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Liu Y, Wang J. Inflammatory myofibroblastic tumors of the bladder in a 20-year-old female. Asian J Surg 2023; 46:5567-5568. [PMID: 37777404 DOI: 10.1016/j.asjsur.2023.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/06/2023] [Indexed: 10/02/2023] Open
Affiliation(s)
- Yijie Liu
- Department of Urology, The Second Affiliated Hospital, Kunming Medical University, Kunming, 650000, Yunnan Province, China
| | - Jiansong Wang
- Department of Urology, The Second Affiliated Hospital, Kunming Medical University, Kunming, 650000, Yunnan Province, China.
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2
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Guan HY, Wang J, Wang JX, Chen QH, Lu J, He L. Renal pelvis sarcomatoid carcinoma with renal vein tumor thrombus: A case report and literature review. World J Clin Cases 2023; 11:7690-7698. [DOI: 10.12998/wjcc.v11.i31.7690] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/06/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Renal pelvis sarcomatoid carcinoma (RPSC) is a rare and aggressive malignancy whose diagnosis is difficult because radiological imaging results can lead to misclassification as a more common type of renal tumor. In addition, clinical management of patients with RPSC is difficult because of the limited efficacy of available treatments. In this study, we present a comprehensive description of a patient who presented with RPSC and a simultaneous renal vein tumor thrombus.
CASE SUMMARY During April, 2020, a 64-year-old female presented with an isolated episode of hematuria accompanied by abdominal pain. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a lesion in the right renal pelvis. We therefore performed a radical nephrectomy of the right kidney. The subsequent histopathological and immunological results verified the diagnosis of RPSC. Despite administration of 6 cycles of a gemcitabine-cisplatin regimen, the patient's condition progressively deteriorated, and she died about 15 mo after the nephrectomy.
CONCLUSION We performed a comprehensive analysis of a patient with RPSC that included CT, MRI, immunohistochemistry, and genetic testing. The insights from our detailed analysis of this patient and our concomitant review of the literature may assist clinicians in their diagnosis and treatment of RPSC.
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Affiliation(s)
- Huai-Yong Guan
- Department of Urology, Jilin University First Hospital, Changchun 130000, Jilin Province, China
| | - Jin Wang
- Department of Urology, Jilin University First Hospital, Changchun 130000, Jilin Province, China
| | - Ji-Xue Wang
- Department of Urology, Jilin University First Hospital, Changchun 130000, Jilin Province, China
| | - Qi-Hui Chen
- Department of Urology, Jilin University First Hospital, Changchun 130000, Jilin Province, China
| | - Ji Lu
- Department of Urology, Jilin University First Hospital, Changchun 130000, Jilin Province, China
| | - Liang He
- Department of Urology, Jilin University First Hospital, Changchun 130000, Jilin Province, China
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Ren D, Niu C, Wei K, Ifegwu I. 10-Year observation of a rare presentation of pure fibromyxoid nephrogenic adenoma in the renal pelvis. Urol Case Rep 2023; 51:102601. [PMID: 37965121 PMCID: PMC10641596 DOI: 10.1016/j.eucr.2023.102601] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/22/2023] [Indexed: 11/16/2023] Open
Abstract
Nephrogenic adenoma (NA) is an unusual benign epithelial tumor in the genitourinary tract. Here we report a fibromyxoid nephrogenic adenoma in a 37-year-old female presenting with over 10-year slow-growing renal pelvic mass that was diagnosed with bland spindle cell lesion in multiple previous biopsies. This is the first reported case of pure fibromyxoid NA in renal pelvis with close comparison and correlation of biopsy and resection findings over a 10-year span. This will enhance awareness of pathologists to consider this unusual entity when examining spindle cell lesions in this setting, and prevent misdiagnosis and overtreatment of a typically benign process.
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Affiliation(s)
- Dong Ren
- Department of Pathology and Laboratory Medicine, University of California Irvine Medical Center, Orange, CA, 92868, USA
| | - Chenchen Niu
- Department of Pathology and Laboratory Medicine, University of California Irvine Medical Center, Orange, CA, 92868, USA
| | - Katherine Wei
- Department of Radiology, University of California Irvine Medical Center, Orange, CA, 92868, USA
| | - Ibe Ifegwu
- Department of Pathology and Laboratory Medicine, University of California Irvine Medical Center, Orange, CA, 92868, USA
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Pinar U, Calleris G, Grobet-Jeandin E, Grande P, Benamran D, Thibault C, Gontero P, Rouprêt M, Seisen T. The role of perioperative chemotherapy for upper tract urothelial carcinoma patients treated with radical nephroureterectomy. World J Urol 2023; 41:3205-3230. [PMID: 36905443 DOI: 10.1007/s00345-023-04330-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/05/2023] [Indexed: 03/12/2023] Open
Abstract
PURPOSE To summarize evidence regarding the use of neoadjuvant (NAC) and adjuvant chemotherapy (AC) among patients treated with radical nephroureterectomy (RNU). METHODS A comprehensive literature search of PubMed (MEDLINE), EMBASE and the Cochrane library was performed to identify any original or review article on the role of perioperative chemotherapy for UTUC patients treated with RNU. RESULTS With regards to NAC, retrospective studies consistently suggested that it may be associated with better pathological downstaging (pDS) ranging from 10.8 to 80% and complete response (pCR) ranging from 4.3 to 15%, while decreasing the risk of recurrence and death as compared to RNU alone. Even higher pDS ranging from 58 to 75% and pCR ranging from 14 to 38% were observed in single-arm phase II trials. With regards to AC, retrospective studies provided conflicting results although the largest report from the National Cancer Database suggested an overall survival benefit in pT3-T4 and/or pN + patients. In addition, a phase III randomized controlled trial showed that the use of AC was associated with a disease-free survival benefit (HR = 0.45; 95% CI = [0.30-0.68]; p = 0.0001) in pT2-T4 and/or pN + patients with acceptable toxicity profile. This benefit was consistent in all subgroups analyzed. CONCLUSIONS Perioperative chemotherapy improves oncological outcomes associated with RNU. Given the impact of RNU on renal function, the rational is stronger for the use of NAC which impacts final pathology and potentially prolongs survival. However, the level of evidence is stronger for the use of AC that has been proven to decrease the risk of recurrence after RNU with a potential survival benefit.
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Affiliation(s)
- Ugo Pinar
- GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière, Urology, Sorbonne University, 75013, Paris, France
| | - Giorgio Calleris
- Department of Urology, San Giovanni Battista Hospital, Città Della Salute E Della Scienza and University of Turin, Turin, Italy
| | | | - Pietro Grande
- GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière, Urology, Sorbonne University, 75013, Paris, France
| | - Daniel Benamran
- Division of Urology, Geneva University Hospitals, Geneva, Switzerland
| | - Constance Thibault
- Department of Medical Oncology, Hopital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, AP-HP Centre, Paris, France
| | - Paolo Gontero
- Department of Urology, San Giovanni Battista Hospital, Città Della Salute E Della Scienza and University of Turin, Turin, Italy
| | - Morgan Rouprêt
- GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière, Urology, Sorbonne University, 75013, Paris, France
| | - Thomas Seisen
- GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière, Urology, Sorbonne University, 75013, Paris, France.
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Lin BH, Chen SH, Chen SM, Qiu QRS, Gao RC, Wei Y, Zheng QS, Miao WB, Xu N. Head-to-head comparisons of 68Ga-PSMA-11 and 18F-FDG PET/CT in evaluating patients with upper tract urothelial carcinoma: a prospective pilot study. Int Urol Nephrol 2023; 55:2753-2764. [PMID: 37477778 DOI: 10.1007/s11255-023-03710-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE To prospectively compare the uptake of 68Ga-prostate specific membrane antigen (68Ga-PSMA)-11 and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in upper tract urothelial carcinoma (UTUC) and investigate the correlation between radiological parameters and pathological features of UTUC. METHODS Clinicopathologic and imaging data were collected from 10 UTUC patients who underwent preoperative 68Ga-PSMA-11 and 18F-FDG PET/CT scans. The diagnostic capabilities of both imaging techniques were analyzed and compared in UTUC. Angiogenesis in the malignancies was assessed using Chalkley counting and the expression of folate hydrolase 1 (FOLH1) and glucose transporter 1 (GLUT1) in UTUC were evaluated in the surgical specimens. Double immunofluorescence staining of PSMA and CD34 was used to examine tumor neovascularization. Tracer uptake and expression were compared and explored. Additionally, 10 patients with clear cell renal cell carcinoma (ccRCC) were included for prospective, comparative research. RESULTS Ten UTUC patients with 12 malignant lesions and another 10 ccRCC patients were included. 18F-FDG PET/CT demonstrated a more effective detection of UTUC foci compared to 68Ga-PSMA-11 PET/CT (the SUVmax of 18.48 ± 6.73 vs. 4.38 ± 1.45, P < 0.01). Immunohistochemical analysis revealed a statistically significant difference in the expression of PSMA and GLUT1 in UTUC (P = 0.048), with higher pathological grades showing more intense GLUT1 staining than PSMA (75% vs. 12.5%). The Chalkley counting of angiogenesis in ccRCC was significantly higher than that in UTUC (229.34 vs. 71.67), which was proportional to 68Ga-PSMA-11 PET/CT SUVmax (both P < 0.05). CONCLUSION 18F-FDG PET/CT holds better clinical potential for evaluating UTUC and detecting lymph node metastasis compared to 68Ga-PSMA-11 PET/CT, likely due to the relatively scant expression of FOLH1 in tumor neovascular endothelium while the abundant expression of GLUT1 in malignancy. Furthermore, the lower neovascular density in UTUC should not be overlooked.
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Affiliation(s)
- Bo-Han Lin
- Department of Urology, Urology Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
- Department of Urology, National Region Medical Centre, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Shao-Hao Chen
- Department of Urology, Urology Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
- Department of Urology, National Region Medical Centre, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Shao-Ming Chen
- Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
| | - Qian-Ren-Shun Qiu
- Department of Urology, Urology Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
- Department of Urology, National Region Medical Centre, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Rui-Cheng Gao
- Department of Urology, Urology Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
- Department of Urology, National Region Medical Centre, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Yong Wei
- Department of Urology, Urology Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
- Department of Urology, National Region Medical Centre, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Qing-Shui Zheng
- Department of Urology, Urology Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
- Department of Urology, National Region Medical Centre, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Wei-Bing Miao
- Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China.
- Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China.
| | - Ning Xu
- Department of Urology, Urology Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China.
- Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China.
- Department of Urology, National Region Medical Centre, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
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Nagy D, Ellinger J, Ritter M, Pelusi N, Kristiansen G. Inflammatory fibroid polyp of the renal pelvis: first report at an extra-gastrointestinal site with molecular confirmation. Virchows Arch 2023; 483:535-539. [PMID: 37184764 PMCID: PMC10611610 DOI: 10.1007/s00428-023-03557-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/16/2023]
Abstract
Inflammatory fibroid polyps (IFP) are rare and benign mesenchymal tumours of the gastrointestinal tract. They are submucosal spindle cell lesions with an eosinophilic-rich inflammatory infiltrate and mutations in the platelet-derived growth factor receptor alpha (PDGFRA) gene. In this report, we present the case of a 74-year-old female with a solid tumour of the kidney, which presented as a bland proliferation of spindle cells with thin-walled blood vessels and an inflammatory infiltrate with eosinophilic granulocytes. Immunohistochemistry revealed a positivity for vimentin and a weak staining for CD99 and CD34 in the spindle cells. Because of the morphological similarity to IFPs of the gastrointestinal tract, a molecular pathology analysis was performed. This identified an oncogenic mutation in exon 18 of the PDGFRA gene, which is characteristic for inflammatory fibroid polyps of the gastrointestinal tract. To the best of our knowledge, this is the first case of an IFP in the urogenital tract.
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Affiliation(s)
- Dora Nagy
- Institute of Pathology, University Hospital Bonn (UKB), Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Jörg Ellinger
- Clinic for Urology, University Hospital Bonn (UKB), Bonn, Germany
| | - Manuel Ritter
- Clinic for Urology, University Hospital Bonn (UKB), Bonn, Germany
| | - Natalie Pelusi
- Institute of Pathology, University Hospital Bonn (UKB), Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Glen Kristiansen
- Institute of Pathology, University Hospital Bonn (UKB), Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
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Li LL, Song PX, Xing DF, Liu K. Early diagnosis of renal pelvis villous adenoma: A case report. World J Clin Cases 2023; 11:6159-6164. [PMID: 37731564 PMCID: PMC10507558 DOI: 10.12998/wjcc.v11.i26.6159] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/12/2023] [Accepted: 07/25/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Villous adenoma is a rare tumor in the urinary system that usually occurs in the bladder. It is extremely uncommon in the renal pelvis. Most of the previously reported cases have been diagnosed with severe hydronephrosis associated with renal parenchyma atrophy prior to surgery. Because of its rarity, available information on the pathogenesis, diagnosis, treatment and prognosis of the disease is limited. We reported a case of kidney stones with hydronephrosis. During percutaneous nephroscopic lithotripsy, a renal pelvis tumor was found. Biopsy confirmed that the tumor was a villous adenoma of the renal pelvis. CASE SUMMARY A 68-year-old female was admitted to the hospital due to right kidney stones with right hydronephrosis. After admission, a urinary system plain computed tomography scan was performed, which revealed right kidney stones with right hydronephrosis and right upper ureteral dilatation. Multiple new cauliflower-like papillary masses were then discovered in the renal pelvis and calyces during right percutaneous nephroscopic lithotripsy. Biopsy results indicated villous adenoma with high-grade glandular intraepithelial neoplasia. The patient underwent laparoscopic radical resection of the right kidney and ureter. Based on histopathological and immunohistochemical examination, the patient was diagnosed with villous adenoma without adenocarcinoma. CONCLUSION Villous adenoma is rare in the urinary system. We reported a case of renal pelvis villous adenoma, which may provide useful information for the early diagnosis and treatment of this tumor.
