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1.
Orbit ; : 1-5, 2023 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-37611021

RESUMO

We describe a case of primary ductal adenocarcinoma of the lacrimal gland with novel histopathological characteristics corresponding to a biphasic growth course and provide a comprehensive genomic profile of this malignancy. A 39-year-old male with a history of slowly progressive unilateral proptosis and hypoglobus presented after 1 month of hyperacute exacerbation. Orbital imaging revealed a superior mass with osseous erosion. The patient underwent orbital exploration and excisional biopsy via lateral orbitotomy. Histopathology demonstrated high-grade adenocarcinoma with a well-differentiated glandular component alongside a poorly differentiated sarcomatoid region. The glandular section was immunopositive for Her-2, CK7, GATA3, and androgen receptor. Tumor recurrence necessitated en-bloc exenteration with dural resection alongside adjuvant radiotherapy and chemotherapy. This represents the first report of sarcomatoid differentiation in primary ductal adenocarcinoma of the lacrimal gland, which may incite hyperacute progression. Conversely, GATA3 immunopositivity may correlate with indolent growth. Genomic variants such as SEMA3C represent potential therapeutic targets for this condition.

2.
BJU Int ; 129(4): 463-469, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-33866683

RESUMO

OBJECTIVE: To evaluate whether urothelial carcinoma (UC) with sarcomatoid differentiation is associated with a lower pathological response rate to neoadjuvant chemotherapy (NAC) and worse oncological outcomes compared to UC without variant histology among patients undergoing radical cystectomy. PATIENTS AND METHODS: Patients with UC undergoing cystectomy from 1995 to 2018 at the Memorial Sloan Kettering Cancer Centre were identified. Patients with sarcomatoid differentiation at transurethral resection (TUR) or cystectomy, and patients without variant histology were selected. Downstaging from ≥cT2 to ≤pT1N0 defined partial response and pT0N0 defined complete response. Recurrence-free, cancer-specific and overall survival were modelled. RESULTS: We identified 131 patients with sarcomatoid differentiation and 1722 patients without variant histology, of whom 25 with sarcomatoid histology on biopsy and 313 without variant histology received NAC. Those with sarcomatoid differentiation presented with higher consensus tumour stage (94% ≥T2 vs 62%; P < 0.001) and were, therefore, more likely to receive NAC (29% vs 18%; P = 0.003). We found no evidence to support a difference in partial (24% vs 31%) or complete (20% vs 24%) response between patients with sarcomatoid histology and those with pure UC at TUR (P = 0.6). Among patients with sarcomatoid differentiation, 5-year recurrence-free survival was 55% (95% confidence interval [CI] 41-74) among patients receiving NAC and 40% (95% CI 31-52) among patients undergoing cystectomy alone (P = 0.1). Adjusting for stage, nodal involvement, margin status and receipt of NAC, sarcomatoid differentiation was associated with worse recurrence-free (hazard ratio [HR] 1.82, 95% CI 1.39-2.39), disease-specific (HR 1.66, 95% CI 1.23-2.22), and overall survival (HR 1.37, 95% CI 1.06-1.78). CONCLUSIONS: Sarcomatoid differentiation was associated with higher stage at presentation and independently associated with worse survival. Given similar pathological response rates if sarcomatoid differentiation is detected at initial resection, and greater survival among patients receiving NAC, treatment with NAC appears warranted. Other drivers of the poor outcomes of this histology must be investigated.


