Low-grade metastases in high-grade clear cell renal cell carcinomas

2016 ◽  
Vol 20 ◽  
pp. 13-18 ◽  
Author(s):  
José I. López ◽  
Lorena Mosteiro ◽  
Rosa Guarch ◽  
Gorka Larrinaga ◽  
Rafael Pulido ◽  
...  
2014 ◽  
Vol 138 (12) ◽  
pp. 1673-1679 ◽  
Author(s):  
Lan L. Gellert ◽  
Rohit Mehra ◽  
Ying-Bei Chen ◽  
Anuradha Gopalan ◽  
Samson W. Fine ◽  
...  

Context While biopsies are now increasingly being performed for the diagnosis of renal cortical neoplasms, the influence of the rendered pathological diagnoses on the clinical management is only rarely documented. Objectives To report our experience with consecutively performed renal biopsies and the potential impact of the diagnosis on subsequent clinical management. Design Material from needle biopsies performed consecutively at our institution between 2006 and 2011 was reviewed. The influence of the reported pathology results on the clinical management was determined from patient follow-up medical record review. Results In total, 218 percutaneous biopsies for renal masses were performed during this period. Among them, 181 (83%) yielded neoplastic tissue, including 81 clear cell renal cell carcinomas, 29 low-grade oncocytic neoplasms, 7 papillary renal cell carcinomas, 5 clear cell papillary renal cell carcinomas, 5 angiomyolipomas, and 14 urothelial carcinomas. Fourteen additional cases (6%) contained lesional material from clinically known nonneoplastic processes, for a total diagnostic yield of 89%. Twenty-three (11%) were nonrepresentative of lesional tissue. In 10 of these, repeat biopsies or resections established the diagnosis of renal tumors. Biopsy diagnosis was confirmed in 29 of 30 cases (97%) on subsequent nephrectomy. Following the biopsy diagnosis, there were significant differences in the clinical management; overall, 79% of clear cell renal cell carcinomas received therapeutic interventions, and 17% were put on active surveillance. In contrast, 77% of the benign or low-grade lesions were put on active surveillance. Conclusions Accurate and specific diagnosis can be rendered on renal core biopsy in most renal tumors, and the biopsy diagnosis can have a definitive role in their clinical management.


2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Ruohua Chen ◽  
Xiang Zhou ◽  
Gang Huang ◽  
Jianjun Liu

Purpose. To determine the relationship between fructose 1,6-bisphosphatase 1 (FBP1) expression and fluorine 18 (18F) fluorodeoxyglucose (FDG) uptake in patients with clear cell renal cell carcinoma (ccRCC), and to investigate how 18F-FDG uptake and FBP1 expression are related to tumor metabolism and tumor differentiation grade. Materials and Methods. A total of 54 patients with ccRCC underwent 18F-FDG combined positron emission tomography and computed tomography (PET/CT) before tumor resection. The maximum standardized uptake value (SUVmax) for the primary tumor was calculated from the 18F-FDG uptake. The relationship between SUVmax of primary tumor and the expression of FBP1, hexokinase 2 (HK2), and glucose transporter 1 (GLUT1) was analyzed via immunohistochemical analysis. Results. We identified an inverse relationship between FBP1 expression and SUVmax (P=0.031). SUVmax was higher in patients with high-grade ccRCC (mean, 11.6 ± 5.0) than in those with low-grade ccRCC (mean, 3.8 ± 1.6, P<0.001). FBP1 expression was significantly lower in patients with high-grade ccRCC (mean, 0.23 ± 0.1) than in those with low-grade ccRCC (mean, 0.57 ± 0.08; P=0.018). FBP1 status could be predicted with an accuracy of 66.7% when a SUVmax cutoff value of 3.55 was used. GLUT1 expression in ccRCC was positively correlated with 18F-FDG uptake and FBP1 status, whereas HK2 expression was not. Conclusion. SUVmax in patients with ccRCC is inversely associated with the expression of FBP1, and FBP1 may inhibit 18F-FDG uptake via regulating GLUT1. SUVmax is higher in patients with high-grade ccRCC than in those with low-grade ccRCC, which could be the result of lower FBP1 expression in patients with high-grade ccRCC.


2016 ◽  
Vol 34 (15_suppl) ◽  
pp. 4564-4564 ◽  
Author(s):  
Heidi Coy ◽  
Michael Douek ◽  
Jonathan Young ◽  
Matthew S. Brown ◽  
Jonathan Goldin ◽  
...  