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Affiliation(s)
- Liang-Liang Li
- Department of Urology, Fuyang Hospital of Anhui Medical University, Fuyang 236000, Anhui Province, China
| | - Pei-Xing Song
- Department of Urology, Fuyang Hospital of Anhui Medical University, Fuyang 236000, Anhui Province, China
| | - De-Fu Xing
- Department of Urology, Fuyang Hospital of Anhui Medical University, Fuyang 236000, Anhui Province, China
| | - Kun Liu
- Department of Urology, Fuyang Hospital of Anhui Medical University, Fuyang 236000, Anhui Province, China
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8
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Shen C, Ying XR, Wu GF, Xia D. [Three cases of primary small cell neuroendocrine carcinoma of the upper urinary tract and review of the literature]. Zhonghua Zhong Liu Za Zhi 2023; 45:525-529. [PMID: 37355472 DOI: 10.3760/cma.j.cn112152-20220331-00221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Affiliation(s)
- C Shen
- Department of Urology, Shaoxing People's Hospital, Shaoxing 312000, China
| | - X R Ying
- Department of Urology, Shaoxing People's Hospital, Shaoxing 312000, China
| | - G F Wu
- Department of Urology, Shaoxing People's Hospital, Shaoxing 312000, China
| | - D Xia
- Department of Urology, the First Affiliated Hospital of Zhejiang University, Hangzhou 310000, China
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9
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Bi Y, Jiao D, Zhang J, Wang Y, Su M, Ren J, Han X. Clinical outcomes of intraluminal Iodine-125 seed strand brachytherapy and percutaneous nephrostomy in patients with ureteral carcinoma. BMC Cancer 2023; 23:517. [PMID: 37308873 DOI: 10.1186/s12885-023-10921-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/05/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND We aimed to evaluate the safety and efficacy of intraluminal iodine-125 seed strand brachytherapy and percutaneous nephrostomy in patients with ureteral carcinoma. METHODS From January 2014 to January 2023, 48 patients with ureteral cancer not suitable for surgical resection were enrolled. Iodine-125 seed strand was inserted in 26 patients under c-arm CT and fluoroscopic guidance (Group A), and 22 patients underwent percutaneous nephrostomy without seed strand (Group B). The clinical outcomes (technical success rate, tumor sizes, hydronephrosis Girignon grade, complications, objective response rate (ORR), disease control rate (DCR), and survival time) were evaluated and compared. RESULTS A total of 53 seed strands were successfully inserted and replaced in Group A, with a technical success rate of 100%. No procedure-related death or severe complications occurred in both group. Migration of seed strand or drainage tube was the most common complication. The Girignon grade of hydronephrosis was significantly improved 1, 3 and 6 months after procedure in both groups. DCR in Group A were 96.2%, 80.0%, and 70.0% at 1-, 3-, and 6-month follow up, respectively. At 1 and 6 months later, ORR in Group A were significantly higher than those in Group B (p < 0.05). The median overall survival were 30.0 months in Group A and 16.1 months in Group B, respectively (p = 0.04). The median progression-free survival were 11.1 months in Group A and 6.9 months in Group B, respectively (p = 0.09). CONCLUSION Intraluminal Iodine-125 seed strand brachytherapy and percutaneous nephrostomy is safe and effective in patients with ureteral carcinoma, with higher ORR and median overall survival than patients underwent percutaneous nephrostomy without seed strand.
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Affiliation(s)
- Yonghua Bi
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, No.1, East Jian She Road, 450052, Zhengzhou, China
| | - Dechao Jiao
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, No.1, East Jian She Road, 450052, Zhengzhou, China
| | - Jianhao Zhang
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, No.1, East Jian She Road, 450052, Zhengzhou, China
| | - Yang Wang
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, No.1, East Jian She Road, 450052, Zhengzhou, China
| | - Mengdan Su
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, No.1, East Jian She Road, 450052, Zhengzhou, China
| | - Jianzhuang Ren
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, No.1, East Jian She Road, 450052, Zhengzhou, China.
| | - Xinwei Han
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, No.1, East Jian She Road, 450052, Zhengzhou, China
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10
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Wu DJ, Wong MN, Lee CT, Zynger DL. The Stratification of Positive Lymph Nodes into pN1 and pN2 for Upper Urinary Tract Carcinoma is not Prognostically Significant. Hum Pathol 2023; 137:48-55. [PMID: 37088434 DOI: 10.1016/j.humpath.2023.04.010] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/09/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
The 3rd-7th edition of the American Joint Committee on Cancer had 3 categories for positive lymph nodes (pN1-3) in upper urinary tract carcinoma. The 8th edition removed pN3, defining pN1 as one lymph node with tumor deposit ≤ 2 cm and pN2 as a node with tumor deposit > 2 cm or metastases in multiple nodes. The aim of this study was to assess if the current pN categories impact survival in renal pelvic and ureteral carcinoma. Nephroureterectomies performed at our institution for primary upper urinary tract carcinoma between 2010-2019 were reviewed. Lymphadenectomy was performed in 73.3% of cases (151/206, median 9 nodes). Eighty-one (53.6%) patients were deceased at last review [pN0, 53 (44.5%); pN1-2, 28 (87.5%)]. There was no difference in overall or recurrence free survival between pN1 and pN2 with 5-year overall survival (95% confidence interval) of pN0, 60.7% (52.0-70.8%); pN1, 15.4% (4.3-35.2%); and pN2, 21.1% (8.8-40.3%). The metastatic deposit size threshold of 2 cm, number of positive lymph nodes, as well as extranodal extension did not correlate with overall or recurrence free survival. As such, pN1 and pN2 were grouped together with a 5-year overall survival of 18.8% (9.12-28.6%). The current stratification of upper urinary tract carcinoma into pN1 and pN2 does not provide prognostic information, and both yield a stage IV classification, regardless of pT or pM category. Therefore, we recommend further simplification of pN classification into one category for regional lymph node metastasis, irrespective of lymph node deposit size or number of positive lymph nodes.
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Affiliation(s)
| | | | - Cheryl T Lee
- Department of Urology. the Ohio State University Wexner Medical Center.
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11
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Rouprêt M, Seisen T, Birtle AJ, Capoun O, Compérat EM, Dominguez-Escrig JL, Gürses Andersson I, Liedberg F, Mariappan P, Hugh Mostafid A, Pradere B, van Rhijn BWG, Shariat SF, Rai BP, Soria F, Soukup V, Wood RG, Xylinas EN, Masson-Lecomte A, Gontero P. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2023 Update. Eur Urol 2023; 84:S0302-2838(23)02652-0. [PMID: 36967359 DOI: 10.1016/j.eururo.2023.03.013] [Citation(s) in RCA: 85] [Impact Index Per Article: 85.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
CONTEXT The European Association of Urology (EAU) guidelines panel on upper urinary tract urothelial carcinoma (UTUC) has updated the guidelines to aid clinicians in evidence-based management of UTUC. OBJECTIVE To provide an overview of the EAU guidelines on UTUC as an aid to clinicians. EVIDENCE ACQUISITION The recommendations provided in these guidelines are based on a review of the literature via a systematic search of the PubMed, Ovid, EMBASE, and Cochrane databases. Data were searched using the following keywords: urinary tract cancer, urothelial carcinomas, renal pelvis, ureter, bladder cancer, chemotherapy, ureteroscopy, nephroureterectomy, neoplasm, (neo)adjuvant treatment, instillation, recurrence, risk factors, metastatic, immunotherapy, and survival. The results were assessed by a panel of experts. EVIDENCE SYNTHESIS Even though data are accruing, for many areas there is still insufficient high-level evidence to provide strong recommendations. Patient stratification on the basis of histology and clinical examination (including imaging) and assessment of patients at risk of Lynch syndrome will aid management. Kidney-sparing management should be offered as a primary treatment option to patients with low-risk UTUC and two functional kidneys. In particular, for patients with high-risk or metastatic UTUC, new treatment options have become available. In high-risk UTUC, platinum-based chemotherapy after radical nephroureterectomy, and adjuvant nivolumab for unfit or patients who decline chemotherapy, are options. For metastatic disease, gemcitabine/carboplatin chemotherapy is recommended as first-line treatment for cisplatin-ineligible patients. Patients with PD-1/PD-L1-positive tumours should be offered a checkpoint inhibitor (pembrolizumab or atezolizumab). CONCLUSIONS These guidelines contain information on the management of individual patients according to the current best evidence. Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen according to the risk stratification of these tumours. PATIENT SUMMARY Cancer of the upper urinary tract is rare, but because 60% of these tumours are invasive at diagnosis, timely and appropriate diagnosis is most important. A number of known risk factors exist.
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Affiliation(s)
- Morgan Rouprêt
- GRC 5 Predictive Onco-Uro, Sorbonne University, AP-HP, Urology, Pitie-Salpetriere Hospital, Paris, France.
| | - Thomas Seisen
- GRC 5 Predictive Onco-Uro, Sorbonne University, AP-HP, Urology, Pitie-Salpetriere Hospital, Paris, France
| | - Alison J Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK; University of Manchester, Manchester, UK
| | - Otakar Capoun
- Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czechia; Department of Pathology, General Hospital of Vienna, Medical University of Vienna, Vienna, Austria
| | - Eva M Compérat
- Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czechia; Department of Pathology, General Hospital of Vienna, Medical University of Vienna, Vienna, Austria; Department of Pathology, Sorbonne University, AP-HP, Hôpital Tenon, Paris
| | | | | | - Fredrik Liedberg
- Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Paramananthan Mariappan
- Department of Urology, Edinburgh Bladder Cancer Surgery, Western General Hospital, Edinburgh, UK
| | - A Hugh Mostafid
- Department of Urology, The Stokes Centre for Urology, Royal Surrey Hospital, Guildford, UK
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, La Croix Du Sud Hospital, Quint Fonsegrives, France
| | - Bas W G van Rhijn
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany; Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Shahrokh F Shariat
- Department of Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czechia; Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Bhavan P Rai
- Department of Urology, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Francesco Soria
- Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
| | - Viktor Soukup
- Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czechia; Department of Pathology, General Hospital of Vienna, Medical University of Vienna, Vienna, Austria
| | | | - Evanguelos N Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Université de Paris, Paris, France
| | | | - Paolo Gontero
- Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
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12
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Anraku T, Hashidate H, Nakahara A, Imai T, Kawakami Y. Sarcomatoid urothelial carcinoma of the renal pelvis treated with immunotherapy. BMC Urol 2023; 23:38. [PMID: 36934227 PMCID: PMC10024438 DOI: 10.1186/s12894-023-01210-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Sarcomatoid carcinoma is a rare, high-grade malignancy with epithelial and mesenchymal components. It may be a good candidate for immunotherapy because it is associated with overexpression of programmed cell death ligand 1. Sarcomatoid urothelial carcinoma (UC) of the upper urinary tract is extremely rare. Here we report the first case of sarcomatoid UC of the renal pelvis that responded to immunotherapy. CASE PRESENTATION A 79-year-old man was referred to our hospital complaining of various symptoms, including anorexia and abdominal pain. A computed tomography scan revealed a right atrial tumor, a 9 cm left renal mass with a renal vein tumor thrombus, para-aortic lymphadenopathy, and multiple small lung nodules. The patient underwent resection of the right atrial tumor. Pathological analysis of the tumor did not lead to an accurate diagnosis even after several rounds of immunohistochemistry. He underwent a needle biopsy of the left kidney and was initially diagnosed with collecting duct carcinoma, a rare subtype of renal cell carcinoma (RCC). Following the initial diagnosis, immunotherapy with nivolumab and ipilimumab commenced. Thereafter, almost all lesions, including the left renal tumor, were reduced in size. However, he underwent a left nephrectomy approximately a year after beginning immunotherapy due to repeated left renal bleeding. Histological examination of the nephrectomy specimen revealed two forms of cancer-sarcomatoid UC and conventional high-grade UC. Two months after surgery, the patient was found to have new lung metastases. He underwent chemotherapy with gemcitabine and cisplatin, followed by immunotherapy with pembrolizumab. However, both treatments were ineffective. The patient died of cancer 19 months after his first admission. CONCLUSIONS The presented case of sarcomatoid UC of the renal pelvis that partially responded to immunotherapy suggests that immunotherapy can be a promising treatment for sarcomatoid UC.
