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Clear Cell Renal Cell Carcinoma, Diagnostic and Therapeutic Difficulties, Case Report and Literature Review. Medicina (B Aires) 2022; 58:medicina58101329. [PMID: 36295490 PMCID: PMC9611557 DOI: 10.3390/medicina58101329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 11/26/2022] Open
Abstract
Nephroblastoma is the most common kidney tumour in children, constitutes about 85% of cases. Although renal cell carcinoma (RCC) is the second-most common kidney malignancy in children, it constitutes only about 2–6% of all cases. Currently, the basis of children’s RCC treatment is Umbrella Protocol of SIOP-RTSG, but, due to the rare diagnosis of this neoplasm in children, in difficult cases, treatment is based on the experience in adult patients with RCC. Nephrectomy improves prognosis and is usually performed at the first step of treatment. Acute kidney injury secondary to urolithiasis in a patient after nephrectomy due to RCC is a unique, very serious complication. Study design: We present a case of a 10-year-old boy with metastatic clear cell renal cell carcinoma (ccRCC) of the right kidney and an acute renal failure of the left kidney secondary to uric acid nephrolithiasis. Partial regression of the spread of ccRCC after 12.5-month treatment with sunitinib, followed by progression being observed and satisfactory effects and tolerance of nivolumab were observed later. Comorbidity of acute kidney injury during nephrolithiasis and ccRCC after nephrectomy in children is unique. Drugs used in the treatment clear cell carcinoma in adults (sunitinib and nivolumab), are also used in children with ccRCC.
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Grabowski J, Silberstein J, Saltzstein SL, Saenz N. Renal tumors in the second decade of life: results from the California Cancer Registry. J Pediatr Surg 2009; 44:1148-51. [PMID: 19524731 DOI: 10.1016/j.jpedsurg.2009.02.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Accepted: 02/17/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND Renal tumors are rare in adolescents and young adults. The aim of this study was to characterize the histologic condition, epidemiology, and survival of renal tumors in patients aged 11 to 20 years old using a large, population-based database. METHODS The California Cancer Registry was reviewed from the years 1988 to 2004. All renal tumors in patients aged 11 to 20 years old were identified. The data were analyzed with relation to patient age, sex and ethnicity, tumor histologic examination, and actuarial mortality rates. RESULTS Seventy-seven primary renal malignancies were identified. Thirty-nine (51%) were renal cell carcinoma, 23 (30%) were Wilms' tumor, and 15 (20%) were other tumor types. The mean age of the patients with renal cell carcinoma was 16.7 years old, which was significantly older than the Wilms' tumor patients (13.9 years; P < .01). The 5-year cumulative survival rate of patients with renal cell carcinoma was 54%, which was worse than that of Wilms' tumor patients (77%). CONCLUSION Primary renal malignancies are uncommon in the second decade of life. The most common tumor type in this age-group is renal cell carcinoma followed by Wilms' tumor. Patients with renal cell carcinoma tend to be older and have a lower survival than patients with other kidney tumors.
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Affiliation(s)
- Julia Grabowski
- Department of Surgery, University of California at San Diego, San Diego, CA 92013, USA.
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Silberstein J, Grabowski J, Saltzstein SL, Kane CJ. Renal cell carcinoma in the pediatric population: Results from the California Cancer Registry. Pediatr Blood Cancer 2009; 52:237-41. [PMID: 18937317 DOI: 10.1002/pbc.21779] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Renal cell carcinoma (RCC) is a rare disease in children and adolescents. This study aimed to review epidemiologic characteristics and survival for pediatric RCC patients using a large, population-based database. PROCEDURE The California Cancer Registry (CCR) was reviewed from 1988 to 2004. All cases of RCC in patients younger than 21 years were identified and annual age-adjusted incidence rates were determined for the overall population and subdivided by ethnicity. Tumors were classified by stage and grade, and actuarial mortality rates were calculated. RESULTS From 1988 to 2004, 43 cases of RCC were identified in patients younger than 21 years, accounting for 4.3% of all renal tumors in this age group. The overall annual age-adjusted incidence was 0.01/100,000 with the tumor more common in non-Hispanic blacks (0.03/100,000) compared to non-Hispanic whites (0.01/100,000), Hispanics (<0.01/100,000), and non-Hispanic Asians/Pacific Islanders (<0.01/100,000). The mean age at presentation was 15.4 years (SD 4.03, SE 0.615). RCC was identified more frequently in females (58.14%). At the time of presentation, 53.49% of tumors were localized, 20.93% were regionally advanced, and 25.58% were metastatic. The observed actuarial survival at 5 and 10 years was 61% (+/-15.7%). CONCLUSION Pediatric RCC is an uncommon and aggressive tumor that occurs most frequently in children in the second decade of life, more often in females and blacks. The epidemiological characteristics of this tumor differ from adult RCC and Wilms tumor, suggesting its distinctive biology and potential need for alternative treatment strategies.