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16049-e16049
Author(s):  
Heidi Coy ◽  
Jonathan Young ◽  
Michael Douek ◽  
Clara Magyar ◽  
Anthony Sisk ◽  
...  

e16049 Background: Clear cell renal cell carcinoma (ccRCC) is the most common tumor of the kidney. Up to 70% are incidentally detected on multiphasic CT. The prognosis for patients with ccRCC is related to Fuhrman grade (FG) and is diagnosed by biopsy or excision. There is a great need for a non-invasive method to assess tumor grade which may help inform clinical decision-making. The purpose of our study is to determine if contrast enhancement on CT predicts FG and microvessel density (MVD) of ccRCC lesions and to assess which combination of quantitative and qualitative radiological features and clinical features predict high FG ccRCC lesions. Methods: With IRB approval for this HIPAA-compliant retrospective study, our pathology and imaging databases were queried to obtain a cohort of ccRCC with a preoperative multiphasic (unenhanced (U), corticomedullary (C), nephrographic (N), and excretory (E)) CT scan. Tumors were stained with CD4 to quantify % MVD. Spearman’s rank correlation was calculated to test the strength of the association between CT enhancement, %MVD and FG. Stepwise logistic regression analysis was performed to determine the quantitative and/or qualitative feature with the highest performance in predicting high FG tumor. The multivariate logistic regression analysis was evaluated using ROC curves and AUCs. Results: Our cohort had 127 patients with 89 low-grade tumors and 43 high-grade tumors. The %wash-in of enhancement from the U to the C phase showed a significant correlation with %MVD of the tumor (R2= 0.181,p < . 001) as did enhancement of the tumor in the early C phase with %MVD (R2= 0.159,p < . 001). There was a significant inverse correlation with %MVD and FG (R2= 0.137,p < . 001). T-stage, tumor size, %MVD and presence of renal vein invasion were determined to be significant independent predictors of high grade lesions with an AUC of .838 (95% CI .748-.927). Conclusions: Lower grade ccRCC tumors have a higher MVD. Therefore, contrast material washes in at a faster rate from the UN to the CM phase, enabling low grade to be discriminated from high-grade tumors on CT.


2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Antonios Katsimantas ◽  
Spyridon Paparidis ◽  
Konstantinos Bouropoulos ◽  
Nikolaos Ferakis

Sporadic, synchronous, bilateral, or unilateral Renal Cell Carcinomas constitute a rare clinical entity. We report the case of a 68-year-old male patient who presented in our department due to incidentally discovered multiple, bilateral renal tumors. Magnetic Resonance Imaging demonstrated cT1b renal tumors at the lower pole of each kidney and a cT1a renal tumor at the upper pole of the right kidney. The patient underwent transperitoneal, laparoscopic left partial nephrectomy with renal artery occlusion, histology revealed high-grade, pT1b, clear-cell renal cell carcinoma; however we observed decline of patient’s estimated glomerular filtration rate postoperatively. Forty days postoperatively, he underwent open partial nephrectomy for the right sided tumors with manual compression of the renal parenchyma and no use of ischemia. Histology revealed high-grade, pT1a, clear-cell renal cell carcinoma at the upper pole of the right kidney and low-grade, pT1b, clear-cell renal cell carcinoma at the lower pole of the right kidney. There was no additional decline in the serum creatinine value postoperatively. The patient avoided permanent or temporary dialysis and 6 months postoperatively he demonstrated no recurrence on imaging and his renal function remained stable.


2021 ◽  
Vol 11 ◽  
Author(s):  
Xin-Yuan Chen ◽  
Yu Zhang ◽  
Yu-Xing Chen ◽  
Zi-Qiang Huang ◽  
Xiao-Yue Xia ◽  
...  

ObjectiveTo develop a machine learning (ML)-based classifier for discriminating between low-grade (ISUP I-II) and high-grade (ISUP III-IV) clear cell renal cell carcinomas (ccRCCs) using MRI textures.Materials and MethodsWe retrospectively evaluated a total of 99 patients (with 61 low-grade and 38 high-grade ccRCCs), who were randomly divided into a training set (n = 70) and a validation set (n = 29). Regions of interest (ROIs) of all tumors were manually drawn three times by a radiologist at the maximum lesion level of the cross-sectional CMP sequence images. The quantitative texture analysis software, MaZda, was used to extract texture features, including histograms, co-occurrence matrixes, run-length matrixes, gradient models, and autoregressive models. Reproducibility of the texture features was assessed with the intra-class correlation coefficient (ICC). Features were chosen based on their importance coefficients in a random forest model, while the multi-layer perceptron algorithm was used to build a classifier on the training set, which was later evaluated with the validation set.ResultsThe ICCs of 257 texture features were equal to or higher than 0.80 (0.828–0.998. Six features, namely Kurtosis, 135dr_RLNonUni, Horzl_GLevNonU, 135dr_GLevNonU, S(4,4)Entropy, and S(0,5)SumEntrp, were chosen to develop the multi-layer perceptron classifier. A three-layer perceptron model, which has 229 nodes in the hidden layer, was trained on the training set. The accuracy of the model was 95.7% with the training set and 86.2% with the validation set. The areas under the receiver operating curves were 0.997 and 0.758 for the training and validation sets, respectively.ConclusionsA machine learning-based grading model was developed that can aid in the clinical diagnosis of clear cell renal cell carcinoma using MRI images.


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