Multifocality in Renal Cell Carcinoma: A Bilateral Event?

Abstract

Objectives: The major disadvantage of nephron-sparing surgery for renal cell carcinoma is the risk of local recurrence. This is most likely a manifestation of undetected small additional tumors in the renal remnant. To define more clearly the incidence and nature of unilateral and bilateral multifocal tumors, an autopsy study was undertaken. Materials and Methods: In a series of 14,793 autopsies from 1985 to 1995, 260 renal cell carcinomas were found. In all cases of renal cell carcinoma a search for small renal lesions was performed in the apparently normal-appearing portion of the kidneys. Every kidney was serially and systematically cut (5 mm) to probe for intraparenchymal lesions. Results: Of the 260 renal cell carcinomas 36 cases (13.85%) had multifocal malignant and/or benign nodules. The number of the additional nodules ranged from 2 to 18. 12% of the malignant multifocal carcinomas were limited to the ipsilateral kidney and 88% were bilateral. The average size of the multifocal renal lesions was 8.7 × 9.0 × 9.5 (range 3–23) mm. Renal cell carcinomas with low stage and good grading have a higher incidence of multifocal nodules. No significant difference was found with regard to metastasized and nonmetastasized renal cell carcinomas. In 38.1% of all chromophilic renal cell carcinomas additional nodules were found. Conclusions: Multifocality in renal cell carcinomas cannot be predicted reliably, although the papillary histological pattern, good grading and low staging seems to be associated with a higher incidence of multifocality. Nearly 90% of the multifocal nodules were bilateral.

Multifocality Incidence and Accompanying Clinicopathological Factors in Renal Cell Carcinoma

“…Multifocality has been associated mainly with papillary subtype [3,5,8,22,23] , clear subtype [12] and mixed histological patterns [3] . Uzzo et al [17] reviewed more than 1,000 cases in the literature from 1980 to 2000 and reported that papillary RCC is associated with a higher incidence of multifocality.…”

“…Other studies found no such association [1-4, 7, 8, 13-16] . Interestingly, Wunderlich et al [23] reported that tumors with good grading showed a higher incidence of multifocality.…”

“…Wunderlich et al [23] concluded that the risk of multifocality increased with low-stage tumors. Di Marco et al [8] , in their study of a large number of patients, as well as other studies [2, 3, 6-8, 15, 16] , found no association between higher stage and multifocal disease.…”

Evolution of Pathological Staging and Histological Classification in Urological Malignancies

“…post mortem examinations, Wunderlich et al found 260 renal tumours, 36 of which (18.95%) were multifocal [91]. Applying the findings of molecular genetic tests, papillary tumours are polyclonal, i.e.…”

“…Our studies were carried out about five years before the publication of the comprehensive reviews cited before [86][87][88][89][90][91]. Our intention was to utilise the HC in diagnostic practice, on the basis of the chromosomal disorders described in the publications that laid its foundations, because the chromosomal deviations described by the HC appeared highly coherent and diagnostic [98,99].…”