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1.
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
2.
J Comput Assist Tomogr ; 43(6): 852-856, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31738204

RESUMO

OBJECTIVE: The objective of this study was to assess renal lesions measuring less than 20 Hounsfield units (HU) on noncontrast computed tomography (NCT). METHODS: Twenty-one (18.1%) of 116 consecutive pathologically proven renal cell carcinomas measured less than 20 HU on NCT and were compared with 40 confirmed benign cysts also measuring less than 20 HU. All lesions were assessed qualitatively (heterogeneous or homogenous) by 3 blinded readers and quantitatively with commercially available textural analysis software. Finally, a combined assessment was performed. RESULTS: Qualitative assessment performed well (sensitivity, 76%-90%; specificity, 70%-88%). Quantitative assessment revealed mean positive pixels as having the highest performance (area under the curve, 0.912; sensitivity, 90%; specificity, 80% at a cutoff value of 21). The combined assessment, using the mean positive pixel cutoff, improved the sensitivity (reader 1, 100%; reader 2, 95%; and reader 3, 95%). CONCLUSION: Qualitative and quantitative assessments have relatively good performance, but the combination can nearly eliminate renal cell carcinomas being missed on NCT.


Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Diagnóstico Diferencial , Feminino , Humanos , Doenças Renais Císticas/diagnóstico por imagem , Masculino , Projetos Piloto , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
3.
Cancer Invest ; 37(9): 501-505, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31583922

RESUMO

Leptomeningeal metastasis (LM) in solid tumors are rare, even more in renal cell carcinoma (RCC). To date there is a lack of consensual treatment modalities of leptomeningeal metastasis. Furthermore, with the improvement of outcomes and more effective systemic targeted therapies, the management of leptomeningeal metastasis becomes a real challenge. We here report two cases of RCC with leptomeningeal metastasis at initial diagnosis. Both patients had concurrent adjacent skull bone metastasis. Therapeutic management of both patients consisted in surgical resection, followed by radiotherapy in one case. Systemic treatment was delayed according to current recommendations for the management of metastatic RCC. The aim of this work is to report the therapeutic approach and related outcomes and also provide a review of the currently available literature on leptomeningeal disease in renal cell carcinoma. Indeed, local treatment with curative outcome of meningeal location in RCC should be performed specially in LM at initial diagnosis.


Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Neoplasias Meníngeas/secundário , Neoplasias Cranianas/secundário , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Carcinoma de Células Renais/tratamento farmacológico , Carcinoma de Células Renais/radioterapia , Terapia Combinada , Humanos , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/radioterapia , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/radioterapia , Neoplasias Meníngeas/cirurgia , Pessoa de Meia-Idade , Neoplasias Cranianas/radioterapia , Neoplasias Cranianas/cirurgia , Sunitinibe/uso terapêutico , Resultado do Tratamento
4.
Can Assoc Radiol J ; 70(4): 434-440, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31585824

RESUMO

PURPOSE: To determine negative predictive value (NPV) of contrast-enhanced ultrasound (CEUS) to demonstrate local tumour progression (LTP) at thermal ablation (TA) sites. METHODS: Our institutional review board approved this retrospective study; acquisition of consent was waived. Consecutive CEUS examinations performed between 2004-2014 for TA site evaluation on patients who could not undergo enhanced computed tomography (CT) or magnetic resonance imaging (MRI), or had inconclusive CT or MRI, were retrospectively reviewed. Those reported as no abnormal enhancement in or surrounding TA site were included. CEUS examination was considered true-negative based on stability or lack of enhancement/washout on follow-up imaging for at least 1 year, and false-negative (FN), if there was an arterially enhancing focus with wash-out at or surrounding TA site on subsequent follow-up imaging. RESULTS: Study population included 56 tumours in 54 patients, 11 women, 43 men; mean age 71 years. Two patients had TA of two different hepatocellular carcinomas. Thirty-six examinations were for hepatic TA and twenty for renal TA. Lesion sizes ranged from 1 cm to 7 cm (mean 3.1 ± 1.2). Mean diameter of 7 recurrences was 13.8 mm. Overall FN rate was 12.5% (7/56). Corresponding numbers were 0% (0/20) for renal TA and 19.4% (7/36) for hepatic TA. Overall NPV of CEUS was 87.5% (49/56) (confidence interval [CI]: 78.8%-96.2%). NPV for renal TA was 100% (20/20) (CI: 100%-100%) and for hepatic TA 81.5% (29/36) (CI: 67.6 %-93.5%). CONCLUSION: In this cohort, CEUS showed high NPV for exclusion of LTP at renal TA sites. NPV for hepatic TA sites was high but lower than renal TA.


