Management of Kidney Cancer: Canadian Kidney Cancer Forum Consensus Update 2011

Jewett, Mas; Finelli, Antonio; Kollmannsberger, Christian; Wood, Lori; Legere, Laura; Basiuk, Joan; Canil, Christina; Heng, Daniel Y.C.; Reaume, N.; Tanguay, Simon; Atkins, Michael B.; Bjarnason, Georg A.; Dancey, Janet; Evans, M; Fleshner, Neil; Haider, M; Kapoor, Anil; Uzzo, Robert G.; Maskens, Deborah; Soulières, Denis; Yousef, George M.; Basappa, Naveen S.; Bendali, N; Black, Peter C.; Blais, Normand; Cagiannos, Ilias; Care, Melanie; Chow, Raymond; Chung, Hannah; Czaykowski, Piotr; DeRosa, David C.; Durrant, K; Ellard, Susan; Farquharson, G; Filion-Brulotte, C; Gingerich, Joel Roger; Godbout, L; Grant, Ron; Hamilton, William; Kassouf, Wassim; Kurban, Ghada; Lane, Kelly; Jb, Lattouf; Lau, Denise; Leveridge, Mike; McCarthy, Joy; Moore, Ronald B.; North, Scott; O'Brien, Paul Edmond; Pituskin, Edith; Racine, P; Rendon, Ricardo; So, Alan; Sridhar, Srikala S.; Stubbs, K; Su, Zhuo; Taylor, Lauren; Udall, T; Venner, Peter; Vogel, Walter; Yap, Stanley A.; Yau, Ping-Wa; Cooper, M; Giroux, N; Miron, Diogo; Mosher, Deane F.; Ross, Kenneth N.; Willacy, J

doi:10.5489/cuaj.11273

“…Prior to such therapeutic approaches, renal biopsy should be performed to establish a histological diagnosis. 15 Image-guided percutaneous core needle biopsy of renal masses has more than 90% sensitivity for the detection of malignancy. 16 However, combined/hybrid tumours consisting of benign and malignant areas can be misdiagnosed, because the biopsy may miss either tumour component or the other.…”

Section: Discussionmentioning

confidence: 99%

Papillary renal cell carcinoma embedded in an oncocytoma: Case report of a rare combined tumour of the kidney

Sejben

¹

,

Szabó

²

,

Lukács

³

et al. 2013

CUAJ

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case report E513Cite as: Can Urol Assoc J 2013;7(7-8):e513-6. http://dx.doi.org/10.5489/cuaj.414 Published online on July 2, 2013. AbstractAn asymptomatic 1-cm large papillary renal cell carcinoma (RCC) embedded in a 3.5-cm large oncocytoma was diagnosed and removed by right nephrectomy in a 68-year-old male investigated for the abdominal symptoms associated with cholelithiasis. The papillary RCC displayed positive immunohistochemical stainings with cytokeratin 7, alpha-methylacyl-CoA racemase and vimentin and was negative for the E-cadherin and CD117 immunostains, whereas the oncocytoma part showed opposite staining patterns. No gains of chromosomes 7 and 17 or loss of chromosome Y was detected in the papillary carcinoma by fluorescent in situ hybridization with centromeric enumeration probes. This finding is in keeping with the morphologic diagnosis of type 2 papillary RCC reported to have lower rates of these characteristic chromosomal changes. The combination of papillary RCC and oncocytoma, two tumours of different postulated origin, is extremely rare. It may represent a simple coincidence, but 2 previous cases and our current one share a few features, including the intimate embedment of the papillary RCC in the oncocytoma, the small size of the RCC and the old age of the patients. This case raises the point that renal oncocytomas can contain a hidden malignant tumour. IntroductionRenal cell neoplasms are supposed to derive from or show differentiation toward different parts of the renal epithelium, as highlighted by immunohistochemical staining patterns and differential expression of some marker proteins.1-3 There are reports on renal tumours with hybrid features between chromophobe renal cell carcinoma (RCC) and oncocytoma, both thought to arise from the distal tubular epithelium. 4 Sometimes RCC arises within an oncocytoma. 5 However, the combination of oncocytoma and papillary RCC, 2 renal neoplasms of different origin, is very rare. 6,7 We present a case of an unusual combination of these 2 tumours, a papillary RCC buried in an oncocytoma. Case reportA 68-year-old male with long-standing hypertension was admitted to our hospital because of right upper abdominal pain. Abdominal ultrasound and computerized tomography (CT) revealed a thick-walled gallbladder with common bile duct stones and a 4-cm mass in the upper pole of the right kidney (Fig. 1). The clinical diagnosis of choledocholithiasis associated with acute cholecystitis and a renal tumour were established. After endoscopic sphincterotomy, the symptoms related to the common bile duct stone vanished and the patient underwent right nephrectomy.The nephrectomy specimen was fixed in 10% neutral buffered formalin for 36 hours. We embedded 3-mm-thick representative tissue sections in paraffin wax and sections of 4 to 5 µm were cut and stained with hematoxylin and eosin (H&E) for light microscopy. The primary antibodies used for immunohistochemistry are shown in Table 1. ResultsThe parenchymal tumour in the nephrectomy specimen was circumscribed, homoge...