Assuntos
Carcinoma de Células de Transição , Neoplasias da Bexiga Urinária , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/cirurgia , Cistectomia , Humanos , Recidiva Local de Neoplasia/cirurgia , Resultado do Tratamento , Neoplasias da Bexiga Urinária/patologia
3.
Pathologica ; 111(4): 369-374, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31965115

RESUMO

A case of a patient with type 2 papillary renal cell carcinoma with eosinophilic cytoplasmatic inclusions is presented. About 50% of tumor cells were characterized by a well-circumscribed intra-cytoplasmatic round-to-oval or irregular inclusion/globule. Inclusions were 7-30 micron in diameter. They were glassy and pale to slightly eosinophilic in color in hematoxylin and eosin, were stained red by trichrome and were negative for periodic acid-Schiff reaction. Immunohistochemically, globules were negative for PAX8, epithelial membrane antigen, Carbonic Anhydrase IX, pan-cytokeratin (AE1/AE3), CD10, S100 protein, α-smooth-muscle actin, cytokeratin 7 and cytokeratin 34ßE12. Glassy hyaline globules were not detected in any adjacent normal kidney cells. The presence of eosinophilic cytoplasmic inclusions in renal cell carcinoma, especially in papillary renal cell carcinoma, has been rarely emphasized in the literature. In this article, we review similar cases in the literature and discuss the nature of eosinophilic globules.


Assuntos
Carcinoma Papilar/diagnóstico , Carcinoma de Células Renais/diagnóstico , Corpos de Inclusão/patologia , Neoplasias Renais/diagnóstico , Idoso , Carcinoma Papilar/patologia , Carcinoma de Células Renais/patologia , Eosinófilos/patologia , Humanos , Imuno-Histoquímica , Rim/patologia , Neoplasias Renais/patologia , Masculino
4.
BMC Urol ; 18(1): 26, 2018 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-29669553

RESUMO

BACKGROUND: The treatment of advanced or metastatic renal cell carcinoma (RCC) has drastically changed since the approval of immune checkpoint therapy. Nivolumab is a treatment option for patients with metastatic RCC, previously treated with targeted antiangiogenic therapy. The efficacy of nivolumab for patients with RCC was established by the Checkmate 025 clinical trial. Chromophobe RCC (CRCC) represents around 5% of RCC cases, but non-clear cell RCC (non-ccRCC) subtypes were excluded from the Checkmate 025 clinical trial. We report a case in which the use of nivolumab as the seventh-line therapy elicited a significant response in the treatment of metastatic CRCC with sarcomatoid differentiation. CASE PRESENTATION: We report a case of a 41-year-old woman with metastatic CRCC with sarcomatoid differentiation. She was treated with sunitinib, pazopanib, everolimus, sorafenib, axtinib, and temsirolimus, but treatment was discontinued because of disease progression or strong adverse events. Seventh-line treatment with nivolumab was initiated and significant clinical improvement was noted after 4 cycles. The treatment was well-tolerated with no significant side effects and the patient continues with nivolumab treatment at present. CONCLUSIONS: Nivolumab may be an attractive treatment option for non-ccRCC patients with sarcomatoid differentiation that exhibited aggressive characteristics and poor prognosis. Further investigation is warranted.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Antineoplásicos/uso terapêutico , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/tratamento farmacológico , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/tratamento farmacológico , Adulto , Anticorpos Monoclonais/farmacologia , Antineoplásicos/farmacologia , Diferenciação Celular/efeitos dos fármacos , Diferenciação Celular/fisiologia , Feminino , Humanos , Nivolumabe , Resultado do Tratamento
5.
Arkh Patol ; 80(4): 39-46, 2018.
Artigo em Russo | MEDLINE | ID: mdl-30059070

RESUMO

The paper describes a case of chromophobe renal cell carcinoma growing into the muscular layer of the descending colon and with metastases in 4 lymph nodes of paranephral tissue in a 66-year-old woman. The tumor had a zonal structure with an alternation of epithelioid and sarcomatoid structural sites and with the signs of grades I, II and III according to the grading system by Paner and et al. (2010). The sarcomatoid renal component occupied about 70.0% of the tumor. There was a pronounced immunohistochemical reaction with VEGF-A (5 scores), a high Ki-67 proliferation index (70%), and a large number of tumor cells with nuclear p53 expression (85%) in the areas with minimal differentiation and sarcomatoid elements (Grade III). These signs can serve as criteria for the aggressive behavior of the tumor. A large volume of the sarcomatoid carcinoma component and a strong reaction with VEGF-A are indications for targeted therapy with anti-VEGF drugs.