Assuntos
Neoplasias Renais/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Ultrassonografia/métodos , Idoso , Idoso de 80 Anos ou mais , Ablação por Cateter , Meios de Contraste , Progressão da Doença , Feminino , Seguimentos , Humanos , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos
5.
Medicine (Baltimore) ; 98(40): e17435, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577762

RESUMO

To compare the efficacies of 3-dimensional laparoscopic partial nephrectomy and conventional laparoscopic partial nephrectomy for complex renal tumors. The complex renal tumors was defined as Preoperative Aspects and Dimensions Used for an anatomical (PADAU) ≥10, including some cT1b tumors.This was a retrospective analysis of patients with local complex renal tumors who presented to our hospital from January 2014 to January 2018. All patients were managed with laparoscopic partial nephrectomy (LPN) or 3-dimensional partial nephrectomy (3DLPN).There were 48 patients in the LPN group and 60 in the 3DLPN group. In the matched groups, demographic and tumor characteristics including Charlson Comorbidity Index, PADUA, based on the preoperative images, were similar. By contrast, 3DLPN achieved better results in terms of warm ischemia time (19 vs 27 minutes), operation time (105 vs 128 minutes), postoperative complications (14.9% vs 23.4%), and marginal width (0.6 cm vs 0.4 cm). We found statistically significant differences in terms of length of stay, estimated blood loss (EBL), positive surgical margin (PSM), and conversion to open or radical nephrectomy (RN). Median follow-up time was 17 and 18.5 months for the LPN and 3DLPN groups, respectively. The recovery of renal function (% change eGFR, 0 vs -8.7) was significantly different between the 3DLPN and LPN groups, whereas 12-month recurrence-free survival did not differ.Both 3-dimensional laparoscopic nephron-sparing nephrectomy and conventional laparoscopic partial nephrectomy are safe, effective, and acceptable approaches to treating complex renal tumors, while the former may facilitate tumor resection and renorrhaphy for challenging cases, offering a minimally invasive surgical option for patients who may otherwise require open surgery.


Assuntos
Imagem Tridimensional , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Laparoscopia , Nefrectomia , Idoso , Feminino , Humanos , Neoplasias Renais/patologia , Tempo de Internação , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Duração da Cirurgia , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento , Isquemia Quente
6.
Arch Esp Urol ; 72(8): 723-728, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31579029

RESUMO

The trend towards the organ sparing and robotic assisted surgeries is clear and is going to expand in the future. Hence, the tools surgeons need to facilitate such minimallly invasive approaches are going to be even more important. The Indocyanine green (ICG) is a water-soluble, relatively hydrophobic dye which bounds to plasma protein and can be used intraoperatively as real time contrast agent. Near infrared fluorescence (NIRF) helps in differentiating the renal planes, and the most common reagent used for the NIRF is ICG. The combination is used frequently during nephron sparing surgery in urology to ensure the ischemia of the kidney after clamping the renal artery, moreover it can help to identify the arterial blood supply to the tumor allowing selective clamping and thus minimizing the ischemia time. Several studies assessed the role of ICG in nephron-sparing surgery and provided evidence that its use allows to improve perioperative and oncological outcomes. This review provides an overview of the articles published regarding the use of ICG during partial nephrectomy, about the oncological outcomes and safety.


