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Gunenc D, Issa W, Gerald T, Zhou Q, Zhang S, Ibezue IC, Bhanvadia R, Tachibana I, Brugarolas J, Hammers H, Qin Q, Kapur P, Woldu S, Gaston K, Lotan Y, Cadeddu J, Wang AZ, Margulis V, Zhang T. Pathological Response and Outcomes in Patients With Metastatic Renal Cell Carcinoma (mRCC) Receiving Immunotherapy-Based Therapies and Undergoing Deferred Cytoreductive Nephrectomy (CN). Clin Genitourin Cancer 2024; 22:102177. [PMID: 39218752 DOI: 10.1016/j.clgc.2024.102177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 07/12/2024] [Accepted: 07/21/2024] [Indexed: 09/04/2024]
Abstract
In this study we evaluated outcomes of patients with metastatic renal cell carcinoma who received immunotherapy before surgery. We found that receiving immunotherapy combinations before surgery can offer patients benefits in reducing tumor size and improving disease control. BACKGROUND Immunotherapy (IO) has improved outcomes for patients with metastatic renal cell carcinoma (mRCC). However, the timing of surgical intervention for cytoreductive nephrectomy (CN) is still controversial for this group of patients. PATIENTS AND METHODS We identified patients with mRCC receiving IO-based therapies and undergoing CN. Patients were divided into 2 cohorts: those who underwent upfront CN and those who underwent deferred CN. Pathologic and radiographic features along with clinical outcomes were systematically collected. Comparisons were performed using Chi-square test, paired t-Test or Mann-Whitney-U test. Progression Free survival (PFS) and Overall Survival (OS) were estimated using the Kaplan-Meier method. RESULTS Fifty-one patients with mRCC were included, with a median follow-up of 21 months. 38 (74.5%) patients received IO-based therapies prior to CN, while 13 (25.5%) patients underwent up-front CN. IO-based therapies reduced median tumor size from pretreatment 10 cm to 8.6 cm post-treatment when given prior to CN. IO-TKI had a trend toward higher tumor shrinkage (-2.3 vs -1.2 cm). Pathologic T downstaging occurred in 42% (n=16) of patients, 11% (n=4) of whom had pT0 disease. Thrombus downstaging occurred in 13% (n=6) of patients, all with either partial response (PR) or complete response (CR) in metastases. PFS (HR=0.7, 95% CI 0.29-1.98, p=0.58) and OS (HR 0.4, 95% CI 0.13-1.57, p=0.21) were not statistically significant between 2 cohorts. CONCLUSIONS IO-based therapies, particularly IO-TKIs, resulted in pathologic necrosis and reductions in tumor size prior to deferred CN. PFS and OS were similar for patients who received either upfront IO-based therapy or after CN.
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Affiliation(s)
- Damla Gunenc
- University of Texas Southwestern, Department of Internal Medicine, Division of Hematology and Oncology, Dallas, TX
| | - Wadih Issa
- University of Texas Southwestern, Department of Internal Medicine, Division of Hematology and Oncology, Dallas, TX
| | - Thomas Gerald
- University of Texas Southwestern, Department of Urology, Dallas, TX
| | - Qinhan Zhou
- University of Texas Southwestern, Department of Internal Medicine, Division of Hematology and Oncology, Dallas, TX
| | - Song Zhang
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern, Dallas, TX
| | - I Chidera Ibezue
- University of Texas Southwestern, Department of Urology, Dallas, TX
| | - Raj Bhanvadia
- University of Texas Southwestern, Department of Urology, Dallas, TX
| | - Isamu Tachibana
- University of Texas Southwestern, Department of Urology, Dallas, TX
| | - James Brugarolas
- University of Texas Southwestern, Department of Internal Medicine, Division of Hematology and Oncology, Dallas, TX
| | - Hans Hammers
- University of Texas Southwestern, Department of Internal Medicine, Division of Hematology and Oncology, Dallas, TX
| | - Qian Qin
- University of Texas Southwestern, Department of Internal Medicine, Division of Hematology and Oncology, Dallas, TX
| | - Payal Kapur
- University of Texas Southwestern, Department of Pathology, Dallas, TX
| | - Solomon Woldu
- University of Texas Southwestern, Department of Urology, Dallas, TX
| | - Kris Gaston
- University of Texas Southwestern, Department of Urology, Dallas, TX
| | - Yair Lotan
- University of Texas Southwestern, Department of Urology, Dallas, TX
| | - Jeffrey Cadeddu
- University of Texas Southwestern, Department of Urology, Dallas, TX
| | - Andrew Z Wang
- University of Texas Southwestern, Department of Radiation Oncology, Dallas, TX
| | - Vitaly Margulis
- University of Texas Southwestern, Department of Urology, Dallas, TX
| | - Tian Zhang
- University of Texas Southwestern, Department of Internal Medicine, Division of Hematology and Oncology, Dallas, TX.
