fibrin and Carcinoma--Renal-Cell

We present a case of renal cell carcinoma growing into the renal pelvis with a fibrin cap in the ureter and bladder. A 66-year-old man presented to our hospital with anemia and gross hematuria. Computed tomography showed a large left renal tumor and space-occupying lesions in the left renal pelvis and ureter. Cystoscopy showed a 2 cm-restiform mass protruding from the left ureteral orifice. We performed open left nephroureterectomy, and there was a 3 cm white mass with a smooth surface in the bladder. Pathological examination of the resected mass revealed clear cell carcinoma with urinary collecting system invasion and fibrin cap in the ureter and bladder. As a result, it would have been difficult to make the diagnossis of renal cell carcinoma preoperatively if we had performed biopsy of the mass in the bladder or ureter. The patient was diagnosed as having lung metastases 5 months after surgery. Urinary collecting system invasion has been considered an independent prognostic factor in pT3 renal cell carcinoma.

Topics: Aged; Carcinoma, Renal Cell; Fibrin; Humans; Kidney Neoplasms; Kidney Pelvis; Male; Ureter; Urinary Bladder

The outcome of surgical treatment of renal cancer depends not only on cancer-specific survival, but also on the degree of loss of renal function, which often develops after surgery, especially radical nephrectomy.. To study the features of functional changes in a solitary kidney as a compensation mechanism after radical nephrectomy for renal cancer.. The functional state of a solitary kidney in 36 patients with renal cancer who undergone to radical nephrectomy was evaluated. There were 20 and 16 women. The mean age was 59.0+/-10.8 years (from 39 to 76 years). The size of the tumor was in the range of 7.0-12.0 cm. All patients with a solitary kidney underwent a follow-up examination 3 months after surgery, including measurement of peripheral blood pressure with calculation of mean dynamic pressure, renal ultrasound, calculation of glomerular filtration rate (GFR), renal doppler ultrasound, determination of serum fibrinogen and fibrin monomers, and microscopy of the bulbar conjunctiva. Patients who had pathological abnormalities during the examination were prescribed reno-cardioprotective drugs, including perindopril in a titrated dose, apixaban 5 mg a day as thromboprophylaxis and for improvement of the flow properties of blood for a period of 3 months with re-evaluation of the above parameters.. In 61.1% of patients after radical nephrectomy, on 2-4 postoperative days, there was a tendency to increase blood pressure compared to baseline values (p<0.05). By the seventh day after the procedure, the volume of the contralateral kidney increased on average by 16% (from 110.4+/-11.2 cm3 to 132.4+/-4.8 cm3, p<0.05). After radical nephrectomy, a decrease in GFR was detected in 33 cases (91.7%; p<0.05). Renal doppler ultrasound showed a moderate increase in linear blood flow, the resistance index in the main renal artery, and a decrease in the pulse index in the segmental and arcuate arteries. The microscopy of the bulbar conjunctiva in 83.3% of patients revealed changes in the microcirculatory bed, including narrowing of arterioles, dilation of venules, a decrease in venular and capillary blood flow. After 3 months of reno-cardioprotective therapy, it was revealed that the target values of blood pressure (<130/85 mm Hg) were achieved with an average dynamic blood pressure of 93.4+/-2.6 mm Hg. In addition, a decrease in creatinine to an average of 106.2+/-6.4, fibrinogen and fibrin monomers to subnormal values of 3.2+/-0.2 g/l and up to 8.1+/-0.5x10-2 g/l, respectively were seen. Renal hypertrophy according to ultrasound examination was preserved with a mean kidney volume 119.7+/-3.6 cm3. Disturbances in peripheral microcirculation according to the microscopy of the bulbar conjunctiva was assessed as moderate.. The development of CKD in patients with a solitary kidney is accompanied by a structural reorganization of the organ with an increase in blood pressure, an increase in its volume, a decrease in function, microcirculatory disorders and hypertensive nephropathy. Considering the prognostic significance of changes in the solitary kidney, it is important not only to control the functional parameters, but also to include reno- cardioprotective therapy as a standard, since it contributes to the preservation of the renal function and prevents the rapid progression of CKD. Thus, medical and social rehabilitation of patients with a solitary kidney is required. However, it is currently cannot be considered comprehensive.

Topics: Aged; Anticoagulants; Carcinoma, Renal Cell; Female; Fibrin; Fibrinogen; Glomerular Filtration Rate; Humans; Kidney; Kidney Neoplasms; Microcirculation; Middle Aged; Nephrectomy; Renal Insufficiency, Chronic; Retrospective Studies; Solitary Kidney; Venous Thromboembolism

