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1.
Arch Esp Urol ; 72(4): 422-428, 2019 May.
Artigo em Espanhol | MEDLINE | ID: mdl-31070139

RESUMO

OBJECTIVE: The incidence of simple renal cysts is very high, especially in elderly people. However, malignant transformation of a simple renal cyst is exceptional. Likewise, the treatment to be carried out, in these rare cases, is controversial, with respect to opting for radical renal surgery. METHODS: We present the case of a patient with a solid nodule in a large cyst. Complete removal of the cyst was performed by transperitoneal laparoscopic technique. The histopathological study of the surgical piece revealed the existence of a cyst with clear renal cell carcinoma with nucleolar grade 2. The clinical evolution has been satisfactory, performing a minimally invasive surgery (laparoscopic cyst excision). DISCUSSION: Although it is considered that surgical treatment of choice is radical surgery in these cases, we believe that nephron sparing surgery may represent a therapeutic option, taking into account the young age of our patient. A histogenetic hypothesis is discussed to explain the appearance of a clear cell tumor in a simple renal cyst. CONCLUSION: The development of a renal cell carcinoma in simple renal cysts is a very infrequent pathology.Laparoscopic total cystectomy is a minimally invasive therapeutic option for the treatment of renal cell carcinoma originating in a simple renal cyst, although it is of an important size. We establish the hypothesis of migration of the cells of the renal collecting tubes into the cyst wall to explain the malignant transformation of the renal simple cyst.


Assuntos
Carcinoma de Células Renais , Doenças Renais Císticas , Neoplasias Renais , Laparoscopia , Idoso , Carcinoma de Células Renais/cirurgia , Humanos , Rim , Doenças Renais Císticas/cirurgia
2.
J Coll Physicians Surg Pak ; 29(5): 456-458, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31036118

RESUMO

OBJECTIVE: To evaluate the variables of cystic renal lesions to predict the renal tumors. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Urology Department, Ankara Yüksek Ihtisas, Samsun Research and Training Hospitals, Turkey, from January 2013 to June 2017. METHODOLOGY: Records of patients with renal cystic lesions were retrospectively evaluated. Preoperative CT results in terms of diameter number and enhancement; and clinical variables such as gender body mass index [(weight (kg)/ height²(m)] and smoking status were recorded. Student's t-test and ANOVA were used for determing significance, which was set at p<0.05. RESULTS: Due to pathology results, all group I patients were benign, 7.9% (3/38) of group II, 31.8% (7/22) of group II-F, 55.3% (21/38) of group III, 69% (40/58) group IV patients were found to be malignant. For clinical factors, obesity and smoking, while for radiological parameters, about 59.3 +11.7 HU enhancement were found to be predictor significant of malignancy (all p<0.05). No significant difference was observed between cystic lesion diameter number or laterality (right/left) and malignancy. CONCLUSION: Renal cysts have a high malignancy possibility in the patients with history of smoking in the past or actively, high BMI, and preoperative CT with about 59.3 +11.7 HU post-contrast enhancement.


Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Doenças Renais Císticas/classificação , Doenças Renais Císticas/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Rim/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Carcinoma de Células Renais/patologia , Meios de Contraste , Progressão da Doença , Feminino , Humanos , Doenças Renais Císticas/patologia , Doenças Renais Císticas/cirurgia , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Metástase Neoplásica , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Índice de Gravidade de Doença
3.
Arch. esp. urol. (Ed. impr.) ; 72(4): 422-428, mayo 2019. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-FGT-3024

RESUMO

Objetivo: La incidencia de los quistes renales simples es muy frecuente, sobre todo en personas de edad avanzada. Sin embargo, la transformación maligna de un quiste renal simple es excepcional. Así mismo, el tratamiento a realizar, en estos casos raros, es un motivo de controversia, con respecto a optar por una cirugía radical renal. Métodos: Presentamos el caso de un paciente con nódulo sólido en un quiste de gran tamaño. Se realiza extirpación completa del quiste mediante técnica de laparoscopia vía transperitoneal. El estudio histopatológico de la pieza quirúrgica revela la existencia un quiste con un carcinoma renal de células claras con grado nucleolar 2. La evolución clínica ha sido satisfactoria, realizando una cirugía de mínima invasión (quistectomía laparoscópica). Discusión: Aunque se considera que el tratamiento quirúrgico es la cirugía radical en estos casos, nosotros consideramos que la cirugía preservadora de nefronas puede representar una opción terapéutica, teniendo en cuenta la edad de nuestro paciente. Se comenta una hipótesis histogenética para explicar la aparición de un tumor de células claras en un quiste renal simple. Conclusiones: El desarrollo de un carcinoma de células renales en quistes renales simples es una patología muy infrecuente. La quistectomía total laparoscópica es una opción terapéutica mínimamente invasiva, para el tratamiento del carcinoma de células renales originado en un quiste renal simple, aunque éste sea de un tamaño importante. Proponemos la hipótesis de una migración de las células de los túbulos renales en la pared del quiste para explicar la transformación maligna del quiste simple renal