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Affiliation(s)
- Jonathan Silberstein
- Division of Urology, Department of Surgery, University of California, San Diego, Medical Center, San Diego, California, USA.
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Selle B, Furtwängler R, Graf N, Kaatsch P, Bruder E, Leuschner I. Population-based study of renal cell carcinoma in children in Germany, 1980-2005: more frequently localized tumors and underlying disorders compared with adult counterparts. Cancer 2007; 107:2906-14. [PMID: 17109448 DOI: 10.1002/cncr.22346] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Childhood renal cell carcinomas (RCCs) differ histologically and biologically from their adult counterparts. The characteristics of RCC-affected children and their tumors, the influence of treatment, and outcome have so far not been studied in a nonselected, population-based cohort. METHODS A retrospective analysis was undertaken of RCC patients less than 16 years old reported to the German Childhood Cancer Registry and to the Kiel Paediatric Tumor Registry from 1980 to 2005. RESULTS Forty-nine RCC in children (24 boys, 25 girls) with a median age of 10.6 years were identified. In about every third child possibly RCC-related underlying disorders (tuberous sclerosis, neuroblastoma, teratoma with chemotherapy, Saethre-Chotzen syndrome, chronic renal failure) or related diseases in their family were found. The pathologic subtypes were papillary in 16 (33%), translocation type in 11 (22%), unclassified in 8 (16%), and rarely clear-cell (n = 3) or others. Thirty-four (69%) patients had localized RCC, 8 (16%) patients regional lymph node metastases, and 4 (8%) patients distant metastases. Event-free survival and overall survival rates at 5 years were 96% for localized RCC, 69% and 75% for regional lymph node-positive, 25% and 33% for distant metastatic RCC, respectively. Two of 4 patients with distant metastases received immunotherapy combined with chemotherapy and surgery, both are alive, 1 of them disease-free for 6.9 years. CONCLUSIONS Pediatric RCCs are predominantly localized diseases. Children with RCC frequently suffer underlying disorders. Survival rates in localized and regional lymph node-positive cases are favorable. Because of the rarity of RCC in childhood, an international study is necessary.
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Affiliation(s)
- Barbara Selle
- Department of Pediatric Hematology and Oncology, St. Annastift Children's Hospital, Ludwigshafen, Germany.
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5
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Abstract
Renal cell carcinoma arising from epithelial cells of the renal tubule is a highly aggressive and malignant tumor in all ages. Less than 2% of cases occur in childhood, relatively in older age group. Only a few pediatric series have been presented in the English literature. Tumor is presented with characteristic findings of flank pain, gross hematuria, and palpable mass. Although one half of the patients have metastasis at the time of diagnosis, most cases are currently being incidentally detected using improved imaging techniques. The overall prognosis in children appears to be similar to that in adults. Tumor stage and complete surgical resection have been reported as the most meaningful prognostic factors for the outcome. The incidence of metastatic disease is same as in adults. The effect of chemotherapy and immunotherapy, either preoperatively or postoperatively, is unclear. Cure is the most likely consequence in localized and completely resected tumors. Here, we present an 8-year-old boy with renal cell carcinoma demonstrating only hematuria without any pathological physical examination findings. The mass was described by abdominal ultrasonography and computed tomography in the left kidney. After the left nephroureterectomy, the patient was given no therapy.
