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

Abstract

Necrosis, cysts, hemorrhage, and calcification represent common findings in renal cell carcinoma. Different lesions, including arteriosclerosis or fibromuscular dysplasia, or both, may involve the main renal artery. This study analyzed the relationship between the presence and extent of necrosis in renal cell carcinoma with renal artery changes in a consecutive series of 112 patients (71 men, 41 women) with mean renal cell carcinoma of 7.7 cm (range, 2 to 20 cm). Necrosis was seen macroscopically and confirmed microscopically in 88 cases (78.6%), with 64 tumors having less than 50% and 24 more than 50% necrosis. Fibromuscular dysplasia was found in 41 patients (36.6%; 17 men, 24 women) and atherosclerotic changes in 21 patients (18.8%; 18 men, 3 women). The results suggest that necrosis of renal cell carcinoma was significantly more common in women with associated fibromuscular dysplasia (especially type I) and men with atherosclerotic changes of renal artery.

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.…”

“…However, the exact pathogenesis of tumor necrosis as well as the cause and nature of renal artery changes and the possible impact Tomic et al 10 on tumor necrosis have not yet been fully clarified [11,17]. We observed an increase in media layer thickness in the group of RCC patients, with the presence and increased extent of tumor necrosis (no necrosis: less than 50% necrosis: more that 50% necrosis= 499.4 µm: 531.4 µm: 657.3 µm), however, the differences were not statistically significant.…”

“…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.…”

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

“…The presence and extent of tumour necrosis were defined from macroscopic and microscopic findings as in similar studies on RCC and on soft-tissue tumour grading [16,17,19]. The degree of the necrosis was designated as absent (0), less than 50% tumour necrosis (I) or more than 50% tumour necrosis (II).…”

“…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].…”