Objective: The incidence of simple renal cysts is very high, especially in elderly people. However, malignant transformation of a simple renal cyst is exceptional. Likewise, the treatment to be carried out, in these rare cases, is controversial, with respect to opting for radical renal surgery. Methods: We present the case of a patient with a solid nodule in a large cyst. Complete removal of the cyst was performed by transperitoneal laparoscopic technique. The histopathological study of the surgical piece revealed the existence of a cyst with clear renal cell carcinoma with nucleolar grade 2. The clinical evolution has been satisfactory, performing a minimally invasive surgery (laparoscopic cyst excision). Discussion: Although it is considered that surgical treatment of choice is radical surgery in these cases, we believe that nephron sparing surgery may represent a therapeutic option, taking into account the young age of our patient. A histogenetic hypothesis is discussed to explain the appearance of a clear cell tumor in a simple renal cyst. Conclusion: The development of a renal cell carcinoma in simple renal cysts is a very infrequent pathology Laparoscopic total cystectomy is a minimally invasive therapeutic option for the treatment of renal cell carcinoma originating in a simple renal cyst, although it is of an important size. We establish the hypothesis of migration of the cells of the renal collecting tubes into the cyst wall to explain the malignant transformation of the renal simple cyst


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Renais/cirurgia , Carcinoma de Células Renais/cirurgia , Doenças Renais Císticas/cirurgia , Neoplasias Renais/diagnóstico por imagem , Carcinoma de Células Renais/diagnóstico por imagem , Doenças Renais Císticas/diagnóstico por imagem , Laparoscopia
4.
Urology ; 129: 126-131, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31009744

RESUMO

OBJECTIVE: To evaluate the histopathologic correlation of recently described subclassification of Bosniak category 3 cysts (3s and 3n). MATERIALS AND METHODS: A total of 106 patients who underwent partial/radical nephrectomy due to a complex renal cyst (≥Bosniak 3) were retrospectively reviewed. All the scans of the patients were reevaluated by 2 experienced uroradiologists. Bosniak 3 cysts were reclassified as 3n (nodularity on the cyst wall/septae) and 3s (septated cysts without nodularity) as described in a recently published paper. Group 1 consisted of patients with Bosniak 3s, Group 2 consisted of patients with Bosniak 3n, and Group 3 consisted of patients with Bosniak 4 cysts. Three groups were compared according to patients' characteristics, radiological findings, histopathologic results, and survival outcomes. RESULTS: There were 52 patients in Bosniak 3 group and 54 patients in Bosniak 4 group. Mean follow-up was 35.3 months. Among Bosniak 3 cysts, 37 lesions were classified in 3s and 15 were classified in 3n. Malignancy was higher in 3n group than 3s (86.7% vs 54.1%, P= .026). Lesion size was significantly lower for malignant cysts compared to benign ones in the patients with Bosniak 3 lesions (44.2 ± 27.5 vs 80 ± 55.9 P= .005). In the subgroups, malignant lesions were significantly smaller than benign lesions in 3s group similar to general Bosniak 3 group. Most of the Bosniak 3 lesions were organ confined and low grade. CONCLUSION: The subclassification of Bosniak 3 cysts as 3s and 3n can help to differentiate highly suspicious malignant lesions from the relatively less suspicious ones.


Assuntos
Doenças Renais Císticas/classificação , Neoplasias Renais/diagnóstico , Imagem por Ressonância Magnética/métodos , Nefrectomia/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Diagnóstico Diferencial , Progressão da Doença , Feminino , Seguimentos , Humanos , Doenças Renais Císticas/diagnóstico , Doenças Renais Císticas/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
Rev Med Liege ; 74(3): 125-128, 2019 Mar.
Artigo em Francês | MEDLINE | ID: mdl-30897310

RESUMO

Cystic nephroma is a rare kidney neoplasm belonging to the entity of cystic tumours. It is a slow-growing tumour, which develops insidiously, sometimes reaching a considerable size. The diagnosis is more often accidental (except for mass syndrome in children). It is a benign tumour that may be treated by partial sparing nephrectomy. Malignant degeneration is few and far between. However, no medical examination can confirm the diagnosis before surgery. On medical imaging, the tumour enhances after contrast injection and there will always be a doubt about the benignity. Furthermore, percutaneous biopsy of the mass is not contributory to the diagnosis. This means that it is not easy to propose a conservative surgical treatment, even though this remains the best way to deal with such a tumour.


