A systematic review of robot-assisted partial nephrectomy outcomes for advanced indications:Large tumors(cT2-T3),solitary kidney,completely endophytic,hilar,recurrent,and multiple renal tumors

Objective:Robot-assisted partial nephrectomy(RAPN)has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses.The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses,large tumors(cT2-T3),renal cell carcinoma in solitary kidney,recurrent tumors,completely endophytic and hilar masses,and simultaneous and multiple tumors.Methods:A comprehensive search in the PubMed,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers.The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered.The secondary endpoint was to evaluate the surgical and functional outcomes.Results:After screening 1250 records,43 full-text manuscripts were selected,comprising over 8500 patients.Twelve and thirteen studies reported data for endophytic and hilar renal masses,respectively.Five and three studies reported outcomes for cT2-T3 and solitary kidney patients,respectively.Four studies focused on redo-RAPN for recurrent tumors.Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney.Conclusion:Over the past decade,evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown.Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes,the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result.Certainly,a higher likelihood of complication might be expected when facing extremely challenging cases.However,none of these indications should be considered per se an exclusion criterion for performing RAPN.Ultimately,a risk-adapted approach should be employed.

Superselective transcatheter arterial embolization to control renal hemorrhage after partial nephrectomy for renal tumors:A report of 9 cases and a literature review

Objective:This study aimed to evaluate the efficacy and safety of selective arterial embolization for hemorrhage after renal surgery and to summarize the clinical experience.Materials and methods:A total of 9 patients underwent arterial embolization after partial nephrectomy from 2010 to 2018.Results:Technical success was achieved in all patients;however,3 patients underwent a secondary arterial embolization because of short-term re-hemorrhage or the co-occurrence of accessory renal arterial hemorrhage.No serious complications occurred during the follow-up.Conclusions:Superselective arterial embolization is an effective and minimally invasive treatment for hemorrhage after partial nephrectomy.To improve the success rate of surgery,attention should be paid to the evaluation of accessory renal arteries and the management of suspected bleeding arteries.

Renal Oncocytoma: Clinical and Therapeutic Aspects about a Case Series and Literature Review

Introduction: The gold of this work was to study the clinical and therapeutic management aspects of renal oncocytoma in our settings. Our Observations: Case 1: there was a 44-year-old patient being followed up for a urinary tract infection due to Escherichia coli. The urological CT-scan showed a tumor-like process on a horseshoe kidney. Radical nephrectomy was performed and the histology report confirmed renal oncocytoma;Case 2: it involved a 62-year-old hypertensive patient. Clinical examination revealed a grade II cystocele and medical imaging showed a tumor-like mass at the lower pole of the right kidney. Radical nephrectomy was performed and histology was concluded in favor of renal oncocytoma;Case 3: there was a 64-year-old patient monitored for chronic renal failure and on dialysis for 6 months. Imaging showed a heterogeneous mass developing from the kidney. Histology and immunohistochemistry confirmed renal oncocytoma. Conclusion: Imaging could contribute greatly to preoperative diagnosis. However, there is a need to think about renal oncocytoma when evaluating kidney tissue masses.

Preoperative diagnosis of renal oncocytoma: case report and literature review

To differentiate renal oncocytoma from renal carcinoma, the clinical data of four patients with incidentally found renal oncocytomas were studied in this report. And additional Immunohistochemistry examinations were done to confirm diagnosis. Renal oncocytomas were found incidentally in four patients during medical examination. No characteristic changes were found in laboratory tests. Radiology examination provided the location and possibility of renal oncocytoma. History, laboratory test and radiology exanimation indicated the diagnosis of renal oncocytoma, but the final identify of renal oncocytoma need pathology examination.

