A 64-year-old man was treated with sunitinib as a first-line therapy for metastatic renal cell carcinoma. He was given oral sunitinib in cycles of 50 mg once daily for 2 weeks followed by a week off. During the 5th week of treatment right upper quadrant pain developed, but this resolved spontaneously during the 6th week (off treatment). However, on the 8th week of treatment, he was admitted to hospital because the acute right upper quadrant pain recurred with nausea, vomiting, and fever. Acute acalculous cholecystitis was then diagnosed by ultrasonography and CT. In addition, his laboratory findings indicated disseminated intravascular coagulation. Accordingly, sunitinib therapy was discontinued and broad-spectrum antibiotics initiated. He subsequently recovered after emergent percutaneous cholecystostomy. His Naranjo Adverse Drug Reaction Probability Scale score was 7, indicaing a probable association of the event with sunitinib. Suspicion of sunitinib-related acute cholecystitis is required, because, although uncommon, it can be life-threatening.
Acalculous Cholecystitis ; Anti-Bacterial Agents ; Carcinoma, Renal Cell ; Cholecystitis, Acute ; Cholecystostomy ; Disseminated Intravascular Coagulation ; Drug-Related Side Effects and Adverse Reactions ; Fever ; Humans ; Middle Aged ; Nausea ; Ultrasonography ; Vomiting

Renal cell carcinoma (RCC) represents 2% to 3% of human cancers and is aggressive, with metastatic capability. The frequent metastatic sites are lung, bone, and liver. Reports of RCC metastatic to skin, and especially scalp are rare. Here we present an 83-year-old woman who was diagnosed with RCC 19 years prior and had a metastatic scalp lesion. An 83-year-old woman presented with a red-to-purple, protruding lesion at the right parietotemporal area. Twenty-three years ago, a right renal mass was incidentally discovered on ultrasound through a routine medical examination. She underwent right nephrectomy for RCC 4 years later. Five months after nephrectomy, new lung nodules were observed. Fifteen years after nephrectomy, metastatic lesions were found in the pelvic bone. She visited dermatology department for evaluation of the new scalp lesion, a year before she first visited our department. Despite chemotherapy, the mass was gradually enlarged. She consulted the plastic surgery department for management of the metastatic RCC was successfully treated with total excision including a 1-cm safety margin, local flap, and STSG coverage. Complete healing was observed, without evidence of recurrence during a 7-month follow-up. Metastases to the skin are rare, but must be kept in mind because of its high metastatic ability and poor prognosis.
Aged, 80 and over ; Carcinoma, Renal Cell ; Dermatology ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Liver ; Lung ; Neoplasm Metastasis ; Nephrectomy ; Pelvic Bones ; Prognosis ; Recurrence ; Scalp ; Skin ; Skin Neoplasms ; Surgery, Plastic ; Ultrasonography

We report our first experience with the use of contrast-enhanced ultrasonography (CEUS) to differentiate between a complicated hemorrhagic renal cyst and a cystic renal cell carcinoma in a 50-year-old man diagnosed with autosomal dominant polycystic kidney disease undergoing hemodialysis for end-stage renal disease. CEUS could successfully differentiate between a complicated hemorrhagic renal cyst and a cystic renal cell carcinoma, as opposed to computed tomography (CT) or magnetic resonance imaging (MRI), which could not distinguish between the 2 disease conditions. CEUS is comparable diagnostic tool as CT or MRI to distinguish between benign and malignant cystic renal masses.
Carcinoma, Renal Cell ; Humans ; Kidney Failure, Chronic ; Magnetic Resonance Imaging ; Middle Aged ; Polycystic Kidney, Autosomal Dominant ; Renal Dialysis ; Ultrasonography