Assuntos
Imunofluorescência , Neoplasias Renais , Nefrectomia , Procedimentos Cirúrgicos Robóticos , Humanos , Verde de Indocianina , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Laparoscopia , Nefrectomia/métodos
7.
Arch Esp Urol ; 72(8): 729-737, 2019 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-31579030

RESUMO

OBJECTIVES: The use of intraoperatory laparoscopic ultrasound for nephron sparring surgery (partial nephrectomy) in patients with technically challenging tumors has emerged during the last years. The objective of this work is to present a literature review and analysis of the published series, as well as the surgical technique of intraoperatory laparoscopic guided partial nephrectomy. METHODS: Pubmed and Scopus serch was performed in January 2019 including the following keywords: "intraoperative ultrasonography", "laparoscopic ultrasonography" and "partial nephrectomy", the published series are presented. We describe the laparoscopic technique of intraoperatory ultrasound during partial nephrectomy. RESULTS: All the published series present similar results in terms of tumour size which varies from 2.3 to 4 cm. Complications results are also very similar in the comparative series to the ones published in partial nephrectomies. They show promising oncological results during follow up with a rate superior to 90% of negative margins, comparable to those of exophytic tumor partial nephrectomies. CONCLUSIONS: The use of intraoperatory ultrasound during laparoscopic surgery to localize intraparenchymatous renal lesions can expand the indications of partial nephrectomy to more technically challenging tumors. These indications are not yet well standardized. Due to its complexity, the need of previous surgical experience is required to achieve good results and corroborate the security and feasibility of this procedure. Prospective randomized trials are needed to confirm the benefits of intraoperatory laparoscopic ultrasound for nephron sparring surgery (partial nephrectomy).


Assuntos
Neoplasias Renais , Laparoscopia , Nefrectomia , Ultrassonografia , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Estudos Prospectivos
8.
Arch Esp Urol ; 72(8): 750-758, 2019 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-31579033

RESUMO

OBJECTIVE: Renal cryotherapy (RC) is an alternative therapeutic option to partial nephrectomy in elderly patients and/or patients with comorbidities. The technique can be guided by ultrasound, CT and MRI. Although CT is the most used technique, there are no comparative studies. The objective of this study was to review the current status of ultrasound as a guide for the planning and execution of RC. METHODS: A systematic review of the literature was carried out in the Pubmed/Medline database following the PRISMA guidelines. We used 42 articles that met the inclusion criteria for the synthesis of the evidence. RESULTS: Ultrasound allows dynamic and real-time monitoring of the entire procedure to guide the biopsy, placement of the cryoprobes, cryoball formation, and early identification of complications. The success rate and recurrences found in the percutaneous renal cryotherapy (PRC) were 97.04% and 1.81%, respectively, with 9.35% complications. The ultrasound during laparoscopic renal cryotherapy (LRC) has been shown to reduce the time spent in localizing the renal mass and also decreases the need for large dissections. On the other hand, contrast-enhanced ultrasound during follow-up shows a concordance with the CT or MRI of 72-96% and no complications have been described associated with its execution. CONCLUSION: Renal cryotherapy guided by ultrasound is a feasible technique, its main advantage is based on real-time monitoring during the procedure. The PRC presents an acceptable rate of complications and excellent oncological results. The LRC allows a rapid localization of the renal mass and reduces extensive dissections. During follow-up, the use of contrast ultrasound is a safe alternative that has been shown to have a good degree of agreement with respect to CT and MRI.


Assuntos
Crioterapia , Neoplasias Renais , Ultrassonografia de Intervenção , Idoso , Criocirurgia , Crioterapia/métodos , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/terapia , Recidiva Local de Neoplasia , Nefrectomia
10.
Zhonghua Yi Xue Za Zhi ; 99(35): 2756-2760, 2019 Sep 17.
Artigo em Chinês | MEDLINE | ID: mdl-31550798

