Multiloculated cystic renal tumors of childhood: Has the final word been spoken

Background: Multicystic renal tumors which include cystic nephroma, cystic partially differentiated nephroblastoma (CPDN) and cystic Wilms tumor has been a diagnostic and therapeutic challenge. Histopathological examination has been the only reliable differentiating method. Management of these tumors is still riddled with controversy as a definitive preoperative differentiation between the three has not been possible. Methods: A retrospective evaluation was performed of the treatment strategies employed with nine cases of multicystic renal tumors treated from 2005 to 2015. Results: The median age at presentation was 12 months with all except one being boys. All except two children underwent primary surgery. The median follow-up was 50 months with six children having long-term survival. One child succumbed to the disease process, one died due to an unrelated cause and another was lost to follow-up. Although there was no ambiguity with cases of cystic nephroma (CN) and cystic Wilms tumor, three of the four cases of CPDN had problems. Conclusion: Primary surgery for multicystic renal tumors is safe and should be seriously considered as it prevents overtreatment in cases of CN and early stage CPDN. Further studies are needed to fully understand the biological behavior of CPDN

Multicentric small cell neuroendocrine neoplasm of the renal pelvis and ureter with concomitant focal high-grade urothelial carcinoma of the ureter: A case report

Malignant small cell neuroendocrine tumors of the pelvi-calyceal system are rare, and even more uncommon is their occurrence with concomitant transitional cell carcinoma, in the same renal unit. We present such a case for its unique presentation

Leukocyte derived chemotaxin 2 (ALECT2) amyloidosis

We describe the first case from India of ALECT2 amyloidosis. An adult Punjabi male presented with progressive renal dysfunction and non-nephrotic range proteinuria. Serum protein electrophoresis and Immunofixation were normal, with mildly elevated serum free light chain ratio. Renal biopsy confirmed the presence of amyloid. Immunohistochemistry was negative for monoclonal light chains. Proteomic analysis confirmed the presence of ALECT2 amyloid. The present case highlights the need for confirmatory testing for typing of amyloid

Chromophobe renal cell carcinoma: A report of two cases with unusual histological features

We report two cases of chromophobe renal cell carcinoma with unusual histological features; one case of eosinophilic variant of chromophobe renal cell carcinoma and another case with extensive metaplastic ossification

Effect of preoperative education about spinal anesthesia on anxiety and postoperative pain in parturients undergoing elective cesarean section: A randomized controlled trial

Background: Preoperative anxiety is a common problem in all patients. The reason could be incomplete information regarding the anesthesia and surgical procedure. Cesarean section (CS) is a common surgery and treatment of postoperative pain after CS continues to be an ongoing challenge. Aim: The present study was carried out to assess if preoperative education with a handout about spinal anesthesia can reduce anxiety and postoperative pain in parturients undergoing CS under spinal anesthesia. Methods and Materials: We randomized 64 parturients into two equal groups; study (Group A) and control group (Group B). The study group was given a handout and a structured education about spinal anesthesia. The control group was given routine preoperative information. The Amsterdam preoperative anxiety and information scale (APAIS) was used to measure anxiety preoperatively and visual analogue scale (VAS) for pain at 5 h and 24 h postoperatively. Statistical Analysis: The two groups were compared using Student's t test and non-parametric Wilcoxon-Mann-Whitney U test. Result: The median difference in preoperative anxiety scores (APAIS) in the two groups was found to be 8.00 (P < 0.001), which was significant statistically. The median value of postoperative pain analyzed using VAS after giving education, at 5 h was significantly reduced in Group A (5.00) as compared to Group B (9.00). The median value of VAS score at 24 h was significantly different in both groups. It was 1.0 in Group A, whereas the same was 5.50 in Group B (P <.00). The median difference in hours in the duration of analgesia between the two groups was 0.62, which was not significant statistically (P < 0.10). Conclusion: A planned preoperative education and handout with details about spinal anesthesia can have a significant impact on reducing the preoperative anxiety and the postoperative pain in parturients undergoing elective CS under spinal anesthesia

Immunohistochemical Glomerular Expression of Phospholipase A2 Receptor in Primary and Secondary Membranous Nephropathy: A Retrospective Study in an Indian Cohort with Clinicopathological Correlations

Background: Limited published literature exists on the utility and standardization of anti-phospholipase A2 receptor (anti-PLA2R) immunohistochemistry (IHC) for the diagnosis of primary membranous nephropathy (MN). The study aimed to validate anti-PLA2R IHC for the diagnosis of primary MN and clinicopathological correlations in an Indian cohort. Methods: Subjects included patients with primary and secondary MN diagnosed between January 2012 and August 2014 with an adequate renal biopsy and at least 1 year of clinical follow-up. Anti-PLA2R IHC was performed in all cases with miscellaneous renal lesions as controls. Electron microscopy was performed in selected cases. Sensitivity and specificity of anti-PLA2R IHC to identify primary MN was evaluated. Histopathological analyses of primary and secondary MN were done with clinicopathological correlations including serum creatinine, eGFR, chronic kidney disease stage, 24-h urine protein, serum cholesterol, serum albumin, and hypertension at presentation and follow-up, using the Kruskal-Wallis test and Spearman rank correlation. A p value of ≤0.05 was considered statistically significant. Results: In 153 MN patients (99 primary, 54 secondary) and 37 miscellaneous controls, anti-PLA2R IHC differentiated primary from secondary MN with a sensitivity of 70.2% and a specificity of 96.6%. Secondary MN had increased mesangial matrix expansion compared to primary MN (p = 0.001). Severe nephrotic syndrome, impaired renal function, and hypertension were all more common in primary than in secondary MN. Conclusion: Anti-PLA2R IHC is a specific marker to distinguish primary MN from secondary MN