PURPOSE: The aims of this study were to present the ultrasonographic (US) features of metastatic renal cell carcinoma (RCC) in the thyroid gland and to evaluate the diagnostic utility of fineneedle aspiration (FNA) and core needle biopsy (CNB). METHODS: Eight patients with nine metastatic RCC nodules in the thyroid glands who were treated from January 2002 to March 2015 in a single tertiary hospital were consecutively selected and retrospectively reviewed. US features and clinical history were obtained from the institution's medical database. FNA was performed nine times on eight nodules and CNB was performed six times on six nodules. The diagnostic utility of FNA and CNB was evaluated. RESULTS: All nine nodules showed mass formation without diffuse thyroid involvement. On ultrasonography, metastatic RCC nodules were solid (100%), hypoechoic (100%), and oval-shaped nodules with a well-defined smooth margin (88.9%) and increased vascularity (100%, with 55% showing extensive vascularity). No calcifications were noted in any nodules. Lymph node metastasis and direct extension to nearby structures beyond the thyroid gland were not found. One FNA (11%) was able to confirm metastatic RCC, whereas all six CNBs confirmed metastatic RCC. CONCLUSION: Metastatic RCC appears as oval-shaped hypoechoic solid nodules with well-defined smooth margins, no calcifications, and increased vascularity on ultrasonography. Characteristic US features along with a previous history of RCC should raise clinical suspicion, and CNB should be performed to make an accurate diagnosis.
Biopsy, Fine-Needle ; Biopsy, Large-Core Needle* ; Carcinoma, Renal Cell* ; Diagnosis ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Retrospective Studies ; Tertiary Care Centers ; Thyroid Gland* ; Ultrasonography

From January 2008 to January 2013, 11 patients with central renal tumors underwent ultrasound-guided open nephron sparing surgery (ONSS) without renal artery occlusion. We removed the lesions, and the cut edges of the tumors were negative. Thus, we deduced that ultrasound-guided ONSS is suitable for the cases with obscure tumor boundary or multiple lesions. It could achieve the purpose of thoroughly removing lesions, as well as to expand the application range of nephron sparing surgery.
Arterial Occlusive Diseases ; etiology ; prevention & control ; Carcinoma, Renal Cell ; surgery ; Female ; Humans ; Kidney Neoplasms ; surgery ; Male ; Nephrons ; surgery ; Postoperative Complications ; Renal Artery ; pathology ; surgery ; Surgery, Computer-Assisted ; adverse effects ; methods ; Ultrasonography

OBJECTIVE: To evaluate whether suppression of tumor microvasculature by double anti-angiogenic protein (DAAP) treatment could increase the extent of radiofrequency ablation (RFA)-induced coagulation in a murine renal cell carcinoma model. MATERIALS AND METHODS: Renal cell carcinoma cell lines were implanted subcutaneously into 10 nude mice. Four mice received adenoviral DAAP treatment and 6 mice received sterile 0.9% saline solution as DAAP-untreated group. The effect of DAAP was evaluated according to the vascularity by contrast-enhanced ultrasound (CEUS) using microbubbles. Four DAAP-treated mice and 4 DAAP-untreated mice were then treated with RFA, resulting in 3 groups: no-therapy (n = 2), RFA only (n = 4), and RFA combined with DAAP treatment (n = 4). Immediately after RFA, the size of coagulation necrosis and mitochondrial enzyme activity were compared between the groups using analysis of variance (ANOVA) and post hoc test. RESULTS: The contrast enhancement ratio for tumor vascularization on CEUS was significantly lower in the DAAP treated group than in DAAP-untreated group (30.2 +/- 9.9% vs. 77.4 +/- 17.3%; p = 0.021). After RFA, the mean coagulation diameter was 0 mm for no-therapy group, 6.7 +/- 0.7 mm for the RFA only group and 8.5 +/- 0.4 mm for the RFA with DAAP group (ANOVA, p < 0.001). The area of viable mitochondria within the tumor was 27.9 +/- 3.9% in no-therapy group, 10.3 +/- 4.5% in the RFA only group, and 2.1 +/- 0.7% in the RFA with DAAP group (ANOVA, p < 0.001). CONCLUSION: Our results suggest the potential value of combining RFA with anti-angiogenic therapy.
Adenoviridae ; Angiogenic Proteins/*antagonists & inhibitors ; Animals ; Carcinoma, Renal Cell/blood supply/surgery/*therapy ; Catheter Ablation/*methods ; Combined Modality Therapy ; Contrast Media ; Kidney Neoplasms/blood supply/surgery/*therapy ; Male ; Mice ; Mice, Nude ; Microbubbles ; Neovascularization, Pathologic/surgery/*therapy/ultrasonography ; Recombinant Proteins

