Palpable Abdominal Mass is a Renal Oncocytoma: Not All Large Renal Masses are Malignant

A 59-year-old woman presented with abdominal pain and a palpable abdominal mass. Initial imaging revealed a 14cm solid, enhancing renal mass and suspicion for liver and bone metastases. Family history included a brother with clear cell renal cell carcinoma and mother with glioblastoma multiforme. After liver biopsy was inconclusive, she underwent radical nephrectomy with final pathologic diagnosis of oncocytoma. Renal oncocytoma is the most common benign renal tumor but remains difficult to distinguish clinically and radiographically from renal cell carcinoma. Should urologists use renal mass biopsy even more frequently prior to surgical intervention?

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Histologic Heterogeneity of Extirpated Renal Cell Carcinoma Specimens: Implications for Renal Mass Biopsy

Journal of Kidney Cancer and VHL ◽

10.15586/jkcvhl.v7i3.134 ◽

2020 ◽

Vol 7 (3) ◽

pp. 20-25

Author(s):

Lauren Nahouraii ◽

Jordan Allen ◽

Suzanne Merrill ◽

Erik Lehman ◽

Matthew Kaag ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Renal Mass ◽

Tumor Stage ◽

High Grade ◽

Renal Masses ◽

Histologic Heterogeneity ◽

Adequate Sampling ◽

Renal Mass Biopsy

Pathologic characteristics of extirpated renal cell carcinoma (RCC) specimens <7 cm were reviewed to get better information on technical nuances of renal mass biopsy (RMB). Specimens were stratified according to tumor stage, nuclear grade, size, histology, presence of lymphovas-cular invasion (LVI), necrosis, and sarcomatoid features. When considering pT1 (0–7 cm) tumors pT1b (4–7 cm), RCC masses were more likely to have necrosis (43% vs 16%, P < 0.001), LVI (6% vs 2%, P = 0.024), high-grade nuclear elements (29% vs 17%, P < 0.001), and sarcomatoid features (2% vs 0%, P = 0.006) compared with pT1a (0–4 cm) tumors. Additionally, pT3a tumors were more highly associated with necrosis (P = 0.005), LVI, sarcomatoid features, and high-grade disease (P for all < 0.001) when compared to pT1 masses. For masses <4 cm, pT3a cancers were more likely to demonstrate necrosis (38% vs 16%, P < 0.001), LVI (10% vs 2%, P = 0.037), high-grade nuclear elements (31% vs 17%, P = 0.05), and sarcomatoid features (3% vs 0%, P = 0.065) compared to pT1a tumors. Similarly, for masses 4–7 cm, pathologic T3a tumors were significantly more likely to have sarcomatoid features (16% vs 2%, P < 0.001) and LVI (28% vs 6%, P < 0.001) compared to pT1b tumors. In summary, pT3a tumors and those RCC masses >4 cm exhibit considerable histologic heterogeneity and may harbor elements that are not easily appreciated with limited renal sampling. Therefore, if RMB is considered for renal masses greater than 4 cm or those that abut sinus fat, a multi-quadrant biopsy approach is necessary to ensure adequate sampling and characterization of the mass.

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Characterizing recurrent and lethal small renal masses in clear cell renal cell carcinoma using recurrent somatic mutations

Urologic Oncology Seminars and Original Investigations ◽

10.1016/j.urolonc.2017.10.012 ◽

2019 ◽

Vol 37 (1) ◽

pp. 12-17 ◽

Cited By ~ 11

Author(s):

Brandon J. Manley ◽

Ed Reznik ◽

Mazyar Ghanaat ◽

Mahyar Kashan ◽

Maria F. Becerra ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Somatic Mutations ◽

Clear Cell ◽

Small Renal Masses ◽

Cell Renal Cell Carcinoma ◽

Renal Masses

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MP47-10 MICRORNA EXPRESSION PROFILES FOR RENAL MASS BIOPSY: A NOVEL TOOL TO AID IN THE STRATIFICATION OF PATIENTS WITH CLEAR CELL RENAL CELL CARCINOMA

The Journal of Urology ◽

10.1016/j.juro.2015.02.1530 ◽

2015 ◽

Vol 193 (4S) ◽

Author(s):

Drew Palmer ◽

Casey Kowalik ◽

Patrick Teebagy ◽

Kari Bailey ◽

Shiv Patel ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Renal Mass ◽

Clear Cell ◽

Expression Profiles ◽

Microrna Expression ◽

Cell Renal Cell Carcinoma ◽

Renal Mass Biopsy

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MP39-01 CHARACTERIZING RECURRENT AND LETHAL SMALL RENAL MASSES IN CLEAR CELL RENAL CELL CARCINOMA USING SOMATIC MUTATIONS

The Journal of Urology ◽

10.1016/j.juro.2017.02.1175 ◽

2017 ◽

Vol 197 (4S) ◽

Cited By ~ 1

Author(s):