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Affiliation(s)
- Ibrahim Otgün
- Department of Pediatric Surgery, Baskent University Faculty of Medicine, 06490 Bahçelievler Ankara, Turkey
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Geller JI, Dome JS. Local lymph node involvement does not predict poor outcome in pediatric renal cell carcinoma. Cancer 2004; 101:1575-83. [PMID: 15378495 DOI: 10.1002/cncr.20548] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Local lymph node involvement in adults with renal cell carcinoma (RCC) is associated with poor outcome. The prognostic significance of local lymph node involvement in children with RCC has not been studied systematically. METHODS A retrospective review of patients treated at St Jude Children's Research Hospital (Memphis, TN) and an extensive review of the medical literature were undertaken to evaluate the prognostic significance of local lymph node involvement in pediatric RCC. RESULTS Thirteen patients with the diagnosis of RCC were treated at St. Jude since the hospital's inception in 1962. Four patients presented with lymph node-positive, distant metastasis-negative (N + M0) disease, and all 4 remain disease free after resection without adjuvant therapy (follow-up duration, 2-9 years). A systematic review of the literature including 243 pediatric patients with RCC revealed stage-specific survival rates of 92.5%, 84.6%, 72.7%, and 12.7% for Stage I-IV disease, respectively. Of 58 children with N + M0 RCC for whom outcome data were available, 42 (72.4%) were alive without disease at last follow-up. Among patients whose therapy could be discerned, those who received no adjuvant therapy fared as well (15 of 16 alive) as those who received various adjuvant treatments (22 of 31 alive). CONCLUSIONS Children with lymph node-positive RCC in the absence of distant metastatic disease had a relatively favorable long-term prognosis, with survival rate nearly triple those of adult historical controls. Until highly effective therapies for RCC are identified, these children should not be exposed to adjuvant treatment. Further investigation of the biologic differences between adult and pediatric RCC is warranted.
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Affiliation(s)
- James I Geller
- Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
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7
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Indolfi P, Terenziani M, Casale F, Carli M, Bisogno G, Schiavetti A, Mancini A, Rondelli R, Pession A, Jenkner A, Pierani P, Tamaro P, De Bernardi B, Ferrari A, Santoro N, Giuliano M, Cecchetto G, Piva L, Surico G, Di Tullio MT. Renal cell carcinoma in children: a clinicopathologic study. J Clin Oncol 2003; 21:530-5. [PMID: 12560445 DOI: 10.1200/jco.2003.02.072] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To identify the prognostic factors, treatment, and outcome of children affected by renal cell carcinoma (RCC). PATIENTS AND METHODS The series included 41 patients (18 males and 23 females) with a median age of 124 months observed at the 11 Italian Association for Pediatric Hematology and Oncology centers from January 1973 to January 2001. Clinical data, surgical notes, pathologic findings, and summaries of therapy were taken from the charts. RESULTS Seven (17%) of the 41 patients had a papillary histology, and 34 (82.4%) had nonpapillary histology. Eighteen patients (43.9%) had stage I, one patient (2.4%) had stage II, two patients (4.8%) had stage IIIA, 10 patients (24.3%) had stage IIIB, and nine patients (21.9%) had stage IV disease. One patient had a bilateral involvement at diagnosis. Seven patients experienced disease recurrence. Lung and liver were the most common distant lesions and usually were fatal. In this study, the major factor influencing the prognosis was the stage. Event-free survival at 20 years was 53.5% for all patients. Overall survival at 20 years was 54.9% for all patients. CONCLUSION RCC is a rare disease in children and adolescents. This neoplasm has a different clinical presentation in children compared with adults but the same outcome. In our experience, patients with localized disease could be cured by nephrectomy alone. Prospective studies in a larger number of patients are needed to confirm radiation therapy and biologic response modifiers as effective adjunct therapy in RCC stage III. The alternative therapy seems warranted in patients with advanced disease.