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Affiliation(s)
- Tsutomu Anraku
- Department of Urology, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata-City, Niigata, 950-1197, Japan.
| | - Hideki Hashidate
- Department of Pathology, Niigata City General Hospital, Niigata, Japan
| | - Asa Nakahara
- Department of Pathology, Niigata City General Hospital, Niigata, Japan
| | - Tomoyuki Imai
- Department of Urology, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata-City, Niigata, 950-1197, Japan
| | - Yoshiaki Kawakami
- Department of Urology, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata-City, Niigata, 950-1197, Japan
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13
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Roupret M, Brouquet A, Colrat F, Diez-Andreu P, Prudent A, Chartier M, Gaudin AF, Bugnard F, Chillotti L, Bénard S, Branchoux S, Bellera C, Negrier S. Population characteristics, management, and survival outcomes in muscle-invasive urothelial carcinoma undergoing radical resection: the MINOTAUR study. World J Urol 2023;:1-7. [PMID: 36929410 DOI: 10.1007/s00345-023-04335-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/07/2023] [Indexed: 03/18/2023] Open
Abstract
PURPOSE To describe the incidence, management, and survival outcomes of patients with muscle-invasive urothelial carcinoma (MIUC) undergoing radical surgery (RS) in France. METHODS We relied on a non-interventional real-world retrospective study based on French National Hospitalization Database. Adults with MIUC with a first RS between 2015 and 2020 were selected. Subpopulations of patients with RS performed in 2015 and 2019 (pre-COVID-19) were extracted, according to cancer site: muscle-invasive bladder cancer (MIBC) or upper tract urothelial carcinoma (UTUC). Disease-free and overall survival (DFS, OS - Kaplan-Meier) were assessed on the 2015 subpopulation. RESULTS Between 2015 and 2020, 21,295 MIUC patients underwent a first RS. Of them, 68.9% had MIBC, 28.9% UTUC, and 2.2% both cancers. Apart from fewer men among UTUC (70.2%) than MIBC patients (90.1%), patients' demographic (mean age ~ 73 years) and clinical characteristics were similar whatever the cancer site or year of first RS. In 2019, RS alone was the most frequent treatment, occurring in 72.3% and 92.6% in MIBC and UTUC, respectively. Between 2015 and 2019, neoadjuvant use rate increased from 13.8% to 22.2% in MIBC, and adjuvant use rate increased from 3.7% to 6.3% in UTUC. Finally, median [95% confidence interval] DFS times were 16.0 [14.0-18.0] and 27.0 [23.0-32.0] months among MIBC and UTUC, respectively. CONCLUSION Among patients with resected MIUC annually, RS alone remained the main treatment. Neoadjuvant and adjuvant use increased between 2015 and 2019. Nonetheless, MIUC remains of poor prognosis, highlighting an unmet medical need, notably among patients at high risk of recurrence.
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14
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Yamada Y, Nakagawa T, Miyakawa J, Kawai T, Taguchi S, Tabata M, Kaneko T, Ishikawa A, Miyazaki H, Kondo Y, Matsumoto A, Naito A, Hikatsu M, Fujii Y, Akiyama Y, Yamada Y, Sato Y, Nomiya A, Yamada D, Murata T, Suzuki M, Enomoto Y, Nishimatsu H, Takeuchi T, Tanaka Y, Kume H. Subclassification of pT3 upper tract urothelial carcinoma: a multicenter retrospective study. World J Urol 2023. [PMID: 36739339 DOI: 10.1007/s00345-023-04300-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/18/2023] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The prognosis of patients with pT3 upper tract urothelial carcinoma (UTUC) varies. The current study aimed to further classify patients with pT3 UTUC into different survival outcome groups based on tumor location and site of invasion. METHODS This retrospective study included 323 patients with pT3 UTUC who underwent nephroureterectomy at 11 hospitals in Japan. Histological and clinical data were obtained via a chart review. Univariate and multivariate Cox proportional hazards analyses showed the effect of different variables on recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). RESULTS The median age of the patients was 72 years. Patients with pT3 UTUCs were divided into two groups: those with renal parenchymal invasion only (pT3a, n = 95) and those with peripelvic or periureteral fat invasion (pT3b, n = 228). pT3b UTUC was significantly associated with hydronephrosis, low preoperative estimated glomerular filtration rate (eGFR), histological nodal metastasis, nuclear grade 3, lymphovascular invasion (LVI), carcinoma in situ, and positive surgical margin. Based on the univariate analyses, patients with pT3b UTUC had a significantly lower 5-year RFS (42.4% vs. 70.1%, p < 0.0001), 5-year CSS (54.3% vs. 80.0%, p = 0.0002), and 5-year OS (47.8% vs. 76.8%, p < 0.0001) than those with pT3a UTUC. According to the multivariate analyses, nodal metastasis, LVI, adjuvant chemotherapy, preoperative eGFR, nuclear grade (RFS only), surgical margin (RFS only), and Charlson comorbidity index (OS only), but not pT3b stage, were associated with survival. CONCLUSION Compared with pT3a UTUC, pT3b UTUC was significantly associated with worse histological features, consequently resulting in unsatisfactory survival outcomes.
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Rochio-Tafoya A, García-Muñiz JA, Flores-Gutiérrez JP, Gutiérrez-González A, Barboza-Quintana O, Garza-Guajardo R. Intestinal-type adenocarcinoma arising from a villous adenoma in the renal pelvis in the context of a kidney abscess: Case report. Urol Case Rep 2023; 46:102325. [PMID: 36687748 PMCID: PMC9851858 DOI: 10.1016/j.eucr.2023.102325] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/04/2022] [Revised: 01/03/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
Villous adenoma is a benign neoplasm with an exceptional presentation in the renal pelvis, hence very few cases have been reported. Herein we present the case of a patient who presented with left flank pain clinically suggestive of complicated pyelonephritis, culminating in simple nephrectomy with a villous adenoma in the renal pelvis as histopathological finding associated to the presence of a microscopic focus of intestinal-type adenocarcinoma.
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Affiliation(s)
- Ary Rochio-Tafoya
- Anatomic Pathology and Cytopathology Service, University Hospital Dr. José Eleuterio González, Autonomous University of Nuevo León, Dr. José Eleuterio Gonzalez S/N, Mitras Centro, 64460, Monterrey, N. L, Mexico
| | - José Antonio García-Muñiz
- Anatomic Pathology and Cytopathology Service, University Hospital Dr. José Eleuterio González, Autonomous University of Nuevo León, Dr. José Eleuterio Gonzalez S/N, Mitras Centro, 64460, Monterrey, N. L, Mexico
| | - Juan Pablo Flores-Gutiérrez
- Anatomic Pathology and Cytopathology Service, University Hospital Dr. José Eleuterio González, Autonomous University of Nuevo León, Dr. José Eleuterio Gonzalez S/N, Mitras Centro, 64460, Monterrey, N. L, Mexico
| | - Adrián Gutiérrez-González
- Urology Service, University Hospital Dr. José Eleuterio González, Autonomous University of Nuevo León, Dr. José Eleuterio Gonzalez S/N, Mitras Centro, 64460, Monterrey, N. L, Mexico
| | - Oralia Barboza-Quintana
- Anatomic Pathology and Cytopathology Service, University Hospital Dr. José Eleuterio González, Autonomous University of Nuevo León, Dr. José Eleuterio Gonzalez S/N, Mitras Centro, 64460, Monterrey, N. L, Mexico
| | - Raquel Garza-Guajardo
- Anatomic Pathology and Cytopathology Service, University Hospital Dr. José Eleuterio González, Autonomous University of Nuevo León, Dr. José Eleuterio Gonzalez S/N, Mitras Centro, 64460, Monterrey, N. L, Mexico,Corresponding author. Current address: 26 Avenue 259, Cumbres, Monterrey N. L, México.
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16
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Ulusoy O, Aydın E, Ateş O, Hakgüder G, Özer E, Olguner M, Miraç Akgür F. Clues for the early loss of renal function in congenital hydronephrosis: Analysis of renal pelvis collagen ratio, diuresis renography and upper urinary tract morphology. J Pediatr Urol 2022; 19:197.e1-197.e7. [PMID: 36464563 DOI: 10.1016/j.jpurol.2022.11.018] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 09/30/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Diagnosing real urinary obstruction and surgical decision making for the operative correction of urinary obstruction, are still problematic in congenital hydronephrosis (CH). Compliance of the renal pelvis is one of the important defense mechanisms of renal parenchyma against urinary obstruction. We observed early loss of function in some cases of CH with low and moderate anteroposterior diameter of the renal pelvis (APDRP). OBJECTIVE To evaluate structural properties of the renal pelvic tissue of patients with CH and the relation of these structural properties with renal function and Anteroposterior diameter of the renal pelvis. STUDY DESIGN Ureteropelvic junction (UPJ) excised during UPJ obstruction operations from 2013 to 2019 were evaluated histopathologically. The patients were divided into the two groups according to initial renal function, i.e. group with initial preoperative differential renal function (DRF) less than 35% and group with initial DRF greater than 35%. The percentage of collagen to whole tissue area were analyzed using image processing program. The relationship between DRF and tissue collagen ratio, SFU and APDRP was evaluated. RESULTS There were 5 patients in the DRF <35% group and 16 patients in the DRF >35% group. However, APDRP's of the DRF <35% group were also significantly lower than the DRF >35% group. The collagen distribution in the muscle layer was more prominent in the DRF <35% group. Proportionally, percentage of collagen stained surface was significantly higher in DRF <35% group. DISCUSSION There are numerous histopathological studies evaluating the cause of UPJ obstruction. Besides these studies that are oriented to etiology, there are many studies comparing the histopathological changes at UPJ with surgical outcome and prognosis. In the present study, we found that renal pelvis collagen ratio was significantly increased in patients with lower APDRP and with severe renal function loss. This increase in the collagen content in the renal pelvis have been shown to affect the compliance negatively and decrease APDRP, which leads to a faster loss of renal function. Thus, pelvic structural changes accompanying UPJ obstruction may aggravate urinary obstructive process. CONCLUSION Increased renal pelvis collagen ratio negatively affects the expansion of the renal pelvis, which is one of the protective mechanisms of the renal parenchyma, and may be one of the triggering mechanisms of early loss of renal function.
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Affiliation(s)
- Oktay Ulusoy
- Department of Pediatric Surgery, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey.
| | - Efil Aydın
- Department of Pediatric Surgery, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Oğuz Ateş
- Department of Pediatric Surgery, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey; Division of Pediatric Urology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Gülce Hakgüder
- Department of Pediatric Surgery, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey; Division of Pediatric Urology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Erdener Özer
- Department of Pathology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Mustafa Olguner
- Department of Pediatric Surgery, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey; Division of Pediatric Urology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Feza Miraç Akgür
- Department of Pediatric Surgery, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey; Division of Pediatric Urology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
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Neuzillet Y, Seisen T, Traxer O, Allory Y, Audenet F, Leon P, Loriot Y, Pradère B, Roumiguié M, Xylinas E, Masson-Lecomte A, Roupret M. French AFU Cancer Committee Guidelines - Update 2022-2024: Upper urinary tract urothelial cancer (UTUC). Prog Urol 2022; 32:1164-1194. [PMID: 36400481 DOI: 10.1016/j.purol.2022.08.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The aim was to propose an update of the French Urology Association Cancer Committee (ccAFU) Recommendations on the management of upper urinary tract urothelial carcinomas (UUT-UC). METHODS A systematic Medline search was performed between 2020 and 2022, taking account of the diagnosis, treatment options and follow-up of UUT-UC, while evaluating the references with their levels of evidence. RESULTS The diagnosis of this rare pathology is based on CTU acquisition during excretion and flexible ureterorenoscopy with histological biopsies. Radical nephroureterectomy (RNU) remains the gold standard for surgical treatment. Nevertheless conservative treatment can be discussed for low risk lesions: tumour of low-grade, with no infiltration on imaging, unifocal<2cm, eligible for full treatment therefore requiring close endoscopic surveillance by flexible ureteroscopy in compliant patients. After RNU, postoperative instillation of chemotherapy is recommended to reduce the risk of recurrence in the bladder. Adjuvant chemotherapy has shown clinical benefits compared to surveillance after RNU for tumours (pT2-T4 N0-3 M0). CONCLUSION These updated recommendations should contribute to improving not only patients' level of care, but also the diagnosis and decision-making concerning treatment for UUT-UC.
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Affiliation(s)
- Y Neuzillet
- Service d'urologie, hôpital Foch, Université Paris Saclay, Suresnes, France.
| | - T Seisen
- Sorbonne Université, GRC 5 Predictive Onco-Uro, AP-HP, Urologie, Hôpital Pitié-Salpetrière, 75013 Paris, France
| | - O Traxer
- Sorbonne Université, GRC#20 Lithiase Urinaire et EndoUrologie, AP-HP, Urologie, Hôpital Tenon, 75020 Paris, France
| | - Y Allory
- Service d'anatomopathologie, Institut Curie, Université Paris Saclay, Saint-Cloud, France
| | - F Audenet
- Service d'urologie, Hôpital européen Georges-Pompidou AP-HP Centre, Université Paris Cité, Paris, France
| | - P Leon
- Service d'urologie, clinique Pasteur, Royan, France
| | - Y Loriot
- Service d'oncologie médicale, Institut Gustave-Roussy, Villejuif, France
| | - B Pradère
- Service d'urologie UROSUD, Clinique Croix Du Sud, 31130 Quint-Fonsegrives, France
| | - M Roumiguié
- Service d'urologie, CHU de Toulouse, UPS, Université de Toulouse, Toulouse, France
| | - E Xylinas
- Service d'urologie, Hôpital Bichat-Claude Bernard AP-HP, Université Paris Cité, Paris, France
| | - A Masson-Lecomte
- Service d'urologie, Hôpital Saint-Louis AP-HP, Université Paris Cité, Paris, France
| | - M Roupret
- Sorbonne Université, GRC 5 Predictive Onco-Uro, AP-HP, Urologie, Hôpital Pitié-Salpetrière, 75013 Paris, France
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Liu M, Zheng C, Wang J, Wang JX, He L. Solitary fibrous tumor of the renal pelvis: A case report. World J Clin Cases 2022; 10:9798-9804. [PMID: 36186182 PMCID: PMC9516909 DOI: 10.12998/wjcc.v10.i27.9798] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/12/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm. SFT derived from the renal pelvis is an exceedingly rare entity. In this study, we report a case of renal pelvis SFT and review the relevant literature on this rare tumor.
CASE SUMMARY A 76-year-old man was hospitalized due to right lumbar and abdominal pain. Abdominal computed tomography showed a hypervascular space-occupying renal lesion, sized 2.3 cm × 1.8 cm. Based on the computed tomography findings, the patient was diagnosed with right renal pelvis tumor and underwent nephrectomy. Postoperative immunohistochemical results confirmed the diagnosis. As of the 3-year follow-up, there were no signs of recurrence, and the patient has recovered well.
CONCLUSION We report a rare case of SFT derived from the renal pelvis and discuss the imaging and histopathological features that distinguish renal pelvis SFT from other renal pelvis tumors.