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Freih-Fraih A, Celada-Luis G, Ranchal T, Lagana C, Canca-Velasco A, Jiménez-Heffernan JA. Complete spontaneous regression of a primary renal cell carcinoma. Report of a pathological proven case and review of the literature. REVISTA ESPANOLA DE PATOLOGIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ANATOMIA PATOLOGICA Y DE LA SOCIEDAD ESPANOLA DE CITOLOGIA 2022; 55 Suppl 1:S69-S73. [PMID: 36075667 DOI: 10.1016/j.patol.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/20/2019] [Accepted: 09/09/2019] [Indexed: 06/15/2023]
Abstract
Regression of primary renal cell carcinoma (RCC) is a rare phenomenon and for several reasons many of the reported cases have been questioned. We present a case that can be considered a true spontaneous and complete regression of a primary RCC. A 79-year-old female underwent nephrectomy because a renal tumor. At the time of surgery image studies showed a small para-aortic lymph node. The tumor measured 3cm and was analyzed completely. Histology showed a fibro-inflammatory lesion with necrosis, foamy macrophages and inflammatory cells. No neoplastic cells were observed and the lesion was interpreted as a localized type of xanthogranulomatous pyelonephritis. One year later a CT control scan, showed that the para-aortic lymph node had increased in size to 4cm. Fine needle aspiration revealed features of clear RCC. Metastatic dissemination was limited so surgical removal of the para-aortic lymph node was performed and the cytologic diagnosis confirmed.
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Affiliation(s)
| | | | - Tamara Ranchal
- Department of Pathology, University Hospital La Princesa, Madrid, Spain
| | - Claudio Lagana
- Department of Radiology, University Hospital La Princesa, Madrid, Spain
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Desmoid-type fibromatosis of the lower extremity: A unique case of complete lesion resolution following core needle biopsy. Clin Imaging 2020; 69:213-218. [PMID: 32920469 DOI: 10.1016/j.clinimag.2020.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/19/2020] [Accepted: 08/28/2020] [Indexed: 11/22/2022]
Abstract
Desmoid-type fibromatosis (DF) is a rare neoplasm characterized by fibroblastic and myofibroblastic proliferation. While characterized as a benign lesion that does not metastasize, desmoid-type fibromatosis exhibits a wide range of behavior from aggressive local tissue invasion and post-surgical recurrence to spontaneous regression. Tumor regression can occur following systemic medical therapy or rarely may occur in the absence of therapy. We present a case of a 50-year-old female with a left thigh vastus medialis intramuscular mass which underwent imaging work-up and subsequent core needle ultrasound-guided biopsy showing results of desmoid-type fibromatosis. Following biopsy, the tumor showed prompt, complete regression with complete MRI resolution 2 months following biopsy. The patient showed no evidence of disease recurrence out to one year on MRI surveillance. This case report will discuss desmoid-type fibromatosis imaging features, treatment strategies, spectrum of disease behavior, and atypical behavior such as the spontaneous tumor regression as seen in this case report. To our knowledge there have been no reported cases of DF spontaneous regression 2 months following a core needle biopsy. Understanding the variable behavior of desmoid-type fibromatosis can assist the radiologist in guiding management of these lesions with the goal of optimizing clinical outcomes and preventing unnecessary aggressive treatments for stable or regressing disease.