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Affiliation(s)
- Paolo Indolfi
- Pediatric Oncology Service-Pediatric Department II, University of Napoli, Napoli, Italy.
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Cela de Julián M, Casanova Morcillo A, Vázquez Estévez J, Galarón García P, Niembro de Rasche E, Cantalejo López M. Carcinoma de células renales. An Pediatr (Barc) 2002. [DOI: 10.1016/s1695-4033(02)77942-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Uchiyama M, Iwafuchi M, Yagi M, Iinuma Y, Ohtaki M, Tomita Y, Hirota M, Kataoka S, Asami K. Treatment of childhood renal cell carcinoma with lymph node metastasis: two cases and a review of literature. J Surg Oncol 2000; 75:266-9. [PMID: 11135269 DOI: 10.1002/1096-9098(200012)75:4<266::aid-jso8>3.0.co;2-h] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Standard treatment for renal cell carcinoma (RCC) is radical nephrectomy with lymph node dissection. Stages I and II have encouraging prognoses, but Stage III with regional lymph node metastasis can be unfavorable. Adjuvant therapy for pediatric patients with advanced RCC with lymph node involvement or metastatic lesion has not been defined. Advanced pediatric RCC is reported in two patients (boys, aged 6 and 9 years: Stage IIIs, Robson; Stage III and IV, pTNM classification) treated by nephrectomy and lymph node dissection followed by postoperative interferon-alpha (IFN), that can be used as an adjuvant therapy with side effects such as fever, bone marrow suppression, or decreased liver function. One is doing well for 7 years, another is suffered from lung metastases at 3 years after surgery. Although immunotherapy is expected to improve survival in pediatric patients with advanced RCC, surgical resection of renal and metastatic tumors remains the standard treatment.
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Affiliation(s)
- M Uchiyama
- Department of Pediatric Surgery, Niigata University School of Medicine, Niigata, Japan.
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RENAL CELL CARCINOMA IN CHILDREN: EXPERIENCE AT A SINGLE INSTITUTION IN JAPAN. J Urol 1999. [DOI: 10.1097/00005392-199910000-00065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Anderson BW, Halverstadt DB, Culkin DJ, Johnson SF, Parkhurst JB, Kropp BP. Wilms' tumor with renal cell carcinoma overgrowth in a 3-year-old child. Urology 1998; 52:128-30. [PMID: 9671885 DOI: 10.1016/s0090-4295(98)00133-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Wilms' tumors that contain features of both renal cell carcinoma and classic Wilms' tumor histology are rare. Even though nine such cases have been previously reported in the literature, we report the first case of a Wilms' tumor with an overwhelmingly renal cell carcinoma histologic pattern.
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Affiliation(s)
- B W Anderson
- Department of Urology, University of Oklahoma, Oklahoma City, USA
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13
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Manion S, Hayani A, Husain A, Rink R, Hatch D. Partial nephrectomy for pediatric renal cell carcinoma: an unusual case presentation. Urology 1997; 49:465-8. [PMID: 9123719 DOI: 10.1016/s0090-4295(96)00498-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Nine years after successful treatment of Stage IV neuroblastoma, a 10-year-old white girl was demonstrated to have a complex cystic mass in the upper pole of her solitary right kidney. Partial nephrectomy was performed, disclosing a renal cell carcinoma, predominantly clear cell type. No metastases were detected. Renal cell carcinoma is a rare cause of secondary malignancy. Partial nephrectomy can be used successfully to treat renal cell carcinoma in children.