Successful management of a mixed epithelial and stromal renal tumor masquerading as lower pole renal cyst:A laparoscopic deroofing approach

Background:Renal cysts are common in clinical practice,but some may harbor rare pathological entities such as mixed epithelial and stromal tumors(MEST).Imaging studies are crucial for accurate diagnosis.While laparoscopic deroofing is an established approach for symptomatic renal cysts,encountering MEST within a cyst is uncommon.Case Presentation:We present the case of a 37-year-old female who presented with persistent left flank pain.Imaging revealed a large renal cyst in the lower pole of the left kidney,classified as Bosniak 2.Despite analgesia,the patient's symptoms persisted,leading to a laparoscopic deroofing procedure.Histopathological examination postprocedure revealed a MEST.The patient reported complete resolution of symptoms at the 3-month follow-up.Conclusion:This unique case presents the successful identification and surgical management of a MEST masquerading as a lower pole renal cyst through laparoscopic deroofing.It also contributes to the existing literature by highlighting the importance of considering rare pathological entities in the evaluation of renal cysts and the value of laparoscopic techniques in their management.

Differentiation of Renal Oncocytoma and Renal Clear Cell Carcinoma Using Relative CT Enhancement Ratio

Background：The difference between renal oncocytomas （RO） and renal clear cell carcinomas （RCCs） presents the greatest diagnostic challenge.The aim of this study was to retrospectively determine ifRO and RCCs could be differentiated on computed tomography （CT） images on the basis of their enhancement patterns with a new enhancement correcting method.Methods：Forty-six patients with a solitary renal mass who underwent total or partial nephrectomy were included in this study.Fourteen of those were RO and 32 were RCCs.All patients were examined with contrast-enhanced CT.The pattern and degree of enhancement were evaluated.We selected the area that demonstrated the greatest degree of enhancement of the renal lesion in the corticomedullary nephrographic and excretory phase images.Regions of interest （ROI） were also placed in adjacent normal renal cortex for normalization.We used the values of the normal renal cortex that were measured at the same time as divisors.The ratios of lesion-to-renal cortex enhancement were calculated for all three phases.The Student＆#39;s t-test and Pearson＆#39;s Chi-square test were used for statistical analyses.Results：All RCCs masses showed contrast that appeared to be better enhanced than RO on all contrast-enhanced phases of CT imaging,but there was no significant difference in absolute attenuation values between these two diseases （P 〉 0.05）.The ratio of lesion-to-cortex attenuation in the corticomedullary phase showed significantly different values between RO and RCCs.The degree of contrast enhancement in RCCs was equal to or greater than that of the normal renal cortex,but it was less than that of the normal cortex in RO in the corticomedullary phase.The ratio of lesion-to-cortex attenuation in the corticomedullary phase was higher than the cut off value of 1.0 in most RCCs （84%,27/32） and lower than 1.0 in most RO （93%,13/14） （P 〈 0.05）.In the nephrographic phase,the ratio of lesion-to-cortex attenuation was higher than that in the corticomedullary phase in most RO （71%,10/14）,showing a prolonged enhancement pattern; and was lower than that in most RCCs （97%,31/32）,showing an early washout pattern （P 〈 0.05）.In the differentiation of RO from RCCs,the sensitivity was 93%,specificity 84%,positive predictive value 72%,negative predictive value 84%,and accuracy for RO was 87,if the ratio of lesion-to-cortex attenuation in a cortex phase was lower than the cutoff value of 1.0.The sensitivity was 71%,specificity was 97%,positive predictive value was 91%,negative predictive value was 91%,and accuracy for RO was 89%,if the ratio of lesion-to-cortex attenuation in nephrographic phase was higher than that in the corticomedullary phase.Conclusions：The ratios of renal lesion-to-cortex attenuation ratios may be helpful in differentiating RO from RCCs.

Renal Tumor Biopsy Technique

Objective： To review hot issues and future direction of renal tumor biopsy （RTB） technique. Data Sources： The literature concerning or including RTB technique in English was collected from PubMed published from 1990 to 2015. Study Selection： We included all the relevant articles on RTB technique in English, with no limitation of study design. Results： Computed tomography and ultrasound were usually used for guiding RTB with respective advantages. Core biopsy is more preferred over fine needle aspiration because of superior accuracy. A minimum of two good-quality cores for a single renal tumor is generally accepted. The use of coaxial guide is recommended. For biopsy location, sampling different regions including central and peripheral biopsies are recommended. Conclusion： In spite of some limitations, RTB technique is relatively mature to help optimize the treatment of renal tumors.