We report an unusual case of synchronous triple primary cancer of the stomach, kidney, and thyroid in a 50-year-old male patient. Initial esophagogastroduodenoscopy with biopsy for the medical check-up revealed poorly differentiated adenocarcinoma. We performed an abdominal/pelvic computed tomography scan for staging and incidentally found a 1.7-cm exophytic hypervascular mass in the left kidney. Thyroid ultrasonography showed suspicious malignant nodules suspicious with multiple lymph nodes (LNs) metastasis in the right side of the neck. Subsequent fine needle aspiration biopsy of a nodule and a LN was performed. Cytologic report revealed papillary thyroid carcinoma with lateral LNs metastasis. Our integrate oncology team performed radical subtotal gastrectomy, partial nephrectomy, and total thyroidectomy with modified radical neck dissection. The postoperative pathologic finding was well-differentiated gastric adenocarcinoma (T1N0M0; stage 1A), renal cell carcinoma (T1aN0M0; stage 1), and papillary thyroid carcinoma (T4bN1bM0; stage 4B). He received postoperative a radio-active iodine ablation and is doing well with no recurrence.
Adenocarcinoma ; Biopsy ; Biopsy, Fine-Needle ; Carcinoma, Renal Cell ; Endoscopy, Digestive System ; Gastrectomy ; Humans ; Iodine ; Kidney* ; Lymph Nodes ; Male ; Middle Aged ; Neck ; Neck Dissection ; Neoplasm Metastasis ; Nephrectomy ; Recurrence ; Stomach Neoplasms ; Stomach* ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy ; Ultrasonography

The prevalence of small renal masses (SRM) has risen, paralleling the increased usage of cross-sectional imaging. A large proportion of these SRMs are not malignant, and do not require invasive treatment such as nephrectomy. Therefore, differentation between early renal cell carcinoma (RCC) and benign SRM is critical to achieve proper management. This article reviews the radiological features of benign SRMs, with focus on two of the most common benign entities, angiomyolipoma and oncocytoma, in terms of their common imaging findings and differential features from RCC. Furthermore, the role of percutaneous biopsy is discussed as imaging is yet imperfect, therefore necessitating biopsy in certain circumstances to confirm the benignity of SRMs.
Abdominal Fat/pathology ; Adenoma, Oxyphilic/diagnosis/radiography/ultrasonography ; Angiomyolipoma/diagnosis/radiography/ultrasonography ; Carcinoma, Renal Cell/*diagnosis/radiography/ultrasonography ; Diagnosis, Differential ; Humans ; Kidney Neoplasms/*diagnosis/*radiography/ultrasonography ; Leiomyoma/diagnosis/radiography/ultrasonography