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“…[2][3][4] Current guidelines from the American, European, and Canadian Urologic Associations all recommend PN as the standard treatment for T1a renal tumours. 43,56,57 In 2008, approximately 45% of patients surgically managed for T1a tumours in the United States underwent PN rather than RN. 58 Results from Canadian population studies have demonstrated parallel patterns of dissemination with a slow but steady uptake of PN over the past decade.…”

Section: The Current Standard -Partial Nephrectomymentioning

confidence: 99%

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

Yap¹,

Alibhai²,

Tomlinson³

et al. 2013

European Urology Supplements

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The surgical management of renal masses involves either radical nephrectomy (RN) or partial nephrectomy (PN). PN has been associated with better long-term renal function, and has also been linked to improved cardiac morbidity and overall survival. However, the relationship between treatment choice and definitive outcomes of chronic kidney disease (CKD) are lacking. Our aim was to examine whether PN is associated with a lower risk of end-stage renal disease (ESRD) requiring renal replacement therapy.We performed a population-based, retrospective cohort study with data from linked administrative databases in the province of Ontario, Canada. We included individuals with pathologically confirmed renal cell carcinoma (RCC) diagnosed between 1995 and 2010. Cox proportional hazards (PH) models, propensity score models, and competing risks models were used to assess the impact of treatment choice. PN compared to RN reduces the risk of ESRD requiring renal replacement therapy in a modern cohort of patients (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). PN is associated with a lower risk of new-onset CKD, lower risk of cardiac morbidity, and improved overall survival. We provide further evidence for the benefit of PN compared to RN, particularly related to definitive outcomes of renal failure.iii ACKNOWLEDGEMENTS

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“…43,56,57 In 2008, approximately 45% of patients surgically managed for T1a tumours in the United States underwent PN rather than RN. 58 Results from Canadian population studies have demonstrated parallel patterns of dissemination with a slow but steady uptake of PN over the past decade.…”

Section: -4mentioning

confidence: 99%

1308 Partial Nephrectomy for the Treatment of Renal Cell Carcinoma and the Risk of End Stage Renal Disease

Yap¹,

Alibhai²,

Tomlinson³

et al. 2013

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The surgical management of renal masses involves either radical nephrectomy (RN) or partial nephrectomy (PN). PN has been associated with better long-term renal function, and has also been linked to improved cardiac morbidity and overall survival. However, the relationship between treatment choice and definitive outcomes of chronic kidney disease (CKD) are lacking. Our aim was to examine whether PN is associated with a lower risk of end-stage renal disease (ESRD) requiring renal replacement therapy.We performed a population-based, retrospective cohort study with data from linked administrative databases in the province of Ontario, Canada. We included individuals with pathologically confirmed renal cell carcinoma (RCC) diagnosed between 1995 and 2010. Cox proportional hazards (PH) models, propensity score models, and competing risks models were used to assess the impact of treatment choice. PN compared to RN reduces the risk of ESRD requiring renal replacement therapy in a modern cohort of patients (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). PN is associated with a lower risk of new-onset CKD, lower risk of cardiac morbidity, and improved overall survival. We provide further evidence for the benefit of PN compared to RN, particularly related to definitive outcomes of renal failure.iii ACKNOWLEDGEMENTS

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Management of Kidney Cancer: Canadian Kidney Cancer Forum Consensus Update 2011

Cited by 20 publications

References 51 publications

Papillary renal cell carcinoma embedded in an oncocytoma: Case report of a rare combined tumour of the kidney

Papillary renal cell carcinoma embedded in an oncocytoma: Case report of a rare combined tumour of the kidney

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

1308 Partial Nephrectomy for the Treatment of Renal Cell Carcinoma and the Risk of End Stage Renal Disease

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