Pathologic findings at the time of nephrectomy for renal mass

Silver, David; Morash, Christopher; Brenner, Phillip; Campbell, Steven C.; Russo, Paul

doi:10.1007/bf02305538

Cited by 86 publications

(29 citation statements)

References 24 publications

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“…Consequently, the frequency of incidental detection of renal tumors has increased [1,2] and currently more than two-thirds of patients operated on for renal cancer are diagnosed incidentally. At our center, approximately 90% of the solid renal masses represent renal cortical tumor [3]. Although 25% of kidney tumor patients will present with large, locally advanced, or metastatic tumors, an excellent overall prognosis is now anticipated.…”

Section: Introductionmentioning

confidence: 97%

Localized renal cell carcinoma

Russo

2001

Curr. Treat. Options in Oncol.

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The last decade has brought dramatic changes in our understanding of localized renal tumors. Due to vast improvements in the abdominal imaging modalities of computed tomography (CT), ultrasound, and magnetic resonance imaging (MRI), approximately two-thirds of patients at our center have their renal tumors discovered incidentally. This tumor stage and size migration has vastly improved survival rates; more than 75% of patients with localized renal tumors achieve cure after surgical resection. In addition, the increased presentation of small, incidental tumors has increased the therapeutic options for urologic surgeons with surgical or tumor ablative techniques who now consider preservation of renal function as a goal equally important to local tumor control. Renal cortical tumors, viewed previously as a single type of cancer (ie, hypernephroma, renal cell carcinoma) with a uniform metastatic potential, are far more complex in nature. Renal cortical tumors are a family of neoplasms with distinct histological subtypes and distinct cytogenetic and molecular defects. Metastatic potential, once thought to be dependent only on tumor size, grade, and stage, varies according to tumor histologic subtype, ranging from the most potentially malignant conventional clear cell carcinoma, to the indolent papillary and chromophobe carcinomas, to the virtually benign renal oncocytoma. Surgical approaches to the localized renal cortical tumors now include the classic radical nephrectomy, kidney-sparing surgery, and innovative techniques that involve laparoscopy. New therapeutic modalities, such as renal cryosurgery and radiofrequency ablation, are under active investigation. Whether these new approaches to localized renal tumors will supplement or replace current surgical techniques will depend on the findings of carefully designed and controlled clinical trials.

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Section: Introductionmentioning

confidence: 97%

Localized renal cell carcinoma

Russo

2001

Curr. Treat. Options in Oncol.

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“…2 Due in part to this high incidence of cancer, biopsy has not been recommended in the routine workup of a patient with a renal mass. Biopsy of renal masses has been recommended in the workup of potentially metastatic disease to the kidney and in the diagnosis of primary lymphoma of the kidney.…”

Section: Diagnosis and Stagingmentioning

confidence: 99%

Recent developments in kidney cancer

Leveridge

Jewett

2013

CUAJ

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Renal cell carcinoma (RCC) diagnosis and management have undergone significant shifts in the recent past. The increasing rate of diagnosis of small renal masses, often in patients at high risk of morbidity with operative treatment, has led to studies, trials and discoveries in renal mass biopsy, active surveillance and minimally invasive thermal ablation. At the other end of the disease spectrum, targeted systemic therapies for metastatic RCC have supplanted cytokine-based treatment, with significant benefits to progression and survival. Recent reviews and trials have also cemented the role of partial nephrectomy as standard surgical management for most low-stage masses, and the roles of regional lymphadenectomy and adrenalectomy concomitant with nephrectomy have been clarified. This review aims to highlight recent evidence that has emerged in the management of this complicated oncologic issue. RésuméLe diagnostic d'hypernéphrome et la prise en charge de cette maladie ont fait l'objet d'importants changements au cours des dernières années. Le taux accru de cas de petites masses rénales, souvent chez des patients présentant un risque élevé de morbidité avec le traitement chirurgical, a amené la conduite d'études et d'essais qui ont entraîné des découvertes touchant la biopsie des masses rénales, la surveillance active et l'ablation thermique minimalement invasive. À l'autre bout du spectre pathologique, les traitements généraux ciblés de l'hypernéphrome métastatique ont supplanté le traitement à base de cytokines, ce qui a amené des avantages significatifs sur le plan de la progression et de la survie. Des articles de synthèse et des essais récents ont aussi confirmé le rôle de la néphrectomie partielle en tant que prise en charge chirurgicale standard pour la plupart des masses de faible stade, et les rôles de la lymphadénectomie régionale et de la surrénalec-tomie en concomitance avec une néphrectomie ont été clarifiés. Le présent article vise à faire ressortir les données récentes dans la prise en charge de ce problème oncologique complexe. IntroductionThe Canadian Cancer Society and the National Cancer Institute of Canada predict 4800 new kidney cancer diagnoses in 2010, and 1650 Canadian deaths from the disease. Kidney cancer is the most lethal genitourinary cancer, but is also among the most interesting cancers due to recent developments exploiting knowledge about known genetic mutations with targeted systemic therapies, better understanding of the extent of associated chronic kidney disease, the utility of nephron-sparing surgery when treating primary tumours and the significant advances in less invasive therapies.This review is not intended to be an exhaustive assessment of the present state of knowledge of kidney cancer, but is an update on recent clinically relevant developments. Diagnosis and stagingOverall, about 85% of renal masses, presumed to be kidney cancers on imaging studies, are carcinomas at nephrectomy. 2Due in part to this high incidence of cancer, biopsy has not been recommended in...

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“…The indications for percutaneous renal biopsy or aspiration in the evaluation of solid renal masses have traditionally been limited, primarily related to concerns about sampling error, difficulty interpreting limited tissue given the inherent similarities between the eosinophilic variants of RCC and oncocytoma, and recognition of the improved diagnostic accuracy of cross-sectional imaging such as CT or MRI. [82,83] Eighty-three percent to 90% of solid renal masses thought to be suspicious for RCC based on careful radiographic evaluation prove to be RCC on final pathologic analysis [84]. Fine-needle aspiration biopsy (FNAB) cannot significantly improve on this degree of diagnostic certainty and is unlikely to influence clinical management in the majority of cases [27,85].…”

Section: Renal Cell Carcinomamentioning

confidence: 99%