To investigate the relationship between angiogenesis and coagulation markers in tumor tissues of primary renal cell carcinoma (RCC). Tumors stimulate angiogenesis and activate the coagulation cascade. The importance of the interplay between these pathways for RCC is unknown.. In all, 69 clear cell RCC specimens were analyzed by immunohistochemical staining applied to tissue microarrays. The expression of vascular endothelial growth factor (VEGF), hypoxia-inducible factor-1alpha, fibrinogen and fibrin, and microvessel density were visually analyzed. Finally, staining patterns were related to clinical variables and survival.. The VEGF expression was detected in 100% of tumors, with 68% showing a high expression, whereas hypoxia-inducible factor-1alpha staining was low (only 26% had a moderate to high staining). Fibrinogen was expressed adjacent to the tumor cells in 26% of cases, whereas in 84% it was expressed around the blood vessels. In 30% of tumors, expression of fibrin was detected. High tumor VEGF expression correlated with high fibrin staining (P = .05). From a multivariate analysis, microvessel density (P = .033) and fibrinogen adjacent to tumor cells (P = .046) were independent factors related to VEGF expression.. In this study, we found clinical evidence for the permeability activity of VEGF as reflected by extravascular fibrinogen expression adjacent to tumor cells in the extracellular matrix. In addition, VEGF and fibrin expression were associated, indicative for concomitant activation of the coagulation cascade and angiogenesis in RCC. Taken together, these data indicate that activation of angiogenesis and coagulation are related in RCC.

Topics: Adult; Aged; Blood Coagulation; Carcinoma, Renal Cell; Fibrin; Fibrinogen; Humans; Kidney Neoplasms; Middle Aged; Neovascularization, Pathologic; Retrospective Studies; Tumor Cells, Cultured; Vascular Endothelial Growth Factor A

A 47-year-old male patient presented with weight loss, hematuria, and a left renal mass, which proved to be a clear cell renal carcinoma with multiple liver, pulmonary and bone metastases. The platelet count was raised initially (414 x 10(9)/L) but declined 10 weeks after a debulking procedure followed by chemotherapy. Fibrin clots were prepared for scanning electron microscopy (SEM) by adding human thrombin to platelet rich plasma (derived by differential centrifugation of fresh blood samples taken from the patient as well as controls). The clots were washed, fixed in 2.5% glutaraldehyde and Dulbecos phosphate buffered saline and prepared for SEM with a Zeiss Ultra 55 FEG SEM. The SEM photographs revealed an altered morphology of the platelet aggregates with multiple breakages in the platelet membrane, showing a pock-marked, crenated, prune-like appearance as opposed to the smooth rounded globular membrane of the controls. The ultrastructural morphology of the fibrin bound platelet aggregates in this patient with renal carcinoma therefore showed a disrupted cytoskeletal architecture which appears to be similar to the apoptotic changes of programmed cell death as described by Bornman et al. (2007) and Pretorius et al. (2008). These features may well be a distinct ultrastructural hematological manifestation of a previously unidentified paraneoplastic syndrome.

Topics: Blood Platelets; Carcinoma, Renal Cell; Fibrin; Humans; Kidney Neoplasms; Male; Microscopy, Electron, Scanning; Middle Aged; Platelet Aggregation

Topics: Aged; Carcinoma, Renal Cell; Fibrin; Foreign-Body Reaction; Humans; Kidney Neoplasms; Male; Neoplasm Recurrence, Local; Nephrectomy

Fibrin was detected by immunospecific techniques associated with both intravascular and extravascular tumor deposits in renal cell carcinoma. In addition, coagulation factors VII and X were demonstrated in intercellular spaces within tumor tissue and adjacent to the surface of tumor cells. Scant accumulation of platelets on intravascular tumor masses was observed. These data suggest that tumor cells in renal cell carcinoma may induce fibrin formation locally by a factor VII-mediated (and thus tissue factor-initiated) pathway of blood coagulation. This mechanism may also account for the hypercoagulable state that exists with this tumor type. We postulate that local fibrin formation may contribute to the growth and spread of this particular type of cancer and that the course of renal cell carcinoma may be ameliorated by anticoagulant therapy.

Topics: Antibodies; Blood Coagulation; Carcinoma, Renal Cell; Cell Communication; Factor VII; Fibrin; Humans; Kidney Neoplasms; Microscopy, Fluorescence; Microscopy, Phase-Contrast; Staining and Labeling

Acquired dysfibrinogenemia has not been previously reported as a paraneoplastic marker for malignancy. This report describes the clinical course of a patient who at the time of diagnosis of nonmetastatic renal cell carcinoma had dysfibrinogenemia characterized by prolongation of the thrombin and Reptilase times and increased sialic acid content of the purified fibrinogen. The thrombin and Reptilase times returned toward normal values after nephrectomy but became abnormal with the development of nonhepatic metastases. It is concluded that acquired dysfibrinogenemia can be part of a paraneoplastic syndrome and is a sensitive plasma marker for tumor progression.

Topics: Carcinoma, Renal Cell; Female; Fibrin; Fibrinogen; Follow-Up Studies; Humans; Kidney Neoplasms; Lung Neoplasms; Middle Aged; N-Acetylneuraminic Acid; Nephrectomy; Paraneoplastic Syndromes; Sialic Acids; Thrombin Time

Topics: Calculi; Carcinoma, Renal Cell; Fibrin; Humans; Kidney; Kidney Calculi; Kidney Neoplasms