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Spontaneous Regression of a Low-Grade Renal Cell Carcinoma With Oncocytic Features After Renal Mass Biopsy. Clin Genitourin Cancer 2018; 16:e1083-e1085. [DOI: 10.1016/j.clgc.2018.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 07/14/2018] [Indexed: 11/17/2022]
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Maruschke M, Anastasiadis AG, Hakenberg OW. Spontaneous regression of renal cell carcinoma: Reality or myth? World J Clin Urol 2014; 3:201-208. [DOI: 10.5410/wjcu.v3.i3.201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/29/2014] [Accepted: 08/29/2014] [Indexed: 02/06/2023] Open
Abstract
Spontaneous regression of a malignant tumor is a very rare phenomenon. Renal cell carcinoma (RCC) is an aggressive malignancy with an often unpredictable behaviour. The incidence of spontaneous regression in metastatic RCC has been estimated to lie between < 1% and 7%. The spontaneous regression of a primary RCC has been reported much less commonly. Our literature review assesses the published literature concerning spontaneous regression of either primary or metastatic RCC. In order to examine this phenomenon in more detail we performed a literature search in the PubMed Database using the Keywords “renal cell carcinoma”, “metastatic disease”, and “spontaneous regression” and included reports from the last 100 years. The incidence of spontaneous regressions in RCC has always been considered a special feature of RCC compared to other solid malignancies. The majority of case reports of spontaneously regressed RCC describe the regression of metastases after nephrectomy rather than the spontaneous regression of a primary tumor. In cases of reported regression of metastatic RCC, this mostly applied to pulmonary lesions. As possible reasons for spontaneous regressions host immune defense mechanisms against metastatic RCC tissue following nephrectomy are discussed as important factor. RCC is known to be highly immunogenic and the possible existence of cytotoxic serum factors and tumor-specific surface antigens may trigger a cell-mediated cytotoxicity as an immunological basis for regression. Histological verification of supposed regression of a primary tumor may cause diagnostic difficulties, since large central areas of necrosis and cystic lesions of the tumor can occur simultaneously. The well-known phenomenon of necrosis in a fast growing RCC at the time of nephrectomy must not be confused with true spontaneous regression. Therefore, in our opinion such reported cases of supposed partial spontaneous regressions of primary RCCs are highly questionable. Most cases of spontaneous regression of RCC metastases have been reported after nephrectomy as the only treatment. Debulking by tumor nephrectomy then gives the immune system the chance to cope effectively with the remaining much lower quantity of tumour antigens. However, the mechanisms leading to spontaneous regression of metastatic lesions after cytoreductive nephrectomy are still poorly understood.
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6
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Donin NM, Mohan S, Pham H, Chandarana H, Doshi A, Deng FM, Stifelman MD, Taneja SS, Huang WC. Clinicopathologic outcomes of cystic renal cell carcinoma. Clin Genitourin Cancer 2014; 13:67-70. [PMID: 25088469 DOI: 10.1016/j.clgc.2014.06.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/21/2014] [Accepted: 06/27/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND The purpose of this study was to describe the clinicopathologic characteristics and oncologic outcomes of patients who underwent nephrectomy for cystic renal masses. PATIENTS AND METHODS Using an institutional review board-approved database, we retrospectively reviewed the clinical, pathologic, radiologic, and oncologic outcome data of patients who received nephrectomy for a complex cystic renal mass. RESULTS Sixty-one patients were identified who received nephrectomy for a complex cystic lesion. Average age was 64 years. Thirty-nine (64%) patients were male. At the time of resection, 1 (1.6%), 3 (4.8%), 53 (86.8%), and 4 (6.5%) had a Bosniak category II, IIF, III, and IV cystic lesion, respectively. Nineteen (31.1%) patients were initially managed expectantly but underwent surgery because of progression of complexity on follow-up. Mean pathologic tumor size was 3.3 cm (range, 0.7-12 cm). Forty-eight (78.6%) of the lesions were found to be malignant. Thirty-seven (77.1%), 5 (10.4%), 4 (8.3%), and 2 (4.1%) were stage T1a, T1b, T2a, and T3a, respectively. Clear cell was the most common histologic subtype (44%), followed by papillary (21.3%), and unclassified RCC (4.9%). With a mean and median follow-up of 48.4 and 43.0 months, respectively, no patients developed a local or metastatic recurrence. All patients were alive at last follow-up. CONCLUSION In our series with moderate follow-up, cystic RCCs do not appear to recur or progress regardless of size, histologic subtype, or grade. These findings suggest the malignant potential of cRCCs is significantly less than solid RCCs. Further investigation is required to determine if cRCCs should be classified and managed independently from solid RCCs.