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Affiliation(s)
- S Manion
- Department of Urology, Loyola University Stritch School of Medicine, Illinois, USA
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14
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Freedman AL, Vates TS, Stewart T, Padiyar N, Perlmutter AD, Smith CA. Renal Cell Carcinoma in Children: The Detroit Experience. J Urol 1996. [DOI: 10.1016/s0022-5347(01)66178-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Andrew L. Freedman
- Departments of Pediatric Urology and Pathology, Children's Hospital of Michigan and Department of Urology, Henry Ford Hospital, Detroit, Michigan
| | - Thomas S. Vates
- Departments of Pediatric Urology and Pathology, Children's Hospital of Michigan and Department of Urology, Henry Ford Hospital, Detroit, Michigan
| | - Thomas Stewart
- Departments of Pediatric Urology and Pathology, Children's Hospital of Michigan and Department of Urology, Henry Ford Hospital, Detroit, Michigan
| | - Niru Padiyar
- Departments of Pediatric Urology and Pathology, Children's Hospital of Michigan and Department of Urology, Henry Ford Hospital, Detroit, Michigan
| | - Alan D. Perlmutter
- Departments of Pediatric Urology and Pathology, Children's Hospital of Michigan and Department of Urology, Henry Ford Hospital, Detroit, Michigan
| | - Craig A. Smith
- Departments of Pediatric Urology and Pathology, Children's Hospital of Michigan and Department of Urology, Henry Ford Hospital, Detroit, Michigan
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Aronson DC, Medary I, Finlay JL, Herr HW, Exelby PR, La Quaglia MP. Renal cell carcinoma in childhood and adolescence: a retrospective survey for prognostic factors in 22 cases. J Pediatr Surg 1996; 31:183-6. [PMID: 8632275 DOI: 10.1016/s0022-3468(96)90344-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
To identify prognostic factors for renal carcinoma in young patients, a retrospective analysis was performed of 22 patients (< or = 21 years of age) with histologically verified renal cell carcinoma. Demographic, staging, and treatment variables were collected in a database, and their effect on survival was determined using Kaplan-Meier probability distribution. The median age was 15.5 years (range, 3 to 21 years), and the male:female ratio was 13:9. Only three patients were black. Histopathologic examination showed 15 clear cell tumors, 4 mixed cell type, 2 papillary, and one well-differentiated adenocarcinoma. The median size of the primary tumor was 10 cm (range, 5 to 20). There were seven patients with stage I tumors, one with stage II, and 14 with stage IV. Complete resection of the primary tumor was accomplished in 12 patients. The overall 5-year survival rate was 30% (confidence interval, 20% to 40%). The 5-year survival rate was better for patients who had complete resection of the primary tumor (60% v 10%). Unresectability was associated with involvement of nodes and/or occurrence of metastases, thus an independent effect of complete resection on survival could not be demonstrated. The data showed that age, tumor size, location, and histology were not predictors of outcome; tumor stage and complete surgical resection were the only meaningful prognostic factors. The presentation of renal cell carcinoma as a localized or systemic disease may reflect a twofold biological behavior. In the first group, the disease is curable with resection, in the second, it is unaffected by surgery or adjuvant therapy. In light of the very low incidence of this renal malignancy in childhood, prospective multicenter studies will be required to improve the poor therapeutic results.
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Affiliation(s)
- D C Aronson
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Lotan D, Laufer J. Metastatic renal carcinoma in a pediatric recipient of an adult cadaveric donor kidney. Am J Kidney Dis 1995; 26:960-2. [PMID: 7503073 DOI: 10.1016/0272-6386(95)90063-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A 15-year old male with chronic renal failure secondary to obstructive uropathy received an adult cadaveric donor kidney. Evaluation for painless macroscopic hematuria occurring 2 years after transplantation disclosed a metastatic renal cell carcinoma, which by the use of restriction fragment length polymorphism analysis was shown to be of the donor's origin. Transplant nephrectomy and cessation of immunosuppressive therapy resulted in complete regression of multiple pulmonary metastases.
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Affiliation(s)
- D Lotan
- Pediatric Nephrology Unit, Chaim Sheba Medical Center, Tel Hashomer, Israel
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18
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Krigman HR, Bentley RC, Strickland DK, Miller CR, Dehner LP, Washington K. Anaplastic renal cell carcinoma following neuroblastoma. MEDICAL AND PEDIATRIC ONCOLOGY 1995; 25:52-9. [PMID: 7753003 DOI: 10.1002/mpo.2950250111] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Renal cell carcinoma is unusual in children. We report a case of anaplastic renal cell carcinoma arising in a 7-year-old girl following treatment for Stage III neuroblastoma. The renal cell carcinoma has unusual histologic and ultrastructural features, which are discussed. The case is further unusual in that few children with advanced stage neuroblastoma survive long enough to develop second malignant neoplasms.