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Affiliation(s)
- Min Liu
- Department of Urology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Chao Zheng
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Jin Wang
- Department of Urology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Ji-Xue Wang
- Department of Urology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Liang He
- Department of Urology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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Takata M, Kumagai M, Tsubata Y, Okanemasa Y, Takenaka M, Terauchi T, Yamashita M, Shioya A, Yamada S. A surgical case of high-grade urothelial carcinoma of the renal pelvis complicated with giant hydronephrosis, giving rise to diagnostic difficulties on a cytological examination. Diagn Pathol 2022; 17:47. [PMID: 35546238 PMCID: PMC9092706 DOI: 10.1186/s13000-022-01227-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/30/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND We report a surgical case of urothelial carcinoma of the renal pelvis, resulting in diagnostic difficulties on cytological examination. CASE PRESENTATION A man in his late 70s underwent nephrectomy for giant hydronephrosis and renal cysts after nephrostomy and renal cyst puncture and drainage. On all cytological examinations performed before surgery, including nephrostomy urine, renal cyst fluid, catheterized bladder urine, and bladder washings, we were unable to make any conclusive diagnosis of malignancy. The pathological diagnosis of the surgical specimen concluded that this was a case of high-grade urothelial carcinoma of the renal pelvis with focal squamous differentiation (pT4). Liver and lung metastases were identified 3 months after surgery, and the patient died 2 months later. CONCLUSION It was very difficult to make a conclusive diagnosis using cytological specimens because of the presence of a small number of atypical cells with severe degenerative changes. Since clinicians cannot predict the potential for malignancy on preoperative imaging findings, it is critical to consider the difficulties in clinically making a correct diagnosis of urothelial carcinoma of the upper urinary tract, especially in cases complicated with giant hydronephrosis.
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Affiliation(s)
- Mao Takata
- Kanazawa Medical University Hospital, 1-1, Ishikawa, 920-0293, Uchinada, Japan
| | - Motona Kumagai
- Kanazawa Medical University Hospital, 1-1, Ishikawa, 920-0293, Uchinada, Japan
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Uchinada, Japan
- Department of Pathology II, Kanazawa Medical University, Uchinada, Japan
| | - Yumi Tsubata
- Kanazawa Medical University Hospital, 1-1, Ishikawa, 920-0293, Uchinada, Japan
| | - Yoshiiku Okanemasa
- Kanazawa Medical University Hospital, 1-1, Ishikawa, 920-0293, Uchinada, Japan
| | - Michiho Takenaka
- Kanazawa Medical University Hospital, 1-1, Ishikawa, 920-0293, Uchinada, Japan
| | - Toshie Terauchi
- Kanazawa Medical University Hospital, 1-1, Ishikawa, 920-0293, Uchinada, Japan
| | - Manabu Yamashita
- Kanazawa Medical University Hospital, 1-1, Ishikawa, 920-0293, Uchinada, Japan
| | - Akihiro Shioya
- Kanazawa Medical University Hospital, 1-1, Ishikawa, 920-0293, Uchinada, Japan
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Uchinada, Japan
| | - Sohsuke Yamada
- Kanazawa Medical University Hospital, 1-1, Ishikawa, 920-0293, Uchinada, Japan.
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Uchinada, Japan.
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Wu Z, Chen Q, Qu L, Li M, Wang L, Mir MC, Carbonara U, Pandolfo SD, Black PC, Paul AK, Di Lorenzo G, Porpiglia F, Mari A, Necchi A, Rouprêt M, Psutka SP, Autorino R. Adverse Events of Immune Checkpoint Inhibitors Therapy for Urologic Cancer Patients in Clinical Trials: A Collaborative Systematic Review and Meta-analysis. Eur Urol 2022; 81:414-425. [PMID: 35101302 DOI: 10.1016/j.eururo.2022.01.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/23/2021] [Accepted: 01/13/2022] [Indexed: 12/17/2022]
Abstract
CONTEXT Therapies based on immune checkpoint inhibitors (ICIs) are transforming the treatment landscape of urologic oncology. Nevertheless, an exhaustive overview of the toxicity spectrum of these novel therapies has yet to be provided. OBJECTIVE To comprehensively investigate the incidence and profile of ICI therapy-related adverse events (AEs) across urologic cancers. EVIDENCE ACQUISITION We searched for all clinical trials investigating the role of ICI therapy published between January 2010 and September 2021. Studies involving urologic cancers with reported overall incidence or tabulated data of treatment-related AEs (trAEs) or immune-related AEs (irAEs) were included. A systematic review and meta-analysis was performed after protocol registration in PROSPERO (CRD42021276435). EVIDENCE SYNTHESIS We identified 2638 records, of which 92 studies (including 22942 participants) met the inclusion criteria. The pooled overall incidence was 81.6% (95% confidence interval [CI] 78.0-84.7) for any-grade trAEs and 29.3% (95% CI 24.9-34.1) for grade ≥3 trAEs. The pooled overall incidence was 34.3% (95% CI 28.5-40.7) for any-grade irAEs and 10.2% (95%CI 8.2-12.7) for grade ≥3 irAEs. On a multivariable analysis, cancer type, therapy combination, clinical settings (perioperative vs advanced/metastatic), and drug exposure were independently associated with the occurrence of trAEs or irAEs. The overall rate of treatment-related mortality was 0.94% (140 of 14 899 participants), with pneumonitis (9.3%), pneumonia (7.9%), and respiratory failure (7.1%) being the most common causes. Immune-related mortality occurred in 0.26% (28 of 10 723) patients, with pneumonitis (35.7%), hepatic failure (10.7%), and hepatitis (7.1%) being most common. CONCLUSIONS Our study provides a comprehensive overview of ICI-associated AEs in urologic cancer patients. The spectrum and incidence of AEs vary across cancer types, ICI types, clinical settings, and therapy combinations. These findings provide important guidance to clinicians in counseling and management of patients with urologic cancers. PATIENT SUMMARY A high proportion of patients experience immune checkpoint inhibitor-associated toxicity. Physician and patient education is critical for early recognition and proper management.
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Affiliation(s)
- Zhenjie Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Qi Chen
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Le Qu
- Department of Urology, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, China.
| | - Mingmin Li
- Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China.
| | - Linhui Wang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China.
| | - Maria C Mir
- Department of Urology, Valencian Oncology Institute Foundation, FIVO, Valencia, Spain
| | | | | | - Peter C Black
- Department of Urologic Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Asit K Paul
- Division of Hematology, Oncology and Palliative Care, Department of Internal Medicine, VCU Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Giuseppe Di Lorenzo
- Oncology Unit, Andrea Tortora Hospital, ASL Salerno, Pagani, Italy; Vincenzo Tiberio Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Andrea Mari
- Department of Clinical and Experimental Medicine, University of Florence. Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Necchi
- Genitourinary Medical Oncology, IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy
| | - Morgan Rouprêt
- Department of Urology, GRC n°5, Predictive Onco-Uro, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA, USA
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Tariq MT, Ullah S, Khan KS, Khan A, Ullah I. Mixed epithelial and stromal tumor (MEST) in a young adult male: A case report and literature review. Ann Med Surg (Lond) 2021; 70:102888. [PMID: 34691429 DOI: 10.1016/j.amsu.2021.102888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction and importance A MEST is a rare renal tumor, with stromal as well as epithelial components. It is predominantly benign and local recurrence is not very common. In the majority of the cases, it occurs in females. Its occurrence in a young male makes it a rarity. Case presentation A 24 years old male presented at SIUT with the complaint of left flank pain on and off for one month. CT scan showed soft tissue density mass in left renal pelvis extending from mid-pole calyces to pelviuretric junction, leading to obstruction and ultimately mild uropathy. We found a partially obstructing staghorn calculus with asymmetrical cortical thinning. Left Robot-Assisted Nephro-ureterectomy plus excision of bladder cuff was planned in which 3 × 4 cm mass involving the left renal pelvis was excised. To date, there is no radiologic evidence of disease recurrence. Clinical discussion MEST in young adults is an extremely rare tumor. They have been referred to by many alternate synonyms including 'adult mesoblastic nephroma' and 'cystic nephroma' with 'ovarian' or 'cellular' type stroma. Majority of patients with MEST present, with hematuria, abdominal pain, palpable flank mass, recurrent urinary tract infections. Similarly, our patient presented initially with nonspecific pain in the left flank region. Majority of cases in the literature presented with the tumor in benign stage, with localized spread, and without recurrence. Conclusion Mixed epithelial and stromal tumors (MEST) of the kidney are distinct entities of benign kidney tumors. MEST in young males is a very rare entity, and a small number of cases exist. Histopathology plays a very cardinal role in diagnosis, and overall the disease has a promising outcome with conservative surgery.
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Shen XZ, Lin C, Liu F. Primary follicular lymphoma in the renal pelvis: A rare case report. World J Clin Cases 2021; 9:6026-6031. [PMID: 34368323 PMCID: PMC8316937 DOI: 10.12998/wjcc.v9.i21.6026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/01/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Follicular lymphoma (FL) is more common in lymph nodes, while primary extranodal lymphomas are rare. Urinary tract lymphoid neoplasms are extremely rare, accounting for less than 5% of all extranodal lymphomas. Only one case of FL from the renal pelvis has previously been reported.
CASE SUMMARY A 70-year-old male patient with a history of esophageal cancer visited our hospital for follow-up examination. Abdominal computed tomography revealed a malignant mass in the right renal pelvis. The whole-body positron emission tomography/computed tomography showed a significant increase in fluorodeoxyglucose uptake of this soft tissue mass and no abnormal fluorodeoxyglucose uptake in the esophageal wall. The patient underwent radical resection of a malignant tumor in the right kidney, which was confirmed by postoperative pathology to be FL. The patient received no radiation or chemotherapy after surgery, and no recurrence of lymphoma or other malignant tumors was found at the 1-year follow-up.
CONCLUSION Extranodal FL is more common in the skin and gastrointestinal tract but rarely occurs in the urinary tract. This is the second report of primary renal FL. Localized extranodal FL is expected to have a favorable prognosis and can be cured by local resection.
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Affiliation(s)
- Xun-Ze Shen
- PET/CT Center, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing 312000, Zhejiang Province, China
| | - Chen Lin
- PET/CT Center, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing 312000, Zhejiang Province, China
| | - Fang Liu
- Department of Pathology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing 312000, Zhejiang Province, China
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23
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Fouimtizi J, Hosni A, Jroundi L, Slaoui A, Koutani A, Ibn Attya Andaloussi A. Renal pelvic rupture: A case report of an unexpected cause. Int J Surg Case Rep 2021; 85:106176. [PMID: 34388893 PMCID: PMC8355923 DOI: 10.1016/j.ijscr.2021.106176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/12/2021] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Renal pelvic rupture (RPR) is a rare condition, that is most usually caused by obstructive calculi. In another hand, primal ureteral tumors are also uncommon, with only a few cases reporting their involvement in a RPR. PRESENTATION OF CASE We report a case with a multimodality discussion of an ureteral tumor, with a spontaneous renal pelvic rupture (RPR) forming a large retrorenal urohematoma. DISCUSSION Only few series reported the subject of RPR in the English literature. Only some single cases reported the causality of urinary tract tumors in RPR. RPR is an imaging based diagnosis. Herein, upper urinary tract tumors show a variable appearances at imaging. CONCLUSION By reporting this case, we highlight the role of both computed tomography (CT) and magnetic resonance (MR) imaging in the diagnosis of the RPR and their accuracy in the detection of the ureteral tumor. We also consolidate the effectiveness of the conservative attitude in the management of the RPR.
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Affiliation(s)
- Jaafar Fouimtizi
- Department of urology “B”, Ibn Sina Universitary Hospital, Rabat, Morocco,Faculty of medicine and pharmacy of Rabat, University Mohamed V, Rabat, Morocco,Corresponding author at: Department of urology “B”, Ibn Sina Universitary Hospital, Rabat, Morocco.
| | - Abdelmoughit Hosni
- Department of Emergency Radiology, Ibn Sina Universitary Hospital, Rabat, Morocco,Faculty of medicine and pharmacy of Rabat, University Mohamed V, Rabat, Morocco
| | - Laila Jroundi
- Department of Emergency Radiology, Ibn Sina Universitary Hospital, Rabat, Morocco,Faculty of medicine and pharmacy of Rabat, University Mohamed V, Rabat, Morocco
| | - Amine Slaoui
- Department of urology “B”, Ibn Sina Universitary Hospital, Rabat, Morocco,Faculty of medicine and pharmacy of Rabat, University Mohamed V, Rabat, Morocco
| | - Abdellatif Koutani
- Department of urology “B”, Ibn Sina Universitary Hospital, Rabat, Morocco,Faculty of medicine and pharmacy of Rabat, University Mohamed V, Rabat, Morocco
| | - Ahmed Ibn Attya Andaloussi
- Department of urology “B”, Ibn Sina Universitary Hospital, Rabat, Morocco,Faculty of medicine and pharmacy of Rabat, University Mohamed V, Rabat, Morocco
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Ogunbona OB, Matoso A, Cheng L, Shen S, Powell SZ, Osunkoya AO. Metastatic urothelial carcinoma to the brain, spinal cord and spine: A contemporary multi-institutional clinicopathologic analysis of 24 cases. Pathol Res Pract 2021; 224:153537. [PMID: 34243109 DOI: 10.1016/j.prp.2021.153537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/20/2021] [Accepted: 06/22/2021] [Indexed: 12/24/2022]
Abstract
Only case reports and small series of metastatic urothelial carcinoma (UCa) to the central nervous system (CNS) or spine have been published. We identified 24 cases at our institutions. The mean patient age was 64 years (range: 41-78 years) with a male predominance. Nineteen (79%) cases involved the brain, 3 (13%) and 2 (8%) cases involved the spinal cord and spine, respectively. Most cases (79%) were a single mass with a mean size of 2.8 cm (range: 0.9-5.5 cm). With the exception of 3 cases demonstrating micropapillary UCa, all metastases showed morphologic features of conventional UCa. Prior to CNS and spinal metastases, there was a history of UCa involving only the bladder in 16 (67%) patients, ureter in 1 (4%) patient, and kidney/renal pelvis in 1 (4%) patient. In 1 additional patient (4%) each, the primary tumor involved both bladder and ureter, bladder and kidney/renal pelvis, and ureter and kidney/renal pelvis, respectively. Three (13%) patients had no known primary site. In two patients, the diagnosis of primary UCa was made concurrently as the CNS metastasis, and ranged up to 30 years in other patients. Follow-up was available in 14 patients with a mean duration of 7 months (range: 0-23 months), and 4 patients died of disease. Both clinicians and pathologists should be aware that concurrent or late CNS or spine metastases may occur and could present as a solitary mass even over a decade after the initial diagnosis.
