BILATERAL ASYNCHRONOUS RENAL CELL CARCINOMA
https://doi.org/10.17650/1726-9776-2010-6-2-14-21
Abstract
Among 1430 patients with renal tumors, followed up at the Urology Clinic, I. M. Sechenov Moscow Medical Academy, in 1973 to 2007, 117 (8.2%) patients were found to have bilateral neoplasms, 81 (5.7%) patients being diagnosed as having bilateral renal cell carcinoma (RCC), out of them 51 (3.6%) and 30 (2.1%) patients had synchronous and asynchronous RCC, respectively. Asynchronous tumor was identified in 19 (63.3%) and 8 (26.7%) patients in the period of under 5 and >10 years (including 22 years in 1 case), respectively, after initial tumor removal. Among 30 patients with asynchronous RCC, 27 had previously undergone nephrectomy and 3 had resection of a kidney with tumor. When asynchronous RCC was detected, its treatment policy consisted of organ-preserving surgery. Analysis of the morphological pattern of a tumor in patients with bilateral asynchronous RCC revealed its similar type in 85.2% of cases and the identical degree of tumor cell differentiation in 48.1%; the patients with a varying degree of differentiation were ascertained to have high-grade asynchronous malignancy in 92.9% of cases. Molecular genetic studies showed that all the patients had mutations of VHL and FHIT genes located on the third pair of chromosomes. Our findings indicate that bilateral RCC is a genetically determined primarily bilateral tumor process that can manifest itself at once (synchronously) or after a (frequently considerable) time (asynchronously). In asynchronous carcinoma, overall and adjusted 5-year survival rates were 53.3 and 60%, respectively. The fact that an asynchronous tumor may occur in the contralateral kidney a considerable time after the first surgery necessitates to make a regular purposeful follow-up of patients operated on for unilateral RCC. The minimum control examination should include chest X-ray study, ultrasonography of the remaining kidney, removed tumor bed, and great vessels, which should be performed every 6 months within the first 5 years, then once every year. If a disease relapse is suspected, multispiral computed tomography of the abdomen and retroperitoneal space is to be made.
About the Authors
Yu. G. Alyaev
Urology Clinics, I.M. Sechenov Moscow Medical Academy
Russian Federation
Russian Federation
Z. G. Grigoryan
Urology Clinics, I.M. Sechenov Moscow Medical Academy
Russian Federation
Russian Federation
A. A. Levko
Urology Clinics, I.M. Sechenov Moscow Medical Academy
Russian Federation
Russian Federation
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Review
For citations:
Alyaev Yu.G., Grigoryan Z.G., Levko A.A. BILATERAL ASYNCHRONOUS RENAL CELL CARCINOMA. Cancer Urology. 2010;6(2):14-21. (In Russ.) https://doi.org/10.17650/1726-9776-2010-6-2-14-21
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