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Affiliation(s)
- Nicholas M Donin
- Department of Urology, New York University School of Medicine, New York, NY.
| | - Sanjay Mohan
- Department of Urology, New York University School of Medicine, New York, NY
| | - Hai Pham
- Department of Urology, New York University School of Medicine, New York, NY
| | - Hersh Chandarana
- Department of Radiology, New York University School of Medicine, New York, NY
| | - Ankur Doshi
- Department of Radiology, New York University School of Medicine, New York, NY
| | - Fang-Ming Deng
- Department of Pathology, New York University School of Medicine, New York, NY
| | | | - Samir S Taneja
- Department of Urology, New York University School of Medicine, New York, NY
| | - William C Huang
- Department of Urology, New York University School of Medicine, New York, NY
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7
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Zito G, Saotome I, Liu Z, Ferro EG, Sun TY, Nguyen DX, Bilguvar K, Ko CJ, Greco V. Spontaneous tumour regression in keratoacanthomas is driven by Wnt/retinoic acid signalling cross-talk. Nat Commun 2014; 5:3543. [PMID: 24667544 PMCID: PMC3974217 DOI: 10.1038/ncomms4543] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 03/04/2014] [Indexed: 02/07/2023] Open
Abstract
A fundamental goal in cancer biology is to identify the cells and signalling pathways that are keys to induce tumour regression. Here we use a spontaneously self-regressing tumour, cutaneous keratoacanthoma (KAs), to identify physiological mechanisms that drive tumour regression. By using a mouse model system that recapitulates the behaviour of human KAs, we show that self-regressing tumours shift their balance to a differentiation programme during regression. Furthermore, we demonstrate that developmental programs utilized for skin hair follicle regeneration, such as Wnt, are hijacked to sustain tumour growth and that the retinoic acid (RA) signalling pathway promotes tumour regression by inhibiting Wnt signalling. Finally, we find that RA signalling can induce regression of malignant tumours that do not normally spontaneously regress, such as squamous cell carcinomas. These findings provide new insights into the physiological mechanisms of tumour regression and suggest therapeutic strategies to induce tumour regression.
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Affiliation(s)
- Giovanni Zito
- Department of Genetics, Yale Stem Cell Center, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut 06510, USA
| | - Ichiko Saotome
- Department of Genetics, Yale Stem Cell Center, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut 06510, USA
| | - Zongzhi Liu
- Department of Pathology, Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut 06510, USA
| | - Enrico G. Ferro
- Department of Genetics, Yale Stem Cell Center, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut 06510, USA
| | - Thomas Y. Sun
- Department of Genetics, Yale Stem Cell Center, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut 06510, USA
| | - Don X. Nguyen
- Department of Pathology, Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut 06510, USA
| | - Kaya Bilguvar
- Department of Genetics, Yale Stem Cell Center, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut 06510, USA
| | - Christine J. Ko
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut 06510, USA
| | - Valentina Greco
- Department of Genetics, Yale Stem Cell Center, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut 06510, USA
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut 06510, USA
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8
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Williamson SR, MacLennan GT, Lopez-Beltran A, Montironi R, Tan PH, Martignoni G, Grignon DJ, Eble JN, Idrees MT, Scarpelli M, Cheng L. Cystic partially regressed clear cell renal cell carcinoma: a potential mimic of multilocular cystic renal cell carcinoma. Histopathology 2013; 63:767-79. [DOI: 10.1111/his.12239] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 07/24/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Sean R Williamson
- Department of Pathology and Laboratory Medicine; Henry Ford Health System; Detroit MI USA
| | | | | | - Rodolfo Montironi
- Institute of Pathological Anatomy and Histopathology; School of Medicine; Polytechnic University of the Marche Region (Ancona); United Hospitals; Ancona Italy
| | - Puay Hoon Tan
- Department of Pathology; Singapore General Hospital; Singapore Singapore
| | - Guido Martignoni
- Department of Pathology and Diagnostics; University of Verona; Verona Italy
| | - David J Grignon