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25
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Rouprêt M, Audenet F, Roumiguié M, Pignot G, Masson-Lecomte A, Compérat E, Houédé N, Larré S, Brunelle S, Xylinas E, Neuzillet Y, Méjean A. [French ccAFU guidelines - update 2020-2022: upper urinary tract urothelial carcinoma]. Prog Urol 2021; 30:S52-S77. [PMID: 33349430 DOI: 10.1016/s1166-7087(20)30750-8] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION -The purpose was to propose an update of the French guidelines from the national committee ccAFU on upper tract urothelial carcinomas (UTUC). METHODS - A systematic Medline search was performed between 2018 and 2020, as regards diagnosis, options of treatment and follow-up of UTUC, to evaluate different references with levels of evidence. RESULTS - The diagnosis of this rare pathology is based on CT-scan acquisition during excretion and ureteroscopy with histological biopsies. Radical nephroureterectomy (RNU) remains the gold standard for surgical treatment, nevertheless a conservative endoscopic approach can be proposed for low risk lesion: unifocal tumor, possible complete resection and low grade and absence of invasion on CT-scan. Close monitoring with endoscopic follow-up (flexible ureteroscopy) in compliant patients is therefore necessary. After RNU, bladder instillation of chemotherapy is recommended to reduce risk of bladder recurrence. A systemic chemotherapy is recommended after RNU in pT2-T4 N0-3 M0 disease. CONCLUSION - These updated guidelines will contribute to increase the level of urological care for diagnosis and treatment for UTUC.
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Affiliation(s)
- M Rouprêt
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sorbonne Université, GRC n° 5, Predictive onco-urology, AP-HP, hôpital de la Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France.
| | - F Audenet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, université Paris-Descartes, Paris, France
| | - M Roumiguié
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'urologie, CHU Rangueil, Toulouse, France
| | - G Pignot
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, Institut Paoli-Calmettes, Marseille, France
| | - A Masson-Lecomte
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Saint-Louis, université Paris-Diderot, Paris, France
| | - E Compérat
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'anatomie pathologique, hôpital Tenon, HUEP, Sorbonne Université, GRC n° 5, ONCOTYPE-URO, Paris, France
| | - N Houédé
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'oncologie médicale, CHU Carémeau, Nîmes, Montpellier Université, France
| | - S Larré
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Reims, Reims, France
| | - S Brunelle
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, Institut Paoli-Calmettes, Marseille, France
| | - E Xylinas
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie de l'hôpital Bichat-Claude-Bernard, AP-HP, université Paris-Descartes, Paris, France
| | - Y Neuzillet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Foch, université de Versailles - Saint-Quentin-en-Yvelines, Suresnes, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sorbonne Université, GRC n° 5, Predictive onco-urology, AP-HP, hôpital de la Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France
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Takamatsu A, Yoshida K, Obokata M, Inoue D, Yoneda N, Kadono Y, Kobayashi S, Gabata T. Urinary collecting system invasion on multiphasic CT in renal cell carcinomas: prevalence, characteristics, and clinical significance. Abdom Radiol (NY) 2021; 46:2090-2096. [PMID: 33226457 DOI: 10.1007/s00261-020-02859-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 09/13/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to determine the prevalence of collecting system invasion (CSI) on multiphasic CT, validate the pathological findings, and investigate the relationship between CSI and clinical outcomes in patients with renal cell carcinomas (RCC). METHODS Patients pathologically diagnosed with RCC between January 2008 and December 2017 were retrospectively enrolled in this study. They were divided into two groups according to the presence of CSI on multiphasic CT images. Patients' clinical characteristics, radiological findings, and overall survival (OS) and recurrence-free survival (RFS) rates were analyzed and compared between the groups. In addition, the correlation of radiological findings with pathological findings was investigated. RESULTS Among the included 347 kidneys of 340 patients, CSI was observed in 11 kidneys (3%; 95% confidence interval, 1.3-5.0%). In all the 11 kidneys, the tumors were pathologically diagnosed as clear cell RCC, and in one kidney, the tumor also had sarcomatoid features. When pathological CSI served as the standard of reference, the sensitivity, specificity, and accuracy of CSI on CT were 50%, 99.7%, and 97.1%, respectively. The OS and RFS rates were not significantly different between patients with CSI on CT and those without CSI. CONCLUSION This study found that the prevalence of RCC-related CSI was 3%. Because of the low prevalence, we cannot exclude the possibility that CSI on CT would be associated with the OS and RFS. Further studies are needed to determine whether CSI on CT can be an independent prognostic factor for survival in patients with RCC.
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Bersanelli M, Buti S, Giannatempo P, Raggi D, Necchi A, Leonetti A, Banna GL, Petrelli F. Outcome of patients with advanced upper tract urothelial carcinoma treated with immune checkpoint inhibitors: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2021; 159:103241. [PMID: 33545355 DOI: 10.1016/j.critrevonc.2021.103241] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/06/2021] [Accepted: 01/20/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Advanced upper tract urothelial carcinoma (UTUC) has different molecular and genetic features from the commonest carcinoma of the bladder, suggesting a possible different sensitivity to immune-checkpoint inhibitors (ICI). METHODS A systematic review and meta-analysis of all relevant clinical studies including advanced UTUC patients treated with ICI was conducted according to PRISMA guidelines. RESULTS Six prospective trials for a total 2537 patients, including 396 (15.6 %) with advanced UTUC, were eligible for the analysis. In UTUC patients, the pooled ORR was 21.2 % (95 % CI, 12.5 %-33.7 %); the risk of death was reduced by 24 % over the standard platinum-based chemotherapy, but this was not statistically significant (hazard ratio = 0.76; 95 % confidence interval, 0.41-1.40; p = 0.37, χ2 = 3.28, p = 0.07; I2 = 70 %). CONCLUSIONS The current evidence does not support a statistically significant effect from ICI over the standard treatment for advanced UTUC patients. Properly performed pre-planned subgroup analyses from randomized clinical trials are eagerly awaited.
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Affiliation(s)
- Melissa Bersanelli
- Medicine and Surgery Department, University of Parma, Parma, Italy; Medical Oncology Unit, University Hospital of Parma, Parma, Italy.
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Daniele Raggi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Leonetti
- Medicine and Surgery Department, University of Parma, Parma, Italy; Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Fausto Petrelli
- Medical Oncology Unit, ASST Bergamo Ovest, Treviglio, BG, Italy
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Sfakianos JP, Gul Z, Shariat SF, Matin SF, Daneshmand S, Plimack E, Lerner S, Roupret M, Pal S. Genetic Differences Between Bladder and Upper Urinary Tract Carcinoma: Implications for Therapy. Eur Urol Oncol 2020; 4:170-179. [PMID: 33386276 DOI: 10.1016/j.euo.2020.12.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/25/2020] [Accepted: 12/16/2020] [Indexed: 01/29/2023]
Abstract
CONTEXT Bladder urothelial carcinoma (BUC) and upper tract urothelial carcinoma (UTUC) have genetic differences, which may influence therapy. OBJECTIVE The aim of the current review was to summarize the current genetic understanding of upper tract and BUC. EVIDENCE ACQUISITION PubMed, Cochrane, and Web of Science online databases were searched systematically up to February 2020, using the following keywords: urothelial carcinomas, upper urinary tract, renal pelvis, ureter, bladder cancer, and genetics. EVIDENCE SYNTHESIS UTUC and BUC share mutations in similar genes, such as FGFR3, TP53, and HRAS, and epigenetic genes, such as KDM6A and KMT2A-C, but at varying frequencies. Furthermore, subtyping of UTUC and BUC has identified similar expression subtypes, but UTUC is more often luminal with more T-cell depletion. Clonal studies indicate that BUC after UTUC is also likely luminal, while UTUC after BUC is often basal. CONCLUSIONS UTUC and BUC share many genomic alterations, but at different frequencies, which recapitulate with their metachronous recurrences. These differences likely contribute to the behavior of these two cancers and imply that they and their metachronous recurrences should be treated as two related yet distinct entities. PATIENT SUMMARY Urothelial carcinoma of the bladder has distinct genomic features, which are different from distinct genomic features of urothelial carcinoma of the renal pelvis and/or ureter. These features can be used for tailored treatment options specific to tumors of different locations.
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Affiliation(s)
- John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Zeynep Gul
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Surena F Matin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Siamak Daneshmand
- Institute of Urology and USC Norris Comprehensive Cancer Center, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | | | - Seth Lerner
- Scott Department of Urology, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Morgan Roupret
- Urology Department, GRC n°5, Predictive Onco-Uro, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Sumanta Pal
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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Favorito LA, Costa WS, Lobo MLP, Gallo CM, Sampaio FJ. Morphology of the fetal renal pelvis during the second trimester: Comparing genders. J Pediatr Surg 2020; 55:2492-2496. [PMID: 32037216 DOI: 10.1016/j.jpedsurg.2019.12.029] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/24/2019] [Accepted: 12/31/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Many studies of neonates have shown that renal pelvis ectasia is more common in boys. The aim of this study was to determine whether there are structural differences in the renal pelvis between male and female fetuses in the second trimester of gestation. MATERIAL AND METHODS We studied 34 renal pelvises obtained from 34 human fetuses (17 males and 17 females), ranging in age from 13 to 23 weeks postconception. The renal pelvis tissue was stained with Masson's trichrome to quantify connective and smooth muscle cells (SMC). The tissue also was fixed for scanning electron microscopy (SEM) in a modified Karnovsky solution. The images were captured with an Olympus BX51 microscope and Olympus DP70 camera. The stereological analysis was done with the Image-Pro and ImageJ programs, using a grid to determine volumetric densities (Vv). Means were statistically compared using simple linear correlation and the Mann-Whitney test (p<0.05). RESULTS Quantitative analysis indicated differences (p=0.0275) in Vv of connective tissue in male renal pelvises (mean=55.3%) compared to female ones (mean=51.46%). Quantitative analysis indicated a significant difference (p=0.0002) in SMC in male renal pelvises (mean=12.57%) compared to female ones (mean=16.22%). When we compared the SMC at different ages, we did not find any correlation in male (r2=0.2657, p=0.3027) or female fetuses (r2=0.3798, p=0.1326). When we compared the connective tissue at different ages, we did not find any correlation in female fetuses (r2=0.3798, p=0.2870), but we did observe a positive correlation between the connective tissue and age in male fetuses (r2=0.8308, p<0.0001). SEM showed that the collagen fibers had no differences between male and female. CONCLUSION The renal pelvis presents significant structural differences between male and female fetuses. The renal pelvis in males had less SMC and presented a positive correlation of connective tissue with age and the renal pelvis in female had less connective tissue without correlation with the age. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Waldemar S Costa
- Urogenital Research Unit, State University of Rio de Janeiro, Brazil
| | | | - Carla M Gallo
- Urogenital Research Unit, State University of Rio de Janeiro, Brazil
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Seisen T, Mari A, Campi R, Peyronnet B, Bensalah K, Rioux-Leclercq N, Pfister C, Gobet F, De La Taille A, Allory Y, Xylinas E, Neuzillet Y, Radulescu C, Descotes JL, Saada-Sebag G, Irani J, Delpech-Debiais C, Bigot P, Eymerit C, Crouzet S, Mege-Lechevallier F, Ruffion A, Decaussin-Petrucci M, Droupy S, Roger P, Durand X, Camparo P, Cussenot O, Compérat E, Rouprêt M. Prognostic Impact of pT3 Subclassification in a Multicentre Cohort of Patients with Urothelial Carcinoma of the Renal Pelvicalyceal System Undergoing Radical Nephroureterectomy: A Propensity Score-weighted Analysis After Central Pathology Review. Eur Urol Focus 2020; 7:1075-1083. [PMID: 33463527 DOI: 10.1016/j.euf.2020.10.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/01/2020] [Accepted: 10/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The current pathological tumour-node-metastasis (pTNM) classification for upper tract urothelial carcinoma (UTUC) does not include any risk stratification of pT3 renal pelvicalyceal tumours. OBJECTIVE To assess the prognostic impact of pT3 subclassification in a multicentre cohort of patients with UTUC of the renal pelvicalyceal system undergoing radical nephroureterectomy (RNU). DESIGN, SETTING, AND PARTICIPANTS Data from all consecutive patients treated with RNU for pT3 renal pelvicalyceal UTUC at 14 French centres from 1995 to 2013 were reviewed retrospectively. INTERVENTION A central pathology review (CPR) was used to stratify pT3 patients into those with infiltration of the renal parenchyma on a microscopic level (pT3a) versus those with infiltration of the renal parenchyma visible on gross inspection of the resection specimen and/or invasion of peripelvic fat (pT3b). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Inverse probability weighting (IPW)-adjusted Cox regression analyses were used to compare recurrence-free survival (RFS) and cancer-specific survival (CSS) between pT3a and pT3b patients. RESULTS AND LIMITATIONS Overall, 202 patients were included and further stratified into pT3a (n = 98; 48.5%) and pT3b (n = 104; 51.5%) subgroups. Median time to follow-up in the weighted population was 68 (interquartile range, 50-95) mo. In IPW-adjusted Cox regression analyses, pT3b versus pT3a substage was associated with a significant adverse effect on RFS (hazard ratio [HR] = 2.02; 95% confidence interval [CI] = [1.36-3.01]; p < 0.001) and CSS (HR = 1.84; 95% CI = [1.20-2.82]; p = 0.005). The study is limited by its retrospective design. CONCLUSIONS Using IPW-adjusted analyses after the CPR, we observed that RNU patients with pT3b renal pelvicalyceal UTUC had adverse prognosis as compared with those with pT3a disease. As such, this subclassification could help refine the current pTNM system for UTUC. PATIENT SUMMARY In this report, we looked at the prognostic interest of stratifying patients with pT3 renal pelvicalyceal upper tract urothelial carcinoma based on the extent of local invasion. We found that those with extensive infiltration (pT3b) had adverse prognosis as compared with those with limited infiltration (pT3a). This information could be provided on pathology reports to further guide clinical decision making.
