Renal artery changes in patients with primary renal cell carcinoma

Abstract

Arterial fibromuscular dysplasia (FMD) is a non-inflammatory, non-atherosclerotic, occlusive condition of the systemic arteries, most frequently affecting renal arteries. Renal cell carcinoma (RCC) might be associated with arterial hypertension, however, there are no data in the literature regarding the relationship between RCC and associated renal artery changes.We analyzed a consecutive series of 57 (35 male and 22 female) patients aging from 35 to 79 years (mean 58.9 years) who underwent nephrectomy due to RCC in the year 2003. The patients had RCC measuring from 2-16 cm (mean 7.1 cm). Specimens were routinely fixed, embedded in paraffin, cut and stained with hematoxylin and eosin, Mallory trichrome method and orcein.Renal arteries of 26 patients (20 male, 6 female) showed no changes. In these patients RCC measured 2.5-11 cm in largest diameter (mean 6.6 cm). In 24 patients (10 male, 14 female) renal arteries showed FMD. RCCs in these patients measured between 2-16 cm (mean 8.0 cm). Seven patients had atherosclerotic changes in renal arteries.In this series FMD was found in a significant proportion of patients with RCC, mainly in women.The cause of such changes and their relationship with RCC and systemic hypertension should be further analyzed.

Morphometric analysis of renal arteries in patients with renal cell carcinoma,

“…Although the present as well as previous studies [11,20] pointed to a high rate of renal artery lesions in RCC patients, we found no significant differences in renal artery diameter or media layer thickness between renal arteries without changes and those with FMD or atherosclerotic lesions. This finding was not unexpected since our study of the control group as well as other studies [4,12,16,19] showed renal artery changes to be mostly segmental, with only a small part of renal artery being available for sampling and histological examination after radical nephrectomy due to RCC.…”

“…The majority of authors suggest that decreased tumor microvessel density leads to chronic hypoxia of the tumor tissue, which then causes coagulative necrosis [10,17]. However, some authors suggest that pathologic changes in renal arteries could also be responsible for tumor necrosis in RCC [11,20]. Different lesions, most frequently atherosclerosis, and less commonly fibromuscular dysplasia (FMD) or some other conditions such as Takayasu arteritis, radiation injury and congenital malformations [15], may affect the main renal artery.…”

The Correlation Between the Tumor Necrosis and Renal Artery Changes in Renal Cell Carcinoma

“…In our previous study, renal artery changes were observed in 31 of 57 patients with RCC. 17 Fibromuscular dysplasia was found in 24 patients and atherosclerosis in an additional 7. In this present study, we observed tumor necrosis in 78.6% of RCCs, with a significant correlation between the presence and type of FMD and the extent of the RCC necrosis.…”

“…5 However, there are few data on the relationship between renal artery changes, including FMD-like changes, and RCC. 17 Onishi et al 18 reported histologic features of hypovascular and avascular RCC; however, the cause of vascular changes was not further analyzed. In our previous study, renal artery changes were observed in 31 of 57 patients with RCC.…”

Correlation of vascular endothelial growth factor and hypoxia-inducible factor-1α expression with pathological renal artery changes in patients with renal cell carcinoma

“…Pathological renal artery changes are found in a high percentage of patients with RCC [15,16]. The results of one morphometric study showed that renal arteries in a group of patients with RCC have a thicker tunica media layer than those in the control group (without RCC) [17].…”