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Filomena GB, Marino F, Scarciglia E, Russo P, Fantasia F, Bientinesi R, Ragonese M, Foschi N, Gulino G, Sacco E, Racioppi M. Simultaneous surgical management of renal cancer with atrial thrombotic extension and severe chronic coronary artery disease: a case report. J Med Case Rep 2023; 17:543. [PMID: 38087378 PMCID: PMC10717298 DOI: 10.1186/s13256-023-04292-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Renal cell carcinoma accounts for 2-3% of all malignant cancers in adults and is characterized by the potential development of venous tumor thrombus. CASE PRESENTATION We present a rare case of a 62-year-old Caucasian man who arrived in the emergency department for monosymptomatic hematuria. Further investigation revealed a right renal cell carcinoma with 16 cm intravascular extension through the renal vein into the inferior vena cava and right atrium associated with significant coronary artery disease based on the computed tomography scan and coronary angiography. To the best of our knowledge, after an extensive literature review, only one similar case has been reported with involvement of the contralateral kidney. Therefore, there are no applicable management recommendations. After performing coronary artery bypass graft surgery, we proceeded with an open right radical nephrectomy and inferior vena cava and right atrium thrombectomy under cardiopulmonary bypass and while the patient's heart was still beating. The postoperative course went without complications, and the patient was discharged from the hospital on the 10th postoperative day. CONCLUSIONS Radical nephrectomy and thrombectomy with reconstruction of the inferior vena cava combined with coronary artery bypass graft can be performed safely and effectively in selected patients with renal cell carcinoma and significant coronary artery disease. Multidisciplinary teamwork and careful patient selection are essential for optimal outcomes.
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Affiliation(s)
- Giovanni Battista Filomena
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Filippo Marino
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eros Scarciglia
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pierluigi Russo
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabrizio Fantasia
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Bientinesi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mauro Ragonese
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nazario Foschi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gaetano Gulino
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emilio Sacco
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Racioppi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Bientinesi R, Pizzuto D, Coluzzi S, Annunziata S, Scarciglia E, Totaro A, Gandi C, Boldrini L, Bassi P, Sacco E. Choline PET/CT radiomic analysis for newly diagnosed prostate cancer: An early monocentric experience. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02358-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Totaro A, Campetella M, Bientinesi R, Gandi C, Palermo G, Ragonese M, Scarciglia E, Dibitetto F, Akhundov A, Nigro D, Bassi P, Sacco E. Perioperative outcomes of RARP performed with the new surgical robotic platform Hugo(TM) RAS: Early experience. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02149-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Santoro AA, Di Gianfrancesco L, Racioppi M, Pinto F, Palermo G, Sacco E, Campetella M, Scarciglia E, Bientinesi R, Di Paola V, Totaro A. Multiparametric magnetic resonance imaging of the prostate: Lights and shadows. Urologia 2021; 88:280-286. [PMID: 34075837 DOI: 10.1177/03915603211019982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Prostate cancer is the second most commonly diagnosed cancer in man. Since the first MRI was performed, enormous progress has been made in diagnosis, treatment, and follow up of PCa, mainly due to multiparametric prostatic MRI (mpMRI). Although mpMRI has become the best imaging tool for identifying PCa, some limitations still exist. Prostate imaging with mpMRI is, to date, the best way to locate suspicious lesions to trigger prostate biopsy, plan active surveillance, or definitive treatment. In case of relapse, mpMRI can help detect local disease and provide specific management. It is well known that there is a subset of patients in whom mpMRI fails to depict csPCa. These missed significant cancers demand great attention. Prostate mpMRI quality depends on several factors related to equipment (including equipment vendor, magnet field and gradient strength, coil set used, software and hardware levels, sequence parameter choices), patient (medications, body habitus, motion, metal implants, rectal gas), and most importantly the radiologic interpretation of images (learning curve effects, subjectivity of observations, interobserver variations, and reporting styles). Inter-reader variability represents a huge current limitation of this method. Therefore, mpMRI remains the best imaging tool available to detect PCa, guiding diagnosis, treatment, and follow up while inter-reader variability represents the best limitation. Radiomics can help identifying imaging biomarkers to help radiologist in detecting significant PCa, reducing examination times, and costs.
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Affiliation(s)
- Agostino Antonio Santoro
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Luca Di Gianfrancesco
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Marco Racioppi
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Francesco Pinto
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Giuseppe Palermo
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Emilio Sacco
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Marco Campetella
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Eros Scarciglia
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Riccardo Bientinesi
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Valerio Di Paola
- Department of Radiology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Angelo Totaro
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
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Lenci N, Francesco P, Scarciglia E, Fiorentino V, Schino M, Palermo G, Racioppi M, Bassi P, Martini M. Metanephric adenoma with BRAF V600K mutation and a doubtful radiological imaging: pitfalls in the diagnostic process. Med Mol Morphol 2020; 54:187-191. [PMID: 33175195 PMCID: PMC8139902 DOI: 10.1007/s00795-020-00269-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/22/2020] [Indexed: 01/15/2023]
Abstract
Metanephric adenoma (MA) is an uncommon benign renal tumor whose histomorphological aspect resembles that of Wilms’ tumor and papillary renal cell carcinoma. From a diagnostic and therapeutic perspective, recognition of this entity is important as it has a more favorable clinical outcome compared with Wilms’ tumor and papillary renal cell carcinoma. MA should not be treated with nephrectomy if the tumor size is small, opting for a conservative treatment. However, the preoperative diagnosis of this disease is extremely challenging. The present study describes a case of this rare disease, showing an ambiguous radiological imaging and that only after a percutaneous biopsy, was defined as a MA and treated with partial nephrectomy. Moreover, the histological diagnosis of this case was partially complicated by the equivocal immunohistochemical analysis showing negativity for BRAF VE1 staining. Only the mutational analysis demonstrated the presence of the BRAF V600K mutation (for the first time described in a case of metanephric adenoma), highlighting the necessity of sequencing in case of MA with negativity for BRAF VE1 clone.
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Affiliation(s)
- Niccolo Lenci
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Pierconti Francesco
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy.,Divisione di Anatomia Patologica, Dipartimento di scienze della vita e sanità pubblica, Università Cattolica del Sacro Cuore A. Gemelli, Rome, Italy
| | - Eros Scarciglia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Vincenzo Fiorentino
- Divisione di Anatomia Patologica, Dipartimento di scienze della vita e sanità pubblica, Università Cattolica del Sacro Cuore A. Gemelli, Rome, Italy
| | - Mattia Schino
- Divisione di Anatomia Patologica, Dipartimento di scienze della vita e sanità pubblica, Università Cattolica del Sacro Cuore A. Gemelli, Rome, Italy
| | - Giuseppe Palermo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Marco Racioppi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy.,Divisione di Urologia, Dipartimento di medicina e chirurgia traslazionale, Università Cattolica del Sacro Cuore A. Gemelli, Rome, Italy
| | - Pierfrancesco Bassi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy.,Divisione di Urologia, Dipartimento di medicina e chirurgia traslazionale, Università Cattolica del Sacro Cuore A. Gemelli, Rome, Italy
| | - Maurizio Martini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy. .,Divisione di Anatomia Patologica, Dipartimento di scienze della vita e sanità pubblica, Università Cattolica del Sacro Cuore A. Gemelli, Rome, Italy.
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Di Gianfrancesco L, Ragonese M, Palermo G, Sacco E, Akhundov A, Scarciglia E, Gandi C, Gulino G, Bassi P, Racioppi M. Could the therapeutic response in patients with non-muscle invasive bladder cancer be affected by chronic urinary retention? EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)36262-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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