Very late locally recurrent chromophobe renal cell carcinoma: 15 years following radical nephrectomy for low-stage disease

Abstract The majority of patients with renal cell carcinoma develop recurrence within 5 years following radical nephrectomy. Very late sole local recurrence beyond 10 years is rare, and all reported cases had clear cell histology. Surgical resection of local recurrence remains the best option for disease management. This case opens the way for further studying the rare histological variants of renal cancer and to encourage prolonged follow-up and offering surgery as the best option for managing these cases.

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Comparative effectiveness of adrenal sparing radical nephrectomy and non-adrenal sparing radical nephrectomy in clear cell renal cell carcinoma: Observational study of survival outcomes

Canadian Urological Association Journal ◽

10.5489/cuaj.2842 ◽

2015 ◽

Vol 9 (9-10) ◽

pp. 583 ◽

Cited By ~ 1

Author(s):

Gregory J. Nason ◽

Leon G. Walsh ◽

Ciaran E. Redmond ◽

Niall P. Kelly ◽

Barry B. McGuire ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Observational Study ◽

Cell Carcinoma ◽

Renal Cell ◽

Radical Nephrectomy ◽

Clear Cell ◽

Risk Groups ◽

Survival Outcomes ◽

Cell Renal Cell Carcinoma

Introduction: We compare the survival outcomes of patients with clear cell renal cell carcinoma (RCC) treated with adrenal sparing radical nephrectomy (ASRN) and non-adrenal sparing radical nephrectomy (NASRN).Methods: We conducted an observational study based on a composite patient population from two university teaching hospitals who underwent RN for RCC between January 2000 and December 2012. Only patients with pathologically confirmed RCC were included. We excluded patients undergoing cytoreductive nephrectomy, with loco-regional lymph node involvement. In total, 579 patients (ASRN = 380 and NASRN = 199) met our study criteria. Patients were categorized by risk groups (all stage, early stage and locally advanced RCC). Overall survival (OS) and cancer-specific survival (CSS) were analyzed for risk groups. Survival analysis was performed using Kaplan-Meier curves and Cox proportional hazards regression.Results: The median follow-up was 41 months (range: 12–157). There were significant benefits in OS (ASRN 79.5% vs. NASRN 63.3%; p = 0.001) and CSS (84.3% vs.74.9%; p = 0.001), with any differences favouring ASRN in all stage. On multivariate analysis, there was a trend towards worse OS (hazard ratio [HR] 1.759, 95% confidence interval [CI] 0.943–2.309, p = 0.089) and CSS (HR 1.797, 95% CI 0.967–3.337, p = 0.064) in patients with NASRN (although not statistically significant). Of these patients, only 11 (1.9%) had adrenal involvement.Conclusions: The inherent limitations in our study include the impracticality of conducting a prospective randomized trial in this scenario. Our observational study with a 13-year follow-up suggests ASRN leads to better survival than NASRN. ASRN should be considered the gold standard in treating patients with RCC, unless it is contraindicated.

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Large and rapid local recurrence of clear cell renal cell carcinoma

BMJ Case Reports ◽

10.1136/bcr-2021-247106 ◽

2021 ◽

Vol 14 (11) ◽

pp. e247106

Author(s):

Alice Thomson ◽

Derek Hennessey ◽

Jeremy Goad ◽

Ned Kinnear

Keyword(s):

Renal Cell Carcinoma ◽

Local Recurrence ◽

Cell Carcinoma ◽

Renal Cell ◽

Radical Nephrectomy ◽

Clear Cell ◽

Cell Renal Cell Carcinoma ◽

Her Family ◽

Open Radical Nephrectomy ◽

Tract Infections

After radical nephrectomy, clear cell renal cell carcinoma (ccRCC) recurs locally in <3% of patients. Recurrences typically occur 1-2 years postoperatively and grow at 5–20 mm per year. In contrast, this patient’s recurrence was unexpectedly large and swift. A 71-year-old woman was initially found on workup for recurrent urinary tract infections to have a 12 cm left renal tumour. After negative staging scans, she progressed to left open radical nephrectomy. Histology revealed a stage T2b 12 cm ccRCCwith sarcomatoid differentiation, International Society of Urological Pathology (ISUP) grade 4, with clear margins. Only 3 months later, the patient developed left-sided abdominal pain, and CT scans revealed a 15 cm left retroperitoneal local recurrence, as well as widespread peritoneal tumours. In discussion with her treating team, the patient and her family elected not to undergo biopsy or systemic therapy. The patient was palliated and passed away 8 days after re-presentation.