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Affiliation(s)
- Thomas Seisen
- Sorbonne University, GRC 5 Predictive ONCO-URO, AP-HP, Urology, Pitie-Salpetriere Hospital, F-75013 PARIS, France
| | - Andrea Mari
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Riccardo Campi
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Benoit Peyronnet
- Department of Urology, Rennes University Hospital, Rennes, France
| | - Karim Bensalah
- Department of Urology, Rennes University Hospital, Rennes, France
| | | | | | - Françoise Gobet
- Department of Pathology, Rouen University Hospital, Rouen, France
| | | | - Yves Allory
- Department of Pathology, Henri Mondor Hospital, Créteil, France
| | | | | | | | - Jean-Luc Descotes
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | | | - Jacques Irani
- Department of Urology, Poitier University Hospital, Poitier, France
| | | | - Pierre Bigot
- Department of Urology, Angers University Hospital, Angers, France
| | - Caroline Eymerit
- Department of Pathology, Angers University Hospital, Angers, France
| | | | | | - Alain Ruffion
- Department of Urology, Lyon Sud University Hospital, Pierre Bénite, France
| | | | - Stéphane Droupy
- Department of Urology, Nîmes University Hospital, Nîmes, France
| | - Pascal Roger
- Department of Pathology, Nîmes University Hospital, Nîmes, France
| | - Xavier Durand
- Department of Urology, Val-de-Grâce Hospital, Paris, France
| | | | | | - Eva Compérat
- Department of Pathology, Tenon Hospital, Paris, France
| | - Morgan Rouprêt
- Sorbonne University, GRC 5 Predictive ONCO-URO, AP-HP, Urology, Pitie-Salpetriere Hospital, F-75013 PARIS, France.
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Usawachintachit M, Opanuraks J, Surintrspanont J, Iampenkhae K, Santingamkun A. Leiomyosarcoma of the renal pelvis diagnosed by percutaneous endoscopic resection. Urol Case Rep 2020; 33:101404. [PMID: 33102102 PMCID: PMC7574154 DOI: 10.1016/j.eucr.2020.101404] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 08/31/2020] [Accepted: 09/03/2020] [Indexed: 11/19/2022] Open
Abstract
We present a case of leiomyosarcoma arising from the renal pelvis, which is a rare clinical entity. A percutaneous endoscopic resection led to the final histopathological diagnosis. The patient underwent radical nephrectomy and did not receive adjuvant therapy. Based on follow-up CT scans, he remains recurrence-free one year after surgery.
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Affiliation(s)
- Manint Usawachintachit
- Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, 10330, Thailand
- Corresponding author. Division of Urology, Department of Surgery, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, The Thai Red Cross Society, Bangkok, 10330, Thailand.
| | - Julin Opanuraks
- Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Jerasit Surintrspanont
- Department of Pathology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Kroonpong Iampenkhae
- Department of Pathology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Apirak Santingamkun
- Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, 10330, Thailand
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Hassler MR, Bray F, Catto JWF, Grollman AP, Hartmann A, Margulis V, Matin SF, Roupret M, Sfakianos JP, Shariat SF, Faltas BM. Molecular Characterization of Upper Tract Urothelial Carcinoma in the Era of Next-generation Sequencing: A Systematic Review of the Current Literature. Eur Urol 2020; 78:209-220. [PMID: 32571725 DOI: 10.1016/j.eururo.2020.05.039] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/27/2020] [Indexed: 12/25/2022]
Abstract
CONTEXT While upper tract urothelial carcinoma (UTUC) share histological appearance with bladder cancer (BC), the former has differences in etiology and clinical phenotype consistent with characteristic molecular alterations. OBJECTIVE To systematically evaluate current genomic sequencing and proteomic data examining molecular alterations in UTUC. EVIDENCE ACQUISITION A systematic review using PubMed, Scopus, and Web of Science was performed in December 2019 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. EVIDENCE SYNTHESIS A total of 46 publications were selected for inclusion in this report, including 13 studies assessing genome-wide alterations, 18 studies assessing gene expression or microRNA expression profiles, three studies assessing proteomics, one study assessing genome-wide DNA methylation, and 14 studies evaluating distinct pathway alteration patterns. Differences between sporadic and hereditary UTUC, and between UTUC and BC, as well as molecular profiles associated with exposure to aristolochic acid are highlighted. Molecular pathways relevant to UTUC biology, such as alterations in FGFR3, TP53, or microsatellite instability, are discussed. Our findings are limited by tumor and patient heterogeneity and different platforms used in the studies. CONCLUSIONS Molecular events in UTUC and BC can be shared or distinct. Consequently, molecular subtypes differ according to location. Further work is needed to define the epigenomic and proteomic features of UTUC, and understand the mechanisms by which they shape the clinical behavior of UTUC. PATIENT SUMMARY We report the current data on the molecular alterations specific to upper tract urothelial carcinoma (UTUC), resulting from novel genomic and proteomic technologies. Although UTUC biology is comparable with that of bladder cancer, the rates and UTUC-enriched alterations support its uniqueness and the need for precision medicine strategies for this rare tumor type.
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Affiliation(s)
- Melanie R Hassler
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Arthur P Grollman
- Department of Pharmacological Sciences and Department of Medicine, Stony Brook University, Stony Brook, New York, NY, USA
| | - Arndt Hartmann
- Institute of Pathology, Friedrich-Alexander Universität, Erlangen, Germany
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Surena F Matin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Morgan Roupret
- Urology, GRC n°5, Predictive Onco-Uro, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; European Association of Urology research foundation, Arnhem, Netherlands.
| | - Bishoy M Faltas
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA; Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA; Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY, USA; Sandra and Edward Meyer Cancer Center at Weill Cornell Medicine, New York, NY, USA; Department of Cell and Developmental Biology, Weill Cornell Medicine, New York, NY, USA
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Aldaoud N, Hallak A, Rousan LA, Halalsheh O, Darayseh B, Al-Abbadi MA. Myxoma of the renal pelvis masquerading pelviureteric stenosis: conservative limited resection with renal preservation: case presentation and literature review. BMC Urol 2020; 20:80. [PMID: 32605652 PMCID: PMC7324961 DOI: 10.1186/s12894-020-00657-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/31/2019] [Accepted: 06/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Myxoma is a relatively rare mesenchymal tumor seen mainly in the heart and skin. Renal myxomas in particular are exceptionally rare where only 17 cases were previously reported in the English Language literature. Only 2 of the 17 reported cases were located in the renal sinus/pelvis. CASE PRESENTATION This is a case of an 18-year-old male patient who complained of right, colicky flank pain associated with abdominal pain and discomfort. Imaging findings revealed right kidney hydronephrosis with a provisional diagnosis of pelviureteric junction (PUJ) stenosis. On computed tomography, there was a very faint thin walled mass abutting the calyces, camouflaged within the dilated renal pelvis. During surgery, a polypoid mass was found at the pelviureteric junction, causing the obstruction. Histological examination showed a hypocellular, paucivascular myxoid neoplasm, with few spindle cells displaying serpentine nuclei and inconspicuous nucleoli. The tumor cells expressed immunoreactivity for vimentin, but not for S100, CD34, actin, or desmin. This will qualify as the third case of renal pelvis myxoma. CONCLUSION Myxomas in the renal pelvis/sinus are extremely rare and can present with hydronephrosis and subtle radiological findings mimicking a PUJ stenosis. Being aware of this entity can save the patient unnecessary nephrectomy with possible preservation of the kidney.
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Affiliation(s)
- Najla Aldaoud
- Department of Pathology and Microbiology, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan.
| | - Amer Hallak
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Liqa A Rousan
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar Halalsheh
- Department of Surgery and Urology, Jordan University of Science and Technology, Irbid, Jordan
| | - Bashar Darayseh
- Department of Pathology and Microbiology, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Mousa A Al-Abbadi
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, University of Jordan, Amman, Jordan
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Rouprêt M, Babjuk M, Burger M, Capoun O, Cohen D, Compérat EM, Cowan NC, Dominguez-Escrig JL, Gontero P, Hugh Mostafid A, Palou J, Peyronnet B, Seisen T, Soukup V, Sylvester RJ, Rhijn BWGV, Zigeuner R, Shariat SF. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2020 Update. Eur Urol 2021; 79:62-79. [PMID: 32593530 DOI: 10.1016/j.eururo.2020.05.042] [Citation(s) in RCA: 446] [Impact Index Per Article: 111.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/28/2020] [Indexed: 12/12/2022]
Abstract
CONTEXT The European Association of Urology (EAU) Guidelines Panel on Upper Urinary Tract Urothelial Carcinoma (UTUC) has prepared updated guidelines to aid clinicians in the current evidence-based management of UTUC and to incorporate recommendations into clinical practice. OBJECTIVE To provide an overview of the EAU guidelines on UTUC as an aid to clinicians. EVIDENCE ACQUISITION The recommendations provided in the current guidelines are based on a thorough review of available UTUC guidelines and articles identified following a systematic search of Medline. Data on urothelial malignancies and UTUC were searched using the following keywords: urinary tract cancer, urothelial carcinomas, upper urinary tract carcinoma, renal pelvis, ureter, bladder cancer, chemotherapy, ureteroscopy, nephroureterectomy, neoplasm, adjuvant treatment, instillation, recurrence, risk factors, and survival. References were weighted by a panel of experts. EVIDENCE SYNTHESIS Owing to the rarity of UTUC, there are insufficient data to provide strong recommendations. The 2017 tumour, node, metastasis (TNM) classification is recommended. Recommendations are given for diagnosis and risk stratification as well as for radical and conservative treatment, and prognostic factors are discussed. A single postoperative dose of intravesical mitomycin after nephroureterectomy reduces the risk of bladder tumour recurrence. Kidney-sparing management should be offered as a primary treatment option to patients with low-risk tumour and two functional kidneys. After radical nephroureterectomy, cisplatin-based chemotherapy is indicated in locally advanced UTUC. CONCLUSIONS These guidelines contain information on the management of individual patients according to a current standardised approach. Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen, based on the proposed risk stratification of these tumours. PATIENT SUMMARY Urothelial carcinoma of the upper urinary tract is rare, but because 60% of these tumours are invasive at diagnosis, an appropriate diagnosis is most important. A number of known risk factors exist.
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Abstract
BACKGROUND Percutaneous access to the renal pelvis still remains the most difficult step before nephrolitholapaxy (PCNL). New imaging techniques, such as 3D imaging and various navigation instruments such as electromagnetic, sonographic, CT-controlled and marker-based/iPAD try to simplify this step and reduce complications. OBJECTIVES In this review, various new techniques for puncturing the renal collecting system are presented and their advantages and disadvantages are evaluated. MATERIALS AND METHODS A systematic literature search was carried out in MEDLINE, whereby only puncture techniques that have already been evaluated in clinical studies were included. RESULTS Five different navigation methods for puncturing the renal pelvis before PCNL were found. CONCLUSION Intraoperative navigation can be useful when puncturing the collecting system. The combination of ultrasound and fluoroscopy currently remains the gold standard. However, there is still a need for further, primarily clinical, prospective studies to determine which new imaging technology and navigation systems will prevail and thus facilitate the access route to the kidney, especially in the case of special anatomical conditions.
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Affiliation(s)
- M-C Rassweiler-Seyfried
- Klinik für Urologie und Urochirurgie, Universitätsmedzin Mannheim, Theodor-Kutzer-Ufter 1-3, 68161, Mannheim, Deutschland.
| | - E Lima
- Department of Urology - Hospital of Braga, University of Minho, Campus de Gualtar, 4709-057, Braga, Portugal
| | - M Ritter
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - J-T Klein
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - M-S Michel
- Klinik für Urologie und Urochirurgie, Universitätsmedzin Mannheim, Theodor-Kutzer-Ufter 1-3, 68161, Mannheim, Deutschland
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36
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Angelidakis G, Mahale P, Jonasch E, Jiang Y, Torres HA. Chronic hepatitis C virus infection and genitourinary cancers: A case-control study. Semin Oncol 2020; 47:165-167. [PMID: 32507667 DOI: 10.1053/j.seminoncol.2020.04.005] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/29/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Chronic Hepatitis C virus (HCV) infection has been associated with extrahepatic cancers. Few studies have reported associations between HCV and genitourinary cancers such as kidney and prostate cancers with inconsistent findings. We sought to study associations between HCV and the most common genitourinary cancers including kidney, prostate and urinary bladder. MATERIAL AND METHODS This case-control study included adult (≥18 years at diagnosis) cancer patients who were screened for HCV antibody (anti-HCV) at MD Anderson Cancer Center from June 2004 through January 2018. Cases had incident primary genitourinary cancers (cancers of the kidney, prostate, renal pelvis and ureter, or urinary bladder). Controls had smoking-associated cancers (esophagus, lung and pancreas). Multivariate logistic regression models were used. RESULTS Among 42,244 patients screened for anti-HCV, 1,493 cases (527 kidney, 691 prostate, 58 renal pelvis and ureter, and 217 urinary bladder cancer) and 1,187 controls (242 esophagus, 709 lung, and 236 pancreas cancer) were studied. In the univariate analysis, the prevalence of anti-HCV positivity did not differ significantly between the controls and the cases with cancers of the renal pelvis and ureter (8% v9%, P = .81), prostate (10% v8%, P = .34), or urinary bladder (8% v 6%, P = .18). In contrast, the prevalence of anti-HCV positivity was lower among the cases with kidney cancer than among the controls (4% v 8%, P< .001). However, in the multivariate analyses after adjustment for cofounders, no significant association between anti-HCV positivity and any genitourinary cancer we evaluated. CONCLUSION Our results do not support an association between chronic HCV and common genitourinary cancers.