RESUMO

Objective: To analyze the diagnostic value of diffusion-weighted imaging (DWI) signal pattern in renal lesions with T(2)WI hypointensity. Methods: Retrospective analysis was performed on DWI imaging datasets of 135 renal lesions with hypointentsity on T(2)WI confirmed by surgery, biopsy, or follow-up in the First Medical Center of Chinese PLA General Hospital from February 2016 to February 2017.One hundred and thirty-five renal lesions,43 benign lesions(age from 28 to 70 years,mean age was 43.5 years, male 18 lesions and female 25 lesions) and 92 malignant lesions (age from 17 to 86 years, mean age was 54.1 years, male 62 lesions and female 30 lesions). DWI signal pattern was classified into six categories: homogeneously high signal, homogeneously low signal, heterogeneously high signal, high halo signal, high halo and nodular signal, and high nodular signal. The agreement between two observers were tested using kappa statistic. The statistical difference between DWI signal characteristics in benign and malignant lesions was analyzed with Chi-Square test. Diagnostic efficacy in differentiation of benign and malignant renal lesions using DWI signal pattern were calculated. Results: One hundred and thirty-five lesions were detected in 135 cases with T(2)WI hypointensity. There were 43 benign lesions and 92 malignant lesions. The agreement between two observers was very good (kappa value=0.878 6). In renal T(2)WI hypointensity lesions, the proportion of DWI homogeneous high signal, homogeneous low signal, heterogeneous high signal, high halo signal, high halo and nodular signal, high nodular signal was 4.7% (2/43), 25.6% (11/43), 30.2% (13/43), 18.6% (8/43), 11.6% (5/43), 9.3% (4/43), respectively. The proportion of malignant lesions was 10.9% (10/92), 0 (0/92), 17.4% (16/92), 13.0% (12/92), 56.5% (52/92) and 2.2% (2/92), respectively. The difference of high halo and nodules signal and homogeneous low signal was statistically significant (all P<0.01). The sensitivity, specificity, positive prediction value (PPV) and negative prediction value (NPV) of high halo and nodular signal for malignancy were 56.5% (52/92), 88.4%(38/43), 91.2% (52/57) and 48.7%(38/78), respectively and homogeneous low signal for benign lesions were 25.6% (11/43), 100.0% (92/92), 100.0% (11/11) and 74.2% (92/124), respectively. Conclusions: DWI signal features may facilitated the accurate diagnosis of renal lesions with T(2)WI hypointensity. Malignant lesions exhibit a higher propensity with high halo and nodular signal on DWI while benign lesions with homogeneous low signal.


Assuntos
Imagem de Difusão por Ressonância Magnética , Rim/diagnóstico por imagem , Rim/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Renais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
11.
Br J Radiol ; 92(1103): 20190183, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31509441

RESUMO

OBJECTIVE: To evaluate the effectiveness of contrast-enhanced ultrasound (CEUS) in detecting incomplete ablation and local recurrence of renal tumors after percutaneous radiofrequency ablation (RFA). METHODS: 31 patients were included for RFA treatment and underwent CEUS examination after RFA, ablation zone and contrast distribution in the ablation area were observed, CEUS images were compared with enhanced CT/MRI images to determine the residual tumors and local recurrence of renal tumors. RESULTS: The average maximum diameters of the tumor and the ablation zone after the first RFA were 32.3 ± 14.7 mm and 35.9 ± 12.2 mm, respectively. A higher rate of complete tumor ablation was achieved if the ablation zone was larger than the primary tumor (p = 0.026). Within 1 month after RFA, contrast-enhanced CT/MRI examinations demonstrated incomplete ablation in 9 of 31 patients (29.0%), while CEUS revealed incomplete ablation in 8 of 31 patients (25.8%). The sensitivity, specificity, positive predictive value and negative predictive value of CEUS in evaluating complete ablation of renal tumors were 88.9%, 100%, 100%, 95.7%, respectively. During the follow-up period, local recurrence was reported in 2 (7.4%) of the 27 patients with complete tumor ablation. Tumor recurrence signs in the two patients were identified by both CEUS and contrast-enhanced CT/MRI. Therefore, both the sensitivity and specificity of CEUS for the evaluation of tumor recurrence were 100%. CONCLUSION: After percutaneous RFA of renal tumors, the effectiveness of CEUS in the follow-up assessment of residual and recurrent tumors is basically the same as that of contrast-enhanced CT/MRI. ADVANCES IN KNOWLEDGE: In this study, we evaluated the effectiveness of CEUS in the follow-up assessment of residual and recurrent tumors after RFA is basically the same as that of contrast-enhanced CT/MRI. Combining multiple follow-up methods may improve the detection rate of residual or recurrent tumors.