- Department of Pathology; Indiana University School of Medicine; Indianapolis IN USA
| | - John N Eble
- Department of Pathology; Indiana University School of Medicine; Indianapolis IN USA
| | - Muhammad T Idrees
- Department of Pathology; Indiana University School of Medicine; Indianapolis IN USA
| | - Marina Scarpelli
- Institute of Pathological Anatomy and Histopathology; School of Medicine; Polytechnic University of the Marche Region (Ancona); United Hospitals; Ancona Italy
| | - Liang Cheng
- Department of Pathology; Indiana University School of Medicine; Indianapolis IN USA
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9
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Chan BPH, Booth CM, Manduch M, Touma NJ. Spontaneous regression of metastatic pulmonary renal cell carcinoma in the setting of sarcomatoid differentiation of the primary tumour. Can Urol Assoc J 2013; 7:E587-9. [PMID: 24069101 DOI: 10.5489/cuaj.169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We present a case of spontaneous regression of pulmonary metastases from renal cell carcinoma (RCC) with sarcomatoid differentiation, prior to intervention. The patient presented with conventional type RCC with Furhman Grade 4/4 and sarcomatoid differentiation, complicated by pulmonary metastases. Palliative systemic therapy was planned, but prior to the onset of treatment, serial computed tomography scans demonstrated regression of metastatic disease. Spontaneous regression of metastases is rare, but well-documented in conventional clear cell RCC. To the best of our knowledge, this has not previously been described in the setting of sarcomatoid differentiation of the primary tumour.
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10
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Spontaneous regression of renal cell carcinoma. Contemp Oncol (Pozn) 2013; 17:123-7. [PMID: 23788977 PMCID: PMC3685371 DOI: 10.5114/wo.2013.34613] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 10/14/2012] [Accepted: 11/21/2012] [Indexed: 02/07/2023] Open
Abstract
Renal cell carcinoma (RCC) comprises 3-4% of all malignant tumours among adults in Poland. Spontaneous regression of RCC is a rare but well-known phenomenon. Its frequency is estimated to be approximately 1% and a large part of the percentage is accounted for by the regression of pulmonary metastases in the course of clear type of RCC treatment. We searched PubMed, Embase and SciVerse Scopus databases, identifying 59 case reports of spontaneous regression of RCC. Those medical histories come from reports from around the world and date back up to 40 years. This review includes their analysis as well as description of possible explanations of this phenomenon postulated by different authors, including both misdiagnosis and immunological reactions. This study indicates that reliable diagnostics and reporting of all the cases of spontaneous regression play a key role, as this is the only method which enables a better perspective in understanding this issue.
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11
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Kryvenko ON, Roquero L, Gupta NS, Lee MW, Epstein JI. Low-grade clear cell renal cell carcinoma mimicking hemangioma of the kidney: a series of 4 cases. Arch Pathol Lab Med 2013; 137:251-4. [PMID: 23368867 DOI: 10.5858/arpa.2011-0615-oa] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Clear cell renal cell carcinoma (CCRCC) has a rich, sinusoid-like vascularity frequently used as a diagnostic criterion. CCRCC with predominantly vascular architecture has not been described. OBJECTIVE To describe 4 unusual CCRCC cases, primarily presenting with hemangioma-like morphologic pattern. DESIGN Clinicopathologic and selected immunohistochemical analysis of 4 cases of CCRCC mimicking hemangioma. RESULTS Cases were seen in 1 woman and 3 men (average age, 48.8 years; range, 40-66 years). Grossly, tumors were red-brown (3 of 4) with scant bright-yellow foci in 1. The average tumor size was 4 cm (range, 2.5-5.5 cm). Microscopically, all were composed of varying proportions of a rich, arborizing, sinusoid-like vasculature with focal hobnail appearance of endothelial cells. Entrapment of renal tubules between blood vessels was seen at the periphery of the tumors. This morphology was reminiscent of anastomosing hemangioma. Isolated tumor cells resembling lymphocytes with clear halos were sparsely interspersed between vessels. Cytokeratin immunostain confirmed the diagnosis of CCRCC. CONCLUSION Extensive sampling and immunohistochemical workup of what is deemed to be a benign vascular neoplasm of the kidney is needed to rule out the presence of individual carcinoma cells or small viable carcinoma cell clusters.
