Spontaneous rupture of renal tumours presenting as surgical emergency

A study of renal tumours filed in the pathology department of a regional hospital in Hong Kong during 1971-1990 showed 6 cases of surgical emergency due to spontaneous rupture of the kidney by tumour. All occurred as a complication of renal angiomyolipoma, a rare tumour or hamartoma. A literature review showed that the renal tumour most frequently reported to cause spontaneous rupture was renal carcinoma. Chinese patients appear to have more renal ruptures due to angiomyolipoma than to renal carcinoma. It is proposed that intra-operative frozen section diagnosis should be sought, when this can be safely performed, in cases of rupture of the kidney by tumour. Surgery aiming at conserving functional renal parenchyma is appropriate for benign lesions such as angiomyolipoma.     

Systemic embolism in a renal transplant patient. Echocardiographic demonstration of bronchial carcinoma with intracardiac invasion

A 45 year old female renal transplant patient was admitted for subacute ischaemia of a lower limb. Echocardiography was performed and showed the presence of bronchial carcinoma with intracardiac invasion. The tumour was confirmed by thoracic computerised tomography and by bronchoscopy. Histological investigation of bronchial biopsies and of the arterial embolism extracted at surgery showed large cell malignant disease. The tumour partially responded to chemotherapy and the patient survived for 5 months. Extension of a bronchial carcinoma to the left atrium is a classical complication in autopsy reports but rarely a source of systemic embolism. Echocardiographic diagnosis of this condition is very rare. The incidence of malignant diseases is higher in renal transplant patients than in the general population but this has not been verified for bronchial carcinoma. Echocardiography played an essential role in this case, detecting the tumour and its extension, indicating a poor prognosis and guiding treatment.     

Unrecognized renal cell carcinoma. Clinical and pathological aspects

In an autopsy series comprising 235 clinically unrecognized renal cell carcinoma metastatic spread was revealed in 24%. The number of metastasizing tumours increased significantly with the size of the primary tumour. Local aggressiveness of the primary tumour was more common for large tumours but was much more closely correlated to metastatic spread than to size. Tumours ingrowth in the renal vein was significantly commoner in metastasizing tumours as compared to non-metastasizing tumours. The study confirmed that an analysis as to local aggressiveness was prognostically valuable and might be useful to define the group of patients that may benefit from adjuvant therapy such as radiation therapy, chemotherapy or immunotherapy.     

Isolated angiomyolipomas of the kidney. Diagnostic difficulties

The authors report 4 cases angiomyolipomas in which the preoperative diagnosis was that of a malignant tumour. They stress the difficulties of arteriographic and even histological diagnosis of these rare tumours of the renal parenchyma.     

Pharmacoangiography in experimental tumours. Evaluation of vasoactive drugs

Pharmacoangiography with four vasoactive drugs was performed in experimental renal and hepatic tumours in rats in order to compare their ability to demonstrate tumour vascularity. Three vasoconstrictors, angiotensin, norepinephrine and vasopressin, and one vasodilator, tolazoline, were tested, vasoconstrictors giving most diagnostic information and the difference in effect among these sometimes being small and probably dose-related. This diagnostic effect is based upon the primitive character of tumour vessels, being unable to react upon a vasoactive stimulus. Angiotensin turned out to be the superior drug which corresponds to clinical experiences of this drug.     

Polycythaemia as sole symptom of renal adenoma (author's transl)]

In two children, a 9 year-old boy and a 10 1/2 year-old girl, who presented with polycythaemia as the only symptom, the expected renal tumour was only found after exclusion of all other causes of polycythaemia. The delay in diagnosis was caused by technically inadequate intravenous urograms, which were erroneously passed as normal. In one child low kv X-ray exposition of the kidneys led to the diagnosis of a renal tumour. In the other child high-dose urography and tomography gave the indication for selective angiography. Normalization of the red blood count postoperatively verifies the connection between preoperative erythrocytosis and the renal tumour. Histologically both cases proved to be renal adenomas, which are extremely rare in childhood.     

Cervical lymph node metastasis disclosing a Grawitz's tumor. Apropos of a case

The authors report a case of advanced renal cell carcinoma presenting in the form of cervical lymph node metastases. In the absence of any specific clinical signs and an ENT portal of entry, this obviously neoplastic subdigastric lymphadenopathy was apparently primary. Histopathological examination of the cervical lymph node dissection revealed metastatic renal cell carcinoma and complementary investigations revealed the primary tumour in the right kidney. The course was fatal within several weeks despite treatment. The various problems raised by this truly metastatic disease are discussed.     