Assuntos
Ablação por Cateter/métodos , Neoplasias Renais/cirurgia , Adulto , Idoso , Meios de Contraste , Feminino , Humanos , Biópsia Guiada por Imagem/métodos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Carga Tumoral , Ultrassonografia
12.
Can Assoc Radiol J ; 70(4): 424-433, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31537315

RESUMO

PURPOSE: To review the computed tomography and magnetic resonance imaging manifestations of acute and chronic renal infections that may mimic malignancy and to provide useful tips to establish an imaging diagnosis. CONCLUSION: Acute and chronic bacterial pyelonephritis are usually readily diagnosed clinically and on imaging when the diagnosis is suspected based upon clinical presentation. When unsuspected, focal, extensive or mass-like, acute and chronic bacterial pyelonephritis may mimic infiltrative tumours such as urothelial cell carcinoma (UCC), lymphoma, and metastatic disease. Infection may be suspected when patients are young and otherwise healthy when there is marked associated perinephric changes and in the absence of metastatic adenopathy or disease elsewhere in the abdomen and pelvis. Renal abscesses, from bacterial or atypical microbial agents, can appear as complex cystic renal masses mimicking cystic renal cell carcinoma. Associated inflammatory changes in and around the kidney and local invasion favour infection. Emphysematous pyelonephritis can mimic necrotic or fistulizing tumour; however, infection is more likely and should always be considered first. Xanthogranulomatous pyelonephritis can mimic malignancy when focal or multifocal and in cases without associated renal calculi. Malacoplakia is an inflammatory process that may mimic malignancy and should be considered in patients with chronic infection. Bacillus Calmette-Guerin (BCG)-induced pyelonephritis is rare but can mimic renal malignancy and should be considered in patients presenting with a renal mass when being treated with BCG for urinary bladder UCC.


Assuntos
Imagem por Ressonância Magnética/métodos , Pielonefrite/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Doença Crônica , Diagnóstico Diferencial , Humanos , Neoplasias Renais/diagnóstico por imagem
13.
Medicine (Baltimore) ; 98(36): e16910, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490375

RESUMO

RATIONALE: Conventional computerized tomography (CT) examination can differentiate renal cortical tumor from urothelial carcinoma on the basis of the highly contrast-enhanced vessels in renal cortical tumors. However, the capillary distribution of renal cell carcinoma (RCC) has been under-investigated. Here, we present a micro-CT image of tumor tissue in a patient with RCC. PATIENT CONCERNS: The patient was a 72-year-old woman with a past history of diabetes mellitus and hypertension. She did not have tumor-related symptoms. DIAGNOSIS AND INTERVENTIONS: The tumor was diagnosed using abdominal CT during her yearly routine health check. After radical nephrectomy, the tumor was subjected to pathological examination and micro-CT imaging. Pathological analysis confirmed a clear cell renal carcinoma. The capillary distribution of the tumor was significantly lesser than that of the normal cortex on micro-CT image. LESSONS: Microvessels of RCC can be detected by micro-CT. We also found that the distribution of microvessels was uneven and lower than that in the normal cortex in this case. For a more general diagnosis, more micro-CT images of RCC tumors are needed.


Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/patologia , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Idoso , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/cirurgia , Feminino , Humanos , Neoplasias Renais/diagnóstico , Neoplasias Renais/cirurgia , Nefrectomia , Tomografia Computadorizada por Raios X
14.
Curr Urol Rep ; 20(10): 56, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31468240

RESUMO

PURPOSE OF REVIEW: The clinical role of fluorine-18 fluoro-2-deoxyglucose (FDG)-positron emission tomography (PET) in renal cell carcinoma (RCC) is still evolving. Use of FDG PET in RCC is currently not a standard investigation in the diagnosis and staging of RCC due to its renal excretion. This review focuses on the clinical role and current status of FDG PET and PET/CT in RCC. RECENT FINDINGS: Studies investigating the role of FDG PET in localized RCC were largely disappointing. Several studies have demonstrated that the use of hybrid imaging PET/CT is feasible in evaluating the extra-renal disease. A current review of the literature determines PET/CT to be a valuable tool both in treatment decision-making and monitoring and in predicting the survival in recurrent and metastatic RCC. PET/CT might be a viable option in the evaluation of RCC, especially recurrent and metastatic disease. PET/CT has also shown to play a role in predicting survival and monitoring therapy response.


Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Carcinoma de Células Renais/metabolismo , Carcinoma de Células Renais/patologia , Radioisótopos de Flúor , Fluordesoxiglucose F18 , Humanos , Neoplasias Renais/metabolismo , Neoplasias Renais/patologia , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos
15.
Clin Nucl Med ; 44(10): e574-e576, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31348078

RESUMO

An end-stage renal disease patient underwent renal transplantation 18 years back and was on triple immunosuppression for acute rejection. She presented with left-sided abdominal lump and underwent ultrasound and noncontrast CT scan, which revealed an exophytic mass lesion in atrophic left kidney (16.2 × 13.1 × 14 cm). Baseline F-FDG PET/CT revealed a large avid exophytic mass (SUVmax 23, 17 × 14 × 13) in atrophic left kidney, with multiple retroperitoneal lymphadenopathies and a suspicious lung nodule. She underwent left open radical nephrectomy. Follow-up PET/CT after 1 month revealed multiple soft tissue deposits in operative bed and other unusual metastatic sites.


Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/patologia , Fluordesoxiglucose F18 , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Transplante de Rim , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Carcinoma de Células Renais/terapia , Progressão da Doença , Feminino , Humanos , Rim/diagnóstico por imagem , Rim/patologia , Neoplasias Renais/terapia , Pessoa de Meia-Idade , Metástase Neoplásica
16.
Medicine (Baltimore) ; 98(29): e16508, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335724

RESUMO

RATIONALE: There is an association between the presence of neuroendocrine neoplasms and incremented risk to develop second primary malignancies. This risk is estimated to be 17%. The most common secondary neoplasms were found in the Gastrointestinal and Genitourinary tracts. PATIENT CONCERNS: A 74-year-old Caucasian patient with melaena came to our observation in June 2015. The Esophago-gastro-duodenoscopy exam found a polypoid formation in the duodenal bulb. Histopathological examination showed a well-differentiated neuroendocrine neoplasm (G1). DIAGNOSIS: During the follow up for the neuroendocrine neoplasm, a CT scan was performed in August 2016 describing infiltration of the right renal sinus and the third proximal ureter segment with heterogeneous enhancement of vascular structure. An US-guided biopsy was conclusive for a Diffuse Large B Cell Lymphoma. In October 2016, a colonoscopy showed a neoplastic lesion at 20 cm from the anal orifice. The Histology exam was positive for an adenocarcinoma with a desmoplastic stroma infiltration. INTERVENTIONS: In November 2016, the patient underwent a left hemicolectomy: the pathologic staging described a G2 adenocarcinoma pT3N1b. In May 2018, the Octreotide scan was negative. In the same month, the patient started a treatment based on 6 cycles of Rituximab, Oxaliplatin, and Capecitabine due to the persistence of lymphomatous disease and hepatic metastases. In July 2018, other 3 cycles of the same treatment were scheduled. OUTCOMES: In January 2019, due to an increase in liver metastases' size, it was decided to start a new regimen for the colon cancer with FOLFIRI+Cetuximab. The patient is still in treatment with this regimen in April 2019. LESSONS: The risk of a second primary tumor is increased among patients older than 70. Therefore, it is necessary to follow them using total body CT scan and endoscopic techniques of gastrointestinal and genitourinary tracts, not only for the evaluation of the neuroendocrine tumor but also for the higher risk to develop other neoplastic diseases.


