients with mRCC. Subgroup analysis revealed that patients receiving sunitinib and pazopanib could have longer PFS and OS. CONCLUSIONS: This study indicated that TKIs-induced hypertension may be a good predictor for better prognosis of patients with mRCC receiving TKIs treatment, especially using sunitinib or pazopanib.


Assuntos
Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/tratamento farmacológico , Hipertensão/complicações , Neoplasias Renais/complicações , Neoplasias Renais/tratamento farmacológico , Inibidores de Proteínas Quinases/uso terapêutico , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/secundário , Intervalo Livre de Doença , Humanos , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Prognóstico , Taxa de Sobrevida
15.
WMJ ; 118(1): 49-51, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31083837

RESUMO

Renal cell carcinoma is well-known for its propensity to present in unusual ways, and renal cell carcinoma presenting as pleural effusion is extremely rare. Pleural effusion secondary to renal cell carcinoma constitutes only about 1% to 2% of all malignant pleural effusions. We report the case of a 34-year-old man with no significant past medical or surgical history who presented in the Emergency Department with dyspnea. Chest x-ray demonstrated right-sided pleural effusion; computed tomography (CT) reported right-sided effusion in the pleura with suspicious mass in the upper border of left kidney. CT-guided pleural tap was performed and cytology was positive for vimentin and common acute lymphocytic leukemia antigen (CD10), leading to the diagnosis of primary renal cell carcinoma presenting as unilateral pleural effusion. While lungs are the common site of metastasis, the presentation of renal cell carcinoma as pleural effusion or pleural metastasis without lung involvement is rare.


Assuntos
Carcinoma de Células Renais/complicações , Neoplasias Renais/complicações , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , Adulto , Diagnóstico Diferencial , Evolução Fatal , Humanos , Masculino , Tomografia Computadorizada por Raios X
16.
J Int Med Res ; 47(6): 2728-2739, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31066322

RESUMO

INTRODUCTION: Primary renal lymphoma is a rare malignant lymphoma that is difficult to differentiate from renal cell carcinoma. Positron emission tomography/computed tomography and image-guided percutaneous biopsy are valuable tools for diagnosis. CASE REPORT: A 64-year-old woman presented with a 2-year history of repeated right waist pain and a 1-month history of nausea, vomiting, and frequent and urgent urination. A computed tomography scan showed a huge mass that was initially considered to be renal cell carcinoma at the upper pole of the right kidney. The mass had invaded the renal pelvis, narrowed the right renal artery, and constricted the inferior vena cava and liver. Postoperative examination of the tumor confirmed lymphoma. We herein present this case and its multidisciplinary team management. CONCLUSION: Multidisciplinary team management is efficient for preoperative assessment and surgery in difficult and high-risk cases. Based on our literature review, we suggest biopsy before chemotherapy whenever possible. Chemotherapy can be implemented after surgery for better survival outcomes.


Assuntos
Carcinoma de Células Renais/patologia , Neoplasias Renais/patologia , Linfoma Difuso de Grandes Células B/patologia , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/terapia , Terapia Combinada , Feminino , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/terapia , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/terapia , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
17.
Urol Int ; 102(4): 435-440, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30970369

RESUMO

BACKGROUND: The side effects of sunitinib, namely onset of hypertension and hypothyroidism, have been reported to be predictive biomarkers of treatment efficacy. However, the relationship between hypothyroidism and prolongation of survival in treatment with axitinib, a drug similar to sunitinib, has not yet been reported. OBJECTIVE: In this study, we examined the relationship between the onset of hypothyroidism caused by axitinib and overall survival (OS) and progression-free survival (PFS). METHODS: In this retrospective study, 44 Japanese patients, including 30 men and 14 women, were enrolled. The average age of subjects in this study was 67 years. RESULTS: During treatment, 68% of patients developed hypothyroidism, with an average peak thyroid-stimulating hormone (TSH) value of 15.7 mIU/L. Patients with TSH > 4 mIU/L and required thyroid hormone regulation with levothyroxine had prolonged PFS (11.1 vs. 3.5 months; p = 0.002) and OS (26.4 vs. 15.6 months; p = 0.02). Hypothyroidism was found to be a significant side effect of axitinib in patients with metastatic renal cell carcinoma (mRCC). Patients with hypothyroidism had significantly longer PFS and OS. CONCLUSION: Our findings indicate that hypothyroidism may be a predictive marker of therapeutic effect of axitinib against mRCC.