Diagnostic Utility of Diffusion-weighted Magnetic Resonance Imaging in Differentiating Small Solid Renal Tumors （≤4 cm） at 3.0T Magnetic Resonance Imaging

Background： The aim of this study was to assess the performance of apparent diffusion coefficient （ADC） measurement obtained with diffusion-weighted magnetic resonance imaging （DW-MRI） to distinguish renal cell carcinomas （RCCs） from small benign solid renal tumors （〈4 cm）. Methods： In this cross-sectional study, 49 consecutive patients with histopathologically confirmed small solid renal tumors, and seven healthy volunteers were imaged using nonenhanced MRI and DW-MRI. The ADC map was calculated using the b values of 0, 50, 400, and 600 s/ mm2 and values compared via the Kruskal-Wallis and Mann-Whitney tests. The utility of ADC for differentiating RCCs and benign lesions was assessed using a receiver operating characteristic curve. Multiple nonenhanced MRI features were analyzed by Logistic regression. Results： The tumors consisted of 33 cases of clear-cell RCCs （ccRCCs） and 16 cases of benign tumors, including 14 cases of minimal fat angiomyolipomas and 2 cases ofoncocytomas. The ADCs showed significant differences among benign tumors （[0.90 ±0.52] x 10 x mm2/s）, ccRCCs （[1.53 ± 0.31 ] x 10 ^3 mm2/s） and the normal renal parenchyma （[2.22 ± 0.12]x 10^-3 mmVs） （P 〈 0.001）. Moreover, there was statistically significant difference between high and low-grade ccRCCs （P = 0.004）. Using a cut-offADC of 1.36± 10 3 mm2/s, DW-MRI resulted in an area under the curve （AUC）, sensitivity, and specificity equal to 0.839, 75.8%, and 87.5%, respectively. Nonenhanced MRI alone and the combination of imaging methods led to an AUC, sensitivity and specificity equal to 0.919, 93.9%, and 81.2%, 0.998, 97%, and 100%, respectively. The Logistic regression showed that the location of the center of the tumor （inside the contour of the kidney） and appearance of stiffblood vessel were significantly helpful for diagnosing ccRCCs. Conclusions： DW-MRI has potential in distinguishing ccRCCs from benign lesions in human small solid renal tumors （〈4 cm）, and in increasing the accuracy for diagnosing ccRCCs when combined with nonenhanced MRI.

Renal tumor in developing countries:142 cases from a single institution at Shanghai,China

Background:The clinical management of children with renal tumors including Wilms'tumor,clear cell sarcoma,rhabdoid tumor and other renal tumors in our center was designed according to the National Wilms'Tumor Study Group protocols.Methods:A total of 142 consecutive patients who had been diagnosed as having renal tumors at Shanghai Children's Medical Center were reviewed retrospectively in the period of December 1998 and September 2012.Diagnosis and treatment were decided by a multi-disciplinary team including oncologists,surgeons,pathologists and sub-specialized radiologists.Results:The median age of the patients at the time of diagnosis was 27 months.The tumor stages of the patients were as follows:stage I 24.6%,stage II 23.2%,stage III 32.3%,stage IV 14.1%,and stage V 5.6%.Favorable histology was diagnosed in 80.3%,anaplasia in 4.2%,clear cell sarcoma in 9.8%,rhabdoid tumor in 4.9%,and other renal tumors in 0.7%of the patients.The event-free and overall 5-year survival rates were 80%and 83%,respectively.Tumor relapse and progress was seen in 25 patients(17.6%).The median relapse time was 6 months(range:2-37 months).Seven relapsing patients were re-treated and four of them got second complete remission(three in stage II,one in stage I).Conclusion:A multi-disciplinary team work model is feasible in developing countries,and the renal tumors protocols basically from developed countries are safe in developing countries.

