Search

Additional File 1: Patient characteristics

A 40-year-old woman was referred to our hospital with right lower back pain as the chief complaint. Contrast-enhanced computed tomography (CT) showed a partially-solid tumor within a cyst measuring approximately 6 cm in diameter in the right renal hilum. The solid part was enhanced in the early phase and contrast medium was washed out earlier in the solid part than in the parenchyma in the equilibrium phase. Plain CT revealed partial cyst wall calcification. A soft tissue shadow approximately 10 mm in diameter in the dorsal inferior vena cava at the upper pole of the kidney and a solid tumor adjacent to the iliopsoas muscle and the kidney were detected. We performed radical nephrectomy and lymph node dissection with transperitoneal approach. The histopathological diagnosis was neuroendocrine tumor. Her clinical course has since been observed on an outpatient basis, for nearly 10 months to date, without any recurrence.

A 72-year-old male underwent laparoscopic radical nephrectomy of left renal cell carcinoma in March 2010. Pathological findings revealed clear cell renal cell carcinoma, G3, pT1b, INFα and v1. At 3 months after operation, computed tomography (CT) showed multiple metastases in bilateral lungs. Sunitinib was administered with a scheduled cycle of drug administration for 4 weeks at a dose of 37.5 mg/day followed by 2 weeks of rest. Administration of sunitinib was interrupted at day 18 due to common terminology criteria for adverse events v 3.0 (CTCAE) grade 2 thrombocytopenia. After 3 weeks, sunitinib was restarted with a scheduled cycle of drug administration for 2 weeks followed by 2 weeks of rest at the same dose. After 6 cycles, CT revealed complete response of lung metastasis and there was no evidence of the disease at 12- month follow-up.

A 71-year-old man underwent a radical nephrectomy for right renal cell carcinoma in April, 2005. Pathological findings revealed clear cell carcinoma, G3＞G2, pT3a. Three years later, he underwent a craniotomy for tumor resectionof solitary brainmetastasis. InOctober, 2008, he came to our hospital because of urinary retention. Benign prostate hypertrophy was diagnosed by ultrasonography and digital rectal examination. Serum prostate specific antigen level was 2.55 ng/dl. While he was treated with oral α 1-blocker initially, a urethral catheter was inserted in December, 2009. Because of frequent obstruction of the catheter by hematuria, transureathral prostectomy was performed. Pathological findings revealed prostatic metastasis of renal cell carcinoma. Metastasis of renal cell carcinoma to the prostate is rare, and only 7 cases including the present case have been reported.

We report a case of marginally resectable gastrointestinal stromal tumor (GIST) in the pelvis treated with neoadjuvant intent before subsequent successful surgical resection. A 46-year old man presented with urinary frequency and rectal discomfort with tenesmus. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a 12 cm diameter mass between the bladder and rectum and the margin of the tumor and prostate was unclear. No metastases were evident. Trans-rectal needle core biopsy confirmed c-kit positive GIST. Because of the locally advanced nature of the tumor, immediate surgical resection would have required total pelvic exenteration with eternal colostomy and urinary diversion. Therefore, the patient was treated with imatinib mesylate 400 mg daily in anticipation of adequate tumor size reduction to enable a more simplified surgical approach. After 3 months of imatinib therapy, MRI demonstrated a reduction in tumor size of 60%. Consequently, a complete surgical resection including the bladder, prostate and part of the sigmoid colon with temporary ileostomy and ileal conduit was performed. Pathological findings of the resected specimen showed widespread degeneration with cystic changes, necrosis, and hypocellularlity, as well as nodules of residual viable c-kit positive tumor cells. The patient has been treated with imatinib mesylate for 39 months following the operation without tumor recurrence.