OBJECTIVE: To evaluate the value of enhancement features and quantitative parameters of contrast-enhanced ultrasonography (CEUS) in differentiating solid hypoechoic renal angiomyolipomas (AMLs) from clear cell renal cell carcinomas (ccRCCs). MATERIALS AND METHODS: We analyzed the enhancement features and quantitative parameters of CEUS in 174 hypoechoic renal masses (32 AMLs and 142 ccRCCs) included in the study. RESULTS: Centripetal enhancement pattern was more common in AMLs than in ccRCCs on CEUS (71.9% vs. 23.2%, p < 0.001). At peak enhancement, all AMLs showed homogeneous enhancement (100% in AML, 27.5% in ccRCCs; p < 0.001). Quantitative analysis showed no significant difference between rise time and time to peak. Tumor-to-cortex (TOC) enhancement ratio in AMLs was significantly lower than that in ccRCCs (p < 0.001). The criteria of centripetal enhancement and homogeneous peak enhancement together with TOC ratio < 91.0% used to differentiate hypoechoic AMLs from ccRCCs resulted in a sensitivity and specificity of 68.9% and 95.8%, respectively. CONCLUSION: Both qualitative and quantitative analysis with CEUS are valuable in the differential diagnosis of hypoechoic renal AMLs from ccRCCs.
Adult ; Aged ; Angiomyolipoma/*diagnosis/pathology/*ultrasonography ; Carcinoma, Renal Cell/*diagnosis/pathology/*ultrasonography ; Contrast Media ; Diagnosis, Differential ; Female ; Humans ; Kidney Neoplasms/diagnosis/pathology/*ultrasonography ; Language ; Lipoma/ultrasonography ; Male ; Middle Aged ; Sensitivity and Specificity

OBJECTIVETo investigate clinical outcomes of ultrasound-guided percutaneous radiofrequency ablation (USG-RFA) in patients with renal clear cell carcinoma.

METHODSMedical records of 34 patients who underwent USG-RFA of renal clear cell carcinoma at the Department of Urology of the Affiliated Drum Tower Hospital of Medical School of Nanjing University from May 2009 to January 2014 were retrospectively reviewed, including 28 male and 6 female patients aged between 25 and 85 years (mean age 60.7 years). Of the included cases, 16 had tumors located in the left kidney, 16 in the right, 1 in the solitary kidney, and 1 in the bilateral kidney. There were 35 tumors in this study totally. The maximum diameter of the tumors was 1.8 to 5.0 cm (mean (2.7 ± 0.3) cm), of which 32 cases of renal tumors were ≤ 4.0 cm and 3 cases of renal tumors were > 4.0 cm to 5.0 cm. Pathological diagnosis were acquired by ultrasound-guided percutaneous biopsy after USG-RFA. Contrast-enhanced ultrasound was used to evaluate tumor outcomes at the time of the surgery, and multi-slice spiral CT enhanced scan and contrast-enhanced ultrasound were used to identify residues and recurrences after treatment.

RESULTSTreatments for all the patients were finished with short postoperative hospital stay about 3-5 days. No complications related to USG-RFA were encountered in any of the cases, such as perirenal fluid collection, perirenal hematoma, and peripheral organ damage. All the cases were diagnosed as clear cell carcinoma according to pathological results. The mean follow-up period was 29 ± 6 (range 3-59) months. Of the 35 USG-RFA-treated subjects, 32 tumors ≤ 4 cm reached the standard of complete treatment after one tumor was found with residue after the first month follow-up, and two tumors were noted recurrence at the 4 and 10 months follow-up after USG-RFA. Nonetheless, no residue or recurrence occurred after secondary treatment for these 3 tumors where pathological diagnosis were acquired again. The other 3 cases with tumors > 4.0 cm to 5.0 cm underwent USG-RFA twice or three times before reaching the standard of complete treatment, of which two had twice and one tumor had three times treatments. There was no carcinoma residue or recurrence during follow-up period.

CONCLUSIONSPercutaneous ultrasound-guided radiofrequency ablation for small renal mass (SRM) has satisfied clinical outcomes, with the advantage of less injury, lower complication rates and shorter recovery time for small size of renal clear cell carcinoma. USG-RFA may become the preferred treatment alternative for SRM.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Renal Cell ; surgery ; Catheter Ablation ; methods ; Female ; Follow-Up Studies ; Humans ; Kidney Neoplasms ; surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Retrospective Studies ; Treatment Outcome ; Ultrasonography, Interventional