Clinical Characteristics Analysis Of Some Rare Renal Carcinomas

[Objectives]Based on the clinical characteristics analysis of three kinds of rare renal carcinomas (thyroid-like follicular carcinoma renal tumor, tubulocystic carcinoma of kidney and metastatic choriocarcinoma of kidney), in order to understand the clinical features, pathological features, differential diagnosis, treatment and prognosis.[Methods]Reported3cases of thyroid-like follicular carcinoma renal tumor (TLFC),1case of renal tubiform cystocarcinoma (TCC) and1case of metastatic choriocarcinoma of kidney (MCK) in our hospital from2011to2013, collected the similar literatures to review from PubMed, Medline and Chinese literature databases, then performed a pooled analysis.[Results]1. Thyroid-like follicular carcinoma renal tumor (TLFC) has been reported19cases in total, combined with3cases in our hospital. The pooled analysis show that the mean age and tumor size of patient with TLFC are40.5±16.19(range22to83, median35) years and4.87±2.70(range1.5to11.8, median4.2) cm respectively. Women comprised the majority of the patients (15/22,68.18%) and show an earlier average age of onset than men (34.07±8.75vs.50.67±19.65, P=0.013). The imageology features of TLFC resemble a large spectrum of benign and malignant renal and extra-renal conditions which should be ruled out in the diagnostic process. All the patients had no lesions in the thyroid during physical and ultrasound examinations, and there were no abnormal manifestations in thyroid function tests. Mediastinum has no ectopic thyroids and tumors. More than12months after primary diagnosis, the3patients are still in good health without recurring disease or related complaints.2. Renal tubiform cystocarcinoma (TCC) is a rare disease in clinic. Review pertinent literatures of83TCC cases, fifty-one of which was elected and analyzed with statistical methods. The results showed an average age of57.43±16.07years (range from18to94, median61). The ratio of incidence between men and women was8:1. The tumor ranged in size from0.2to17.0cm in its greatest dimension with a mean size of28±3.01cm(58.82%≤4cm). By sex group, the age of onset and size of tumor showed no statistical difference. However, the age of onset was found to be significantly lower on patients with clinical symptoms (39.40±16.24vs.59.39±14.95, P<0.05). In our case, a follow-up of13months showed no recurrence and metastasis after radical resection of right kidney.3. Metastatic choriocarcinoma of kidney was rarely reported. To summarize the common features of this disease combined with one case analysis in our hospital:a. were usually seen in normal or ectopic pregnancy, b. sudden pain occurred in waist and abdomen, tenderness and rebound tenderness were positive, c. blood pressure sharply dropped, d. blood HCG was positive, e. CT showed perinephritic hematoma and often combined with pulmonary metastasis.[Conclusions]1. Thyroid-like follicular carcinoma renal tumor is a very rare kidney epithelial cell tumor, which is attributable to any known subtypes of renal cell carcinoma. It occurs mainly in young women and clinical manifestations have no difference with other renal tumors. Confirmed diagnosis depends on the examination of pathomorphology and immunohistochemistry. Surgical ablation is the preferred therapeutic method. Limited data shows good prognosis, but still need to accumulate more cases and long-term follow-up. To improve the understanding of it can avoid misdiagnosis and prevent inappropriate treatment.2. TCC is a rare entity of renal cell carcinoma with a male preponderance of8:1. There was no characteristic of clinical manifestation with other renal neoplasms. Confirmed diagnosis depends on the examination of pathomorphology and immunohistochemistry. Surgical resection is the preferred treatment of TCC, with favorable postoperative prognosis and low malignant potential. It’s in need to improve the understanding of this kind of tumor in clinic.3. Metastatic choriocarcinoma of kidney is rare and the cure rate of simple choriocarcinoma after chemotherapy is now close to100%. However, renal metastasis may be accompanied by acute and rapid bleeding due to the high malignancy, fast growth and hemorrhagic tendency of this tumor. The optimal treatment is early chemotherapy after effective control of hemorrhage. It’s necessary to carry out careful differential diagnosis for the rupture hemorrhage of other renal tumors to avoid misdiagnosis and delayed treatment.