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Affiliation(s)
- H R Krigman
- Department of Pathology, Duke University Medical Center, Durham, North Carolina 27710, USA
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Affiliation(s)
- S K Fernbach
- Radiology Department, Children's Memorial Hospital, Chicago, IL 60614, USA
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20
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Agrawal R, Picken M, Kinzler GJ, Hatch D, Moel DI. Renal cell carcinoma developing in the pediatric recipient of an adult cadaveric donor kidney. Pediatr Nephrol 1994; 8:595-7. [PMID: 7819010 DOI: 10.1007/bf00858138] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Renal cell carcinoma is an uncommon renal tumor in children, comprising between 1.8% and 6.3% of all malignant renal tumors of childhood (whereas renal cell carcinoma is the commonest renal tumor in adults). We describe a 15-year-old girl with chronic renal failure secondary to renal dysplasia and branchio-oto-renal syndrome, who received a cadaveric renal transplant at 8 years of age from a 25-year-old male donor. She developed severe chronic rejection 4 years after the transplant. A transplant nephrectomy was performed because of persistent gross hematuria. Histopathology of this graft showed chronic severe rejection and papillary necrosis. A fortuitous finding was a 1.5-cm renal cell carcinoma at one of the poles. We suggest that tumors which occur more commonly in adults and less commonly in children must be considered in children receiving adult organ transplants.
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Affiliation(s)
- R Agrawal
- Division of Pediatric Nephrology, Loyola University Medical Center, Maywood, Illinois 60153
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21
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MacArthur CA, Isaacs H, Miller JH, Ozkaynak F. Pediatric renal cell carcinoma: a complete response to recombinant interleukin-2 in a child with metastatic disease at diagnosis. MEDICAL AND PEDIATRIC ONCOLOGY 1994; 23:365-71. [PMID: 8058009 DOI: 10.1002/mpo.2950230409] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Renal cell carcinoma is a rare pediatric malignancy that appears to have a similar clinical outcome in children and adults. We review the experience of Childrens Hospital Los Angeles and compare it with the published pediatric series, reporting on seven cases from 1954 to the present. As in earlier pediatric series, we find that Stage I/II patients do well (five of five complete responses with prolonged disease-free survival) with surgical resection. As in other pediatric series, our only Stage III patient died of disease. We also report on a recent case of renal cell carcinoma, metastatic to lymph nodes and lung parenchyma at diagnosis (Stage IV). This patient was treated with high dose continuous infusion recombinant interleukin-2 and had a partial response. The patient attained a complete response following a second laparotomy and two subsequent cycles of recombinant interleukin-2. He is presently well, without evidence of disease, 3 1/2 years after diagnosis. The significance of this form of therapy to advanced renal cell carcinoma in childhood is discussed.
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Affiliation(s)
- C A MacArthur
- Department of Pediatrics, Childrens Hospital Los Angeles, University of Southern California School of Medicine 90027
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Burnett AL, Epstein JI, Gearhart JP. Spectrum of differentiation in pediatric epithelial tumors of kidney: report of two cases. Urology 1993; 42:93-8. [PMID: 8328132 DOI: 10.1016/0090-4295(93)90351-a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Two unusual presentations of childhood renal cell epithelial tumors including one whose unique clinical manifestation was polycythemia are described. One was a renal cell carcinoma which was so poorly differentiated that ancillary histopathologic techniques were necessary to arrive at the correct diagnosis. The other case represented the opposite extreme being so well-differentiated as to raise the differential diagnosis of renal cell carcinoma versus renal cell adenoma with blastemal areas. These case studies exemplify the practical role for specialized histopathologic techniques in diagnosing pediatric renal tumors, which may not be feasibly or even accurately categorized into known renal tumor types using routine diagnostic methods.
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Affiliation(s)
- A L Burnett
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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