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Solitary Metastasis in the Mediastinal Lymph Node After Radical Nephrectomy for Clear Cell Renal Cell Carcinoma: A Case Report and Literature Review

Frontiers in Oncology ◽

10.3389/fonc.2020.593142 ◽

2020 ◽

Vol 10 ◽

Author(s):

Hang Lin ◽

Heng Zhang ◽

Yuanda Cheng ◽

Chunfang Zhang

Keyword(s):

Renal Cell Carcinoma ◽

Lymph Node ◽

Cell Carcinoma ◽

Renal Cell ◽

Radical Nephrectomy ◽

Clear Cell ◽

Mediastinal Lymph Node ◽

Cell Renal Cell Carcinoma ◽

Posterior Mediastinal

BackgroundRenal cell carcinoma can metastasize to virtually any anatomical site throughout the body, especially the lung, bone, lymph nodes, liver, and brain. However, it is extremely rare for renal cell carcinoma to metastasize solely to the mediastinal lymph node more than 15 years after radical nephrectomy.Case PresentationThe case we present here is that of a 50-year-old Chinese male with an isolated posterior mediastinal lymph node metastasis of clear cell renal cell carcinoma 16 years after radical nephrectomy. However, based on imaging examination, the mass was clinically misdiagnosed as Castleman’s disease before operation. Following surgical excision of the mass, it was finally judged to be a metastasis from clear cell renal cell carcinoma according to the patient’s medical history and immunohistochemical findings. Currently, there is no clinical or radiological finding the recurrence of metastasis after 10 months of follow-up.ConclusionWe report a case of solitary metastasis in the posterior mediastinal lymph node 16 years after radical nephrectomy for clear cell renal cell carcinoma. Given the long disease-free interval between primary renal cell carcinoma to isolated mediastinal lymph node metastasis, it is important to conduct a lifelong regular follow-up, including thoracic computed tomography. In addition, surgical resection remains the best method of treatment for mediastinal lymph node metastases from clear cell renal cell carcinoma if the metastatic lesion is limited.

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Relationship between prognosis of patients with primary clear cell renal cell carcinoma after radical nephrectomy and expression of CD99 and analysis of prognostic factors

Academic Journal of Second Military Medical University ◽

10.3724/sp.j.1008.2011.00517 ◽

2011 ◽

Vol 31 (5) ◽

pp. 517-520

Author(s):

Ting-hu CAO ◽

Lei WANG ◽

Yu-bin KOU ◽

Jin-xin HU ◽

Jun ZHU ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Prognostic Factors ◽

Cell Carcinoma ◽

Renal Cell ◽

Radical Nephrectomy ◽

Clear Cell ◽

Cell Renal Cell Carcinoma

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PD12-03 ASSOCIATION OF PARTIAL AND RADICAL NEPHRECTOMY ON SURVIVAL IN YOUNG PATIENTS WITH NON-CLEAR CELL RENAL CELL CARCINOMA

The Journal of Urology ◽

10.1016/j.juro.2018.02.639 ◽

2018 ◽

Vol 199 (4S) ◽

Author(s):

Kristian Stensland ◽

Jared Schober ◽

David Canes ◽

Navneet Ramesh ◽

Brendan Waldoch ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Radical Nephrectomy ◽

Clear Cell ◽

Young Patients ◽

Cell Renal Cell Carcinoma

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S124 EVALUATION OF BCL-2 AND P-53 MARKERS AS PROGNOSTIC FACTORS IN PATIENTS WITH CLEAR CELL TYPE RENAL CELL CARCINOMA IN PATIENT UNDERGONE RADICAL NEPHRECTOMY

European Urology Supplements ◽

10.1016/s1569-9056(10)61409-1 ◽

2010 ◽

Vol 9 (6) ◽

pp. 589

Author(s):

H. Shahrokh ◽

H. Ajami ◽

Daneshvar S. Erfanian

Keyword(s):

Renal Cell Carcinoma ◽

Prognostic Factors ◽

Cell Carcinoma ◽

Renal Cell ◽

Radical Nephrectomy ◽

Clear Cell ◽

Cell Type ◽

Clear Cell Type ◽

P 53

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Implications of Programmed Death Ligand-1 Positivity in Non-Clear Cell Renal Cell Carcinoma

Journal of Kidney Cancer and VHL ◽

10.15586/jkcvhl.2018.107 ◽

2018 ◽

Vol 5 (4) ◽

pp. 6-13 ◽

Cited By ~ 2

Author(s):