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12
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Jawanda GG, Drachenberg D. Spontaneous regression of biopsy proven primary renal cell carcinoma: A case study. Can Urol Assoc J 2012; 6:E203-5. [PMID: 23093646 PMCID: PMC3478393 DOI: 10.5489/cuaj.11035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Spontaneous regression of renal cell carcinoma (RCC) is a well-recognized and interesting phenomenon that is poorly understood and rarely documented. There are very few reported cases of spontaneously regressed primary RCC. We present a 63-year-old male with a biopsy-proven RCC that regressed with complete resolution of symptoms.
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13
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Multilocular Cystic Renal Cell Carcinoma: Comparison of Imaging and Pathologic Findings. AJR Am J Roentgenol 2012; 198:W20-6. [DOI: 10.2214/ajr.11.6762] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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14
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Johnson MT, Bahnson RR, Zynger DL. Metastatic clear cell renal cell carcinoma to the adrenal gland without an identifiable primary tumor. Int J Urol 2011; 19:92-3. [PMID: 22146098 DOI: 10.1111/j.1442-2042.2011.02904.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Katz MD, Serrano MF, Grubb RL, Skolarus TA, Gao F, Humphrey PA, Kibel AS. Percent Microscopic Tumor Necrosis and Survival After Curative Surgery for Renal Cell Carcinoma. J Urol 2010; 183:909-14. [DOI: 10.1016/j.juro.2009.11.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Indexed: 11/26/2022]
Affiliation(s)
- Matthew D. Katz
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Maria F. Serrano
- Division of Anatomic and Molecular Pathology (Department of Pathology and Immunology), Washington University School of Medicine, St. Louis, Missouri
| | - Robert L. Grubb
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Ted A. Skolarus
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Feng Gao
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
| | - Peter A. Humphrey
- Division of Anatomic and Molecular Pathology (Department of Pathology and Immunology), Washington University School of Medicine, St. Louis, Missouri
| | - Adam S. Kibel
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
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16
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Lekanidi K, Vlachou PA, Morgan B, Vasanthan S. Spontaneous regression of metastatic renal cell carcinoma: case report. J Med Case Rep 2007; 1:89. [PMID: 17877824 PMCID: PMC2034581 DOI: 10.1186/1752-1947-1-89] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 09/18/2007] [Indexed: 11/29/2022] Open
Abstract
Spontaneous regression of metastatic renal cell carcinoma is rarely observed. A case of suspected spontaneous regression of pulmonary metastases following nephrectomy for histologically proven renal cell carcinoma without systemic treatment is presented along with a brief review of the literature.
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Affiliation(s)
- Katerina Lekanidi
- Department of Medicine, Leicester Royal Infirmary, Leicester, LE1 5WW, UK
| | | | - Bruno Morgan
- Department of Radiology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK
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17
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Foria V, Surendra T, Poller DN. Prognostic relevance of extensive necrosis in renal cell carcinoma. J Clin Pathol 2005; 58:39-43. [PMID: 15623480 PMCID: PMC1770541 DOI: 10.1136/jcp.2004.018846] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS Evidence suggests that the presence of tumour necrosis is an adverse prognostic factor in renal cell carcinoma (RCC). However, it has also been shown that tumour regression, a microscopic feature associated with necrosis, may be a favourable short term prognostic factor in RCC. METHODS Pathology reports of 253 RCCs from 1992 to 2001 were reviewed, and identified 37 tumours with substantial macroscopic or microscopic necrosis. Microscopic pathology, TNM 1997 tumour stage, and clinical follow up were reviewed and correlated with pathological findings. Three cases were rejected because two were diagnosed at necropsy, and a third was the result of renal arterial embolisation. RESULTS Twenty of the 34 cases showed <50% necrosis, 10 showed 50-94% tumour necrosis, and four showed >95% tumour necrosis. Follow up data were unavailable in three cases. Nine of the remaining 31 tumours progressed; six were group 3 tumours showing <50% necrosis, three were group 2 tumours showing 50-94% necrosis, and none was a group 1 tumour showing >95% necrosis. CONCLUSIONS Extensive necrosis (>95% necrosis) is rare in RCC, accounting for only 1.6% of those diagnosed during eight years in this unselected hospital series. The microscopic pattern of necrosis was typical, requiring extensive tumour sampling for definitive tumour diagnosis. Although there were only four patients with extensive necrosis, none developed recurrent or metastatic carcinoma, or died from RCC. Although extensive (>95%) necrosis may imply better short term prognosis after adjusting for tumour pathological TNM stage, it is probably not a prognostic variable in RCC.