Assuntos
Carcinoma de Células Renais/genética , Antígeno Ki-67/genética , Proteína Supressora de Tumor p53/genética , Fator A de Crescimento do Endotélio Vascular/genética , Idoso , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/terapia , Diferenciação Celular/genética , Proliferação de Células/genética , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Linfonodos/metabolismo , Linfonodos/patologia , Metástase Linfática , Terapia de Alvo Molecular
7.
BJU Int ; 115(3): 405-11, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24730416

RESUMO

OBJECTIVE: To demonstrate sarcomatoid differentiation is an independent prognostic feature for patients with grade 4 renal cell carcinoma (RCC) with or without distant metastases. To identify independent predictors of survival, evaluate the correlation between the amount of sarcomatoid differentiation and cancer-specific survival (CSS), and to design a multivariate prognostic model for patients with sarcomatoid RCC. PATIENTS AND METHODS: We used the Mayo Clinic Nephrectomy Registry to identify 204 post-nephrectomy patients with sarcomatoid-variant RCC, as well as 207 patients with unilateral grade 4 RCC without sarcomatoid features for comparison. All slides were reviewed by one pathologist. CSS was estimated using the Kaplan-Meier method. The associations of clinical and pathological features with death from RCC were evaluated using Cox proportional hazards regression models. RESULTS: For all patients with grade 4 RCC, the presence of sarcomatoid differentiation was associated with a 58% increased risk of death from RCC (P < 0.001). For patients with grade 4 non-metastatic (M0) RCC, the presence of sarcomatoid differentiation was associated with an 82% increased risk of death from RCC (P < 0.001). For patients with sarcomatoid RCC, the 2009 primary tumour classifications, presence of regional lymph nodes and distant metastases, coagulative tumour necrosis, and the amount of sarcomatoid differentiation were each significantly associated with death from RCC in a multivariate setting. After adjusting for other prognostic variables, each 10% increase in the amount of sarcomatoid differentiation was associated with a 6% increased risk of death from RCC (P = 0.028). Patients whose tumours contained ≥30% (median amount) sarcomatoid differentiation were 52% more likely to die from RCC compared with patients whose tumours contained <30% sarcomatoid differentiation (hazard ratio 1.52; P = 0.018). CONCLUSIONS: Among patients with grade 4 RCC, either with or without distant metastases at surgery, sarcomatoid differentiation is significantly associated with adverse survival in a multivariate setting. We also suggest for the first time that the percentage of sarcomatoid differentiation is an independent prognostic feature in a multivariate setting. The 2009 primary tumour classifications, regional lymph node status, the presence of distant metastases classifications, coagulative tumour necrosis, and the amount of sarcomatoid differentiation are independent predictors of survival for patients with sarcomatoid RCC.


Assuntos
Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/mortalidade , Neoplasias Renais/diagnóstico , Neoplasias Renais/mortalidade , Modelos Estatísticos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/patologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Prognóstico
8.
Clin Exp Med ; 24(1): 61, 2024 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-38554222