Assuntos
Doenças Renais Císticas , Neoplasias Renais , Criança , Humanos , Doenças Renais Císticas/diagnóstico , Doenças Renais Císticas/cirurgia , Neoplasias Renais/diagnóstico , Neoplasias Renais/cirurgia , Nefrectomia
6.
Urol Int ; 103(2): 235-241, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30889610

RESUMO

OBJECTIVES: To determine the efficacy and safety of laparoscopic deroofing of symptomatic simple renal cysts. METHODS: A Cochrane style systematic review was conducted on published literature from 1990 to 2017, to include case series and randomised controlled trials. A pooled meta-analysis was conducted. RESULTS: A total of 696 patients who had laparoscopic deroofing of their simple renal cysts were identified. Complete radiological resolution was seen in 96% of patients with 95% of patients completely symptoms free. Less than 1% of patients had intra-operative complications and 1.4% developed postoperative complications. CONCLUSIONS: Cumulative analysis of the literature examining the role of laparoscopic decortication in the management of symptomatic simple renal cysts reveals that the procedure is highly efficacious to relieve symptoms. The procedure was also associated with a significant radiological success rate (96.3%). It was also shown to be safe, with a low complication rate. We deduced a protocol following this systematic review for the management of symptomatic renal cyst in an aim to help select patients that would benefit from laparoscopic decortication.


Assuntos
Doenças Renais Císticas/cirurgia , Laparoscopia , Protocolos Clínicos , Humanos , Laparoscopia/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
7.
AJR Am J Roentgenol ; 212(4): 830-838, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30779659

RESUMO

OBJECTIVE: The objective of our study was to evaluate the cost-effectiveness of active surveillance (AS) versus nephron-sparing surgery (NSS) in patients with a Bosniak IIF or III renal cyst. MATERIALS AND METHODS: Markov models were developed to estimate life expectancy and lifetime costs for 60-year-old patients with a Bosniak IIF or III renal cyst (the reference cases) managed by AS versus NSS. The models incorporated the malignancy rates, reclassification rates during follow-up, treatment effectiveness, complications and costs, and short- and long-term outcomes. An incremental cost-effectiveness analysis was performed to identify management preference under an assumed $75,000 per quality-adjusted life-year (QALY) societal willingness-to-pay threshold, using data from studies in the literature and the 2015 Medicare Physician Fee Schedule. The effects of key parameters were addressed in a multiway sensitivity analysis. RESULTS: The prevalence of malignancy for Bosniak IIF and III renal cysts was 26% (25/96) and 52% (542/1046). Under base case assumptions for Bosniak IIF cysts, the incremental cost-effectiveness ratio of NSS relative to AS was $731,309 per QALY for women, exceeding the assumed societal willingness-to-pay threshold, and AS outperformed NSS for both life expectancy and cost for men. For Bosniak III cysts, AS yielded greater life expectancy (24.8 and 19.4 more days) and lower lifetime costs (cost difference of $12,128 and $11,901) than NSS for men and women, indicating dominance of AS over NSS. Superiority of AS held true in sensitivity analyses for men 46 years old or older and women 57 years old or older even when all parameters were set to favor NSS. CONCLUSION: AS is more cost-effective than NSS for patients with a Bosniak IIF or III renal cyst.


Assuntos
Doenças Renais Císticas/cirurgia , Nefrectomia/economia , Conduta Expectante/economia , Análise Custo-Benefício , Feminino , Humanos , Doenças Renais Císticas/patologia , Expectativa de Vida , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Complicações Pós-Operatórias/economia , Anos de Vida Ajustados por Qualidade de Vida
8.
Indian J Pathol Microbiol ; 62(1): 95-98, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30706867

RESUMO

Glomerulocystic kidney disease (GCKD) is an uncommon type of cystic renal disease affecting children. It has both sporadic and familial occurrence and is characterized by cortical microcysts associated with dilatation of Bowman's spaces. In some instances, GCKD is an early manifestation of autosomal dominant polycystic kidney disease. Here, we present three cases of GCKD, two in infants and one in a perinatal postmortem. The first one is a case of GCKD with unilateral involvement, diagnosed on surgical biopsy. GCKD is a morphological expression of several hereditary and nonhereditary disorders that differ vastly in their management and long-term outcome. Hence, accurate morphological diagnosis of this entity is important for prognostication and genetic counseling.


