Diagnostic and interventional radiology is a milestone in the management of renal tumors in Birt-Hugg-Dubé syndrome

Percutaneous Thermal Ablation for Renal Tumors in Patients with Birt–Hogg–Dubé Syndrome

BHD syndrome is characterized by an increased risk of bilateral and multifocal renal cell carcinoma (RCCs), but is rarely metastatic. Our report aims to analyze the outcome of patients with BHD syndrome who underwent percutaneous thermal ablation (TA). The present report included six BHD syndrome patients (five men) with a mean age of 66 ± 11 (SD) years who had a proven germline FLCN gene mutation and underwent TA for a renal tumor. Nineteen renal tumors (median two tumors per patient; range: 1–3), including seven chromophobe RCCs, five clear-cell RCCs, four papillary RCCs, two clear-cell papillary RCC, and one hybrid oncocytic/chromophobe tumor were treated in 14 ablation sessions. The mean size of the tumors was 21 ± 11 (SD) mm (median: 20 mm; interquartile range (IQR): 14–25 mm) for a mean volume of 7 ± 11 (SD) mL (median: 3; IQR: 1–5 mL). Technical success was achieved in all ablation sessions (primary success rate, 100%). The procedure was well tolerated under conscious sedation with no significant Clavien–Dindo complication (grade 2, 3, 4). All patients were alive with no distant metastasis during a median follow-up period of 74 months (range: 33–83 months). No local tumor progression was observed. The mean decrease in estimated glomerular filtration rate was 8 mL/min/1.73 m2. No patients required dialysis or renal transplantation. In this case series, percutaneous TA appeared as a safe and efficient nephron-sparing treatment for treating RCCs associated with BHD syndrome, even in the case of advanced chronic kidney disease.

Birt-Hogg-Dubé syndrome with rare unclassified renal cell carcinoma: A case report

INTRODUCTION

Birt-Hogg-Dubé syndrome (BHDS) is a rare genetic disease. Renal cell carcinoma is the most serious complication of BHDS. The histological types of BHDS-related renal cell carcinoma are mostly mixed chromophobe/eosinophil and chromophobe cell types. BHDS with unclassified renal cell carcinoma is extremely rare.

PATIENT CONCERNS

A 37-year-old man was admitted to the hospital because of lumbago and hematuria.

DIAGNOSIS

Combined with abdominal enhanced CT and pulmonary CT, BHDS complicated with renal cell carcinoma was diagnosed, and right partial nephrectomy was performed. The postoperative pathological diagnosis was unclassified renal cell carcinoma. Gene detection revealed the FLCN frameshift mutation.

OUTCOMES

No signs of recurrence were observed after regular follow-up.

CONCLUSION

The pathogenesis of BHDS has not been fully elucidated, and the pathological type of BHDS with unclassified renal cell carcinoma is extremely rare. Through case presentation and review of related literature, this paper summarizes the diagnosis and treatment of BHDS complicated with unclassified renal cell carcinoma.

CT evaluation of patent artery after percutaneous cryoablation of renal cell carcinoma

PURPOSE

The purpose of this retrospective study was to determine the incidence of persistent patent artery after percutaneous cryoablation of renal cell carcinoma (RCC) and the relationship between patent arteries one month after cryoablation and early tumor progression.

MATERIALS AND METHODS

One hundred and fifty-nine patients (112 men, 47 women; mean age, 63.6±14.6 [SD] years; age range: 21-91 years) who underwent percutaneous cryoablation for 186 RCCs (mean diameter, 1.9±0.6 [SD] cm; range: 0.7-4.0cm) were retrospectively included. After cryoablation, patients underwent contrast-enhanced computed tomography (CT) with ≤2-mm slice thickness within one week from cryoablation, and at one, three, and six months. The time course of patent artery in the ablated renal parenchyma after cryoablation was the primary endpoint. The relationships between patent arteries one month after cryoablation and treatment effectiveness, tumor vascularity, tumor enhancement one month after cryoablation, tumor subtype, and renal function changes were evaluated as secondary endpoints.

RESULTS

CT showed patent arteries in the ablated renal parenchyma within one week in 166 RCCs (89.2%), at one month in 54 RCCs (29.0%), at three months in 8 RCCs (4.3%), and at six months in 2 RCCs (1.1%). The presence of patent artery one month after cryoablation was significantly associated with tumor enhancement at the same time point (P=0.015). There was no association between patent arteries one month after cryoablation and treatment effectiveness (P=0.693).

CONCLUSION

Patent arteries in the ablated renal parenchyma are commonly observed on CT examination after percutaneous cryoablation of RCC. However, they gradually disappear and do not require specific treatment.

A case of bilateral renal oncocytomas in the setting of Birt-Hogg-Dube syndrome

Birt-Hogg-Dube syndrome is a rare autosomal dominant disorder characterized by pulmonary cysts, renal tumors, and dermal lesions. This syndrome results from a mutation in the gene folliculin, located on chromosome 17p11.2. Herein, a case is described in which the presence of bilateral renal oncocytomas led to the diagnosis of Birt-Hogg-Dube syndrome via an interdisciplinary effort by radiology, pathology, and primary care medicine. No radiographic features alone are sufficient to confirm the diagnosis of Birt-Hogg-Dube. A high index of suspicion must be maintained by both the pathologist and radiologist in the appropriate clinical setting.

3D-printed face protective shield in interventional radiology: Evaluation of an immediate solution in the era of COVID-19 pandemic

Purpose

The purpose of this study was to report the clinical evaluation of a 3D-printed protective face shield designed to protect interventional radiologists from droplet transmission of the SARS-Cov-2.

Materials and methods

A protective face shield consisting in a standard transparent polymerizing vinyl chloride (PVC) sheet was built using commercially available 3D printers. The 3D-printed face shield was evaluated in 31 interventional procedures in terms of ability to perform the assigned intervention as usual, quality of visual comfort and tolerance using a Likert scale (from 1, as very good to 5, as extremely poor).

Results

The mean rating for ability to perform the assigned intervention as usual was 1.7 ± 0.8 (SD) (range: 1–4). The mean visual tolerance rating was 1.6 ± 0.7 (SD) (range: 1–4). The mean tolerability rating was 1.4 ± 0.7 (SD) (range: 1–3).

Conclusion

The 3D-printed protective face shield is well accepted in various interventions. It may become an additional option for protection of interventional radiologists.