RESUMO

This study aimed to validate the prognostic value of a four-tiered grading system recently proposed by Avulova et al. and to explore the prognostic ability of another four-tiered classification grading system in which there is a separate Grade 3 for tumor necrosis. Grading of chromophobe renal cell carcinoma (ChRCC) by the Fuhrman system is not feasible because of the inherent nuclear atypia in ChRCC. We collected relevant data of 263 patients with ChRCC who had undergone surgery in our hospital from 2008 to 2020. The Kaplan-Meier method was used to calculate the survival rate and Cox proportional hazard regression models to assess associations with cancer-specific survival and distant metastasis-free survival by hazard ratios (HRs) and 95% confidence intervals (CIs). Ten patients died from ChRCC, and 12 developed metastases. The 5 year CSS rates were 95.9%. Grades 2 (HR = 10.9; CI 1.11-106.4; P = 0.04), 3 (HR = 33.6, CI 3.32-339.1; P = 0.003), and 4 (HR = 417.4, CI 35.0-4976.2; P < 0.001) in a four-tiered grading system were significantly associated with CSS in a multivariate setting. However, the difference in CSS between Grades 2 and 3 was not significant (HR = 2.14, 95% CI 0.43-10.63; P = 0.35). The HRs of the associations between an exploratory grading system that includes a separate Grade 3 for tumor necrosis and CSS were as follows: Grade 2, 10.2 (CI 1.06-97.9, P = 0.045); Grade 3, 11.4 (CI 1.18-109.6, P = 0.04); and Grade 4, 267.9 (CI 27.6-2603.3, P < 0.001). Similarly, Grades 2 and 3 did not differ significantly. The four-tiered grading system studied is useful for predicting death from ChRCC and metastasis. However, Grade 3 did not more accurately predict risk of death and metastasis than did Grade 2. This was also true for the novel exploratory grading system that classifies tumors with necrosis into a separate Grade 3.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Humanos , Carcinoma de Células Renais/patologia , Neoplasias Renais/patologia , Gradação de Tumores , Prognóstico , Necrose
9.
Int J Surg Pathol ; 32(2): 279-285, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37306114

RESUMO

Renal cell carcinoma (RCC) is occasionally associated with vena cava involvement. Despite recent advances in therapeutic modalities, the 5-year survival in this population continues to be poor. Therefore, further studies are required to better characterize this patient population, especially from the clinicopathologic standpoint. A comprehensive review of patients with RCC and vena cava involvement managed at our institution from 2014 to 2022 was performed. Multiple clinicopathologic parameters including follow-up were obtained. A total of 114 patients were identified. The mean patient age was 63 years (range: 30-84 years). The cohort consisted of 78/114 (68%) males and 36/114 (32%) females. The mean primary tumor size (excluding tumor thrombus) was 11 cm. The majority of tumors (104/114, 91%) were unifocal. Tumor stages were categorized as follows: pT3b (51/114, 44%), pT3c (52/114, 46%), and pT4 (11/114, 10%). Most of the tumors were clear cell RCC 89/114 (78%), although other more aggressive RCC subtypes were also present. Most tumors were WHO/ISUP grade 3 (44/114, 39%) or 4 (67/114, 59%) with sarcomatoid differentiation present in 39/67 (58%). Necrosis was present in 94/114 (82%) tumors. Twenty-three of 114 (20%) tumors were categorized as pM1 and the ipsilateral adrenal gland was the most common site of metastasis. Of the 91 patients categorized as pM, not applicable at nephrectomy, 42/91 (46%) subsequently developed metastasis, most frequently to the lung. Of all patients, only 16/114 (14%) had positive vascular margins and 7/114 (6%) had positive soft tissue margins despite having very advanced disease and a subset considered inoperable at other centers.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Feminino , Masculino , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/cirurgia , Glândulas Suprarrenais , Necrose , Nefrectomia , Neoplasias Renais/cirurgia
10.
Eur J Surg Oncol ; 50(6): 108251, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38492258

