Renal-cell carcinoma.

Renal cell carcinoma (RCC) denotes cancer originated from the renal epithelium and accounts for >90% of cancers in the kidney. The disease encompasses >10 histological and molecular subtypes, of which clear cell RCC (ccRCC) is most common and accounts for most cancer-related deaths. Although somatic VHL mutations have been described for some time, more-recent cancer genomic studies have identified mutations in epigenetic regulatory genes and demonstrated marked intra-tumour heterogeneity, which could have prognostic, predictive and therapeutic relevance. Localized RCC can be successfully managed with surgery, whereas metastatic RCC is refractory to conventional chemotherapy. However, over the past decade, marked advances in the treatment of metastatic RCC have been made, with targeted agents including sorafenib, sunitinib, bevacizumab, pazopanib and axitinib, which inhibit vascular endothelial growth factor (VEGF) and its receptor (VEGFR), and everolimus and temsirolimus, which inhibit mechanistic target of rapamycin complex 1 (mTORC1), being approved. Since 2015, agents with additional targets aside from VEGFR have been approved, such as cabozantinib and lenvatinib; immunotherapies, such as nivolumab, have also been added to the armamentarium for metastatic RCC. Here, we provide an overview of the biology of RCC, with a focus on ccRCC, as well as updates to complement the current clinical guidelines and an outline of potential future directions for RCC research and therapy.

Renal cell carcinoma.

Magnetic resonance imaging (2)

The introduction of an effective blood test, prostate specific antigen (PSA), has made it possible to diagnose more and more men in an earlier stage where they can be offered potentially curative treatments. The other side of the coin is that if effective diagnostic procedures are used unselectively in elderly men with a short life expectancy, a problem with over diagnosis and over treatment might occur. Thus the same stage of prostate cancer may need different treatment strategies, pending on the patient’s life expectancy. This, and many other issues regarding the disease, is the subject of the EAU guidelines on prostate cancer. G UI DE LI N ES O N P RO ST AT E CA N CE R 10

/pdf/guidelines-on-prostate-cancer-xdnunn4th8.pdf

Guidelines on Prostate Cancer

IN the 12 years since the topic was last reviewed in the Journal,1 prostatic cancer has become the most common newly diagnosed cancer in men It is the cause of death in more than 28,000 men per year, accounting for 11 percent of cancer deaths, third in men after lung and colon cancer2 Important questions remain about the cause and prevention of prostatic cancer, but new advances permit earlier diagnosis and more accurate staging Curative therapy is possible for localized disease with much less morbidity than previously In advanced disease, androgen-deprivation therapy remains the mainstay of treatment Biology and   

Carcinoma of the Prostate

A patient with milk of calcium (MOC) in an obstructued kidney and ureter is presented. Although MOC is occasionally confused radiographically with other conditions, such as cholelithiasis or ureteral calculi, its main significance lies in its occasional association with urinary tract obstruction, the presence of which should not be overlooked. Erect or decubitus radiographic examination will demonstrate layering.

Milk of calcium and ureterocele

Metastatic malignant melanoma mimicking renal cell carcinoma.

Percutaneous nephrostolithotomy and ureterolithotomy is now widely accepted as the preferred method of managing symptomatic upper urinary tract calculi. The success of these procedures depends on an optimally oriented, percutaneously established nephrocutaneous track. These nephrostomies are often technically difficult if the collecting system is unobstructed or if calculi interfere with percutaneous manipulations. Several technical refinements have been developed that have aided in the performance of over 200 such nephrostomies as well as percutaneous ureterolithotomy. These include the use of externally applied abdominal compression to distend the collecting system after intravenous administration of contrast material for renal puncture, distend the ureter beyond an obstructing ureteral calculus to aid in percutaneous extraction, and relocate ptotic kidneys back into the renal fossa to optimize renal access; targeting on an opaque caliceal calculus for nephrostomy puncture; use of a saline flush to conf...

Technical refinements in percutaneous nephroureterolithotomy.

Using a perurethral transvesical approach, we attempted a total of 180 varied pyeloureteral uroradiologic interventional procedures during a 20-month period; 168 were successfully accomplished (93% success rate) We used standard interventional equipment, fluoroscopy, and (for access to the upper urinary tract) ureteral catheters that had been partially or completely inserted at cystoscopy by urologists The successful procedures included insertion of double-pigtail ureteral stents (42 procedures), insertion of single-pigtail ureteral stents (47), advancement of arrested or incompletely inserted retrograde ureteral catheters (42), urothelial biopsy (30), balloon dilatation of ureteral strictures (three), retrograde cannulation of ureteropelvic junction obstructions that could not be negotiated in a percutaneous antegrade fashion (three), and ureteral stone extraction (one) The method was unsuccessful in 12 patients Failures were due to caudal migration of a ureteral catheter into the bladder in eight pa

https://www.ajronline.org/doi/pdfplus/10.2214/ajr.152.1.97

Fluoroscopically guided pyeloureteral interventions by using a perurethral transvesical approach.

Eight patients with a duplex kidney demonstrated severe attenuation of parenchyma in the lower pole. The radiographic appearance of a diminutive lower collecting system indicated the proper diagnosis when there was sufficient parenchyma for visualization. Parenchymal attenuation may represent either hypoplasia or inflammatory atrophy. Whichever the cause, it is important that the diminutive lower pole not be mistaken for a renal mass, extrinsic tumor, renal infarction, or a postoperative change.

Howard M. Pollack

Papers

Milk of calcium and ureterocele

Metastatic malignant melanoma mimicking renal cell carcinoma.

Technical refinements in percutaneous nephroureterolithotomy.

Fluoroscopically guided pyeloureteral interventions by using a perurethral transvesical approach.

Renal duplication with a diminutive lower pole: the Nubbin sign.