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Affiliation(s)
| | - Parag Mahale
- Departments of Infectious Diseases, Infection Control and Employee Health
| | | | - Ying Jiang
- Departments of Infectious Diseases, Infection Control and Employee Health
| | - Harrys A Torres
- Departments of Infectious Diseases, Infection Control and Employee Health; Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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Anand A, Gupta R, Chandail VS. Pyeloduodenal fistula: A rare case report. Urol Case Rep 2020; 32:101224. [PMID: 32368500 DOI: 10.1016/j.eucr.2020.101224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 11/22/2022] Open
Abstract
Pyeloduodenal fistula is a rare entity, with very few cases reported in the world literature so far. Commonly found in three disease entities – chronic renal inflammatory disease secondary to renal calculi, renal tuberculosis and renal malignancies in order of frequency; this disease entity is a rare to diagnose and treat.
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38
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Xie J, Huang JS, Huang XJ, Peng JM, Yu Z, Yuan YQ, Xiao KF, Guo JN. Profiling the urinary microbiome in men with calcium-based kidney stones. BMC Microbiol 2020; 20:41. [PMID: 32111156 PMCID: PMC7049185 DOI: 10.1186/s12866-020-01734-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 02/24/2020] [Indexed: 12/13/2022] Open
Abstract
Background The dogma that urine is sterile in healthy individuals has been overturned by recent studies applying molecular-based methods. Mounting evidences indicate that dysbiosis of the urinary microbiota is associated with several urological diseases. In this study, we aimed to investigate the urinary microbiome of male patients with calcium-based kidney stones and compare it with those of healthy individuals. Results The diversity of the urinary microbiota in kidney stone patients was significantly lower than that of healthy controls based on the Shannon and Simpson index (P < 0.001 for both indices). The urinary microbiota structure also significantly differed between kidney stone patients and healthy controls (ANOSIM, R = 0.11, P < 0.001). Differential representation of inflammation associated bacteria (e.g., Acinetobacter) and several enriched functional pathways were identified in the urine of kidney stones patients. Meanwhile, we found the species diversity, overall composition of microbiota and predicted functional pathways were similar between bladder urine and renal pelvis urine in kidney stone patients. Conclusions A marked dysbiosis of urinary microbiota in male patients with calcium-based kidney stones was observed, which may be helpful to interpret the association between bacteria and calcium-based kidney stones.
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Affiliation(s)
- Jing Xie
- Department of Urology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, 518020, China
| | - Jian-Sheng Huang
- Department of Urology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, 518020, China
| | - Xiang-Jiang Huang
- Department of Urology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, 518020, China
| | - Jun-Ming Peng
- Department of Urology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, 518020, China
| | - Zhou Yu
- Department of Urology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, 518020, China
| | - Ye-Qing Yuan
- Department of Urology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, 518020, China
| | - Ke-Feng Xiao
- Department of Urology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, 518020, China
| | - Ji-Nan Guo
- Department of Urology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, 518020, China.
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Rolim I, Henriques V, Rolim N, Blanca A, Marques RC, Volavšek M, Carvalho I, Montironi R, Cimadamore A, Raspollini MR, Cheng L, Lopez-Beltran A. Clinicopathologic analysis of upper urinary tract carcinoma with variant histology. Virchows Arch 2020; 477:111-20. [PMID: 31950242 DOI: 10.1007/s00428-020-02745-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/31/2019] [Accepted: 01/08/2020] [Indexed: 02/05/2023]
Abstract
We report on the clinicopathologic features of 115 cases of high-grade urothelial carcinoma of the upper urinary tract with variant histology present in 39 (34%). Variant histology was typically seen in high pathological stage (pT2-pT4) (82%, 32 cases) patients with lower survival rate (70%, 27 cases, median survival 31 months) and consisted in urothelial with one (23%), two (3%), and three or more variants (3%); 4% of cases presented with pure variant histology. Squamous divergent differentiation was the most common variant (7%) followed by sarcomatoid (6%) and glandular (4%), followed by 3% each of micropapillary, diffuse-plasmacytoid, inverted growth, clear cell glycogenic, or lipid-rich. The pseudo-angiosarcomatous variant is seen in 2%, and 1% each of nested, giant-cell, lymphoepithelioma-like, small-cell, trophoblastic, rhabdoid, microcystic, lymphoid-rich stroma, or myxoid stroma/chordoid completed the study series. Loss of mismatch repair protein expression was identified in one case of upper urinary tract carcinoma with inverted growth variant (3.6%). Variant histology was associated to pathological stage (p = 0.007) and survival status (p = 0.039). The univariate survival analysis identified variant histology as a feature of lower recurrence-free survival (p = 0.046). Our findings suggest that variant histology is a feature of aggressiveness in urothelial carcinoma of the upper urinary tract worth it to be reported.
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Abdalla M. Anatomical features in the kidney involved in water conservation through urine concentration in dromedaries ( Camelus dromedarius). Heliyon 2020; 6:e03139. [PMID: 31922050 PMCID: PMC6948238 DOI: 10.1016/j.heliyon.2019.e03139] [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: 11/01/2019] [Revised: 12/13/2019] [Accepted: 12/27/2019] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to report some of the morphological characteristics of the kidney involved in urine concentration and hence water conservation in the dromedaries. A total of 20 fresh kidneys of 10 apparently healthy camels were used in this study. The architecture of the renal pelvis was revealed by dissection and polyvinyl chloride corrosion casts. Samples were also processed for histology and for enzyme histochemistry. The camel kidney is bean shaped, smooth, multilobar, unipapillary, in which the fusion of renal papillae is complete forming a common renal papilla or crest, which channel urine into a central renal pelvis. It is more or less similar to equine, caprine, ovine and canine kidney. Under certain anatomical requisites the renal pelvis is known to play a role in urine concentration through recycling of urea to increase the medullary osmotic concentration which favors the counter-current mechanism. One of these requisites is an elaborate renal pelvis which is closely associated with the renal medulla. The renal pelvis of the camel has a main crescentic cavity following the long axis and curvature of the kidney. A thick extensive renal crest projects into the cavity of the pelvis. The thick renal crest contains large numbers of long loops of Henle and vasa recta which are important for urine concentration. The renal crest is formed by convergence of the medullary pyramids before it projects into the cavity of the renal pelvis. The crescentic main cavity of the pelvis forms 20-24 three dimensional radiating collateral recesses which contain the medullary pyramids. This close association of the renal pelvis and medulla provide a large surface area for the recycling of urea and hence urine concentration. This large pelvic-medullary interface is lined by simple low cuboidal epithelium which enhances the recycling of urea and water from the pelvic urine into the medulla and directly contributes to urine concentration. The rest of the wall of the renal pelvis and its recesses facing away from the renal crest and medullary pyramids is lined by impermeable transitional epithelium. Another feature is the intense activity of alkaline phosphatase demonstrated in the proximal convoluted tubules which indicates increased membrane transport. It is concluded that the kidney in dromedaries has the anatomical and histochemical requisites for the production of concentrated urine. These requisites enable the kidney to adequately contribute to the ability of the camel to conserve water and withstand the aridity of its habitat.
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Affiliation(s)
- M.A. Abdalla
- Department of Anatomy, Faculty of Medicine, University of Khartoum, Sudan
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Ayari Y, Boussaffa H, Taktak T, Ghorbel Z, Sellami A, Ben Rhouma S, Nouira Y. Locally advanced squamous cell carcinoma of the renal pelvis masquerading as emphysematous pyelonephritis. Urol Case Rep 2019; 27:100780. [PMID: 31687340 PMCID: PMC6819774 DOI: 10.1016/j.eucr.2018.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 10/19/2018] [Indexed: 11/19/2022] Open
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Rouprêt M, Xylinas E, Colin P, Houédé N, Compérat E, Audenet F, Larré S, Masson-Lecomte A, Pignot G, Brunelle S, Roumiguié M, Neuzillet Y, Méjean A. [French ccAFU guidelines - Update 2018-2020: Upper tract urothelial carcinoma]. Prog Urol 2018; 28 Suppl 1:R34-47. [PMID: 31610873 DOI: 10.1016/j.purol.2019.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 07/31/2018] [Indexed: 12/29/2022]
Abstract
INTRODUCTION To propose an update of the French guidelines from the national committee ccAFU on upper tract urothelial carcinomas (UTUC). METHODS A systematic Medline search was performed between 2016 and 2018, with regards to the diagnosis, the options of treatment and the follow-up of UTUC, to evaluate the different studies with levels of evidence. RESULTS The diagnosis of this rare disease is based on CT-scan acquisition during excretion and ureteroscopy with histological biopsies. Radical nephroureterectomy (RNU) remains the gold standard for surgical treatment, nevertheless a conservative endoscopic approach can be proposed for low-risk diseases: unifocal tumour, possible complete resection low-grade and lack of invasion on CT-scan. Close monitoring with endoscopic follow-up (flexible ureteroscopy) in compliant patients is therefore necessary. After RNU, bladder instillation of chemotherapy is recommended in order to reduce the risk of bladder recurrence. An adjuvant chemotherapy is recommended after RNU in pT2-T4 N0-3 M0 disease. CONCLUSION These updated guidelines will contribute to increase the level of urological care for diagnosis and treatment of UTUC.
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Campi R, Cotte J, Sessa F, Seisen T, Tellini R, Amparore D, Mormile N, Gobert A, Mari A, Porpiglia F, Serni S, Minervini A, Rouprêt M. Robotic radical nephroureterectomy and segmental ureterectomy for upper tract urothelial carcinoma: a multi-institutional experience. World J Urol 2019; 37:2303-11. [PMID: 31062121 DOI: 10.1007/s00345-019-02790-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 04/26/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To report a multi-institutional experience on robotic radical nephroureterectomy (RNU) and segmental ureterectomy (SU) for upper tract urothelial carcinoma (UTUC). METHODS Data were prospectively collected from patients with non-metastatic UTUC undergoing robotic SU or RNU at three referral centers between 2015 and 2018. Transperitoneal, single-docking robotic RNU followed established principles. Bladder cuff excision (BCE) was performed with robotic or open approach. Techniques for SU included: ureteral resection and primary uretero-ureterostomy; partial pyelectomy and modified pyeloplasty; ureteral resection with BCE and direct- or psoas hitch-ureteroneocystostomy. We retrospectively evaluated the technical feasibility, and peri-operative and oncologic outcomes after robotic RNU/SU. RESULTS 81 patients were included. No case required conversion to open surgery. Early major (Clavien-Dindo grade > 2) complications were reported in six (7.4%) patients (two after SU, four after RNU). Three patients experienced late major complications (one after SU, two after RNU). Median ΔeGFR at 3 months was - 1 ml/min/1.73 m2 after SU and - 15 ml/min/1.73 m2 after RNU. Positive surgical margins were recorded in five patients (one after SU, four after RNU). Median follow-up was 21 months and 22 months in the SU and RNU groups, respectively. Three (20%) patients had ipsilateral upper tract recurrence after SU, while five (7.5%) developed metastases after RNU. No case of port-site metastases or peritoneal carcinomatosis was reported. At last follow-up, 67 (82.7%) patients were alive without evidence of disease. CONCLUSION Robotic SU and RNU are technically feasible and achieved promising peri-operative and oncologic outcomes in selected patients with non-metastatic UTUC.
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Hasan MN, Rouprêt M, Keeley F, Cracco C, Jones R, Straub M, Traxer O, Osther PJS, Brehmer M. Consultation on UTUC, Stockholm 2018 aspects of risk stratification: long-term results and follow-up. World J Urol 2019; 37:2289-2296. [PMID: 30944969 PMCID: PMC6825637 DOI: 10.1007/s00345-019-02739-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 12/30/2018] [Accepted: 03/23/2019] [Indexed: 12/11/2022] Open
Abstract
Purpose To summarize current knowledge on upper urinary tract carcinoma (UTUC) regarding risk stratification, long-term results, and follow-up. Methods A scoping review approach was applied to search literature in Pubmed, Web of Science, and Embase. Consensus was reached through discussions at Consultation on UTUC, September 2018, Stockholm. Results To optimize oncological outcome considering both cancer-specific survival (CSS) and overall survival (OS), it is essential to identify pre- and postoperative prognostic factors. In low-risk UTUC, kidney-sparing surgery (KSS) and radical nephroureterectomy (RNU) offer equivalent CSS, whereas RNU may result in poorer OS due to nephron loss. For more aggressive tumours, undergrading can lead to insufficient treatment. The strongest prognostic factors are tumour stage and grade. Determining grade is best achieved by ureterorenoscopy (URS) with focal samples, biopsy and cytology. Staging is more difficult but can be indirectly achieved by multiphase computed tomography urography (CTU) or tumour grade determined by cytology and histopathology. Patients treated with KSS should be monitored closely with regular follow-ups (URS and CTU). Conclusion KSS should be offered in low-risk UTUC when feasible, whereas RNU is the treatment of choice in organ-confined high-risk UTUC. Intravesical recurrence (IVR) is common after RNU, but a single postoperative dose of mitomycin instillation decreases IVR. Endourological management has high local and bladder recurrence rates; however, its effect on CSS or overall survival OS is unclear. RNU is associated with significant risk of chronic kidney disease. Careful selection of patients and risk stratification are mandatory, and patients should be followed according to strict protocols.