RESUMO

OBJECTIVES: Sarcomatoid renal pelvis carcinoma (SRPC) is a rare variant of RPC. We aimed to summarize the clinicopathological features and prognostic factors of SRPC. METHODS: In this retrospective study, we collected data from 24 patients with SRPC who were treated at the Department of Urology, Affiliated Hospital of Qingdao University between 2008 and 2021. The clinicopathological features of the patients were obtained from their medical records to evaluate the diagnosis, prognostic factors, and response to systemic therapy. RESULTS: Immunohistochemical staining revealed that cytokeratin was expressed in 19 patients with SRPC, while vimentin was expressed in all patients. Computer tomography showed these tumors as low-density (n = 12) or mixed-density masses, with or without necrotic areas (n = 12). All patients showed different degrees of enhancement on computed tomography. Lymph node metastasis was present in 6 patients and distant metastasis in 5. The median survival of all patients was 28 months. Patients without metastasis had a median survival of 46 months compared with 18 months in those with metastasis (P < 0.05). Necrosis had no significant influence on prognosis (P > 0.05). The median survival of patients with and without hydronephrosis was 18 and 104 months (P < 0.05). Among patients without metastasis, those without hydronephrosis survived longer than those with hydronephrosis (104 vs 18 months, P < 0.05), and necrosis had no effect on prognosis. In patients with metastasis, necrosis and hydronephrosis had no effect on prognosis (P > 0.05). CONCLUSION: The prognosis of SRPC is poor, and the clinical stage, particularly the presence of distant metastasis, has a significant impact on prognosis.


Assuntos
Neoplasias Renais , Pelve Renal , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Neoplasias Renais/patologia , Neoplasias Renais/terapia , Estudos Retrospectivos , Idoso , Pelve Renal/patologia , Adulto , Prognóstico , Metástase Linfática , Vimentina/metabolismo , Tomografia Computadorizada por Raios X , Taxa de Sobrevida , Queratinas/metabolismo , Hidronefrose/etiologia , Nefrectomia , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/terapia , Necrose
11.
Indian J Pathol Microbiol ; 66(4): 839-841, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38084543

RESUMO

Chromophobe renal cell carcinoma (CRCC) is a distinct subtype of renal cell carcinoma with unique histological, immunohistochemical, cytogenetic, and ultrastructural features, which usually has a favorable clinical course, with only a small percentage of patients developing recurrence, metastasis, or death due to its complications. Sarcomatoid differentiation can occur in any subtype of renal cell carcinoma and currently represents the transformation into a higher degree of malignancy, its presence being associated with a reserved prognosis, with a reported incidence of average survival of less than 1 year after diagnosis. In this study, we present an unusual case of CRCC with massive sarcomatoid differentiation, which infiltrated the left adrenal gland and was surgically resected. The histological features of this tumor as well as a brief review of literature are presented.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Humanos , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/cirurgia , Carcinoma de Células Renais/patologia , Neoplasias Renais/diagnóstico , Neoplasias Renais/cirurgia , Prognóstico , Nefrectomia , Diferenciação Celular
12.
Am J Clin Exp Urol ; 11(1): 75-78, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36923724

RESUMO

Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare type of kidney tumor that has only recently been described, with less than eighty cases in the literature. This was only recognized as a specific entity in the World Health Organization 2004 classification of Renal Cell Carcinoma (RCC). MTSCCs are polymorphic renal neoplasms characterized by small, elongated tubules lined by cuboidal cells with cords of spindled cells separated by pale mucinous stroma. We report the case of a 57 year old lady who had an incidental finding of a mass in her right kidney. The radiological features were consistent with a RCC and following a multidisciplinary team discussion she underwent a laparoscopic radical nephrectomy. Macroscopic examination revealed a well circumscribed 6.5 × 6 × 6.5 cm right lower pole mass. Histologically it was composed of elongated tubules, small tubules and papillary structures with a necrotic centre. The cells demonstrated cuboidal and spindle cell morphology. Histological grade was Fuhrman grade 2. The majority of MTSCCs are indolent, and there are only two reports of distant metastases which responded favorably to adjuvant sunitinib. To date there is no international consensus on long term surveillance of these patients. Due of the favorable prognosis with this type of tumor, MTSCC must be differentiated from papillary renal cell carcinoma to avoid administration of excessive adjuvant treatment to patients.

