Clear cell and papillary renal cell carcinomas in hereditary papillary renal cell carcinoma (HPRCC) syndrome: a case report

Occurrence of papillary renal cell carcinoma and clear cell renal carcinoma in a patient: A unique case report

RATIONALE

Renal cancer is one of the most common neoplasms in both males and females. Precise diagnosis, grading, and staging are very important for the outcome and the prognosis of the malignant process. Renal carcinoma disorders are presented by kidney tumors usually of the same histological type. The presence of various tumor histological types is an extremely rare event.

PATIENT CONCERNS

Two different histological types of tumors were found in the left kidney of a 74-year-old man.

DIAGNOSES

The diagnosis obtained was papillary renal cell carcinoma type 1 and clear cell renal carcinoma with pathologic stage T2N0M1.

INTERVENTIONS AND OUTCOMES

After abdominal ultrasound and computer tomography, consultation with an anesthesiologist, and a cardiologist, the patient underwent radical left nephrectomy.

LESSONS

Pathologists must be aware of the possibility of the presence of more than one histological type of renal carcinoma due to genomic alterations. Further genetic investigations must be conducted to identify the specific type and thus the treatment will be most precise.

Hereditary papillary renal cell carcinoma

Hereditary papillary renal cell carcinoma (HPRCC) is an autosomal dominant syndrome characterized by the occurrence of bilateral and multifocal, classic type papillary renal cell carcinomas. In the recent decades, extensive molecular studies have narrowed the molecular underpinnings of this syndrome to missense mutations in tyrosine kinase domain of MET proto-oncogene. Although MET mutations are specific to HPRCC, it has been found in sporadic papillary renal cell carcinomas and as recently reported, in biphasic squamoid alveolar variant of papillary renal cell carcinoma. Dual MET/VEGFR2 kinase inhibitor and tyrosine kinase inhibitors have shown promising results in systemic therapy for HPRCC.

Predicting COVID-19 prognosis in hospitalized patients based on early status

IMPORTANCE

COVID-19 remains the fourth leading cause of death in the United States. Predicting COVID-19 patient prognosis is essential to help efficiently allocate resources, including ventilators and intensive care unit beds, particularly when hospital systems are strained. Our PLABAC and PRABLE models are unique because they accurately assess a COVID-19 patient's risk of death from only age and five commonly ordered laboratory tests. This simple design is important because it allows these models to be used by clinicians to rapidly assess a patient's risk of decompensation and serve as a real-time aid when discussing difficult, life-altering decisions for patients. Our models have also shown generalizability to external populations across the United States. In short, these models are practical, efficient tools to assess and communicate COVID-19 prognosis.