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Affiliation(s)
- V Foria
- Department of Pathology, Queen Alexandra Hospital, Cosham, Portsmouth, P06 3LY, UK
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18
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Saleh FH, Crotty KA, Hersey P, Menzies SW, Rahman W. Autonomous histopathological regression of primary tumours associated with specific immune responses to cancer antigens. J Pathol 2003; 200:383-95. [PMID: 12845635 DOI: 10.1002/path.1369] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Spontaneous histopathological regression of cancer has been reported. The involvement of the immune system in such regression has been advocated, leading to the theory of immunological surveillance against cancer. A prediction of this theory is that common tumour antigens can be recognized upon repeated exposure by cell-mediated immunity, which leads to tumour regression and the subsequent appearance of tumour antigen-loss variants. However, no direct evidence has been provided in non-viral-induced experimental animal models of primary malignancy or in human primary cancer. This study examined two groups of melanoma patients where histopathological regression of the primary tumour was observed. Many of the 23 patients with multiple (> or =3) primary melanomas showed significant regression of their last melanoma (median 33%, mean 40) compared with matched melanomas from patients with a single primary melanoma (median 0%, mean 12) (p=0.0080), or compared with their first primary melanoma (p=0.0013). Regression was consistent with an 'immunization effect' seen in murine tumour transplantation studies, where inoculation with > or =3 asynchronous tumours induces transplantation rejection on subsequent challenge. A significant decrease in the expression of the melanoma common tumour antigen MART-1 in the last primary tumour from multiple melanoma patients (median 8%, mean 24) versus matched single melanoma patients (median 79%, mean 68) (p=0.0041) and in the last versus first tumour in multiple primary patients was found (p=0.0083). Metastases from 17 patients whose primary skin melanomas had completely regressed (occult primary melanoma) also showed significant MART-1 loss (median 0%, mean 11) compared with matched metastases from patients with non-regressing primary melanoma (median 51%, mean 50) (p=0.0013). MART-1 antigen-loss variants observed in the multiple primary and occult primary patients correlated with the presence of peripheral blood MART-1-specific cytotoxic T lymphocytes (CTLs) (p=0.03). No similar effects were observed with two other melanoma antigens, gp100 and CD63. Thus, in two groups of human melanoma patients, evidence is provided for histopathological tumour regression associated with cancer immune surveillance.
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Affiliation(s)
- Farid H Saleh
- Department of Human Morphology, Faculty of Medicine, The American University of Beirut, PO Box 11-0236, Beirut, Lebanon. FaridS l
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Lee JG, Kim JS, Kim HJ, Kim ST, Yeon JE, Byun KS, Kim JS, Bak YT, Lee CH. Simultaneous duodenal and colon masses as late presentation of metastatic renal cell carcinoma. Korean J Intern Med 2002; 17:143-6. [PMID: 12164092 PMCID: PMC4531661 DOI: 10.3904/kjim.2002.17.2.143] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We report a case of pathologically proven simultaneous duodenal and colonic metastases about four years after nephrectomy for mixed clear and granular cell type renal cell carcinoma (RCC). A 76-year-old female patient who had undergone a left radical nephrectomy 4 years previously for RCC presented with a 1-month history of dyspepsia and pain in the right upper abdomen. An abdominopelvic CT scan showed circumferential wall thickening with high enhancement at the second portion of the duodenum and additional enhancement of an irregular protruding mass into the lumen of the ascending colon. A gastroscopy showed a large and ulcerative protruding mass nearly obstructing the second portion of the duodenum. A colonoscopy revealed a polypoid, nodular and purplish mass in the ascending colon. Microscopy of the biopsy specimen showed the features identical to those of the RCC which was resected 4 years earlier in this patient. We believe this to be the first case illustrating a metastatic renal cell carcinoma as simultaneous duodenal and colon masses.