13.
Cancer Med ; 12(13): 14149-14156, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37325945

RESUMO

OBJECTIVE: To investigate the efficacy of tyrosine kinase inhibitors (TKIs) in the treatment of metastatic renal cell carcinoma (mRCC) with rhabdoid (mRCC-R) and sarcomatoid (mRCC-S) differentiations. MATERIALS AND METHODS: In this single-institutional cohort study, we included patients with RCC with rhabdoid (RCC-R) and sarcomatoid (RCC-S) differentiation, who were treated with TKIs after metastasis at our institute from 2013 to 2021. Patient characteristics, treatments, and clinical outcomes were recorded and analyzed. RESULTS: We identified 111 patients with RCC-R or RCC-S differentiations, of which 23 patients were included in the final analysis. Of the 23 patients, 10 (43.5%) were grouped as mRCC-R and 13 (56.5%) as mRCC-S. At a median follow-up of 40 months, mRCC-R and mRCC-S progressed in 7 of 10 and 12 of 13 patients, respectively. In addition, four and eight patients died in the mRCC-R and mRCC-S groups, respectively. The median progression-free survival (PFS) of the two groups was 19 months (mRCC-R: 95% confidence interval [CI] 4.08-33.92) and 7 months (mRCC-S: 95% CI 2.03-11.96), while the median overall survival (OS) was 32 months and 21 months, respectively. mRCC-S had a worse prognosis than mRCC-R. Based on the univariate Cox regression model, single metastasis or multiple metastasis of tumor, rhabdoid differentiation, and sarcomatoid differentiation were predictors of PFS but not OS. CONCLUSION: The efficacy of TKIs in the treatment of mRCC-R and mRCC-S may be different.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Humanos , Carcinoma de Células Renais/patologia , Neoplasias Renais/patologia , Estudos de Coortes , Prognóstico , Estudos Retrospectivos , Inibidores de Proteínas Quinases/uso terapêutico
14.
Front Oncol ; 13: 941835, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36816976

RESUMO

The category of non-clear cell renal cell carcinoma (nccRCC) includes several clinically, histologically, and molecularly diverse entities. Traditionally, they comprise type 1 and type 2 papillary, chromophobe, unclassified, and other histologies (medullary, collecting duct carcinoma, and translocation-associated). Molecular knowledge has allowed the identification of some other specific subtypes, such as fumarate hydratase-deficient renal cell carcinoma (RCC) or succinate dehydrogenase-associated RCC. In addition, it has recognized some alterations with a possible predictive role, e.g., MET proto-oncogene receptor tyrosine kinase (MET) alterations in papillary tumors. Standard therapies for the management of advanced clear cell RCC (ccRCC), i.e., vascular endothelial growth factor receptor (VEGFR) pathway inhibitors and mammalian target of rapamycin inhibitors, have shown poorer results in nccRCC patients. Therefore, there is a need to improve the efficacy of the treatment for advanced nccRCC. Immunotherapy, especially immune checkpoint inhibitors (ICIs) targeting programmed death 1/programmed death ligand 1 and cytotoxic T-lymphocyte associated protein 4 (CTLA-4), has demonstrated a significant survival benefit in several malignant neoplasias, including ccRCC, with a proportion of patients achieving long survival. The combinations of ICI or ICI + VEGFR tyrosine kinase inhibitors (TKIs) are the standard of care in advanced ccRCC. Unfortunately, major pivotal trials did not include specific nccRCC populations. In recent years, several studies have retrospectively or prospectively evaluated ICIs alone or in combination with another ICI or with TKIs in nccRCC patients. In this article, we review data from available trials in order to elucidate clinical and molecular profiles that could benefit from immunotherapy approaches.

15.
J Kidney Cancer VHL ; 10(4): 7-12, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37936865

RESUMO

A third of patients with renal cell carcinoma (RCC) present with metastatic disease. Metastasis in RCC from small renal mass (SRM) (≤4 cm) is rare. We report a case of stage cT1a clear-cell RCC with low-risk features on pathology presenting with disproportionately large synchronous solitary metastasis to the transverse colon. He underwent resection of the mass with the involved transverse colon and adjoining mesocolon. Intestinal continuity was restored, following which partial nephrectomy was performed for the right renal tumor. Final pathology of the right renal mass confirmed clear-cell RCC. The large mass after immunohistochemistry profile confirmed metastasis from the renal tumor.