Assuntos
Doenças do Sistema Nervoso Central/diagnóstico , Esmalte Dentário/anormalidades , Diabetes Mellitus Tipo 2/diagnóstico , Doenças Renais Císticas/diagnóstico , Rim Policístico Autossômico Dominante/diagnóstico , Biópsia , Doenças do Sistema Nervoso Central/patologia , Esmalte Dentário/patologia , Diabetes Mellitus Tipo 2/patologia , Feminino , Humanos , Lactente , Recém-Nascido de muito Baixo Peso , Rim/diagnóstico por imagem , Rim/patologia , Doenças Renais Císticas/patologia , Doenças Renais Císticas/cirurgia , Masculino , Nefrectomia , Rim Policístico Autossômico Dominante/patologia , Rim Policístico Autossômico Dominante/cirurgia , Ultrassonografia
9.
J Vasc Access ; 20(4): 442-445, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30608014

RESUMO

Exhaustion of vascular accesses is a major complication in patients undergoing hemodialysis, especially in pediatric setting. We report the case of a boy treated for loss of hemodialysis access after a combined liver-kidney transplantation and transient renal dysfunction. An interventional dilatation of calcific superior vena cava allowed to insert a stable central venous line for dialysis until full graft recovery. Careful management of central lines allows to spare the main vessels and reduces the need for unusual accesses.


Assuntos
Angioplastia com Balão , Cateterismo Venoso Central/métodos , Função Retardada do Enxerto/terapia , Doenças Renais Císticas/cirurgia , Nefropatias/terapia , Transplante de Rim/efeitos adversos , Cirrose Hepática/cirurgia , Transplante de Fígado/efeitos adversos , Diálise Renal , Calcificação Vascular/terapia , Veia Cava Superior , Criança , Função Retardada do Enxerto/diagnóstico , Função Retardada do Enxerto/etiologia , Função Retardada do Enxerto/fisiopatologia , Humanos , Nefropatias/diagnóstico , Nefropatias/etiologia , Nefropatias/fisiopatologia , Doenças Renais Císticas/complicações , Doenças Renais Císticas/diagnóstico , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Masculino , Flebografia , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/fisiopatologia , Grau de Desobstrução Vascular , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/fisiopatologia
10.
Urology ; 125: 243-247, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30452965

RESUMO

OBJECTIVE: To describe a modified technique for easily locating cystic wall during flexible ureteroscopic surgery for treatment of parapelvic renal cysts. METHODS: Nineteen patients with symptomatic/asymptomatic parapelvic renal cyst were treated with modified or conventional flexible ureteroscopic surgery between February 2015 and March 2017, and the differences of the 2 techniques were compared. The detailed surgical procedures and results, postoperative complications, and patients' follow-ups were evaluated. RESULTS: All the patients received endoscopic management by flexible ureteroscope successfully, without requiring another complicated surgery. The cysts were seen clearly in 9 patients with modified method. Two of ten patients who underwent conventional ureteroscopic surgery changed to the modified surgery intra-operatively since it was difficult to identify the cyst. The total time of search and incision of cysts was 24.2 ± 6.2 minutes and 17.7 ± 2.5 minutes for conventional and modified technique respectively (P = .01), of which 11.4 ± 4.8 minutes and 5.1 ± 1.1 minutes to search the cysts, respectively (P = .002), and the mean time of the procedure of puncture was 8 ± 2.3 minutes. Duration of pure incising the cystic wall was 12.8 ± 3.3 minutes and 12.6 ± 2.5 minutes for patients who underwent conventional and modified technique, respectively (P = .859). All patients acquired relief from the presentation of flank discomfort after surgery. All of the patients were followed-up over 12 months and no serious complications and recurrence was observed. CONCLUSION: The modified technique can decrease time of searching the renal cyst and decrease the total time in flexible ureteroscopic treatment of parapelvic cysts. The limitations of our study were also observed and further studies are needed.