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Affiliation(s)
- Jung Gu Lee
- Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
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Ueki T, Takeuchi T, Nishimatsu H, Kajiwara T, Moriyama N, Narita Y, Kawabe K, Ueki K, Kitamura T. Silencing of the caspase-1 gene occurs in murine and human renal cancer cells and causes solid tumor growth in vivo. Int J Cancer 2001; 91:673-9. [PMID: 11267979 DOI: 10.1002/1097-0215(200002)9999:9999<::aid-ijc1113>3.0.co;2-u] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Renal cell cancer is a unique solid tumor that occasionally shows spontaneous regression even at an advanced stage, of which the underlying mechanism is not well understood. To investigate a potential role of the pro-apoptotic molecule caspase-1 in the growth regulation of renal cell cancer, we created transfectants expressing exogenous caspase-1 from a murine renal cancer cell line, Renca. Overexpression of caspase-1 did not affect the growth of Renca cells in vitro at the exponential phase but induced apoptotic cell death at 50% to 75% confluence, whereas control cells underwent apoptosis only after reaching 100% confluence. When implanted into the flank of a syngeneic BALB/c mouse, caspase-1-overexpressing Renca cells did not effectively establish growth as a solid tumor, forming a measurable tumor in only 7 of 11 (64%) animals, whereas control cells formed a tumor in 6 of 6 (100%) animals. The growth of tumors from caspase-1-overexpressing cells slowed down markedly after the tumors reached 5 to 10 mm in diameter, and histological examination of such tumors revealed numerous apoptotic cells positively stained by TUNEL assay. Interestingly, endogenous caspase-1 was not detected in the tumors from control cells, which re-expressed caspase-1 when they were re-cultured and exposed to a demethylation reagent, 5-aza-2'-deoxycytidine. Furthermore, treatment of a human renal cancer cell line, ACHN, with 5-aza-2'-deoxycytidine also caused recovery of caspase-1 expression, which was not detected before treatment. These data suggest that silencing of caspase-1 through DNA methylation may be involved in the oncogenesis of some renal cell cancers growing as a solid tumor.
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Affiliation(s)
- T Ueki
- Department of Urology, University of Tokyo Hospital, Tokyo, Japan.
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Brinker DA, Amin MB, de Peralta-Venturina M, Reuter V, Chan DY, Epstein JI. Extensively necrotic cystic renal cell carcinoma: a clinicopathologic study with comparison to other cystic and necrotic renal cancers. Am J Surg Pathol 2000; 24:988-95. [PMID: 10895821 DOI: 10.1097/00000478-200007000-00010] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Renal cell carcinomas often show varying degrees of necrosis and cystic change. The prognostic importance of necrosis so extensive that only a few tumor cells can be identified is not clear. We gathered clinicopathologic and follow-up data on a group of eight such cases ("type I"). These patients were compared with two other groups of renal cell carcinomas: those with extensive necrosis (>50%), yet with readily identifiable tumor ("type II"), and cancers with extensive cystic change not resulting from necrosis, usually multiloculated ("type III"). The groups showed similar demographic characteristics, and within each group there was great variation in tumor size. Conventional (clear cell) histology was more common than papillary morphology in all groups. The type II neoplasms tended to be of higher nuclear grade and pathologic stage than the other groups. While one of six type I patients with follow up progressed 131 months after diagnosis, eight of 20 type II patients showed progression. None of the six type III patients with follow up progressed. We conclude that renal cell carcinomas showing extensive necrosis are capable of aggressive behavior, and patients with these lesions cannot be assured of cure following surgery. Pathologists must be aware of this entity and extensively sample any renal lesion showing extensive necrosis. The tumors showing a greater amount of viable neoplastic cells yet at least 50% necrosis had a higher rate of progression than did the type I patients. The lack of progression of any of the type III cases supports the idea that type III multiloculated cystic renal cell carcinomas may carry a distinctly better prognosis than other forms of renal cell carcinoma.
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Affiliation(s)
- D A Brinker
- Department of Pathology and The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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