Metanephric adenoma is a rare benign kidney tumor with a favorable prognosis. These neoplasms are often interpreted as malignant at the preoperative stage, since they do not have specific characteristics showing during instrumental imaging methods, which leads to excessive surgical treatment in the context of nephrectomy volume. Therefore, histological verification is the gold standard for diagnosis. The morphological features of metanephric adenoma are in many ways similar to such kidney tumors as papillary renal cell carcinoma and nephroblastoma (Wilms’ tumor), so sometimes additional research methods are required, including immunohistochemical and molecular genetic ones. In this article, we report a rare clinical case of metanephric adenoma in a forty-seven-year-old woman. The results of clinical and instrumental exams, as well as morphological features of the tumor are presented. A review of the literature on the clinical, morphological, and molecular aspects of this tumor is also presented.
Renal cancer (RC) is one of the three most common diseases in oncologic urology. Its accurate diagnosis and prognosis remain difficult and important problems. Some cases of RC are associated with hereditary cancer syndromes and are caused by germline mutations. This review describes monogenic forms of hereditary RC (von Hippel–Lindau syndrome, Birt–Hogg– Dubé syndrome, hereditary leiomyomatosis and renal cell cancer, hereditary papillary renal carcinoma, BAP1 tumor predisposition syndrome) and diseases with several candidate genes (SDH-mutated tumors, tuberous sclerosis complex). Additionally, the review discusses the increased risk of RC in patients with frequent hereditary cancer syndromes predisposing to the development of a wide range of tumor types: Lynch and Li-Fraumeni syndromes. RC in combination with other carcinomas can develop in patients carrying pathogenic mutations in the candidate genes of different hereditary cancer syndromes – multi-locus inherited neoplasia allele syndrome (MINAS) – which is especially important due to the growing role of high-throughput sequencing in practical oncologic genetics. Additionally, guidelines on modern laboratory genetic diagnostics and active surveillance are presented for each syndrome.
The review covers reduced kidney function in the context of renal cell carcinoma. According to international studies, some patients already have chronic kidney disease at time of disease onset. Surgical treatment leads to a decrease in the total number of functioning nephrons. Drug therapy causes several adverse events including nephrotoxicity. The review discusses the problem of using combination regimens in patients with solitary kidney.
Aim . To evaluate the effect of cytoreductive nephrectomy (CN) on overall survival (OS) in patients with metastatic renal cell carcinoma (mRCC) and to identify a group of patients who are candidates for cytoreductive surgical treatment. Materials and methods . We retrospectively analyzed a database of 403 patients with mRCC treated at the Moscow City Oncological Hospital No. 62 and the City Clinical Oncological Dispensary (Saint Petersburg) between 2006 and 2022. In total, 330 (81.9 %) patients underwent CN. All patients received systemic anti-tumor therapy: targeted anti-angiogenic therapy - 317 (78.6 %), cytokines - 61 (15.1 %), checkpoint inhibitors - 25 (6.2 %). The groups of operated and non-operated patients were unbalanced: CN was more often not performed in patients with multiple metastases, bone and liver lesions, laboratory abnormalities (anemia, increased serum alkaline phosphatase and lactate dehydrogenase) and unfavorable prognosis per IMDC (International mRCC Database Consortium) classification ( p >0.05 for all). Results . CN was associated with a significant increase in OS compared with primary tumor preservation in situ : median OS was 36 months with 95 % confidence interval 29.1-37.1, and 11 months with 95 % confidence interval 8.1-21.3, respectively ( p <0.0001). The benefit for OS in the CN group was also observed in clear-cell mRCC ( p <0.0001), grade G3 ( p <0.0001), multiple metastases ( p <0.0001) groups, and in the IMDC poor prognosis group ( p <0.0001). Conclusion . CN in selected mRCC patients results in a significant increase in OS. Further research is needed to determine selection criteria for surgical treatment candidates.
Despite constant improvements in radical prostatectomy technique, some questions on standardization of both perioperative management stages and surgical intervention itself remain. We conducted an anonymous online survey of 45 oncological urologists from 15 regions of the Russian Federation who are actively involved in the surgical treatment of patients with prostate cancer. According to the results of the survey, there is huge variability associated, to a great extent, with equipment availability in clinics and the lack of sufficient evidence-based information in some matters of perioperative management. A detailed study of each step of surgical treatment, clinical trials, and involvement of professional societies will contribute to the standardization of perioperative management of patients and radical prostatectomy technique.
