Study of histomorphological spectrum of lesions in nephrectomy specimen in a tertiary care hospital in South Gujarat

Abstract

Background: Nephrectomy is a standard surgical procedure in urology indicated in patients with organ confined renal malignancies and irreversible kidney damage resulting from chronic infection, trauma, obstruction and congenital malformation. This study aims to study the histomorphological features of lesions in nephrectomy specimens in a tertiary care hospital, to analyse the neoplastic and non-neoplastic lesions of kidney according to age, gender and site and observe any variation from the conventional pattern.Methods: The present study was conducted in department of pathology, Tertiary care hospital over a period of 5 years and 7 months (1 Jan 2013 to July 31, 2018). This included 4 years retrospective and 1 year 7 months prospective. A total of 73 cases of were studied.Results: Males constituted 65.73% and females constituted 35.27% of all nephrectomy cases. Right kidney was more commonly affected. Highest percentage of patients belonged to 41-50 years age group. 45 cases were of non-neoplastic lesions and 28 cases were of neoplastic lesions. Among neoplastic lesions, one case was benign while remaining 27 cases were malignant. Chronic Pyelonephritis was the most common indication overall and also amongst non-neoplastic lesions with stone identified in 55% cases. Most common neoplastic lesion in nephrectomy specimen was Renal Cell carcinoma (71.4.1%) followed by Wilms tumour (14%).Conclusions: This study gives a fair insight of the current state of incidence of neoplastic and non-neoplastic lesions of kidney requiring surgical intervention.

Histomorphological Spectrum of Lesions in Nephrectomy Specimen

“…1 It peaks with different age groups -infancy and early childhood, women of child bearing age and both men and women older than 60 years of age. 11 In our study chronic pyelonephritis was the most common non-neoplastic lesion which is similar to findings of Suryawanshi et al and Bajaj et al 8,11 Majortiy of these patients were in the age group of 21-30 years followed by 41-50, 51-60 and 31-40 years in our study. Likewise, chronic pyelonephritis was common in 21-40, 41-50 years age group and 3 rd and 4 th decade of life in study conducted by Suryawanshi et al, Amin et al and Kumar et al respectively.…”

“…Majority of the patients belonged to age group of 41-50years which is similar to the study conducted by Suryawanshi et al, Bajaj et al and Vinay et al 8,11,12 In our study, male patients were 38(54.28%). Similarly male preponderance was seen in studies by Suryawanshi et al, Amin et al, Bajaj et al and Vinay et al 8,9,11,12 Right sided nephrectomy were more in number compared to left consisting of 38(58.29%) cases which was similar to studies conducted by Bajaj et al and Kumar et al 11,13 In contrast, left sided nephrectomy was more common in the study done by Fadil et al 10 Among the non-neoplastic lesions, chronic pyelonephritis, acute kidney injury, nephritic and nephrotic syndromes, renal cyst, chronic kidney disease, urinary tract obstruction are common. 1 In this study, non-neoplastic lesions constituted a total of 53(75.71%) cases which is concordant with the studies done by Suryawanshi et al and Kumar et al in which 24(72.73%) and 36(72%) cases of non-neoplastic lesions were present.…”

“…[11][12][13] Simple cyst consisted of 1(1.89%) case which is comparable to Bajaj et al and Kumar et al 11,13 However, some studies had no case of simple cyst. 8,11,12 The discrepancies in the distribution of lesions among these studies are due to differences in the size of the sample, duration and place of study.…”

“…Likewise, chronic pyelonephritis was common in 21-40, 41-50 years age group and 3 rd and 4 th decade of life in study conducted by Suryawanshi et al, Amin et al and Kumar et al respectively. 8,9,13 Among the other non-neoplastic lesion 2(3.77%) cases of renal tuberculosis were found which was comparatively less than Amin et al, Vinay et al and Kumar et al 9,12,13 However, no case of renal tuberculosis were present in studies done by Suryawanshi et al and Bajaj et al 8,11 Xanthogranulomatous pyelonephritis comprised 1(1.89%) case which is similar to findings of Amin et al 9 Other studies showed higher frequency of Xanthogranulomatous pyelonephritis. [11][12][13] Simple cyst consisted of 1(1.89%) case which is comparable to Bajaj et al and Kumar et al 11,13 However, some studies had no case of simple cyst.…”

“…8,9,13 Among the other non-neoplastic lesion 2(3.77%) cases of renal tuberculosis were found which was comparatively less than Amin et al, Vinay et al and Kumar et al 9,12,13 However, no case of renal tuberculosis were present in studies done by Suryawanshi et al and Bajaj et al 8,11 Xanthogranulomatous pyelonephritis comprised 1(1.89%) case which is similar to findings of Amin et al 9 Other studies showed higher frequency of Xanthogranulomatous pyelonephritis. [11][12][13] Simple cyst consisted of 1(1.89%) case which is comparable to Bajaj et al and Kumar et al 11,13 However, some studies had no case of simple cyst. 8,11,12 The discrepancies in the distribution of lesions among these studies are due to differences in the size of the sample, duration and place of study.…”