Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0016199 (flank pain)
 2,189 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Renal carcinoid tumors are exceedingly rare tumors that have been primarily documented as case reports in the literature. In this study, we report a series of 21 renal carcinoid tumors, with emphasis on histopathologic features and clinical outcomes. Patient age ranged from 27 to 78 years (average 52 y). The majority of specimens consisted of radical nephrectomies with or without associated lymph node dissection. Nine tumors were present in the left kidney and 10 were present in the right; location was not available for 2 specimens. No anatomic region of the kidney appeared to be preferentially involved. Twenty tumors were unifocal and ranged in size from 2.6 to 17 cm (average 6.4 cm), and 1 tumor presented as 2 nodules measuring 1 and 2.8 cm. Four patients had a documented history of a horseshoe kidney. Two patients had a history of renal calculi and 1 patient had a history of urothelial carcinoma 8 years prior. Presenting symptoms and clinical findings included back or flank pain (n=6/9), enlarging abdominal mass or fullness (n=2/9), hematuria (n=2/9), and anemia (n=1/9). Twelve patients had concurrent metastases at the time of initial surgery to sites including lymph nodes (n=11/12), liver (n=5/12), bone (n=1/12), and lung (n=1/12). One additional patient developed subsequent metastases to the liver within 6 months of surgery. Examination of the specimens identified carcinoid tumor with a variety of patterns including tightly packed cords and trabeculae with minimal stroma (n=17/21), trabecular growth with prominent stroma (n=4/21), focal solid nests (n=4/21), focal glandlike lumina (n=4/21). The border between tumor and normal kidney was sharply defined in most cases (n=16/21), although focal infiltration was noted in 5/21 cases. Extracapsular extension was documented in 11/21 (52%) cases. Calcifications were present in 5/21 cases. Mitotic activity, measured as mitoses per 10 high-power fields, ranged from 0 to 2 in most cases, with 1 case demonstrating up to 4 mitotic figures per single high-power field. Necrosis was absent in all cases. Immunostains were frequently positive for synaptophysin (n=18/20), chromogranin (n=13/20), Cam5.2 (n=14/16), and vimentin (n=12/15). CK7 was focally positive in a small subset of cases (n=3/18) and CK20 was positive in 1 case. TTF-1 and WT-1 were negative in all cases examined. Clinical follow-up was available on 15 patients and ranged from 3 months to 11 years. One patient died of disease at 8 months after surgery and 1 patient died without disease at 11 years after surgery. Of the remaining patients, 7 patients were alive without disease and 6 patients were alive with disease. Additional metastases developed in 4 patients and included metastases to the liver and bone.
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PMID:Renal carcinoid tumor: a clinicopathologic study of 21 cases. 1789 55

A 66-year-old man presented for a second attempt of radiofrequency ablation of a metastatic carcinoid liver lesion. The first attempt using intravenous sedation was unsuccessful because of inadequate pain control and subsequent patient combativeness. Despite fentanyl being given during general anaesthesia, the patient complained of severe right flank pain after emergence. A thoracic paravertebral block was performed without complication and the patient's pain decreased to "3 out of 10" on a standard 10-point scale after 10 min, and "0 out of 10" after 30 min. The patient's pain score remained 0 throughout the following day, and no further analgesics were required. Thoracic paravertebral block can provide complete and lasting analgesia following hepatic radiofrequency ablation, and warrants further study for patients undergoing hepatic radiological interventions.
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PMID:Thoracic paravertebral block for analgesia following liver mass radiofrequency ablation. 1807 Aug 25

Renal carcinoid tumor is a rare neoplasm. In this article, we review this neoplasm with a focus on clinical and pathobiological aspects. The majority of patients present in the fourth to seventh decades, but there is no gender predilection. Clinically, patients with renal carcinoid tumor frequently present with abdominal, back or flank pain. This tumor is occassionally associated with horseshoe kidney and/or mature cystic teratoma located in the kidney. Macroscopically, these tumors are well demarcated with a lobulated appearance and yellow or tan-brown color cut surface. Microscopically, these tumors are composed of monomorphic round to polygonal cells with granular amphophilic to eosinophilic cytoplasm. Tumor cells are arranged in trabecular, ribbon-like, gyriform, insular, glandular and solid patterns. The nuclei are round to oval and with evenly distributed nuclear chromatin, frequently with a "salt and pepper"-pattern. Immunohistochemically, tumor cells demonstrate immuno-labeling for chromogranin A and synaptophysin. Ultrastructurally, the neoplastic cells contain abundant dense core neurosecretory granules. In previous genetic studies, abnormalities of chromosomes 3 or 13 have been reported. The clinical behavior of renal carcinoid tumors is variable, but is more indolent than most renal cell carcinomas. Further investigations are warranted in order to elucidate the critical genetic abnormalities responsible for the pathogenesis of this rare entity in renal neoplastic pathology.
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PMID:Review of renal carcinoid tumor with focus on clinical and pathobiological aspects. 2323 56

Primary carcinoid tumors of the kidney are very rare, malignant tumors consisting of neuroendocrine cells. The pathogenesis of renal carcinoid is unclear because neuroendocrine cells are not normally found in adult renal parenchyma. Electron microscopy, immunohistochemistry, octreotide scan, positron emission tomography along with conventional radiographic imaging techniques are used in diagnosis and follow-up. Presenting symptoms usually include flank pain and haematuria. Early stage disease is treated with surgery only. However, randomized trials are lacking because of the very low number of reported cases. Thus, the role of debulking surgery, chemotherapy, radiotherapy, octreotide and targeted therapy in the management of advanced disease remains an open question. In this article the clinicopathologic features and prognosis of this very rare disease along with treatment outcomes of the reported cases are reviewed. In addition, we report a new case of a metastatic primary renal atypical carcinoid tumor treated with octreotide therapy.
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PMID:Primary renal carcinoid: treatment and prognosis. 2347 51

Carcinoid tumors are well documented in the pulmonary and gastrointestinal systems, but very rare in the urinary tract, especially in the renal pelvis. We report on a 60-year-old female patient who presented with left flank pain and fever. Abdominal computed tomography demonstrated a heterogeneously enhancing mass in the left renal pelvis and a stone at the left proximal ureter. Multiple parenchymal lesions were also observed, which were identified as uneven caliectasis displaying air-fluid levels and renal parenchymal atrophy. The patient underwent simple nephro-ureterectomy. Macroscopically, a polypoid mass was observed in the renal pelvis. Microscopically, the tumor revealed acinar, tubular, and solid pattern and was composed of small, monotonous and hyperchromatic cells. Lining epithelia in renal pelvis and ureter revealed columnar epithelia with dysplastic change. The tumor cells were positive for chromogranin A, synaptophysin, CD56, and focally positive for cytokeratin. Immunohistochemical staining of synaptophysin and chromogranin A highlighted the neuroendocrine cells in the columnar epithelium. Ki-67 (1:50; MIB-1) labeling index was less than 1% in the area with highest uptake. We report here a case of carcinoid tumor of the renal pelvis that was associated with adjacent dysplastic columnar epithelium.
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PMID:Carcinoid tumor associated with adjacent dysplastic columnar epithelium in the renal pelvis: A case report and literature review. 2664 87