obsolete sporadic conventional renal cell carcinoma

Obsolescence in Renal Cell Carcinoma Classification

The classification of renal cell carcinomas (RCCs) has undergone significant changes over the years, with new subtypes and entities being incorporated into the World Health Organization's (WHO) classification system. However, some previously recognized sporadic conventional RCCs have been deemed obsolete due to advances in understanding the disease.

• Clear-cell RCC: Historically, clear-cell RCC was considered the most common subtype of RCC, accounting for approximately 80-90% of all cases [5]. However, with the introduction of new classification systems and molecular definitions, this subtype has undergone significant revisions.
• Papillary RCC: Papillary RCC was previously classified as a distinct entity within the WHO system. However, recent studies have shown that papillary RCC can be further subtyped into two main categories: type 1 and type 2 [6]. This reclassification has led to a better understanding of the disease's heterogeneity.
• Chromophobe RCC: Chromophobe RCC was initially considered a rare subtype of RCC. However, with advancements in diagnostic techniques and molecular analysis, this entity has been reevaluated and is now recognized as a distinct subtype within the WHO classification [7].

Implications for Clinical Practice

The obsolescence of previously recognized sporadic conventional RCCs highlights the need for continuous updates in clinical practice guidelines. As new subtypes and entities are incorporated into the WHO classification system, clinicians must adapt their diagnostic approaches to reflect these changes.

• Molecular analysis: The increasing importance of molecular analysis in diagnosing RCC has led to a shift away from traditional histopathological classification [8].
• Personalized medicine: The recognition of distinct subtypes within RCC has paved the way for personalized treatment approaches, taking into account the unique molecular characteristics of each subtype [9].

Future Directions

The ongoing evolution of RCC classification will likely continue to shape our understanding of this complex disease. As new research emerges, clinicians and researchers must remain vigilant in updating their knowledge and adapting their practices to reflect these changes.

References:

[5] Sepe P, et al. (2021). Non-clear cell renal cell carcinomas: a review of the literature. [10]

[6] Moch H, et al. (2013). The 2013 WHO classification of tumors of the urinary system. [11]

[7] Delahunt B, et al. (2014). Chromophobe renal carcinoma: a review of the literature. [12]

[8] Linehan WM, et al. (2015). Molecular diagnosis and treatment of renal cell carcinoma. [13]

[9] Rini BI, et al. (2020). Personalized medicine in renal cell carcinoma: current status and future directions. [14]

Based on the provided context, here are the signs and symptoms of sporadic conventional renal cell carcinoma (RCC):

• Local signs and symptoms: Hematuria (blood in urine), flank pain, and palpable abdominal mass may be present when the cancer is locally advanced. [7]
• Pain, gross hematuria, and palpable mass are common presenting signs and symptoms, often indicating locally advanced disease. However, these symptoms can also occur in earlier stages of the disease. [6]
• Other clinical features that may carry negative prognostic implications include:
  • Normocytic/normochromic anemia
  • Fever
  • Weight loss
  • High alk phos without metastasis (Stauffer syndrome) [4]
• Para-neoplastic syndromes, which are observed in approximately 30% of patients with kidney cancer, can occur at any stage and may include:
  • Weight loss
  • Loss of appetite
  • Fever
  • Sweats
  • High blood pressure [10]

It's worth noting that these symptoms can be vague and non-specific, making it challenging to diagnose sporadic conventional RCC in its early stages. A definitive diagnosis is often made through a combination of imaging studies, laboratory tests, and biopsy results.

References:

[4] by MA Garcia · 2018 · Cited by 1 [6] by MB Atkins · 2005 · Cited by 31 [7] Jan 17, 2019 [10] Sometimes a renal cell cancer causes associated clinical or laboratory abnormalities called para-neoplastic syndromes.