Assuntos
Doenças Renais Císticas/cirurgia , Azul de Metileno/administração & dosagem , Ureteroscopia/métodos , Feminino , Seguimentos , Humanos , Injeções Intralesionais , Doenças Renais Císticas/diagnóstico por imagem , Pelve Renal , Masculino , Pessoa de Meia-Idade , Punções , Estudos Retrospectivos , Ureteroscópios
11.
J Med Case Rep ; 12(1): 284, 2018 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-30285879

RESUMO

BACKGROUND: Incidence of simultaneous renal cyst with calyceal diverticula in contralateral kidney is rare in children. A minimally invasive procedure in different sittings is often recommended. CASE PRESENTATION: A Chinese 15-month-old boy presented to the Urology department of a tertiary care center with right flank pain. He was subjected to magnetic resonance urography and was diagnosed as having right renal cyst and contralateral calyceal diverticula. He underwent robotic cyst decortication and calyceal diverticulectomy using da Vinci robot. His postoperative period was uneventful. He was discharged on fifth postoperative day. Histopathology was consistent with simple renal cyst. CONCLUSIONS: Robotic combined cyst decortication and contralateral diverticulectomy is feasible in selected small children. However, it demands adequate technical skill and experience.


Assuntos
Doenças Renais Císticas , Rim , Laparoscopia , Imagem por Ressonância Magnética/métodos , Nefrotomia , Procedimentos Cirúrgicos Robóticos , Diagnóstico Diferencial , Dor no Flanco/diagnóstico , Humanos , Lactente , Rim/diagnóstico por imagem , Rim/cirurgia , Doenças Renais Císticas/diagnóstico , Doenças Renais Císticas/fisiopatologia , Doenças Renais Císticas/cirurgia , Laparoscopia/instrumentação , Laparoscopia/métodos , Masculino , Nefrotomia/instrumentação , Nefrotomia/métodos , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento , Urografia/métodos
12.
J Pak Med Assoc ; 68(7): 1124-1128, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30317318

RESUMO

We retrospectively evaluated the results of Harmonic Scalpel (Ethicon, Cincinnati, Ohio) used for laparoscopic decortication of simple renal cysts (SRC). Between May 2011 and December 2014, 28 patients with symptomatic SRC (Bosniak type 1) underwent laparoscopic decortication with Harmonic Scalpel, were reviewed. All cysts were evaluated with ultrasonography and abdominal computed tomography. Symptomatic and surgical success was defined as no recurrence on computed tomography imaging and complete pain relief, respectively. The mean age of patients was 51.7±9.6 years and there were 16 female and 12 male. While a transperitoneal approach was preferred in 18 cases, a retroperitoneal approach was chosen in 10 patients. The mean cyst size and duration of operation was 8,8±2,8 (6-12) cm and 72,8±28,4 (50-110) minutes, respectively. A total of three minor complications were observed postoperatively. Mean hospital stay was 1,3±0,9 (1-3) days. After the mean 12,6±3,2 (3-24) months follow-up the radiological and symptomatic successes were 100% and 89,2%, respectively. Our results showed that laparoscopic decortication of SRC using Harmonic Scalpel is consistent with the literature and provides a reasonable complication but increases cost.


Assuntos
Doenças Renais Císticas/cirurgia , Laparoscopia/instrumentação , Adulto , Feminino , Humanos , Doenças Renais Císticas/diagnóstico por imagem , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Recidiva , Estudos Retrospectivos , Instrumentos Cirúrgicos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia
13.
Int Braz J Urol ; 44(5): 958-964, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30088721

RESUMO

OBJECTIVE: To assess the safety, feasibility, and efficacy of simultaneous treatment of parapelvic renal cysts and stones by flexible ureterorenoscopy with a novel four-step cyst localization strategy in selected patients. PATIENTS AND METHODS: We retrospectively reviewed 11 consecutive cases of parapelvic renal cysts with concomitant calculi treated by flexible ureterorenoscopy and laser lithotripsy (FURSL). Marsupialization was performed subsequently with holmium: YAG laser in our institution. Fragmentation was used to manage renal stones and a novel four-step cyst localization strategy was applied in each case for marsupialization. RESULTS: There were no intraoperative complications. Two cases of cystitis were reported postoperatively. The mean operative times of FURSL and marsupialization were 23.6 ± 3.9 minutes and 29.1 ± 9.7 minutes, respectively. During marsupialization, seven patients underwent the first two steps of the new strategy, two patients underwent three steps and two patients underwent all four steps. The mean reduction in hemoglobin level was 4.7 ± 1.7 g / L (range 3-8 g / L). The mean length of hospital stay was 1.2 ± 0.4 days. During a mean follow-up duration of 18 months, all cases remained stonefree and there was no stone recurrence. Parapelvic cysts became undetectable in eight cases and decreased in size by at least half in three cases. CONCLUSION: With appropriate patient selection, FURSL and marsupialization with a four-step cyst localization strategy is feasible, safe, and effective in treating parapelvic renal cysts with concomitant calculi.


