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1.
Oncology ; 98(2): 117-122, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31715614

RESUMO

BACKGROUND: The treatment of kidney cancer usually involves surgery, and in some cases systemic therapy. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to control postsurgical pain in patients undergoing nephrectomy for renal cancer. Nevertheless, the association between these drugs and adverse postsurgical outcomes, including deterioration of renal function, is not fully established. METHODS: This retrospective cohort study included patients >18 years old with kidney cancer undergoing nephrectomy between January 2006 and January 2018. The primary endpoint was to determine the impact of postsurgical analgesic therapy (NSAIDs vs. acetaminophen) on renal function and postsurgical complications. This study was approved by our scientific and bioethical committee. RESULTS: One hundred patients were included in the final analysis. Clear-cell renal-cell carcinoma was the most frequent histologic subtype. Adequate acute pain control was accomplished in 91% of the patients during hospitalization. Twenty percent of the patients presented postsurgical complications. Bleeding-related complications were the most frequent (9%), followed by surgical-site infection (6%) and acute renal injury (6%). The administration of NSAIDs was not related to any postsurgical complication in comparison with the use of acetaminophen (21.3 vs. 17.9%, respectively). The length of hospital stay did not differ between patients treated with NSAIDs and those treated with acetaminophen (the average stay was 4 days for both groups, p = 0.32). CONCLUSION: The use of NSAIDs was not related to acute kidney injury, postsurgical complications, or prolonged hospital stay in patients with renal cancer undergoing nephrectomy.


Assuntos
Analgésicos/efeitos adversos , Neoplasias Renais/complicações , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Idoso , Analgésicos/administração & dosagem , Biomarcadores , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Renais/diagnóstico , Neoplasias Renais/cirurgia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/metabolismo , Prognóstico , Resultado do Tratamento
2.
Urology ; 135: e1, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31604068

RESUMO

A 29-year-old female was referred to the urology clinic because of an incidentally found left renal mass discovered during workup for secondary erythrocytosis. Since 12 years of age, she has had headaches and poorly controlled hypertension refractory to trimodal antihypertensive therapy. Laboratory workup revealed markedly elevated aldosterone and renin levels. Computed tomography demonstrated a 3 cm left renal mass. The patient was admitted for intravenous blood pressure control. After partial nephrectomy, aldosterone and renin levels normalized. The patient was weaned off of blood pressure medications. Pathology was consistent with a juxtaglomerular cell tumor secreting renin (ie, reninoma).


Assuntos
Anti-Hipertensivos/farmacologia , Hipertensão/etiologia , Sistema Justaglomerular/patologia , Neoplasias Renais/complicações , Adulto , Aldosterona/sangue , Anti-Hipertensivos/uso terapêutico , Resistência a Medicamentos , Quimioterapia Combinada , Feminino , Humanos , Hipertensão/sangue , Hipertensão/tratamento farmacológico , Sistema Justaglomerular/diagnóstico por imagem , Sistema Justaglomerular/metabolismo , Neoplasias Renais/diagnóstico , Neoplasias Renais/cirurgia , Nefrectomia , Renina/sangue , Renina/metabolismo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
Urology ; 137: e8-e9, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31883877

RESUMO

Adult Wilms tumors (nephroblastomas) are exceedingly rare with less than 500 cases reported in the literature. To our knowledge, ours is the first reported case of a patient with velocardiofacial syndrome (Shprintzen syndrome) acquiring an adult Wilms tumor. The case highlights the possible role of chromosome 22q aberrations toward the pathogenesis of a subset of Wilms tumors.


Assuntos
Síndrome de DiGeorge/complicações , Neoplasias Renais/complicações , Tumor de Wilms/complicações , Adulto , Feminino , Humanos
4.
Clin Nucl Med ; 45(2): e103-e105, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31876802

RESUMO

Primary Ewing sarcoma/primitive neuroectodermal tumor is a group of rare aggressive tumors in adults derived from neuroectoderm, and primary renal involvement is extremely rare. We describe an F-FDG PET/CT findings of a 28-year-old man who presented with left renal mass with inferior vena cava thrombus, which turned out to be primary Ewing sarcoma on histopathology specimen post left nephrectomy.