Juan Chipollini ◽

Mounsif Azizi ◽

Charles C Peyton ◽

Dominic H Tang ◽

Jasreman Dhillon ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Clear Cell ◽

Type I ◽

Cell Renal Cell Carcinoma ◽

Programmed Death Ligand 1 ◽

Programmed Death ◽

Papillary Type

The purpose of this study was to assess the prognostic value of programmed death ligand-1 (PD-L1) positivity in a non-clear cell renal cell carcinoma (non-ccRCC) cohort. PD-L1 expression was evaluated by immunohistochemistry (IHC) using formalin-fixed paraffin-embedded (FFPE) specimens from 45 non-ccRCC patients with available tissue. PD-L1 positivity was defined as ?1% of staining. Histopathological characteristics and oncological outcomes were correlated to PD-L1 expression. Cancer-specific survival (CSS) and recurrence-free survival (RFS) stratified by PD-L1 status were estimated using the Kaplan–Meier method. Median age was 58 years and median follow-up was 40 months. Non-ccRCC subtypes included sarcomatoid (n = 9), rhabdoid (n = 6), medullary (n = 2), Xp11.2 translocation (n = 2), collecting duct (n = 1), papillary type I (n = 11), and papillary type II (n = 14). PD-L1 positivity was noted in nine (20%) patients. PD-L1 positivity was significantly associated with higher Fuhrman nuclear grade (P = 0.048) and perineural invasion (P = 0.043). Five-year CSS was 73.2 and 83% for PD-L1 positive and negative tumors, respectively (P = 0.47). Five-year RFS was 55.6 and 61.5% for PD-L1 positive and negative tumors, respectively (P = 0.58). PD-L1 was expressed in a fifth of non-ccRCC cases and was associated with adverse histopathologic features. Expression of biomarkers such PD-L1 may help better risk-stratify non-ccRCC patients to guide treatment decisions and follow-up strategies.

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Metastatic renal cell carcinoma of unknown primary site. Clinical follow-up

Modern Oncology ◽

10.26442/18151434.2020.3.200301 ◽

2020 ◽

Vol 22 (3) ◽

pp. 149-153

Author(s):

N. A. Ognerubov ◽

T. S. Antipova ◽

G. E. Gumareva

Keyword(s):

Computed Tomography ◽

Renal Cell Carcinoma ◽

Adrenal Gland ◽

Cell Carcinoma ◽

Renal Cell ◽

Clear Cell ◽

Cell Cancer ◽

Primary Site ◽

The Right

Renal cell cancer metastases without evidence of a primary tumor are extremely rare. These variants are usually showed as a spontaneous description of single clinical cases. Aim.This contribution is a clinical follow-up of synchronous renal cell cancer metastases of unknown primary site. Results.A 52-year-old patient U. with a history of increased blood pressure, up to 170/100 mmHg for the last 5 years, who had undergone many instrumental examinations, including ultrasound examination, because of this disease. The computed tomography of the abdomen showed a 4975 mm heterogeneous tumor in the right adrenal gland in October 2017. The combined positron emission and X-ray computed tomography showed a 795441 mm mass in the right adrenal gland, associated with elevated fluorodeoxyglucose metabolic activity SUVmax 7.25. Focal accumulation of the radiopharmaceutical SUVmax 4.31 in a 171124 mm mass was detected in the space of bifurcation in the mediastinum. The lytic lesion (1015 mm) was found in right superior L3 articular process. The patient underwent retroperitoneoscopic adrenalectomy and thoracoscopic removal of mediastinal tumor in November 2017 because of the oligometastatic nature of the process. The histological study identified clear-cell carcinoma with areas of papillary structure in the right adrenal gland. The immunohistochemical study showed carcinoma cells intensively expressing CD10, and some other cells RCC. The immune phenotype of the tumor was identified as clear-cell renal cell carcinoma. The immunohistological and immunohistochemical analysis reviled the metastases of the same variant of renal cell carcinoma in one of 9 lymph nodes. The patient was treated with pazopanib. The primary renal tumor was not detected during the dynamic observation, including the application of annual combined positron emission and X-ray computed tomography. The patient is alive without disease progression with a follow-up of 32 months. Conclusion.Metastases of clear-cell renal cell carcinoma, including adrenal gland, without evidence of a primary site are extremely rare. The main method of treatment is a combination of surgery and targeted therapy, providing long-term local control of the course of the disease.

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