16.
Ecancermedicalscience ; 17: 1557, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37396104

RESUMO

Ovarian mucinous cystic tumours with mural nodules are rare tumours of the ovary that are often missed out during diagnosis. They are classified under the ovarian mucinous surface epithelial-stromal tumours. These mural nodules can be sarcoma-like (benign), anaplastic carcinoma, sarcomas, or mixed malignant (carcinosarcoma). However, very few cases of anaplastic malignant mural nodules have been reported. Here, we present a case of a borderline ovarian mucinous cystadenoma with anaplastic mural nodule that has sarcomatoid differentiation, in a 39-year-old woman who presented with a 1-year history of progressive abdominal swelling and pain. There were intraoperative findings of huge right ovarian cystic tumour with omental and umbilical deposits. Differential diagnosis of possible germ cell tumours, vascular tumours, melanoma, sarcoma and sarcoma-like nodules were ruled out with routine histology (Haematoxylin & Eosin), histochemical (reticulin) and immunohistochemical stains (CK AE1/3+, CD30+, AFP-, HCG-, EMA-, S100 protein-, CD31-, and CD34-) and the final diagnosis of a mural nodule of anaplastic carcinoma with sarcomatoid differentiation in a borderline ovarian mucinous cystadenoma established. Unfortunately, due to the aggressive nature of the tumour and disease progression, the patient passed on a few months after the surgery. This rare tumour, especially the ones with anaplastic carcinoma or mixed tumours, usually has an aggressive clinical course with most patients presenting late when the disease is advanced with poor clinical outcomes as is seen with the index patient. A high index of suspicion of this tumour with early detection and a multidisciplinary approach to its management is advised.

17.
Int Cancer Conf J ; 11(4): 286-291, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36186227

RESUMO

Renal cell carcinoma (RCC) is the most predominant type of kidney cancer in adults and comprises several histological subtypes. Among them, the chromophobe RCC (ChRCC) with sarcomatoid differentiation is a rare subtype, and its therapeutic strategy remains unclear. Hence, to provide more information on effective therapeutic strategies against ChRCC, we report two cases of ChRCC with sarcomatoid differentiation treated with nivolumab monotherapy or ipilimumab-nivolumab combination therapy. One patient was treated with nivolumab monotherapy after the failure of sunitinib, while the other was treated with ipilimumab-nivolumab combination therapy as a first-line option. The therapeutic strategies adopted in both cases were effective, but the patients experienced immune-related adverse events such as interstitial nephritis and colitis. Thus, our report indicates that immune checkpoint therapy is effective for ChRCCs with sarcomatoid differentiation.

18.
Res Rep Urol ; 14: 241-245, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35734241

RESUMO

Background: Sarcomatoid differentiation is a rare condition that could present in different subtypes of renal cell carcinomas (RCCs) and is associated with a significantly poor prognosis. Sarcomatoid renal cell carcinoma (SRCC) patients are typically aged between 54 and 63, with a male-to-female ratio ranging from 1.3:1 to 2:1. Here, we report a case of SRCC in a 29-year-old female patient. Case Presentation: A 29-year-old female presented with left flank pain. A large lump was palpated on left flank and there was costovertebral angle tenderness. The lump was enlarged, and the patient also suffered from anemia. Abdominopelvic CT demonstrated solid mass with an internal gliosis in the left part of the renal cortex and the solid component was enhanced with contrast admission. Then, the patient underwent left radical nephrectomy with wide perirenal excision and paraaortic lymph nodes resection. Histopathological examination revealed SRCC with no lymphovascular invasion. Conclusion: The scarcity of data on SRCCs emphasizes the need for ongoing research into the biology, diagnostics, and effective treatment options for patients with this disease, as responses to conventional therapies have been disappointing, leaving patients with few options. Cytoreductive nephrectomy for SRCC patients with metastatic disease is debatable, although some research suggests resection at any stage in patients with good performance status. In this case, radical nephrectomy was performed and there was no evidence of metastasis.

