No abstract

Purpose Renal cell carcinoma (RCC) most commonly metastasizes to the lung. Preoperative indeterminate pulmonary nodules (IPNs) occur in half of patients with localized RCC; however clinical significance remains poorly defined. We aimed to determine whether IPNs, their size, or number, are associated with RCC outcomes. Materials and Methods Data of 1,102 patients with RCC who had chest computed tomography within 6 months before nephrectomy from 2002-2012 were reviewed. Patients with metastatic disease at presentation, benign tumors, pulmonary nodules >2cm, or concurrent pulmonary disease were excluded, leaving 748 for analysis. Study outcomes included lung metastases, any distant metastases, or death from RCC. Cox proportional hazards models were used to assess whether presence of IPNs, nodule size, or number were associated with outcomes. Models were evaluated by comparing discrimination using Harrell's c-index. Results IPNs were present in 382/748 patients (51%). Median follow-up was 4.1 years (IQR, 2.2–6.1). Presence of IPNs was not associated with distant metastases or death from kidney cancer; however, compared to sub-centimeter IPNs, nodules >1cm were associated with metastatic disease after adjusting for tumor histology, stage, and size (HR=2.48; 95% CI, 1.08–5.68; p=0.031). C-indices for outcomes increased slightly after adding size of nodules to a predictive model adjusted for tumor characteristics. Conclusions In the current study, no evidence suggested IPNs <1cm were associated with RCC progression, although large nodules significantly predicted metastatic disease. Patients with sub-centimeter IPNs will unlikely benefit from extensive postoperative chest imaging surveillance, which should be reserved for patients with nodules >1cm.

Objective To evaluate clinicopathologic characteristics and treatment outcomes of patients undergoing partial (PN) or radical nephrectomy (RN) for unilateral synchronous multifocal renal tumors. Methods We retrospectively reviewed medical records for 128 patients with non-metastatic unilateral synchronous multifocal renal tumors who underwent surgical resection at our institution from 1995 to 2012. Five patients with hereditary renal cell carcinoma were excluded. Differences between patient and tumor characteristics from the two nephrectomy groups were evaluated. Outcomes in terms of recurrence-free survival, overall survival, and chronic kidney disease upstaging were estimated using Kaplan-Meier methods. The log-rank test was used for group comparisons. Results The study cohort included 78 PN patients (63%) and 45 RN patients (37%); 17/95 planned PN (18%) were converted to RN. Tumor diameter and R.E.N.A.L. nephrometry scores were greater in RN patients (p<0.0001 and p=0.0002, respectively). Pathological stage T3 was seen in 40% of RN patients and 10% of PN patients (p=0.0002). Histologic concordance was apparent in 60/123 patients (49%). Median follow-up for patients alive without a recurrence was 4 years. Five-year recurrence-free survival was 98% for PN and 85% for RN. Five-year overall survival was 96% for PN and 86% for RN (p=0.5). Five-year freedom from chronic kidney disease upstaging was 74% for PN, and 55% for RN (p=0.11). Conclusion Partial nephrectomy for the treatment of unilateral synchronous multifocal renal tumors with favorable characteristics was associated with a low recurrence rate. These findings suggest PN is an appropriate management strategy for this group of carefully selected patients.

To the best of our knowledge, this is the first report of CT data aiding in the prediction of brushite stone composition. Both HUm and HUsd can help predict stone composition and their combined use results in higher likelihood ratios influencing probability.

Sertoliform cystadenoma is a rare benign tumor of the rete testis with 8 previously reported cases and an additional 14 cases reported in an abstract form. It usually presents with a unilateral scrotal mass, clinically and radiologically indistinguishable from malignant testicular tumors. We report a 39-year-old man who presented with a right testicular mass. The patient underwent radical inguinal orchiectomy. Grossly, no masses were appreciated. After histologic examination with subsequent immunohistochemical staining, a sertoliform cystadenoma of the rete testis was diagnosed.