Carcinosarcoma of the adult kidney

Carcinosarcoma of the adult kidney is a very rare tumour and there are only a few well documented cases in the literature. In this report such a tumour is described from a 50-year-old white male, which progressed very rapidly with widespread metastases. Histologically, the tumour consisted of renal cell carcinoma and fibrosarcomatous components. The interesting features in this case were that both the carcinomatous and sarcomatous elements of the tumour exhibited metastases separately to various organs.     

Imaging of small renal tumors

The increased incidence of detection of small renal tumours, less than or equal to 3 cm in diameter, is related to the generalization and improvement of radiological techniques. Many asymptomatic renal tumours are discovered by ultrasonography and computed tomography. Medical imaging is now able to identify simple cysts (morphological characters, absence of blood supply), angiomyolipomas (demonstration of the fatty contingent) and other solid renal tumours (tumour enhancement on computed tomography). Plain, followed by postcontrast CT looking for contrast enhancement of the lesions is the examination of choice in this context. MRI with Gadolinium injection looking for neoplastic enhancement can be useful in doubtful cases. Medical imaging is able to reliably demonstrate the vascular nature of solid lesions, but cannot distinguish between renal cancer, oncocytoma or another benign solid tumour. Medical imaging allows precise preoperative mapping when partial nephrectomy is envisaged.     

Congenital absence and aberrant course of the internal carotid artery

OBJECTIVE: To evaluate the extent of vascularization by assessing vascular surface density in renal cell carcinomas (RCCs) of different nuclear grades, and in normal renal cortex and medulla. MATERIALS AND METHODS: Specimens of 79 RCCs of different nuclear grades (16 of G1, 42 of G2 and 21 of G3) were immunostained with the lectin Ulex europaeus agglutinin-I (UEA I). The vascular surface density of tumour tissue was assessed stereologically using a test grid at x400 magnification and compared to the values obtained in normal renal tissue. RESULTS: G3 tumours had a lower vascular surface density than had G1 and G2 RCCs and normal renal tissue of the cortex and medulla (P < 0.001, respectively). G1 tumours had a significantly higher vessel density than had normal medullary parenchyma and G2 carcinomas (P < 0.001). Vessel density was not significantly different among G1 tumours and cortical parenchyma in controls and among normal medullary tissue and G2 tumours. Statistical analysis showed that the vascular surface density was independent of tumour stage and size and the age and sex of the patients. CONCLUSION: The degree of vascularization in RCCs decreased with their grade of differentiation, suggesting that the extent of neovascularization in tumour tissue reflects the relationship between tumour cell proliferation and vascular growth. The values of vascular surface density in normal renal tissue of the cortex and medulla partially overlapped with those obtained in tumour tissue.     

Serum lysozyme as a marker of host resistance. II. Patients with malignant melanoma, hypernephroma or breast carcinoma

Serum lysozyme activity was measured in groups of untreated patients with malignant melanoma, hyperneophroma and breast carcinoma. Significant elevation of serum levels of the enzyme was confined to patients with localized disease. In the presence of metastatic disease such elevation was not detected. The rise in serum lysozyme activity was not due to renal damage or any infective process and in the case of malignant melanoma was shown to be associated with infiltration of the tumour mass by macrophages. In vitro studies demonstrated that the macrophages resident in a tumour mass are responsible for relasing lysozyme in large amounts. It is proposed that the elevation of serum lysozyme in these cases may be an indicator of macrophage-mediated host resistance and that the measurement of macrophage products such as lysozyme in the extracellular fluid may under well defined conditions provide useful clinical information concerning host reactions.     

Bilateral renal tumors

At the Urological Clinic in Hradec Králové in 1990-1994 320 patients with renal tumours were admitted and treated. In 12 the tumour was bilateral (3.7%), incl. 8 patients where it was synchronous and four where it was asynchronous. Only in one female patient bilateral nephrectomy was performed, in 8 patients unilateral nephrectomy and on the other side enucleation of the tumour, in two patients bilateral enucleation of the tumour and in one patient with a malignant lymphoblastic lymphoma only unilateral enucleation of the tumour and epinephrectomy. In 10 patients histological examination confirmed a renal carcinoma, in one patient a malignant lymphoblastic lymphoma, in one female patient a bilateral multifocal oncocytoma. The patients survival was not evaluated in the report.     

Histogenesis and diagnostic of kidney cancer in the light of electron microscopic data

Electron microscopic examinations of human renal carcinoma showed that both light and dark (granular) differentiated tumour cells may have ultrastructural features of the cells of any nephron segment. In the light of these results and concepts of the capacity of undifferentiated tumour cells for specific differentiation, the decisive importance in histogenesis (cytogenesis) of the renal carcinoma belongs not to the site of its origin in one or another nephron segment but to the level of differentiation of stem cells (polypotent or monopotent) undergoing malignization and to the direction of their further differentiation. The paper presents concrete ultrastructural differential diagnostic features of renal carcinoma cells.     