19.
Front Surg ; 9: 922150, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36338616

RESUMO

Background: There are still differences in the prognostic factors of renal cell carcinoma with sarcomatoid dedifferentiation (sRCC). The aim of this study was to evaluate important predictors of survival in patients with sRCC. Patients and methods: A comprehensive search of PubMed, Embase, and Cochrane Library was conducted to identify eligible studies. The endpoints embraced overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS). Hazard ratios (HRs) and related 95% confidence intervals (CIs) were extracted. Results: A total of 13 studies were included for analyses. The pooled results showed that high European Cooperative Oncology Group performance score (HR 2.39, 95% CI 1.32-4.30; P = 0.004), high T stage (HR 2.18, 95% CI 1.66-2.86; P < 0.001), positive lymph node (HR 1.54, 95% CI 1.40-1.69; P < 0.001), distant metastasis (HR 2.52, 95% CI 1.99-3.21; P < 0.001), lung metastases (HR 1.45, 95% CI 1.16-1.80; P < 0.001), liver metastases (HR 1.71, 95% CI 1.30-2.25; P < 0.001), tumor necrosis (HR 1.78, 95% CI 1.14-2.80; P = 0.010), and percentage sarcomatoid ≥50% (HR 2.35, 95% CI 1.57-3.52; P < 0.001) were associated with unfavorable OS. Positive lymph node (HR 1.57, 95% CI 1.33-1.85; P < 0.001) and high neutrophil to lymphocyte ratio (HR 1.16, 95% CI 1.04-1.29; P = 0.008) were associated with unfavorable CSS. High T stage (HR 1.93 95% CI 1.44-2.58; P < 0.001) was associated with unfavorable progression-free survival. Conclusions: A meta-analysis of available data identified important prognostic factors for CSS, OS, and PFS of sRCC, which should be systematically evaluated for patient counseling, risk stratification, and treatment selection. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=249449.

20.
Arch Esp Urol ; 75(4): 310-317, 2022 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-35818910

RESUMO

OBJECTIVES: We aimed to evaluate oncologic outcomes of pT3a renal cell carcinoma (RCC) patients that treated with radical or partial nephrectomy and identify clinical or pathological factors that predict local recurrence or metastasis. METHODS: In this single center, retrospective study, we evaluated medical records of 856 patients who underwent radical or partial nephrectomy for RCC. Patients who had pT3aN0M0 RCC in final pathology and at least 6 months of follow-up included in the study. Patients' demographic characteristics, laboratory parameters, tumor characteristics and oncological outcomes were recorded. Cancer specific and overall survivals were our primary outcomes. Multivariate analysis was performed to identify factors affecting oncologic outcomes. RESULTS: A total of 86 pT3aN0M0 RCC patients were included final analysis of our study. During the mean 60.75 months follow up, 3 patients (3.5%) had experienced local recurrence and 19 patients (22.1%) had experienced metastasis. Total of 24 patients (27.9%) had died during the follow up. In this population 10-year OS was 70.8%, 10-year PFS was 61.3% and 10-year CSS was 78.4%. In multivariate analysis, chronic renal failure (CRF) was an independent worse prognostic factor for overall survival (p=0.03). Besides this sarcomatoid differentiation was an independent prognostic factor for PFS, CSS and OS (p=<0.001). CONCLUSIONS: Our study investigated the predictive factors for worse oncologic outcomes in pT3aN0M0 RCC patients. Although many factors have predictive value in univariate analysis, only sarcomatoid differentiation have independent predictive value for worse CSS, PFS and OS. Besides sarcomatoid differentiation, CRF is an independent prognostic factor for poor OS.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Carcinoma de Células Renais/patologia , Humanos , Neoplasias Renais/patologia , Estadiamento de Neoplasias , Nefrectomia , Prognóstico , Estudos Retrospectivos
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