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Affiliation(s)
- Mudhar N Hasan
- Division of Urology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Morgan Rouprêt
- Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Francis Keeley
- Bristol Urological Institute, Southmead Hospital, Bristol, England, UK
| | - Cecilia Cracco
- Department of Urology, Cottolengo Hospital of Torino, Torino, Italy
| | - Robert Jones
- Institute of Cancer Sciences, University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Michael Straub
- Department of Urology, University Hospital Klinikum Rechts Der Isar, Technical University Munich, Munich, Germany
| | | | | | - Marianne Brehmer
- Division of Urology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
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Huang J, Zhu R, Wu R, Li R, Yao N, Deng S. Hepatoid adenocarcinoma of the renal pelvis in a 59-year-old male with nephrolithiasis: Case report and review of the literature. Curr Probl Cancer 2019; 43:471-476. [PMID: 30683324 DOI: 10.1016/j.currproblcancer.2018.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 11/21/2018] [Accepted: 12/21/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hepatoid adenocarcinoma arising from urological system is extremely rare, and the pathogenesis and therapeutic regimen have been poorly understood. CASE REPORT we report a unique case of ɑ-fetaprotein (AFP)-producing neoplasm of renal pelvis associated with nephrolithiasis. A 59-year-old male patient was diagnosed with right renal tumor and nephrolithiasis with no evidence of lesions in his digestive or reproductive system. He was successfully treated with right laparoscopic radical nephroureterectomy and lymph node dissection. Pathology analysis showed moderately or poorly hepatocellular differentiation and adenocarcinoma differentiation with lymph node reactive hyperplasia. Immunohistochemical analysis demonstrated that the cancer cells were positive for AFP, HepPar-1, GPC3, CK7, and PLAP. The patient's recovery was on schedule and no sign of recurrence was observed for 3 months. We recently reviewed AFP-producing nongerm cell tumors in upper urinary tract and discussed the clinical aspect, morphology features, pathogenesis, and therapeutic regimen for a better understanding of this rare entity. CONCLUSION The present case is the first documented of hepatoid adenocarcinoma of renal pelvis complicated with nephrolithiasis, which was treated with laparoscopic approach. The prognosis of the hepatoid adenocarcinomas arising from renal pelvis and ureter seems good.
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Affiliation(s)
- Jun Huang
- Department of Urology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of SUN YAT-SEN University, Jiangmen, Guangdong, China
| | - Ruilong Zhu
- Department of Urology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of SUN YAT-SEN University, Jiangmen, Guangdong, China.
| | - Ronghai Wu
- Department of Urology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of SUN YAT-SEN University, Jiangmen, Guangdong, China
| | - Ronggang Li
- Department of Pathology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of SUN YAT-SEN University, Jiangmen, Guangdong, China
| | - Nan Yao
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of SUN YAT-SEN University, Jiangmen, Guangdong, China
| | - Shuo Deng
- Department of Urology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of SUN YAT-SEN University, Jiangmen, Guangdong, China
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Abstract
BACKGROUND Staging of bladder cancer, hematuria as well as the evaluation of unclear findings of the kidneys and ureters are the most frequent indications for imaging of the upper urinary tract (UUT). Endourological assessment of the UUT is much more invasive compared to imaging of the bladder, raising the question of the optimal imaging technique. Several technical improvements regarding computed tomography (CT) as well as magnetic resonance imaging (MRI) were implemented in recent years. OBJECTIVES To compare the efficacy and limitations of the most important imaging techniques regarding the UUT. MATERIALS AND METHODS Systematic review of the literature and current German, European, and American guidelines regarding bladder cancer, urothelial carcinoma of the UUT and hematuria. RESULTS The CT-based urography has superseded excretory urography and is the first choice for imaging of the UUT. In case of contraindications, MRI is a feasible alternative. In all cases, a urography phase is indispensable. CONCLUSIONS Imaging of the UUT has to be used in a reasonable combination together with endourological methods and cytology. Optical coherence tomography, confocal laser endomicroscopy and scientific innovations such as radiomics might improve UUT imaging and differential diagnosis of UUT lesions in the future.
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Affiliation(s)
- G B Schulz
- Urologische Klinik und Poliklinik, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
| | - E K Gresser
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Campus Großhadern, München, Deutschland
| | - J Casuscelli
- Urologische Klinik und Poliklinik, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - F Strittmatter
- Urologische Klinik und Poliklinik, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - S Tritschler
- Urologische Klinik und Poliklinik, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - A Karl
- Urologische Klinik und Poliklinik, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - C G Stief
- Urologische Klinik und Poliklinik, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - D Nörenberg
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Campus Großhadern, München, Deutschland
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Gandhi KR, Chavan S. Revisiting the morphology of pelvicalyceal system in human cadaveric kidneys with a systematic review of literature. Asian J Urol 2018; 6:249-255. [PMID: 31297316 PMCID: PMC6595142 DOI: 10.1016/j.ajur.2018.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 04/17/2018] [Revised: 07/26/2018] [Accepted: 09/04/2018] [Indexed: 11/30/2022] Open
Abstract
Objective Renal collecting system macroscopically consists of minor calyx, major calyx, renal pelvis and ureter. Stone in renal collecting system is a common presentation in everyday urological practice. The prevalence of renal calculi ranges from 4% to 20% in different geographical distribution. Anatomical variation in renal collecting system plays a significant role in formation of calculi in its parts. The large extra renal pelvis leads to stagnation of urine for longer durations and formation of stones. The stone free rate after percutaneous nephrolithotomy and extra corporeal shock wave lithotomy is significantly related to anatomical factors, particularly the type of renal pelvis and dimensions (length and width) of lower infundibulum. Previous authors described the morphology of pelvicalyceal system in a highly variable manner and the available anatomical description of pelvicalyceal system is contradictory and incomplete. Hence an attempt has been made to provide the precise anatomy of pelvicalyceal system in adult human kidneys. Methods We studied 196 formalin embalmed kidneys to note the number of infundibulum, major and minor calyces. The location and shape of pelvis were also studied. Results The intra-renal pelvis was narrow and had funnel shaped appearance in 95 of total 196 (48.5%) specimens, and the extra-renal pelvis was dilated as balloon shaped in 43 of 196 (21.9%) specimens. In 41 (20.9%) specimens, the renal pelvis was having partially intra- and extra-renal in location. Bilateral symmetry was found in only 27.1% of 196 renal collecting systems. The length of lower infundibulum was more than 22 mm in 19 (9.7%) of 196 cases which directly affects the stone clearance rate during open and endoscopic surgeries on pelvicalyceal system. Conclusion This study provides the accurate morphological details of the shape and dimensions of renal pelvicalyceal system to help the urologists and nephrologists.
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Affiliation(s)
- Kusum Rajendra Gandhi
- Department of Anatomy, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Sushama Chavan
- Department of Anatomy, Rural Medical College, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
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Rouprêt M, Xylinas E, Colin P, Houédé N, Compérat E, Audenet F, Larré S, Masson-Lecomte A, Pignot G, Brunelle S, Roumiguié M, Neuzillet Y, Méjean A. RETRACTED: Recommandations françaises du Comité de Cancérologie de l’AFU — Actualisation 2018—2020 : tumeurs de la voie excrétrice supérieure French ccAFU guidelines — Update 2018—2020: Upper tract urothelial carcinoma. Prog Urol 2018; 28:S32-S45. [PMID: 30318333 DOI: 10.1016/j.purol.2018.07.284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 07/31/2018] [Indexed: 11/18/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).
Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations.
Le nouvel article est disponible à cette adresse: doi:10.1016/j.purol.2019.01.005.
C’est cette nouvelle version qui doit être utilisée pour citer l’article.
This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published.
The replacement has been published at the doi:10.1016/j.purol.2019.01.005.
That newer version of the text should be used when citing the article.
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Affiliation(s)
- M Rouprêt
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Sorbonne Université, GRC n∘5, ONCOTYPE-URO, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
| | - E Xylinas
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie de l'hôpital Bichat-Claude Bernard, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 75018 Paris, France
| | - P Colin
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital privé de la Louvière, 59042 Lille, France
| | - N Houédé
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Département d'oncologie Médicale, CHU Caremaux, Montpellier université, 30029 Nîmes, France
| | - E Compérat
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Service d'anatomie pathologique, hôpital tenon, HUEP, Sorbonne Université, GRC n∘5, ONCOTYPE-URO, 75020 Paris, France
| | - F Audenet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Européen-Georges-Pompidou, université Paris Descartes, AP-HP, 75015 Paris, France
| | - S Larré
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Reims, 51100 Reims, France
| | - A Masson-Lecomte
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Saint-Louis, université Paris-Diderot, 75010 Paris, France
| | - G Pignot
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie oncologique 2, institut Paoli-Calmettes, 13009 Marseille, France
| | - S Brunelle
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, institut Paoli-Calmettes, 13009 Marseille, France
| | - M Roumiguié
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Département d'urologie, CHU Rangueil, 31400 Toulouse, France
| | - Y Neuzillet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Foch, université de Versailles-Saint-Quentin-en-Yvelines, 92150 Suresnes, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Européen-Georges-Pompidou, université Paris Descartes, AP-HP, 75015 Paris, France
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Nakasato T, Hiramatsu A, Matsui Y, Unoki T, Shimoyama H, Oshinomi K, Morita J, Maeda Y, Naoe M, Fuji K, Ogura H, Homma M, Yamochi T, Takimoto M, Ogawa Y. Systematic review and two new cases of primary upper urinary tract neuroendocrine carcinomas. Cancer Treat Res Commun 2018; 17:23-30. [PMID: 30326420 DOI: 10.1016/j.ctarc.2018.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/11/2018] [Accepted: 10/08/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Upper urinary tract neuroendocrine carcinoma (UUT-NEC) is extremely rare and has a poor prognosis. Although a few cases of successful treatment have been reported, no treatment has shown established efficacy. PATIENTS AND METHODS We analyzed 70 UUT-NEC patients, including 68 with small cell neuroendocrine carcinoma (SCNEC) and large cell neuroendocrine carcinoma (LCNEC) reported between 1985 and 2017 and 2 treated at our hospital. RESULTS Median patient age was 66 years, 58.6% were men, and 60% were of Asian descent. Most UUT-NECs were SCNEC (68; 95.7%), whereas LCNEC was very rare (2; 2.9%). More than half of the patients had accompanying other histological components, the most common being urothelial carcinoma (51.5%), whereas 41.4% had NEC alone. Of the 70 patients, 27 underwent additional therapy (e.g., chemotherapy and radiotherapy) along with surgery. Median survival was 15 months. In univariate analysis, stages T1-2 disease showed better prognosis than stages T3-4 (P < 0.001). Additional treatment (e.g., chemotherapy and radiotherapy) significantly improved prognosis (P = 0.014). Moreover, platinum-based chemotherapy also was associated with improved prognosis (P = 0.017). For platinum-based chemotherapy, multicollinearity with additional treatments was strong, and, thus, these data were not included in the analysis. Multivariate analysis revealed pathological stage (T1-2 vs. T3-4; P = 0.003) and additional treatment (P = 0.028) to be independent predictors of improved prognosis. CONCLUSION Although UUT-NEC has a poor prognosis, additional treatment along with surgery and therapeutic intervention and stage T1-2 disease are independent factors to improve prognosis.
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Upfill-Brown A, Lenis AT, Faiena I, Salmasi AH, Johnson DC, Pooli A, Drakaki A, Gollapudi K, Blumberg J, Pantuck AJ, Chamie K. Treatment utilization and overall survival in patients receiving radical nephroureterectomy versus endoscopic management for upper tract urothelial carcinoma: evaluation of updated treatment guidelines. World J Urol 2019; 37:1157-64. [PMID: 30267197 DOI: 10.1007/s00345-018-2506-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 09/24/2018] [Indexed: 01/19/2023] Open
Abstract
PURPOSE While radical nephroureterectomy (RNU) is the gold standard treatment for upper tract urothelial carcinoma (UTUC), select patients may benefit from endoscopic treatment (ET). European Association of Urology guidelines recommend ET for patients with low-risk (LR) disease: unifocal, < 2 cm, low-grade lesions without local invasion. To inform the utility of ET, we compare the overall survival (OS) of patients receiving ET and RNU using current and previous guidelines of LR disease. MATERIALS AND METHODS Patients with non-metastatic, cT1 or less UTUC diagnosed in 2004-2012 were collected from the National Cancer Database. OS was analyzed with inverse probability of treatment weighted Cox proportional hazard regression. Analyses were conducted for LR disease under updated (size < 2 cm) and previous guidelines (size < 1 cm). RESULTS Patients who were older, healthier, and treated at an academic facility had higher odds of receiving ET. In 851 identified patients with LR disease, RNU was associated with increased OS compared with ET (p = 0.006); however, there was no difference between ET and RNU (p = 0.79, n = 202) under the previous guidelines (size < 1 cm). In, otherwise, LR patients, the largest tumor size with no difference between ET and RNU was ≤ 1.5 cm (p = 0.07). CONCLUSIONS RNU is associated with improved survival when compared with ET in the management of LR UTUC using current guidelines with a size threshold of < 2 cm. In appropriately selected LR patients, we find no difference between RNU and ET up to a tumor size of ≤ 1.5 cm. However, in the absence of prospective studies, the usage of ET is best left up to clinician discretion.
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