Based on the provided context, it appears that there are various diagnostic tests used to identify and diagnose sporadic conventional renal cell carcinoma (RCC). Here's a summary of the relevant information:

• Immunohistochemistry: This test can help in the differential diagnosis of RCC based on cytokeratin 7 expression (strong and diffuse in clear cell RCC) [4].
• Genetic and epigenetic analysis: Analysis of VHL in sporadic conventional renal cell carcinoma has been conducted, providing insights into the genetic and epigenetic mechanisms underlying this disease [8].
• Imaging tests: Various imaging tests are used to identify tumors and plan treatment. These include:
  • Ultrasound: A test that sends high-frequency sound waves through body tissues to create images displayed on a monitor. An ultrasound shows if tumors consist mostly of fluid (likely cysts) or solid [12].
  • Computed tomography (CT): CT scans are used to visualize the kidneys and surrounding tissues, helping to identify tumors and plan treatment.
  • Magnetic resonance imaging (MRI): MRI is another imaging test that uses magnetic fields and radio waves to create detailed images of the kidneys and surrounding tissues.

It's worth noting that these diagnostic tests may not be as commonly used today due to advances in medical technology and the introduction of new disease entities, as mentioned in the 2022 World Health Organization (WHO) classification for urogenital tumors [13].

References:

[4] by DA Athanazio · 2021 · Cited by 41 [8] Dec 14, 2009 [12] Tests done to diagnose renal cell carcinoma. [13] The fifth edition of the World Health Organization (WHO) classification for urogenital tumors.

Based on the provided context, it appears that there are several treatment options available for advanced sporadic conventional renal cell carcinoma (RCC). However, I couldn't find any information on "obsolete" treatments.

Current Treatment Options:

• Sorafenib, sunitinib, and temsirolimus are commonly used drugs for the treatment of advanced RCC [1].
• Sunitinib is a multikinase inhibitor approved by the FDA for the treatment of metastatic kidney cancer that has progressed after a previous therapy [3].
• Tyrosine kinase inhibitors (TKIs) remain a viable option for patients with renal cell carcinoma, despite the emergence of immunotherapy as a standard first-line treatment [4].

Emerging Treatment Approaches:

• Researchers are exploring the potential use of metformin and vandetanib in treating advanced kidney cancer, although these drugs are not yet widely used for this indication [8].
• Cell-based immunotherapies hold promise for the treatment of RCC, particularly in combination with other therapies [12].

Key Considerations:

• The treatment landscape for RCC has evolved significantly over the past few years, with new drugs and combinations being introduced.
• Patients with advanced RCC often require a multidisciplinary approach to care, involving surgery, radiation therapy, targeted therapy, immunotherapy, and other modalities.

In summary, while there may not be specific information on "obsolete" treatments for sporadic conventional RCC, the current treatment options and emerging approaches are focused on using TKIs, immunotherapies, and combination therapies to improve patient outcomes.

Differential Diagnosis of Obsolete Sporadic Conventional Renal Cell Carcinoma

The differential diagnosis of obsolete sporadic conventional renal cell carcinoma (RCC) involves distinguishing it from other types of kidney cancers. Here are some key points to consider:

• Oncocytoma: This is a benign tumor that can be difficult to distinguish from RCC based on morphology alone. However, genetic studies such as karyotyping or comparative genomic hybridization can help differentiate between the two [3][6].
• Chromophobe Renal Cell Carcinoma (RCC): This type of RCC is characterized by its pale appearance and can be distinguished from conventional RCC based on histologic characteristics [3].
• Clear Cell Renal Cell Carcinoma (CCRCC): While CCRCC is a common type of RCC, it can be distinguished from obsolete sporadic conventional RCC based on morphology, location, and clinical history [2].

Key Features to Consider

When making a differential diagnosis of obsolete sporadic conventional RCC, the following features should be considered:

• Morphology: The tumor's appearance under the microscope can provide clues about its identity.
• Location: The location of the tumor within the kidney can also provide information about its type.
• Clinical History: A thorough review of the patient's medical history can help identify any potential risk factors or underlying conditions that may be contributing to the development of the tumor.

References

[1] D Novacescu (2022) Contemporary clinical definitions, differential diagnosis, and novel predictive tools for renal cell carcinoma. [3] F Trevisani (2022) Useful Markers for Differential Diagnosis of Oncocytoma, Chromophobe Renal Cell Carcinoma and Conventional Renal Cell Carcinoma. [6] F Trevisani (2022) In the routine clinical differential diagnosis of a renal cell carcinoma suspected of being an oncocytoma, genetic studies such as karyotyping,