Assuntos
Cálculos Renais/cirurgia , Doenças Renais Císticas/cirurgia , Litotripsia a Laser/métodos , Ureteroscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Am J Surg Pathol ; 42(10): 1396-1401, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30001236

RESUMO

Acquired cystic disease-associated renal cell carcinoma (ACKD-RCC), originally described by Tickoo and colleagues, is found exclusively in patients with end-stage renal disease. Tickoo and colleagues noted: "Many of the tumors (16 of 24 dominant tumors) appeared to arise in a cyst, most often completely filling the cystic space. The cells lining such cysts were morphologically similar to those in the rest of the tumor." Subsequent literature lacks analysis of cysts lined by cells identical to ACKD-RCC, yet lacking areas of solid growth. The current study evaluates 16 cases ACKD-RCC-like cysts. All specimens were nephrectomies and occurred in the setting of end-stage renal disease. Of the 16 cases, 9 were in men. Patient's ages ranged from 32 to 66 years (median: 57). The cysts ranged in size from 0.2 to 2.5 cm. Twelve cases had unilateral cysts with the remaining 4 seen in both kidneys. Nine cysts were multilocular, 6 unilocular, and 1 consisted of closely clustered cysts. The atypical cysts showed architectural variation. One cyst was lined by a single layer of atypical cells (1/16), whereas in the majority these were either focally lined by 2 to 4 cell layers of atypical cells (6/16 cases) or showed occasional short papillary formations (9/16). Calcium oxalate crystals were noted in cyst walls in 7/16 cases. A total of 12/16 cases had separate RCCs (2 cases with 2 RCCs each; 1 case with 3). Carcinoma ranged in size from 3 mm to 5 cm in the largest dimension: 4 were pT1 ACKD-RCC; 5 were pT1 papillary RCC; 5 were pT1 clear cell papillary RCC; 1 was pT3 clear cell RCC; and 1 pT1 unclassified. Our study formally analyzes for the first time in the literature atypical cysts lined with vacuolated cells with eosinophilic cytoplasm that are likely the earliest precursors of ACKD-RCC. When these cysts are encountered, especially ones that are multilocular or clustered, they may be misdiagnosed as ACKD-RCC. ACKD-RCC-like cysts should be recognized as a distinct entity from ACKD-RCC, defined by the lack of any solid nodular growth within the cyst.


Assuntos
Carcinoma de Células Renais/patologia , Doenças Renais Císticas/patologia , Falência Renal Crônica/patologia , Neoplasias Renais/patologia , Neoplasias Císticas, Mucinosas e Serosas/patologia , Adulto , Idoso , Biópsia , Carcinoma de Células Renais/cirurgia , Bases de Dados Factuais , Diagnóstico Diferencial , Feminino , Humanos , Doenças Renais Císticas/cirurgia , Falência Renal Crônica/cirurgia , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Císticas, Mucinosas e Serosas/cirurgia , Nefrectomia , Valor Preditivo dos Testes , Carga Tumoral
16.
Urologiia ; (3): 111-115, 2018 Jul.
Artigo em Russo | MEDLINE | ID: mdl-30035429

RESUMO

RELEVANCE: Renal cysts remain the most common of benign renal lesions, but current literature is lacking large observational studies on the incidence of their malignant transformation. AIM: To assess the incidence of malignant transformation of renal cysts of category 1, 2, and 2F by the Bosniak classification into multilocular cystic renal cell carcinoma. MATERIALS AND METHODS: From January 2009 to December 2017, 177 patients with renal cysts of category 1 (n=50), 2 (n=74), and 2F (n=53) underwent laparoscopic decortication. In 10 cases, post-operative histological and immunohistochemical studies revealed foci of grade 1 (pT1a) multilocular cystic renal cell carcinoma. RESULTS: Foci of grade 1 (pT1a) multilocular cystic renal cell carcinoma were detected in 10 (5.65%) patients (five men, five women, mean age 58.9 years). The incidence of malignant transformation of renal cysts of categories 1, 2, and 2F was 0%, 2.7% (2 of 74 patients), and 15.1% (8 of 53 patients), respectively. Subsequently, all ten patients were submitted to surgical treatment: eight of them underwent a partial nephrectomy, and two received a nephrectomy. During a median of 49.3 (31-72) months follow-up, no metastasis, and recurrence of multilocular cystic RCC were observed. CONCLUSION: A more modern algorithm for managing patients with Bosniak category 1, 2 and 2F cysts need to be developed to establish early surveillance of patients starting with category 1 cysts. Given the low malignant potential of these tumors, they should be treated with organ-sparing surgery.