Assuntos
Neoplasias Renais/diagnóstico por imagem , Tumores Neuroectodérmicos/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Sarcoma de Ewing/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Adulto , Fluordesoxiglucose F18 , Humanos , Neoplasias Renais/complicações , Masculino , Tumores Neuroectodérmicos/complicações , Compostos Radiofarmacêuticos , Sarcoma de Ewing/complicações , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia , Trombose Venosa/complicações
5.
Medicine (Baltimore) ; 98(52): e18422, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876718

RESUMO

RATIONALE: Extramedullary plasmacytoma (EMP) is a very rare malignant neoplasm arising from clonal proliferation of atypical plasma cells. Most EMPs involve mucosal lymphoid tissue, particularly in the nasopharyngeal area, respiratory tract, and head and neck region. Such neoplasms of the kidney in patients with a human immunodeficiency virus (HIV) infection are extremely rare. PATIENT CONCERNS: A 55-year-old male who had been diagnosed with HIV 1 year previously presented with a 2-week history of intermittent right abdominal pain and gross hematuria. DIAGNOSES: Ultrasonography and computed tomography detected a mass that occupied the upper half of the right kidney. A clinical diagnosis of a renal tumor was suspected. INTERVENTIONS: The patient subsequently underwent a retroperitoneal radical nephrectomy. The postoperative pathological diagnosis was solitary EMP of the kidney. Adjuvant radiation therapy was provided at doses of 50 Gy in 20 fractions. OUTCOMES: Currently, the patient is alive and disease free at 7 months postoperatively. To the best of our knowledge, this is the first case of a primary renal EMP in a patient with HIV. LESSONS: The present case illustrates that this rare type of solitary EMP associated with acquired immune deficiency syndrome can occur in the kidney. Additionally, although rare, solitary EMP should be considered in the differential diagnosis of a renal mass in HIV-infected patients.


Assuntos
Infecções por HIV/complicações , Neoplasias Renais/complicações , Plasmocitoma/complicações , Terapia Combinada , Humanos , Neoplasias Renais/diagnóstico , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/terapia , Masculino , Pessoa de Meia-Idade , Nefrectomia , Plasmocitoma/diagnóstico , Plasmocitoma/diagnóstico por imagem , Plasmocitoma/terapia , Tomografia Computadorizada por Raios X , Ultrassonografia
6.
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
7.
J Radiol Case Rep ; 13(2): 34-42, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31565170

RESUMO

Trans-radial access offers several unique advantages and is being used more frequently for interventional radiology procedures. We report the use of trans-radial arterial access to embolize a large bleeding angiomyolipoma in a 30-year-old pregnant patient presenting in the first trimester. Trans-radial approach was chosen to minimize the effects of radiation on the fetus. Subsequent postprocedural pregnancy course was uneventful with stability of the angiomyolipoma and no further hemorrhage. This case highlights the benefits of trans-radial embolotherapy in gravid patients to reduce the risk of radiation exposure to the fetus.


Assuntos
Angiomiolipoma/complicações , Embolização Terapêutica/métodos , Hemorragia/etiologia , Hemorragia/terapia , Neoplasias Renais/complicações , Complicações Neoplásicas na Gravidez/terapia , Adulto , Angiografia Digital , Angiomiolipoma/diagnóstico por imagem , Feminino , Fluoroscopia , Hemorragia/diagnóstico por imagem , Humanos , Neoplasias Renais/diagnóstico por imagem , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico por imagem , Artéria Radial , Tomografia Computadorizada por Raios X , Ultrassonografia
8.
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
9.
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
11.
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
12.
Ned Tijdschr Geneeskd ; 1632019 10 02.
Artigo em Holandês | MEDLINE | ID: mdl-31580031

RESUMO

A 55-year-old woman presented at the Emergency Department with flank pain. She was pale, hemodynamically unstable, and had a palpable mass in her right flank. CTA of the abdomen revealed a bleeding from an angiomyolipoma of the right kidney, which was successfully treated by selective coiling of the supplying renal artery.