Renal granuloma misdiagnosed as renal papillary carcinoma: a case report

The imaging appearance of renal granuloma is very similar to that of a renal tumor.Granulomatous lesions usually do not require surgical treatment,while kidney tumors typically necessitate surgical removal.The diagnosis of renal granuloma typically relies on the history of bacillus Calmette-Guérin perfusion and the position of the renal pelvis in the image(malignant tumors usually destroy or compress the surrounding renal pelvis).However,in this case,the patient has no history of bacillus Calmette-Guérin perfusion,making the diagnosis more challenging.The ultrasound and enhanced CT findings were consistent with renal papillary carcinoma.Laparoscopic partial nephrectomy was performed,revealing degeneration and necrosis of the renal cortex and formation of granulomas.The imaging diagnosis of renal granuloma is difficult.Ultrasound-guided biopsy may be a preferable method to avoid unnecessary surgery.

EXPRESSION AND SIGNIFICANCE OF TUMOR INFILTRATING DENDRITIC CELLS IN RENAL CELL CARCINOMA

Objective: To study the expression of dendritic cells in human renal cell carcinoma and explore the cause, so to reveal the mechanism of escaping immune surveillance in RCC. Methods: The expressions of CD83+DCS, CD1a+DCS,VEGF and TGF-β1 in tumoral, peritumoral and normal kidney tissues of RCC in 30 cases were detected by immunohistochemistry using streptavidin/peroxidese(SP) Results: CD83+DCS were mainly located in the peritumoral areas; whereas CD1a+DCS、were mainly retained within the cancer nests. The number of CD83+DCS was inversely correlated with the clinical stage(P<0.05); but there were no significant correlations between the number of CD1a+DCS、and the clinical stage(P>0.05). The expressions of CD83+DCS and CD1a+DCS have significant difference between the tumoral, peritumoral and normal kidney tissues(P<0.001). The expression of VEGF and TGF-β1 were significantly lower in samples with highly infiltrating CD83+DCS(P<0.05); Whereas CD1a+DCS were not (P>0.05). Conclusion: DC has the tendency to gathering in tumor, but because of the immunosuppressive cytokins, for example VEGF and TGF-β1, inhibits the maturation of DC, there are less mature TIDCS(CD83+TIDCS) in the tumoral tissues, they are mainly located in the peritumoral areas. This may contribute to the mechanism of escaping immune surveillance in RCC.

DETERMINATION OF URINE TUMOR NECROSIS FACTOR, IL-6, IL-8 AND SERUM IL-6 IN PATIENTS WITH HEMORRHAGIC FEVERS WITH RENAL SYNDROME

Objective To explore the roles of cytokines in the pathogenesis of hemorrhagic fever with renal syndrome(HFRS). Methods Double-antibody sandwich ELISA was used to determine serum interleukin (IL)-6, urine tumor necrosis factor (TNF), IL-6 and IL-8 levels in 56 patients with HFRS. Results Serum IL-6, urine TNF, IL-6 and IL-8 concentrations in HFRS patients were significantly higher than those in control group, respectively (P<0.001). The concentrations increased at fever stage, then continued to increase during hypotension stage and peaked at oliguria stage. The concentrations of serum IL-6, urine TNF, IL-6 and IL-8 increased in accord with the severity of the disease and differed greatly among different types of the disease. Serum IL-6 had remarkable relationships with serum specific antibodies. It was positively related to serum β_2-microglobulin (β_2-MG), blood ureanitrogen (BUN) and creatinine (Cr). Significant positive relationships were also found both between urine IL-6 and TNF, and between IL-6 and IL-8 (r=0.5768, P<0.05; r=0.3760, P<0.01). Conclusion TNF, IL-6 and IL-8 activated during the course of the disease. IL-6 is associated with the immunopathological lesions caused by the hyperfunction of humoral immune response. IL-6, IL-8 and TNF are involved in the renal immune impairment. Determining them might, in certain extent, be used in predicting the prognosis and outcome of patients with HFRS.