Assuntos
Carcinoma de Células Renais/patologia , Doenças Renais Císticas/classificação , Doenças Renais Císticas/patologia , Neoplasias Renais/patologia , Carcinoma de Células Renais/epidemiologia , Carcinoma de Células Renais/cirurgia , Feminino , Humanos , Incidência , Doenças Renais Císticas/epidemiologia , Doenças Renais Císticas/cirurgia , Neoplasias Renais/epidemiologia , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia
17.
Eur J Radiol ; 105: 41-48, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30017297

RESUMO

On cross-sectional imaging studies performed for other indications, incidental discovery of renal lesions is not uncommon. In daily use, grey-scale ultrasonography (US) and conventional Doppler modes are often the modality of choice for the initial assessment. While simple cysts are fully characterized with US, other lesions require further characterization, which is traditionally obtained by multiphase imaging, such as contrast-enhanced CT and MRI. Contrast-enhanced ultrasound (CEUS) has become a powerful additional tool for imaging renal lesions. With its lack of nephrotoxicity, the absence of ionizing radiation, and the ability to evaluate the enhancement pattern of renal lesions quickly and in real- time, CEUS has unique advantages over traditional modes. Established applications are differentiation between solid tumours, pseudolesions, and complex cysts; characterization of complex cysts with different malignant potential, and evaluation of tumor ablation. Microbubble contrast agents are safe. Adverse reactions are rare. This article provides an overview of the current clinical applications of CEUS in characterizing renal masses, discussing advantages and limitations. The aim is to provide the framework for sonologists to make informed decisions regarding this emerging imaging test in appropriate circumstances.


Assuntos
Meios de Contraste , Doenças Renais Císticas/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Microbolhas , Ablação por Cateter , Feminino , Humanos , Achados Incidentais , Rim/diagnóstico por imagem , Doenças Renais Císticas/patologia , Doenças Renais Císticas/cirurgia , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Imagem por Ressonância Magnética , Masculino , Segurança do Paciente , Ultrassonografia/métodos
18.
Pediatr Med Chir ; 40(1)2018 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-29871474

RESUMO

Simple renal cysts, although common in adults, are rare in children. They are usually discovered incidentally in the course of the study of other urinary tract symptoms, although they are not always asymptomatic. Renal cysts can be classified as being either simple or complex. The purpose of this review is to present our case series of simple symptomatic renal cysts treated with laparoscopy. Nineteen patients with symptomatic renal cysts (6 to 13.5 cm) were referred to our institution between January 2006 and January 2017. They comprised 12 (40.5%) females and seven (59.5%) males, aged 8 to 15, with a mean age of 12.2 years. Of these patients, nine had previously been treated unsuccessfully by ultrasound-guided aspiration/alcoholization with 95%-ethanol, between 9 and 13 months prior to the laparoscopy. Five patients had undergone one treatment and four had undergone two treatments. All of the patients were treated by laparoscopic threetrocar deroofing. The cysts were opened and the wall excised using scissors and a monopolar hook. In most cases, to better handle the edges of the cyst and obtain a better grip, a needle was used to aspirate a small amount of fluid (used for cytological examination). The wall of the cyst was excised, the cyst edges were sealed, and the perirenal fat was placed on the bottom of the cyst (wadding technique). The mean operating time was 95 minutes (range 50- 150). The postoperative course was uneventful for all of the patients. The hospital stay ranged from one to three days. All of the patients were asymptomatic following the treatment. At a mean follow-up time of 3.6 years, none of the patients had experienced a recurrence. Renal function, as assessed by a MAG3 renal scintigraphy scan, was well-preserved in all of the patients, and all of them undergo an annual ultrasound scan.