Assuntos
Axitinibe/efeitos adversos , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/diagnóstico , Hipotireoidismo/induzido quimicamente , Neoplasias Renais/diagnóstico , Idoso , Carcinoma de Células Renais/mortalidade , Intervalo Livre de Doença , Feminino , Humanos , Japão , Estimativa de Kaplan-Meier , Neoplasias Renais/complicações , Neoplasias Renais/mortalidade , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estudos Retrospectivos , Tireotropina/sangue , Resultado do Tratamento
18.
Minerva Urol Nefrol ; 71(4): 339-358, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30957477

RESUMO

INTRODUCTION: Current guidelines recommend considering surgical excision of non-metastatic renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombosis in patients with acceptable performance status. Of note, several authors have pioneered specific techniques for laparoscopic and robotic management of renal cancer with level I-IV IVC thrombosis. EVIDENCE ACQUISITION: A systematic review of the English-language literature on surgical techniques and perioperative outcomes of minimally-invasive radical nephrectomy (RN) and IVC thrombectomy for nonmetastatic RCC was performed without time filters using the MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials and Web of Science (WoS) databases in September 2018 according to the PRISMA statement recommendations. EVIDENCE SYNTHESIS: Overall, 28 studies were selected for qualitative analysis (N.=13 on laparoscopic surgery, N.=15 on robotic surgery). The quality of evidence according to GRADE was low. Laparoscopic techniques included hand-assisted, hybrid and pure laparoscopic approaches. Most of these series included right-sided tumors with predominantly level I or II IVC thrombi. Similarly, most robotic series reported right-sided RCC with level I-II IVC thrombosis; yet, few authors extended the indication to level III thrombi and to left-sided RCC. Surgical techniques for minimally-invasive IVC thrombectomy evolved over the years, with specific technical nuances aiming to tailor surgical strategy according to both tumor side and thrombus extent. Among the included studies, perioperative outcomes were promising. CONCLUSIONS: Minimally-invasive surgery is technically feasible and has been shown to achieve acceptable perioperative outcomes in selected patients with renal cancer and IVC thrombosis. The evidence is premature to draw conclusions on intermediate-long term oncologic outcomes. Robotic surgery allowed to extend surgical indications to more challenging cases with more extensive tumor thrombosis. Nonetheless, global experience on minimally-invasive IVC thrombectomy is limited to high-volume surgeons at high-volume Centers. Future research is needed to prove its non-inferiority as compared to open surgery and to define its benefits and limits.


Assuntos
Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/cirurgia , Neoplasias Renais/complicações , Neoplasias Renais/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Urológicos/métodos , Veia Cava Inferior , Trombose Venosa/complicações , Humanos , Laparoscopia , Procedimentos Cirúrgicos Robóticos
19.
BMJ Case Rep ; 12(4)2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31015235

RESUMO

A 47-year-old previously healthy man presented with acute moderate flank pain. Evaluation revealed left renal cell carcinoma, with inferior vena cava tumour thrombus invasion. Patient had no significant history or risk factors to pre-dispose him to genitourinary cancers. Surgery was deemed to not be appropriate due to distant metastases, but patient received targeted molecular therapy and immunotherapy with striking regression of the thrombus.


Assuntos
Carcinoma de Células Renais/patologia , Nivolumabe/administração & dosagem , Nódulo Pulmonar Solitário/secundário , Trombose/tratamento farmacológico , Veia Cava Inferior/patologia , Trombose Venosa/tratamento farmacológico , Assistência ao Convalescente , Antineoplásicos Imunológicos/efeitos adversos , Antineoplásicos Imunológicos/uso terapêutico , Carcinoma de Células Renais/complicações , Humanos , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Nivolumabe/efeitos adversos , Nivolumabe/uso terapêutico , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/patologia , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/patologia
20.
Tumori ; 105(6): NP72-NP74, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30935288

RESUMO

BACKGROUND: Cytotoxic and immunosuppressive therapies for cancer treatment may allow hepatitis reactivation. Hepatitis due to viral hepatitis reactivation is detected in 14%-25% of hepatitis B surface antigen (HBsAg)-positive cancer patients undergoing anticancer treatments. Drug toxicity may be confused with hepatitis reactivation, which may cause a delay in diagnosis. CASE REPORT: A 60-year-old man with metastatic renal cell carcinoma was treated with sunitinib. Sixteen months after sunitinib inception, liver enzymes were elevated and viral hepatitis reactivation was detected as hepatitis delta virus infection in the HBsAg-positive patient. CONCLUSION: Cancer patients should be screened for viral hepatitis prior to immunosuppressive therapy or chemotherapy.


Assuntos
Antineoplásicos/efeitos adversos , Carcinoma de Células Renais/complicações , Hepatite D/etiologia , Vírus Delta da Hepatite , Neoplasias Renais/complicações , Sunitinibe/efeitos adversos , Ativação Viral/efeitos dos fármacos , Antineoplásicos/uso terapêutico , Antivirais/uso terapêutico , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/tratamento farmacológico , Hepatite D/diagnóstico , Hepatite D/tratamento farmacológico , Vírus Delta da Hepatite/efeitos dos fármacos , Vírus Delta da Hepatite/fisiologia , Humanos , Neoplasias Renais/diagnóstico , Neoplasias Renais/tratamento farmacológico , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Sunitinibe/uso terapêutico , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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