Assuntos
Neoplasias Duodenais/patologia , Segunda Neoplasia Primária/diagnóstico por imagem , Tumores Neuroendócrinos/patologia , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/secundário , Idoso , Neoplasias do Colo/diagnóstico por imagem , Neoplasias do Colo/patologia , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Masculino , Neoplasias Ureterais/diagnóstico por imagem
17.
J Comput Assist Tomogr ; 43(4): 628-633, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31162237

RESUMO

OBJECTIVES: This study aimed to quantify nonenhancing tumor (NT) component in clear cell renal cell carcinoma (ccRCC) and assess its association with histologically defined tumor necrosis, stage, and survival outcomes. METHODS: Among 183 patients with ccRCC, multi-institutional changes in computed tomography attenuation of tumor voxels were used to quantify percent of NT. Associations of NT with histologic tumor necrosis and tumor stage/grade were tested using Wilcoxon signed rank test and with survival outcomes using Kaplan-Meier curves/Cox regression analysis. RESULTS: Nonenhancing tumor was higher in ccRCC with tumor necrosis (11% vs 7%; P = 0.040) and higher pathological stage (P = 0.042 and P < 0.001, respectively). Patients with greater NT had higher incidence of cancer recurrence after resection (P < 0.001) and cancer-specific mortality (P < 0.001). CONCLUSION: Nonenhancing tumor on preoperative computed tomographic scans in patients with ccRCC correlates with tumor necrosis and stage and may serve as an independent imaging prognostic biomarker for cancer recurrence and cancer-specific survival.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/epidemiologia , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/patologia , Feminino , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/epidemiologia , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Necrose , Prognóstico , Estudos Retrospectivos
18.
Urologiia ; (1): 56-62, 2019 Apr.
Artigo em Russo | MEDLINE | ID: mdl-31184019

RESUMO

INTRODUCTION: our aim was to assess and compare a zero ischemia enucleation and enucleoresection of tumor, as well as classical partial nephrectomy. In addition, we defined a role of a three-dimensional reconstruction of the tumor for the planning of intervention. MATERIALS AND METHODS: a total of 83 patients with localized renal tumors were included in the study. There were 48 men (57.8%) and 35 women (42.2%), with mean age 56.8+/-11.9 years. The patients were divided into 3 groups depending on the type of intervention. The enucleation, enucleoresetion and classical partial nephrectomy with removal of 0.5-1 cm margin of normal parenchyma was performed in Group 1 (n=41), Group 2 (n=31) and Group 3 (n=11), respectively. A computer program Amira was used for the reconstruction of 3D-model of tumor during preoperative planning. On the basis of 3D-model, an information about the structures situated beneath the tumor was obtained, as well as anatomy of vessels and relationship between the renal pelvis system and the tumor. RESULTS: In all cases the interventions were performed laparoscopically. Transperitoneal access was used in 34 (41%) cases, while retroperitoneal access was chosen in 49 patients (59%). The amount of blood loss was higher in 23 patients (27.7%) with tumors located in renal sinus (205.7+/-29.1 ml), than in patients with exophytic and endophytic tumors (142.3+/-15.2 and 208.2+/-35.9 ml, respectively; p=0.005). The duration of the surgery was less in those cases where parenchyma was under the bottom of the tumor, according to the 3D-model (58.3+/-6.8 min), compared to the patients with collecting system or vessels located under the tumor (87,6+/-5.2 min, p=0.005). The amount of blood loss was 179.4 +/- 41.8 ml in patients with one vessel located beneath the tumor, according to the 3D-model, in comparison with those cases with three vessels (360.0+/-87.2 ml). There was no need for clamping of the renal vessels or conversion to the open surgery. In the enucleation group, neither intraoperative nor postoperative complications were observed. CONCLUSION: According to the results, we can conclude that 3D modeling undoubtedly gives clear advantages for the urologist during the planning of the intervention. Tumor enucleation seems to be the optimal method of partial nephrectomy, which allows to perform a dissection near to the renal sinus with the small risk of complications.


