Search

Renal Cell Carcinoma (RCC) is by far the most common malignant tumor of the kidney. It is a disease with many faces, known for its clinical diversity and often unpredictable behavior. Less is known about its etiology and risk factors than for most other human cancers. Mortality-to-incidence ratio is higher compared to other urologic malignancies, and the malignancy confers adverse prognosis for the majority of patients. At the same time as incidence of RCC has been rising globally, progress has been made in the understanding of the disease, especially within the field of genetics and biological research. Immunotherapies together with tyrosine kinase inhibitors and growth factor/angiogenesis modulators are being developed for patients with advanced disease and improvements have been made in the surgical approach. This, together with increased incidental detection secondary to the widespread use of modern imaging procedures, suggests improved prognosis of these patients in the future. For unknown reasons the incidence of RCC is higher in Iceland than in most other countries, about 30 new cases being diagnosed every year, with 14 deaths due to RCC occurring. This evidence-based article reviews major studies on different aspects of RCC with special emphasis on the epidemiology and clinicopathological presentation of the disease in Iceland.

Objective: To evaluate the aetiology, severity and mortality of patients with acute pancreatitis at Landspítali - University Hospital (LSH) and to estimate the incidence in Iceland., Material and Methods: A prospective study of all patients diagnosed with acute pancreatitis LSH during the one-year period October 1998 - September 1999 inclusive. The main outcome measures were APACHE II, Ranson, and Imrie scores, and C-reactive protein (CRP) concentrations. The Balthazar - Ranson criteria were used for scoring of computed tomograms (CT)., Results: Twenty seven of the 50 patients were male. The median age of the whole series was 60 years (range 19-85). The estimated incidence was 32/100000 for the first attack of acute pancreatitis. The causes were; gallstones 42%, alcohol 32%, miscellaneous 24%, and idiopathic 2%. Thirty three percentage of the patients had APACHE II scores 9, 38% had Ranson scores of 3, 50% had Imrie scores of 3, and 34% had CRP concentrations >210 mg/L during the first 4 days or >120 mg/L during the first week. Seven patients had severe pancreatitis. Two patients in the whole group died, and both had clinically severe pancreatitis., Conclusions: Incidence and aetiology of acute pancreatitis in Iceland is in concordance to that described in other studies. Prospective assessment makes it possible to evaluate the aetiological factors more accurately. Measurement of the CRP concentration is an attractive and simple alternative to the severity scoring systems currently in use.

Spontaneous regression of metastatic renal cell carcinoma is a rare but well documented event, most often involving pulmonary metastasis. Two cases involving brain and pleural metastasis are presented. In both cases nephrectomy was the only treatment.

The etiology of RCC is incompletely understood and the inherited genetic contribution uncertain. Although there are rare mendelian forms of RCC stemming from inherited mutations, most cases are thought to be sporadic. We sought to determine the extent of familial aggregation among Icelandic RCC patients in general. Medical and pathologic records for all patients diagnosed with RCC in Iceland between 1955 and 1999 were reviewed. This included a total of 1,078 RCC cases, 660 males and 418 females. With the use of an extensive computerized database containing genealogic information on 630,000 people in Iceland during the past 11 centuries, several analyses were conducted to determine whether the patients were more related to each other than members drawn at random from the population. Patients with RCC were significantly more related to each other than were subjects in matched groups of controls. This relatedness extended beyond the nuclear family. RRs were significantly greater than 1.0 for siblings, parents and cousins of probands. RRs were 2-3 for first-degree relatives and 1.6 for third-degree relatives. The risk of RCC is significantly higher for members of the extended family of an affected individual, as well as the nuclear family. Our results indicate that germline mutations are significantly involved in what has been defined as sporadic RCC., (Copyright 2002 Wiley-Liss, Inc.)