Assuntos
Dor Aguda/cirurgia , Angiomiolipoma/cirurgia , Dor no Flanco/cirurgia , Neoplasias Renais/cirurgia , Dor Aguda/etiologia , Angiomiolipoma/complicações , Feminino , Dor no Flanco/etiologia , Humanos , Rim/irrigação sanguínea , Rim/cirurgia , Neoplasias Renais/complicações , Pessoa de Meia-Idade , Artéria Renal/cirurgia
13.
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
14.
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
15.
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
16.
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
17.
Urology ; 133: 243-244, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31404584

RESUMO

OBJECTIVE: To present the surgical approach to a multifocal Wilms tumor found on screening ultrasound in an asymptomatic 2-year-old female. MATERIALS: A 2-year-old female with hemihypertrophy underwent screening imaging every 3 months with renal ultrasound. A solitary, incidental renal mass was detected. Physical exam was unremarkable except for left leg hemihypertrophy. Laboratory workup was largely normal other than an elevated lactate dehydrogenase. Staging imaging revealed multiple masses on the right kidney and a normal left kidney. There were no distant metastases. The most likely diagnosis was Wilms tumor. After receiving chemotherapy for 6 weeks, imaging revealed an excellent response to chemotherapy and surgery was performed. RESULTS: The patient underwent open partial nephrectomy of the 3 tumors on the right. Prior to beginning, cystoscopy and ureteral stent placement was performed as it was felt the collecting system would likely be entered during resection. The renal hilum was not clamped throughout this resection and manual parenchymal compression was used to minimize global ischemia. Retroperitoneal lymph node dissection was also performed. The patient recovered well and was discharged home 5 days after surgery. Her stent was removed at home without complications. Final pathology revealed nephrogenic rests with all 7 lymph nodes were negative for malignancy. CONCLUSION: Management of multifocal, unilateral Wilms tumor with open partial nephrectomy after neoadjuvant chemotherapy is an important part of protocol management for patients with Wilms tumor with predisposition syndromes.


Assuntos
Neoplasias Renais/cirurgia , Nefrectomia/métodos , Tumor de Wilms/cirurgia , Pré-Escolar , Feminino , Humanos , Hiperplasia/complicações , Neoplasias Renais/complicações , Neoplasias Renais/patologia , Tumor de Wilms/complicações , Tumor de Wilms/patologia
18.
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
20.
Pediatr Blood Cancer ; 66(11): e27930, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31339231

RESUMO

INTRODUCTION: Preoperative chemotherapy is recommended for children with Wilms tumour with intravascular extension. Extended chemotherapy may improve resectability, but increase tumour adherence to vascular endothelium, precluding complete resection. To evaluate the optimal length of preoperative treatment, we report a two-part review comprising systematic review of the literature and investigation of patients treated in the International Society of Paediatric Oncology (SIOP) WT 2001 trial. METHODS: Studies were identified using Medline and Embase databases from 1996 to present. English language titles reporting management of intravascular Wilms tumour were analysed. Patients with Wilms tumour and thrombus were identified from the SIOP WT 2001 trial. Overall survival (OS) and event-free survival (EFS), tumour regression, completeness of resection and cavectomy were investigated. RESULTS: The search retrieved 43 articles documenting 498 children. Note that 72% of the patients received neoadjuvant chemotherapy: 101 received standard course (4-6 weeks, standard course neoadjuvant chemotherapy [StC]) and 62 extended course (> 6 weeks, extended course neoadjuvant chemotherapy [EC]). There was no significant difference between the groups in terms of thrombus regression or completeness of resection. EFS was greater in the StC group (78 vs 54%; P = .04). Of 4511 patients registered in the SIOP WT 2001 trial, 166 had thrombus. Note that 97% of the patients received neoadjuvant chemotherapy: 63 StC and 67 EC. There was no significant difference between the groups with regard to tumour regression, complete resection, or cavectomy. Survival was significantly higher in those receiving StC than EC (OS: 95% vs 82%, P = .025; EFS: 88% vs 72%, P = .047). CONCLUSION: There is no evidence that prolonged courses of neoadjuvant chemotherapy beyond the recommended protocols confer any additional benefit in treating intravascular extension of Wilms tumour.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Renais/tratamento farmacológico , Terapia Neoadjuvante , Trombose Venosa/etiologia , Tumor de Wilms/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Pré-Escolar , Ensaios Clínicos como Assunto/estatística & dados numéricos , Dactinomicina/administração & dosagem , Doxorrubicina/administração & dosagem , Esquema de Medicação , Feminino , Veias Hepáticas , Humanos , Lactente , Estimativa de Kaplan-Meier , Neoplasias Renais/complicações , Neoplasias Renais/cirurgia , Masculino , Estudos Multicêntricos como Assunto/estatística & dados numéricos , Nefrectomia , Intervalo Livre de Progressão , Veias Renais , Veia Cava Inferior , Vincristina/administração & dosagem , Tumor de Wilms/complicações , Tumor de Wilms/cirurgia
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