Assuntos
Imagem Tridimensional , Neoplasias Renais , Laparoscopia , Cirurgia Assistida por Computador , Adulto , Idoso , Feminino , Humanos , Rim , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia , Néfrons
19.
Urologiia ; (1): 63-67, 2019 Apr.
Artigo em Russo | MEDLINE | ID: mdl-31184020

RESUMO

INTRODUCTION: The choice of method of surgical treatment for endophytic kidney tumors depends on the precise definition of the location and size, the extent of invasion into adjacent tissues and the type of vascularization. Intraoperative ultrasound (IOUS) in combination with 3D-CT allow to receive this information. The aim of this study was to compare the laparoscopic-assisted extracorporeal partial nephrectomy and laparoscopic partial nephrectomy with IOUS and visualization in Full HD, 3D Full HD and 4K modes. MATERIALS AND METHODS: A total of 77 patients aged 43-75 years with endophytic renal tumors were included in the study. They were undergone either extracorporeal partial nephrectomy or laparoscopic partial nephrectomy with IOUS. We compared the rate of positive surgical margins, early postoperative bleeding, de novo renal failure or aggravation of preexisting renal failure and stricture of vesico-ureteric anastomosis. RESULTS: The rate of early postoperative bleeding, chronic kidney failure and pathologically-proven positive surgical margin in patients who underwent extracorporeal partial nephrectomy followed by kidney autotransplantation was 23.1%, 13.4% and 13.4%, respectively. After laparoscopic partial nephrectomy these values were 12%, 16.7% and 8.3%, respectively. The best outcomes were achieved in patients who underwent laparoscopic partial nephrectomy with IOUS and with a use of visualization in Full HD, 3D Full HD and 4K modes.


Assuntos
Neoplasias Renais , Laparoscopia , Nefrectomia , Ultrassonografia de Intervenção , Adulto , Idoso , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Margens de Excisão , Pessoa de Meia-Idade , Ultrassonografia
20.
Ann R Coll Surg Engl ; 101(6): e136-e138, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31155895

RESUMO

Completely endophytic renal tumours pose challenges in laparoscopic nephron-sparing tumour excisions, with the use of intraoperative imaging techniques (e.g. ultrasound) being crucial when managing such tumours. The use of a percutaneous hookwire for tumour localisations are in use in several other surgical fields, such as breast surgery. An asymptomatic 52-year-old man presented with an incidental small right sided solid 33-mm interpolar renal mass identified on computed tomography. A guided insertion of a percutaneous localisation wire was carried out prior to a laparoscopic partial nephrectomy to assist in intraoperative tumour landmark/margins identification. Operative time was 210 minutes with zero ischaemia time, with an estimated blood loss of 200 ml. No perioperative complications were observed and the patient was discharged two days postoperatively. Histology revealed the mass to be a Fuhrman grade 2 clear-cell carcinoma with a 2-mm clear surgical margin. The patient remained free of recurrence at 16 months of follow-up. We have reported our first experience of wire localisation prior to laparoscopic partial nephrectomy for an intrarenal mass, which to our knowledge could be the first of its kind in renal surgery. Percutaneous wire localisation of endophytic renal tumours is potentially safe and effective and can allow nephron-sparing surgery where laparoscopic ultrasound is not available. Longer-term and further evidence should be encouraged.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Laparoscopia/métodos , Instrumentos Cirúrgicos , Carcinoma de Células Renais/diagnóstico por imagem , Humanos , Neoplasias Renais/diagnóstico por imagem , Laparoscopia/instrumentação , Masculino , Pessoa de Meia-Idade , Nefrectomia/instrumentação , Nefrectomia/métodos , Radiografia Intervencionista/instrumentação , Radiografia Intervencionista/métodos , Tomografia Computadorizada por Raios X
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