Multimodality imaging evaluation of pseudotumors in chronic renal dysfunction: exposing the masquerade!

Focal renal lesions in the background of chronic kidney disease (CKD) present a diagnostic challenge. Contrast administration is usually avoided in such a setting, undermining the usefulness of computed tomography and magnetic resonance imaging. Focal regenerating nodules may occur in the background of CKD and closely mimic renal neoplasms. The aim of the present article was to highlight the salient manifestations of such CKD pseudotumors on different imaging modalities and also to depict the differentiating features from malignancy. Radiologists must be aware of the imaging appearance of this uncommonly talked about entity so as to avoid inadvertent surgery or cause undue anxiety to the patient.

Heterotopic Ossification in Benign and Malignant Renal Neoplasms

Introduction/Objective Heterotopic bone formation in renal neoplasms is a rare phenomenon. Ossification with or without marrow elements has been reported in both benign and malignant renal tumors. Due to its rarity, the epidemiological and clinical features of this finding are not well-documented. Herein, we have examined heterotopic ossification in renal neoplasms and summarized the epidemiological and clinical features of this entity. Methods/Case Report A database search on PubMed, Scopus, and Google Scholar was performed using a combination of proper search terms. Full article texts of all search results were reviewed with reference lists screened for additional articles matching the search criteria. The demographic details of the patients, disease characteristics, treatment, and outcomes were all extracted from full text articles and were summarized in a pre-standardized form. The inclusion criteria were set as any epithelial renal neoplasm with histological evidence of heterotopic ossification. A case of clear cell renal cell carcinoma (CCRCC) with heterotopic ossification diagnosed in our institution is included in the study. Results (if a Case Study enter NA) A total of 30 cases were found of renal neoplasms with bone formation. The majority of patients were between the ages of 40 to 60. The male to female ratio was 1:1. The majority (19/30) were histologically diagnosed as CCRCC, the most common subtype of kidney tumor with a few cases diagnosed as chromophobe RCC (4/30), papillary RCC (3/30), and cystic nephroma (2/30). Of the neoplasms reported, tumor size varied from 3.0 cm to 28.8 cm. Conclusion Heterotopic ossification of renal neoplasms often presents a diagnostic challenge to the radiologist as other benign conditions such as extramedullary hematopoiesis can be in the differential. The rarity of this phenomenon renders pre-surgical diagnosis difficult. Our study documents this phenomenon to be seen in a variety of renal neoplasms and underscores the necessity to be aware of this rare entity.

Absolute quantitative proteomics using the total protein approach to identify novel clinical immunohistochemical markers in renal neoplasms

Background Renal neoplasms encompass a variety of malignant and benign tumors, including many with shared characteristics. The diagnosis of these renal neoplasms remains challenging with currently available tools. In this work, we demonstrate the total protein approach (TPA) based on high-resolution mass spectrometry (MS) as a tool to improve the accuracy of renal neoplasm diagnosis. Methods Frozen tissue biopsies of human renal tissues [clear cell renal cell carcinoma (n = 7), papillary renal cell carcinoma (n = 5), chromophobe renal cell carcinoma (n = 5), and renal oncocytoma (n = 5)] were collected for proteome analysis. Normal adjacent renal tissue (NAT, n = 5) was used as a control. Proteins were extracted and digested using trypsin, and the digested proteomes were analyzed by label-free high-resolution MS (nanoLC-ESI-HR-MS/MS). Quantitative analysis was performed by comparison between protein abundances of tumors and NAT specimens, and the label-free and standard-free TPA was used to obtain absolute protein concentrations. Results A total of 205 differentially expressed proteins with the potential to distinguish the renal neoplasms were found. Of these proteins, a TPA-based panel of 24, including known and new biomarkers, was selected as the best candidates to differentiate the neoplasms. As proof of concept, the diagnostic potential of PLIN2, TUBB3, LAMP1, and HK1 was validated using semi-quantitative immunohistochemistry with a total of 128 samples assessed on tissue micro-arrays. Conclusions We demonstrate the utility of combining high-resolution MS and the TPA as potential new diagnostic tool in the pathology of renal neoplasms. A similar TPA approach may be implemented in any cancer study with solid biopsies.