Assuntos
Doenças Renais Císticas/cirurgia , Laparoscopia/métodos , Ultrassonografia/métodos , Adolescente , Criança , Feminino , Seguimentos , Humanos , Doenças Renais Císticas/diagnóstico , Tempo de Internação , Masculino , Duração da Cirurgia , Resultado do Tratamento
19.
J Urol ; 200(6): 1200-1206, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29935273

RESUMO

PURPOSE: Our objective was to assess the prevalence of intraoperative cyst rupture and its impact on oncologic outcomes. MATERIALS AND METHODS: All patients who underwent partial nephrectomy for a cystic renal mass via an open or robot-assisted approach at a total of 8 academic institutions were included in this retrospective study. All operative reports were carefully reviewed and any description of cyst rupture, cyst effraction or local spillage intraoperatively was recorded as cyst rupture. Multivariate logistic regression analysis was done to assess the variables associated with cyst rupture. Recurrence-free, cancer specific and overall survival was estimated by the Kaplan-Meier method and compared with the log rank test. RESULTS: Overall 268 patients were included in study. There were 50 intraoperative cyst ruptures (18.7%) in the whole cohort. No preoperative parameter was significantly associated with a risk of intraoperative cyst rupture on univariate or multivariate analysis. Of the cystic renal masses 75% were malignant on the final pathology report. At a median followup of 32 months 5 patients (2.5%) had local recurrence while progression to metastasis was observed in 2%. There were no peritoneal carcinomatosis nor port site metastasis. There was also no local or metastatic recurrence in the subgroup with intraoperative cyst rupture. Estimated recurrence-free survival did not differ significantly between patients with vs without intraoperative cyst rupture at 100% vs 92.7% at 5 years (p = 0.20). CONCLUSIONS: Intraoperative cyst rupture during partial nephrectomy is a relatively common occurrence but with few oncologic implications.


Assuntos
Complicações Intraoperatórias/epidemiologia , Doenças Renais Císticas/cirurgia , Neoplasias Renais/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Nefrectomia/efeitos adversos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Idoso , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Complicações Intraoperatórias/etiologia , Estimativa de Kaplan-Meier , Rim/patologia , Rim/cirurgia , Doenças Renais Císticas/mortalidade , Doenças Renais Císticas/patologia , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Prevalência , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos
20.
G Ital Nefrol ; 35(3)2018 May.
Artigo em Italiano | MEDLINE | ID: mdl-29786190

RESUMO

Kidney cystic diseases are inherited disorders causing chronic renal failure. According to the genetic defect they are classified as diseases of the primary ciliary complex and uromodulin-associated diseases. Mutations in genes coding for ciliary proteins are the basis of a broad category of genetic diseases, called ciliopathies. To date, three important ciliopathies are known: the autosomal dominant form and the recessive shape of the polycystic kidney and the nephronophthisis (NPHP). Juvenile Nephronophthisis (NPHP) is a progressive renal tubulo-interstitial disorder with a form of autosomal recessive inheritance that progresses inexorably towards terminal renal failure. Three different forms have been distinguished: juvenile (NPH1), infantile (NPH2) and adolescent (NPH3). Juvenile Nephronophthisis or nephronophthisis type 1 (NPH1), is the most frequent form. In most patients with a suspected diagnosis of NPHP, based primarily on clinical and radiological data, the deletion in homozygous NPHP1 is present in 20-40% of cases. Heterozygous deletions are found in 6% of patients, with concomitant mutation of the NPHP1 gene on the second allele. In this study we subjected to genetic screening 6 patients with suspected NPHP causing chronic renal failure, belonging to 6 families. The genetic screening identified in 2/6 patients a deletion of exons 5-7-20 and in 4/6 patients an heterozygous deletion of exon 20 and an heterozygous deletion on exon 17 not yet described in literature. Our results suggest that genetic screening should be included in the diagnostic procedure of patients with suspected nephronophthisis and that it may be used alternatively to renal biopsy.


Assuntos
Proteínas Adaptadoras de Transdução de Sinal/genética , Doenças Renais Císticas/congênito , Proteínas de Membrana/genética , Proteínas Adaptadoras de Transdução de Sinal/deficiência , Adolescente , Criança , Éxons/genética , Feminino , Testes Genéticos , Heterozigoto , Humanos , Doenças Renais Císticas/complicações , Doenças Renais Císticas/genética , Doenças Renais Císticas/cirurgia , Doenças Renais Císticas/terapia , Falência Renal Crônica/etiologia , Transplante de Rim , Masculino , Proteínas de Membrana/deficiência , Diálise Renal , Deleção de Sequência
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