Small bowel obstruction caused by secondary jejunal tumor from renal cell carcinoma: A case report

BACKGROUND Secondary jejunal tumor from renal cell carcinoma(RCC)is extremely rare in clinical practice and is easily missed and misdiagnosed because of the low incidence and atypical symptoms.CASE SUMMARY A 38-year-old male patient was diagnosed pathologically with left RCC after radical nephrectomy in 2012.The patient then suffered multiple lung metastases 2 years later and was treated with oral sorafenib without progression for 6 years.In 2020,an emergency intestinal segmental resection due to intestinal obstruction was required,and postoperative pathology confirmed a jejunal secondary tumor from RCC.The patient had a smooth recovery following surgery.Three months after surgery,the patient was diagnosed with left adrenal metastasis,and subsequent sintilimab therapy has stabilized his condition.CONCLUSION This report is written to remind urologists and pathologists of the potential for small intestinal secondary tumors when a patient with a history of RCC seeks treatment for digestive symptoms.Enteroscopy and abdominal contrast-enhanced computed tomography are essential means of examination,but severe cases require immediate surgical intervention despite the lack of a preoperative examination to distinguish tumor attributes.

Pheochromocytoma with delayed tumor thrombus detection in renal vein: A case report

BACKGROUND Pheochromocytomas with inferior vena cava(IVC)or renal vein tumor thrombus are rare.Surgical management is the first choice.CASE SUMMARY We presented a 42-year-old man with adrenal pheochromocytoma and delayed tumor thrombus detection in the renal vein at the entrance of the IVC three months after adrenalectomy.We performed laparoscopic adrenalectomy during the first surgery and robot-assisted laparoscopic nephrectomy and resection of tumor thrombus during the second surgery.CONCLUSION We report the surgical management of a patient with adrenal pheochromocytoma with tumor thrombus at the entrance of the IVC.Robot-assisted laparoscopic surgery is safe and efficient.

Application of Circulating Tumor Cells in Peripheral Blood in Judging the Prognosis of Patients with Renal Cancer and Related Indexes of Blood Coagulation

Objective: To investigate the value of the number of circulating tumor cells (CTC) in peripheral blood in the prognosis and coagulation-related indicators of patients with renal cancer. Methods: 65 patients with renal cell carcinoma (RCC) confirmed pathologically were divided into CTC positive group and CTC negative group according to the CTC count (5 pcs/3.5 ml). Compare the age, gender, tumor location, TNM (clinical stage), pathological grade, tissue type, lymph node metastasis, distant metastasis, prognosis and prothrombin time (PT), fibrinogen (FIB), partial coagulation of the two groups of patients The correlation between the results of zymogen time (APTT) and D-dimer (DD) and the number of CTC. Results: There were significant differences in TNM, lymph node metastasis, and distant metastasis between the two groups (P < 0.05). The number of CTC in patients was correlated with FIB and D-D levels (P < 0.05). Conclusion: The number of CTC in patients with renal cell carcinoma is correlated with some clinical phenotypes (TNM, lymph node metastasis, distant metastasis) and some coagulation indexes (FIB, D-D), and can jointly predict the prognosis of renal cancer.

Comprehensive treatment for primary right renal diffuse large B-cell lymphoma with a renal vein tumor thrombus:A case report

BACKGROUND Renal involvement in lymphoma is commonly associated with widespread nodal or extranodal lymphoma.Primary renal diffuse large B-cell lymphoma is an extremely rare extranodal lymphoma,accounting for fewer than 1%of all renal masses.Interestingly,the patient in this study had a renal vein tumor thrombus that was observed after laparoscopic radical nephrectomy.CASE SUMMARY We report the case of a 56-year-old female patient with primary renal lymphoma and a renal vein tumor thrombus whose first symptom was right pain in the back and gross hematuria.Histopathology revealed primary renal diffuse large B-cell lymphoma.The patient received 8 standard cycles of rituximab with cyclophosphamide,doxorubicin,vincristine,and prednisone chemotherapy after surgery,and no obvious signs of recurrence were observed during the one-year follow-up.CONCLUSION We evaluated comprehensive treatment of primary renal diffuse large B-cell lymphoma and multidisciplinary management of this malignancy.

