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Query: UMLS:C0027651 (tumor)
 685,946 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Nephron-sparing surgery is more technically demanding than conventional nephrectomy. The urologist can benefit from modern radiological methods to plan and monitor surgery and to provide post-surgical surveillance. This article describes how 3D volume renderings of CT and MRI data can be useful in planning nephron-sparing surgery, how intraoperative imaging can guide surgery and tumor ablation, and how CT and MRI can be used to monitor for recurrent disease and postoperative complications.
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PMID:Imaging for nephron-sparing surgery. 1264 Nov 4

A 66-year-old Japanese woman, whose left kidney was non-functioning, was referred to us with a diagnosis of invasive bladder carcinoma and right renal pelvic carcinoma. The latter tumor was clearly packed in the renal calyx and was considered to be of low-grade malignancy. Nephron preserving surgery of the right kidney was performed, followed by radical cystectomy and construction of an ileal conduit. The postoperative course was good, without significant complications. Renal function was restored and a postoperative imaging study showed a well-functioning transplanted kidney. At present (20 months after surgery), the patient is doing well and has presented no signs of recurrence of the disease.
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PMID:Kidney autotransplantation in a patient with renal pelvic and bladder carcinomas. 1253 12

Oncocytoma is the most common benign solid renal tumor, comprising roughly 5% of resected renal masses. Typically discovered incidentally, oncocytoma is generally asymptomatic and very rarely metastasizes; however, multifocal disease and coexistence with renal cell carcinoma can occur. No currently used imaging techniques can reliably distinguish between oncocytoma and malignant lesions; therefore, patients must undergo resection, or in certain circumstances, biopsy, to definitively establish diagnosis. Careful attention to pathologic features and the adjunctive use of immunostains can aid in discriminating oncocytoma from other renal tumors characterized by granular, eosinophilic cytoplasm, especially chromophobe renal cell carcinoma. Nephron-sparing and laparoscopic surgical approaches can be used to treat appropriately selected patients.
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PMID:Update on oncocytoma. 1253 36

Vitamin D co-regulates cell proliferation, differentiation and apoptosis, the processes that are disturbed in cancer tissues. It acts through the vitamin D nuclear receptor (VDR) that binds to DNA in the regulatory sequences of the target genes. As the kidney is one of the key organs for vitamin D metabolism and action, we analyzed VDR expression and its DNA binding activity in human renal clear cell cancer. 24 tumors, 24 controls that were excised from the opposite pole of the same kidney and 7 controls originating from kidneys without cancer were examined. Independently of tumor grading neither Northern blots nor immunoblotting demonstrated statistically significant differences of the mean VDR mRNA and protein amounts, respectively, in the cancer as compared to both control types. In contrast, the amount of VDR-DNA complexes was lower in 52.2% of the tumors in comparison to their corresponding controls. After normalization against VDR receptor protein amount in 34.8% of the tumors VDR-DNA binding was at least 3-4 times weaker than in the controls. However, the expression of vitamin D-dependent P21 gene on the mRNA level was not decreased in these cancers. It remains to be elucidated if altered VDR function due to its impaired binding to DNA contributes to the process of tumorigenesis, and what potential vitamin D-dependent mechanisms are involved in this process.
Nephron Exp Nephrol 2003
PMID:Vitamin D receptor binding to DNA is altered without the change in its expression in human renal clear cell cancer. 1275 76

The association of von Hippel-Lindau disease and renal call carcinoma is well recognized. However, the most appropriate surgical approach in patients with von Hippel-Lindau disease and renal carcinoma remains controversial. We examine this controversy and report on our experience. Our cohort consisted of 28 affected members of three von Hippel-Lindau kindreds. Screening of these individuals consisted of an abdominal ultrasound (US) in their early teens and a baseline computerized axial tomography (CT) scan in their late teens. To date, nine patients have been found to have renal cell carcinoma. In three of these patients, the surgical specimen revealed multiple small foci of "clear cells" characteristic of renal cell carcinoma that had not been detected by careful radiological assessment prior to surgery. In two patients, these lesions were located at the opposite pole from the radiologically-detected tumor. Nephron-sparing surgery, therefore, risks leaving potential tumor that may be responsible for mortality. Conversely, radical procedures condemn a patient to life-long dialysis and/or transplantation with associated risk and morbidity. The potential for the metachronous emergence of contralateral renal cell carcinoma, however, justifies efforts to preserve normal tissue in patients harboring radiologically-detected lesions; however, we need to know with some certainty the natural history of the correct management of this disorder.
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PMID:Renal cell carcinoma in von Hippel-Lindau disease: another piece of the puzzle. 1283 61

Hydro-MR imaging is a technique based on the use of a strongly T2-weighted single-shot fast spin-echo (SSFSE) sequence, similar to that used for MR-cholangiography. We report herein one case of carcinoid tumor of the small bowel diagnosed by hydro-MR imaging. This non invasive MR technique showed suggestive features such as radial convergence and segmental dilatation of a small bowel loop, similar to those seen on conventional follow-through studies. This case illustrates the major role that may be played in the future by hydro-MR imaging for the non invasive diagnosis of carcinoid tumor of the small bowel without the use of ionizing radiation.
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PMID:[Carcinoid tumor of the small bowel: value of hydro-MR imaging for diagnosis]. 1471 50

