Solitary Renal Fossa Recurrence of Renal Cell Carcinoma After Nephrectomy

Renal cell carcinoma without metastasis responds well to surgical excision but is known to recur postnephrectomy. In a small but significant number of patients this recurrence is not accompanied by metastasis, which is important as these people benefit from further surgery. We examined 20 articles from the current literature to ascertain how best to treat this condition. Surgical management renders better results than conservative or medical therapies. Readily available investigations such as blood tests and computed tomography can help determine the right patients for surgery in an evidence-based fashion. Current findings have allowed us to suggest a protocol for the treatment of solitary renal fossa recurrence of postnephrectomy renal cell carcinoma. There are further opportunities for study in validating our protocol, and in novel renal cell carcinoma treatment strategies that have not been tested on solitary renal fossa recurrences.Key words: Renal cancer, Recurrence, Nephrectomy, Complications, ManagementKidney cancers represent 2% of cancers worldwide; the most common type is renal cell carcinoma. Curative treatment of localized disease is a nephrectomy. Following surgery, recurrence can happen locally with an incidence of 1.61%.^1–5 A solitary renal fossa local recurrence is rare but important to distinguish from local recurrence with metastasis, which would not benefit from surgical resection. The 5-year survival postresection of local recurrence for those without metastasis compared with those with metastasis was 62% compared with 0%.⁴ The kidneys are bordered by the colon, spleen, liver, stomach, and associated neurovascular structures, all of which may be invaded in this form of recurrence; specific morbidity is related to the invasion and subsequent resection of these organs. General morbidity is caused by the surgery itself, with pain, infection, and hemorrhage being major contributors (Figure 1). This article explains predictive factors in recurrence, useful diagnostic modalities, and management, and provides recommendations and highlights opportunities for further study.Open in a separate windowFigure 1Computed tomography image of a patient with renal fossa recurrence of renal cancer after nephrectomy. Of note is the large mass identifiable in the spleen.     

Renal Failure After Radiological Contrast Media

Over a 12-month period four patients developed acute renal failure after undergoing radiological investigations using contrast media. Though the incidence of serious complications is low, the possibility of adverse side effects must be weighed against the usefulness of the information provided by these techniques.     

Serum and Urinary Enzyme Activity After Renal Infarction

Recently it has been observed that the activity of certain enzymes in serum and urine may be increased after renal infarction. Although aortography or selective renal angiography should be the diagnostic corner-stone on which one would proceed to embolectomy, it is possible that enzyme assays may serve as laboratory aids to suggest or confirm the diagnosis. This paper reviews the few existing clinical and experimental studies and reports on two patients who had a total of three episodes of renal infarction. Serial determinations after one episode showed increased activity of serum oxaloacetic glutamic transaminase (SGOT) and of lactic acid dehydrogenase (LDH) and alkaline phosphatase in the serum and urine; some elevated serum LDH and SGOT values were recorded after the other two infarctions. The time of onset and duration of these increases are discussed, and the possible difficulty in differentiating renal from myocardial infarction is illustrated.     

Angiopoietins Modulate Endothelial Adaptation,Glomerular and Podocyte Hypertrophy after Uninephrectomy

Glomerular capillary remodeling is an essential process in the development of glomerular hypertrophy. Angiopoietins, which are important regulators in angiogenesis, plays a role in the development of glomerulus during embryogenesis. Here, we evaluated the influence of angiopoietin on glomerular components and hypertrophy after uninephrectomy in adult male BALB/c mice. The actions of angiopoietin 1 or 2 were systemically antagonized by the subcutaneous administration of antagonists. We observed that the angiopoietin system was activated after uninephrectomy, and that the blockade of angiopoietin 1 or 2 decreased the activation of the angiopoietin receptor—tyrosine kinase with Ig and EGF homology domains-2—and attenuated the development of glomerular and podocyte hypertrophy. The increase in endothelial density staining (anti-CD31) following uninephrectomy was also reversed by angiopoietin 1 or 2 blockades. Glomerular basement thickness and foot process width were observed to decrease in the angiopoietin blockade groups. These changes were associated with the down regulation of the expression of genes for the glomerular matrix and basement membrane, including collagen type IV α1, collagen type IV α2, collagen type IV α5, and laminin α5. Thus, angiopoietin 1 or 2 may play an important role in the development of glomerular hypertrophy after uninephrectomy. A blockade of the angiopoietin system not only influenced the endothelium but also the podocyte, leading to diminished gene expression and morphological changes after uninephrectomy.     

Renal Capsule Xenografting and Subcutaneous Pellet Implantation for the Evaluation of Prostate Carcinogenesis and Benign Prostatic Hyperplasia

New therapies for two common prostate diseases, prostate cancer (PrCa) and benign prostatic hyperplasia (BPH), depend critically on experiments evaluating their hormonal regulation. Sex steroid hormones (notably androgens and estrogens) are important in PrCa and BPH; we probe their respective roles in inducing prostate growth and carcinogenesis in mice with experiments using compressed hormone pellets. Hormone and/or drug pellets are easily manufactured with a pellet press, and surgically implanted into the subcutaneous tissue of the male mouse host. We also describe a protocol for the evaluation of hormonal carcinogenesis by combining subcutaneous hormone pellet implantation with xenografting of prostate cell recombinants under the renal capsule of immunocompromised mice. Moreover, subcutaneous hormone pellet implantation, in combination with renal capsule xenografting of BPH tissue, is useful to better understand hormonal regulation of benign prostate growth, and to test new therapies targeting sex steroid hormone pathways.     

DNA Demethylation and Carcinogenesis

DNA methylation plays an important role in the establishment and maintenance of the program of gene expression. Tumor cells are characterized by a paradoxical alteration of DNA methylation pattern: global DNA demethylation and local hypermethylation of certain genes. Hypermethylation and inactivation of tumor suppressor genes are well documented in tumors. The role of global genome demethylation in carcinogenesis is less studied. New data provide evidence for independence of DNA hypo- and hypermethylation processes in tumor cells. These processes alter expression of genes that have different functions in malignant transformation. Recent studies have demonstrated that global decrease in the level of DNA methylation is related to hypomethylation of repeated sequences, increase in genetic instability, hypomethylation and activation of certain genes that favor tumor growth, and increase in their metastatic and invasive potential. The recent data on the role of DNA demethylation in carcinogenesis are discussed in this review. The understanding of relationships between hypo- and hypermethylation in tumor cells is extremely important due to reversibility of DNA methylation and attempts to utilize for anti-tumor therapy the drugs that modify DNA methylation pattern.__________Translated from Biokhimiya, Vol. 70, No. 7, 2005, pp. 900–911.Original Russian Text Copyright © 2005 by Kisseljova, Kisseljov.This article was not published in the journal special issue devoted to the 70th anniversary of B. F. Vanyushin (Biochemistry (Moscow) (2005) 70, No. 5) because of the limiting volume of the journal.