Isolated late metastasis of a renal cell cancer treated by radical distal pancreatectomy

A 53-year-old man underwent right nephrectomy for a locally renal cell carcinoma with concomitant resection of a solitary metastasis in the right lung. Ten years later, he presented with haematochezia caused by a tumour in the tail of pancreas, invading the transverse colon and the greater curvature of the stomach. The tumour was radically resected, and histological examination revealed a solitary metastasis of the previous renal cell carcinoma. This case illustrates a rare indication for pancreatic resection because of pancreatic metastasis.     

Trichomonas foetus meningoencephalitis after allogeneic peripheral blood stem cell transplantation

The authors report a case of adrenal metastasis contralateral to a renal cell carcinoma in a 74-year-old patient who had undergone right radical nephrectomy for renal cell carcinoma. Nine months later, computed tomography revealed a hypervascular mass considered to be an aneurysm of the splenic artery. Arteriography led to the diagnosis of hypervascular adrenal tumour. Left adrenalectomy was performed. Histological examination showed a metastasis from renal cell carcinoma. This is an unusual form of renal cancer metastasis. Its treatment and prognosis are discussed.     

Renal adenocarcinoma with lung metastasis in an adolescent

OBJECTIVE: The finding of a renal adenocarcinoma in a young patient is a rare occurrence. We report on a case of renal adenocarcinoma with lung metastases arising in an 18-year-old girl with non-specific symptoms and normal blood chemistry and urinary analysis. RESULTS AND CONCLUSION: We underscore the aggressive nature of the tumour which grew asymptomatically, giving rise to lymph node and pulmonary metastases.     

Narrow resection of cutaneous melanoma

We report the case of a young pregnant woman with a malignant tumour of the kidney suggestive of oncocytoma. Because of the pregnancy, preoperative staging consisted of abdominal ultrasound and magnetic resonance imaging. Caesarean section was performed. Several days later, surgical exploration of the kidney was performed with tumourectomy and frozen section analysis: radical nephrectomy was finally performed. The definitive histology was chromophobe renal cell carcinoma. This is a rare tumour of the kidney, with its own characteristics allowing histopathological diagnosis and with a better prognosis than renal cell carcinoma. In the literature, pregnancy, a situation of immune depression, does not increase the prevalence of malignant neoplasms.     

Biodistribution of radiolabeled monoclonal antibody E48 IgG and F(ab'')2 in patients with head and neck cancer

The amphibian pronephros is fated to die during early development. Pronephric cells undergo apoptosis and their function is replaced by the mesonephros, which becomes the functional kidney of the adult frog. Tadpoles of the northern leopard frog, Rana pipiens, were inoculated with a Lucké tumour herpesvirus (LTV) preparation. Most of the animals developed typical Lucké renal carcinomas at metamorphosis. Fewer developed carcinomas of the pronephric cell type. A pronephric carcinoma, rescued from apoptosis by the herpesvirus, was harvested from a post-metamorphic frog. The tumour was judged to be pronephric by its anatomical location (in the anterior part of the body) and because both mesonephric kidneys were intact and tumour-free upon removal of the tumour mass. A tumour fragment was fixed for histological examination, which confirmed that the tissue was a renal carcinoma. A further fragment was subjected to short-term culture in order to produce metaphase cells for cytogenetical analysis. Based upon silverstained nucleolar organizing region numbers, 14 of 15 metaphase cells were estimated to have the diploid number (2N = 26) of chromosomes and a karyotype was constructed which did not appear to differ from that of normal cells. A single cell was estimated to be tetraploid (4N = 52). This is the first report of chromosomes of a pronephric Lucké carcinoma. LTV replicates only in tumour tissue maintained in the cold. Because the frog in this study had been maintained in the laboratory at 22 degrees C for about 10 months, no viruses would have been detectable with electron microscopy. However, the presence of Lucké herpesvirus DNA was detected in tumour homogenates by polymerase chain reaction amplification of a 1.2 kbp Hind III restriction fragment of the LTV DNA. The presence of LTV DNA provided assurance that the rescued pronephric tumour was indeed a Lucké carcinoma.     

Renal leiomyosarcoma

Presentation of one case of renal leiomyosarcoma, a tumour with little incidence, focusing the interest of this paper in the treatment and follow-up carried out. Incidence of this type of tumour in the kidneys is scarce, but even more so the number of patients treated with post-nephrectomy chemotherapy. It is therefore unsuitable to draw any conclusions from the review of available publications. However, we believe to have obtained a good result in this case treated with nephrectomy and chemotherapy.