Radical nephrectomy is the gold standard curative operation for patients with localized renal cell carcinoma (RCC). Since its introduction in 1990, laparoscopic radical nephrectomy is being increasingly done at numerous institutions worldwide. In the hands of experienced laparoscopic urological surgeons and with adherence to established principles of open radical nephrectomy, laparoscopic radical nephrectomy is now a standard of care for patients with T1-3a N0 M0 RCC. Intermediate-term outcome data indicate equivalent cancer-free survival to open radical nephrectomy in such cases. Nephron-sparing surgery (NSS) is now an established approach for patients with localized RCC when there is a clinically relevant need to preserve renal function. NSS is also indicated in patients with a single, small, unilateral, localized RCC when the opposite kidney is completely normal. The technical success rate with NSS for RCC is excellent, and long-term patient survival free of cancer is comparable with that obtained after radical nephrectomy. We recently reviewed the results of NSS in 107 patients with localized sporadic RCC treated at the Cleveland Clinic before 1988 who were followed up for a minimum of 10 years. Long-term preservation of renal function was achieved in 93% of patients, and the 10-year cancer specific survival rate was 73%. Although open surgical partial nephrectomy remains the gold standard for nephron-sparing treatment of RCC, laparoscopic partial nephrectomy is now available in selected cases. The optimal indications for laparoscopic NSS are in patients with a relatively small and peripheral renal tumor. In such cases, laparoscopic NSS is proving to be an effective, minimally invasive therapeutic approach with respect to renal functional outcome, with additional advantages of reduced postoperative narcotic use, earlier hospital discharge, and a faster convalescence. The laparoscopic approach is associated with longer warm renal ischemia time, more major intraoperative complications, and more postoperative urological complications. Continued efforts are required to develop laparoscopic renal hypothermia techniques and to facilitate intrarenal suturing while minimizing the warm ischemia time.
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PMID:Laparoscopic and partial nephrectomy. 1544 25

Metanephric adenoma (MA) is a renal tumor that is rarely found in children. We present a case of MA that was incidentally discovered in an 8-year-old child on computed tomography. We also review the literature regarding this lesion in the pediatric population. There are certain imaging features of MA that may suggest the diagnosis preoperatively. Metanephric adenoma is often hyperechoic on sonography, hyperdense on noncontrast computed tomography scans, and of low signal intensity on T1- and T2-weighted magnetic resonance images. Nephron sparring surgery has been performed in several cases. However, the distinction of MA from other metanephric lesions as well as from Wilms' tumor and papillary renal cell carcinoma may not be readily apparent at the time of surgery.
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PMID:Metanephric adenoma in an 8-year-old child: case report and review of the literature. 1593 2

Nephron sparing surgery has become the gold standard for the treatment of small (< 4 cm) renal tumors. More recently, renal tumor ablation, destroying renal tumors with energy based modalities and leaving the tissue in situ, has gained popularity. Radiofrequency ablation (RFA) utilizes heat energy to cause cellular destruction. RFA can be applied laparoscopically, percutaneously, and as an adjunct with partial nephrectomy. A comprehensive MEDLINE search of the English literature from 1990 to present was performed to identify articles on renal RFA. RFA is an effective minimally invasive treatment alternative for small renal masses in patients with significant comorbidities that preclude extirpative surgery. Limited follow up from a number of series demonstrate a success rate of 92%. RFA has proven to be an effective ablative therapy in a number of organ systems. Over the past decade it has been applied to the treatment of small renal tumors. The short-term efficacy and minimum morbidity of RF thermal therapy for renal tumors has been encouraging. RFA provides a versatile tool to add to the urologist's armamentarium in the minimally invasive treatment of renal cancer.
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PMID:Renal tumor radiofrequency ablation. 1624 48

Von Hippel-Lindau disease (VHL) is an autosomal-dominant inherited condition that predisposes patients to develop renal cysts and tumors, most commonly in the second to fourth decades of life. Renal cysts and tumors have historically been a major cause of disease-related morbidity and mortality, so urologists are often called on to manage patients with VHL. Knowledge of the extrarenal manifestations of VHL (hemangioblastomas of the central nervous system and retina, endolymphatic sac tumors, pancreatic cysts, epididymal and broad-ligament cysts, and pheochromocytomas) and integration of nonurologic specialties into management teams for VHL patients will help to achieve successful outcomes. Screening for renal manifestations of VHL, by regular imaging of the abdomen, begins late in the second decade of life. Because renal tumors in VHL can be multifocal and bilateral, management can be complex. Radical nephrectomy removes all tissue at risk for forming renal tumors; however, this necessitates renal replacement therapy. In an effort to control cancer effectively while preserving native renal function and minimizing intervention, some researchers have proposed an observational strategy. Patients are screened until the largest tumor reaches 3 cm in diameter, at which time operative intervention is recommended. Nephron-sparing surgery is undertaken, whenever technically feasible, with the goal of removing all tumors in that renal unit. The role of minimally invasive technologies is currently being evaluated in selected patients with VHL renal masses. Elucidation of molecular pathways associated with VHL renal tumors may facilitate development of effective medical treatments for these lesions in the future.
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PMID:Management of von Hippel-Lindau-associated kidney cancer. 1647 36


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