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Byline: S. Srivishnu, Ganesh. Bakshi, Santosh. Menon Extrarenal primary renal cell carcinoma is an extremely rare entity with limited literature. Characteristic findings of renal cell carcinoma (RCC) at the metastatic [...]

Byline: Akash. Sali, Ganesh. Bahirwade, Ganesh. Bakshi, Gagan. Prakash, Amit. Joshi, Sangeeta. Desai, Santosh. Menon Introduction: The grading system of chromophobe renal cell carcinoma (ChRCC) is not well established. In [...]

Byline: Abhilash. Cheriyan, Arun. Nellickal, Nirmal. John, Lakshmanan. Jeyaseelan, Santosh. Kumar, Antony. Devasia, Nitin. Kekre Introduction: Optimal patient selection plays a vital role in management of renal tumors with the [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/S0140-6736(09)60229-4 Byline: Brian I Rini (a), Steven C Campbell (b), Bernard Escudier (c) Abstract: Considerable progress has been made in the treatment of patients with renal cell carcinoma, with innovative surgical and systemic strategies revolutionising the management of this disease. In localised disease, partial nephrectomy for small tumours and radical nephrectomy for large tumours continue to be the gold-standard treatments, with emphasis on approaches that have reduced invasiveness and preserve renal function. Additionally, cytoreductive nephrectomy is often indicated before the start of systemic treatment in patients with metastatic disease as part of integrated management strategy. The effectiveness of immunotherapy, although previously widely used for treatment of metastatic renal cell carcinoma, is still controversial, and is mainly reserved for patients with good prognostic factors. Development of treatments that have specific targets in relevant biological pathways has been the main advance in treatment. Targeted drugs, including inhibitors of the vascular endothelial growth factor and mammalian target of rapamycin pathways, have shown robust effectiveness and offer new therapeutic options for the patients with metastatic disease. Author Affiliation: (a) Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA (b) Section of Urologic Oncology, Glickman Urological and Kidney Institute, Cleveland, OH, USA (c) Medical Oncology Department, Institut Gustave Roussy, Villejuif, France

Abstract The genetics of renal tumors in children is widely recognized. However, most of the studies published to date emphasize the association between Wilms tumor and the WT-1 gene. Recently, [...]

The case of a 51-year-old woman illustrates the dangers of diagnosing a disease based on the pattern of signs and symptoms. She was initially diagnosed with diabetes but her severe weight loss was unexplained. A chest X-ray revealed nodules in her lungs, which her physicians suspected was blood clots from infected heart valves. However, blood cultures revealed no infection and she did not appear that ill. A CT scan of her pelvis showed a kidney mass and she was ultimately diagnosed with metastatic renal-cell carcinoma. This diagnosis could have been made much sooner if her physicians had not focused on the diagnosis of diabetes.

BACKGROUND. The differential diagnosis of metastatic clear cell carcinoma is broad. To date, there are no specific immunohistochemical markers for renal cell carcinoma (RCC) in general use. Loss of heterozygosity (LOH) at 3p25.5, the von Hippel-Lindau (VHL) gene locus, is frequent in sporadic clear cell RCC. The authors compared LOH in primary and metastatic RCC through microdissection and the polymerase chain reaction (PCR) to evaluate these techniques as potential diagnostic tools. METHODS. The authors identified 14 patients with known clear cell RCC who underwent fine-needle aspiration (FNA) evaluation of presumed metastatic lesion. Direct-visualization microdissection was performed from archival histologic glass slides of the primary neoplasm and the adjacent normal kidney parenchyma. Malignant cell clusters were microdissected from archival FNA slides of metastatic lesions. The cytology slides were previously stained with either Diff-Quik or Papanicolaou stain. This was followed by a single-step DNA extraction and PCR amplification for evaluation of LOH using polymorphic markers, D3S1038 and D3S1110, flanking the VHL gene. RESULTS. Thirteen of the 14 cases contained DNA suitable for PCR in both the paraffin embedded and the FNA material. Eight of the 13 cases were heterozygous (informative) for the above markers, and 6 of these showed identical allelic loss in the primary and metastatic tumor for either one or both of the markers used. The remaining two cases did not show LOH at the VHL locus with the two polymorphic markers used. CONCLUSIONS. DNA from archival cytologic material stained with Papanicolaou stain or Diff-Quik is reliable for PCR amplification. Visually directed microdissection in combination with PCR has the potential to be a useful technique for confirmatory identification and diagnosis of metastatic clear cell RCC in cytologic material, because a specific genetic abnormality is present in the primary tumor. As characteristic genetic abnormalities are identified in various neoplasms, the use of this technique has the potential for conclusive evaluation of metastatic disease with FNA material, when used in comparison with surgical or cytologic material from the primary tumor. The utility of this combination of techniques has the potential for the molecular diagnosis of morphologically ambiguous cell populations. Cancer (Cancer Cyto pathol) 1997;81:180-6. [C] 1997 American Cancer Society.