RNF43 is a novel tumor-suppressor and prognostic indicator in clear cell renal cell carcinoma

Identifying prognostic indicators of clear cell renal cell carcinoma(ccRCC)and elucidating the mechanisms underlying ccRCC progression are crucial for improving ccRCC patient prognosis.This study investigated the clinical significance and biological role of Ring finger protein 43(RNF43)in ccRCC.Two independent cohorts of patients with ccRCC were employed to determine the prognostic significance of RNF43 by immunohistochemistry and statistical analyses.In vitro and in vivo experiments,RNA-seq,and other techniques were used to determine the biological role of RNF43 in ccRCC and related molecular mechanisms.RNF43 expression was commonly decreased in ccRCC specimens,and low expression of RNF43 indicated a higher TNM stage,SSIGN score,and WHO/ISUP grade and short survival in patients with ccRCC.Additionally,RNF43 overexpression suppressed the proliferation,migration,and targeted drug resistance of ccRCC cells,while the knockdown of RNF43 enhanced these characteristics of ccRCC.RNF43 knockdown activated YAP signaling by decreasing YAP phosphorylation by p-LATS1/2 and increasing the transcription and nuclear distribution of YAP.By contrast,RNF43 overexpression showed the opposite effects.Decreasing YAP abolished the effect of RNF43 knockdown in promoting the malignant features of ccRCC.Additionally,restoring RNF43 expression suppressed the resistance of the targeted drug pazopanib in in vivo orthotopic ccRCC.Furthermore,combining the expression of RNF43 and YAP with TNM stage or the SSIGN score exhibited greater accuracy than any of these indicators alone in assessing the postoperative prognosis of ccRCC patients.In summary,our study identified a novel tumor suppressor,RNF43,which is also a prognostic indicator and potential target for ccRCC.

Solitary fibrous tumor of the renal pelvis:A case report

BACKGROUND Solitary fibrous tumor(SFT)is a rare mesenchymal neoplasm.SFT derived from the renal pelvis is an exceedingly rare entity.In this study,we report a case of renal pelvis SFT and review the relevant literature on this rare tumor.CASE SUMMARY A 76-year-old man was hospitalized due to right lumbar and abdominal pain.Abdominal computed tomography showed a hypervascular space-occupying renal lesion,sized 2.3 cm×1.8 cm.Based on the computed tomography findings,the patient was diagnosed with right renal pelvis tumor and underwent nephrectomy.Postoperative immunohistochemical results confirmed the diagnosis.As of the 3-year follow-up,there were no signs of recurrence,and the patient has recovered well.CONCLUSION We report a rare case of SFT derived from the renal pelvis and discuss the imaging and histopathological features that distinguish renal pelvis SFT from other renal pelvis tumors.

Translating new data to the daily practice in second line treatment of renal cell carcinoma:The role of tumor growth rate

The therapeutic options for patients with metastatic renal cell carcinoma(mRCC) have completely changed during the last ten years. With the sequential use of targeted therapies, median overall survival has increased in daily practice and now it is not uncommon to see patients surviving kidney cancer for more than four to five years. Once treatment fails with the first line targeted therapy, head to head comparisons have shown that cabozantinib, nivolumab and the combination of lenvatinib plus everolimus are more effective than everolimus alone and that axitinib is more active than sorafenib. Unfortunately, it is very unlikely that we will ever have prospective data comparing the activity of axitinib, cabozantinib, lenvatinib or nivolumab. It is frustrating to observe the lack of biomarkers that we have in this field, thus there is no firm recommendation about the optimal sequence of treatment in the second line. In the absence of reliable biomarkers, there are several clinical endpoints that can help physicians to make decisions for an individual patient, such as the tumor burden, the expected response rate and the time to achieve the response to each agent, the prior response to the agent administered, the toxicity profile of the different compounds and patient preference. Here, we propose the introduction of the tumor-growth rate(TGR) during first-line treatment as a new tool to be used to select the second line strategy in m RCC. The rapidness of TGR before the onset of the treatment reflects the variability between patients in terms of tumor growth kinetics and it could be a surrogate marker of tumor aggressiveness that may guide treatment decisions.

Successful Management of Pulmonary Tumor Embolism from Renal Cell Carcinoma

Although invasion of renal cell carcinoma (RCC) into the inferior vena cava is common, pulmonary tumor embolism is rare. We present a case of a pulmonary tumor embolism from type II papillary renal cell carcinoma successfully treated using a staged approach. Such staged procedures are particularly effective in cases of massive renal tumors. Pulmonary tumor embolectomy using normothermic cardiopulmonary bypass is considerably less invasive than under deep hypothermic circulatory arrest.