Towards the doctrine of hypernephromas

By hypernephromas, it is customary to mean kidney neoplasms, which are rarely found in clinics, but, nevertheless, occupy the first place among other renal neoplasms.

Absorbable Self-Retaining Barbed Double-Needle Suture(SRBDS) in Transperitoneal Laparoscopic Partial Nephrectomy for T1 Renal Neoplasms

ObjectiveTo evaluate the safety and hemostatic efficacy of absorbable self-retaining barbed double-needle suture (SRBDS) in transperitoneal LPN for T1 renal neoplasms.MethodsIn total, 75 patients with renal neoplasm masses (< 7 cm) undergoing transperitoneal LPN were collected since January 2018 to October 2019. After tumor resection with a cold Endoscissor, 3-0 and 0 SRBDS was performed for inner and outer running stitches without either hem-o-lok or LapraTy clip, respectively. Patient demographic information, neoplasm characteristics, perioperative factors, and oncologic outcomes were collected and analyzed.ResultsAccording to our result, Median tumor size and R.E.N.A.L score was 4.69 cm and 7. Median operative time and overall warm ischemia time was 73 min and 13.14 min. Mean estimated blood loss was 67 ml. intraoperative complications was not showing up and no case was switched to open radical nephrectomy. Postoperative pathological assessment confirmed that negative surgical margins. only single patient experienced secondary surgery-related hemorrhage on the fifth day post-operation, and was treated by transfusion and digital subtraction angiography (DSA) highly selective embolization of the bleeding vessel. No patients developed urinoma or urinary fistula. the overall complications were manageable during three-year follow-up period.ConclusionSRBDS was a safe and efficient surgical endoscopic suturing technique with low complication rate in T1 renal neoplasms, which might be considered as an alternative to other suturing techniques, tissue sealants and glues for partial nephrectomy in the future.

HISTOPATHOLOGICAL STUDY OF TUMOURS AND TUMOUR LIKE LESIONS OF KIDNEY AND RENAL PELVIS

Background : Tumour and tumour like lesions of kidney and renal pelvis include a wide spectrum of entities. Renal neoplasms occurs both in adults and in children, with few rare tumours and account for 1% to 2% of all body cancers. Majority of which are RCC. Tumour and tumour like lesions of kidney and renal pelvis may present with nonspecic clinical manifestations, incidental ndings on radiology or at autopsy, may present with the classical triad of ank pain, haematuria and abdominal mass or can be asymptomatic. Hence histopathological examination is essential for the diagnosis of renal neoplasms. Material and method : It is retrospective study (July 2003 to June 2013) for a period of 10 years. Histopathological features of 38 tumours and tumour like lesions of the kidney and renal pelvis were analysed.Out of 38 cases, 27 were nephrectomy specimens and 11 were renal biopsies The histopathological reports and clinical details were collected and corresponding slides were reviewed. Tumours are classied according to WHO classication 2016. Results: The present study included 38 cases of tumour and tumour like lesions of kidney and renal pelvis. Histopathological evaluation revealed malignant neoplasms in 27 (71.05%) cases, benign neoplasm in 5 (13.15%) cases and tumour like lesions in 6 (15.79%) cases.Among malignant tumours, clear cell RCC was the most frequent tumour in our study observed in 13 (86.67%) cases. Overall higher numbers of tumours and tumourth th like lesions of kidney and renal pelvis were seen in the rst decade of life followed by 4 to 5 decade of life in our study with a male predominance having M:F ratio of 1.23:1. Conclusion: Malignant tumours outnumbered the benign tumours. Most of the malignant, benign and tumour like lesions present with similar clinical features hence histopathology remains the gold standard method.