Brandon Manley ◽

Ed Reznik ◽

Maria Becerra ◽

Jozefina Casuscelli ◽

Daniel Tennenbaum ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Somatic Mutations ◽

Clear Cell ◽

Small Renal Masses ◽

Cell Renal Cell Carcinoma ◽

Renal Masses

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Treating the Two Extremes in Renal Cell Carcinoma: Management of Small Renal Masses and Cytoreductive Nephrectomy in Metastatic Disease

American Society of Clinical Oncology Educational Book ◽

10.14694/edbook_am.2014.34.e214 ◽

2014 ◽

pp. e214-e221 ◽

Cited By ~ 3

Author(s):

Dae Y. Kim ◽

Christopher G. Wood ◽

Jose A. Karam

Keyword(s):

Renal Cell Carcinoma ◽

Targeted Therapy ◽

Cell Carcinoma ◽

Renal Cell ◽

Renal Mass ◽

Cytoreductive Nephrectomy ◽

Renal Cell Carcinomas ◽

Small Renal Masses ◽

Renal Masses ◽

Renal Mass Biopsy

OVERVIEW: The incidental renal mass represents a heterogeneous group that contains both benign and malignant pathologies. The majority of renal cell carcinomas are discovered incidentally, without the presence of symptoms directly related to the mass, and are closely associated with the term small renal masses because of the discovery before the onset of symptoms. In general, small renal masses are defined as 4 cm or smaller, and may account for greater than half of renal cell carcinoma diagnosis. The use of renal mass biopsy may offer additional pathological information but the clinician must be reminded of the technical and diagnostic limitations of renal mass biopsy. Patient-dependent factors, such as life expectancy and comorbidities, guide the management of small renal masses, which include active surveillance, partial nephrectomy, radical nephrectomy, and ablative techniques (cryoablation and radiofrequency ablation). Partial nephrectomy has demonstrated durable oncologic control for small renal masses while preserving renal function and, if feasible, is the current treatment of choice. In the other extreme of the renal cell carcinomas spectrum and in the presence of metastatic disease, the removal of the renal primary tumor is termed cytoreductive nephrectomy. Two randomized trials (SWOG 8949 and EORTC 30947) have demonstrated a survival benefit with cytoreductive nephrectomy before the initiation of immunotherapy. These two studies have also been the motivation to perform cytoreductive nephrectomy in the targeted therapy era. Currently, there are two ongoing randomized prospective trials accruing to investigate the timing and relevance of cytoreductive nephrectomy in the contemporary setting of targeted therapy.

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Differentiation of Clear Cell Renal Cell Carcinoma from other Renal Cell Carcinoma Subtypes and Benign Oncocytoma Using Quantitative MDCT Enhancement Parameters

Medicina ◽

10.3390/medicina56110569 ◽

2020 ◽

Vol 56 (11) ◽

pp. 569

Author(s):

Claudia-Gabriela Moldovanu ◽

Bianca Petresc ◽

Andrei Lebovici ◽

Attila Tamas-Szora ◽

Mihai Suciu ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Clear Cell ◽

Renal Tumors ◽

3D Analysis ◽

Imaging Features ◽

Enhancement Ratio ◽

Cell Renal Cell Carcinoma ◽

Renal Masses

Background and objectives: The use of non-invasive techniques to predict the histological type of renal masses can avoid a renal mass biopsy, thus being of great clinical interest. The aim of our study was to assess if quantitative multiphasic multidetector computed tomography (MDCT) enhancement patterns of renal masses (malignant and benign) may be useful to enable lesion differentiation by their enhancement characteristics. Materials and Methods: A total of 154 renal tumors were retrospectively analyzed with a four-phase MDCT protocol. We studied attenuation values using the values within the most avidly enhancing portion of the tumor (2D analysis) and within the whole tumor volume (3D analysis). A region of interest (ROI) was also placed in the adjacent uninvolved renal cortex to calculate the relative tumor enhancement ratio. Results: Significant differences were noted in enhancement and de-enhancement (diminution of attenuation measurements between the postcontrast phases) values by histology. The highest areas under the receiver operating characteristic curves (AUCs) of 0.976 (95% CI: 0.924–0.995) and 0.827 (95% CI: 0.752–0.887), respectively, were demonstrated between clear cell renal cell carcinoma (ccRCC) and papillary RCC (pRCC)/oncocytoma. The 3D analysis allowed the differentiation of ccRCC from chromophobe RCC (chrRCC) with a AUC of 0.643 (95% CI: 0.555–0.724). Wash-out values proved useful only for discrimination between ccRCC and oncocytoma (43.34 vs 64.10, p < 0.001). However, the relative tumor enhancement ratio (corticomedullary (CM) and nephrographic phases) proved useful for discrimination between ccRCC, pRCC, and chrRCC, with the values from the CM phase having higher AUCs of 0.973 (95% CI: 0.929–0.993) and 0.799 (95% CI: 0.721–0.864), respectively. Conclusions: Our observations point out that imaging features may contribute to providing prognostic information helpful in the management strategy of renal masses.

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