Multiple Discordant Histology After Nephrectomy: Descriptive Analysis and Outcomes

BACKGROUND - While RCC is the most common primary renal neoplasm, few cases of ipsilateral renal lesions of different RCC histologic subtypes have been described. The objective of this study was to evaluate our experience with synchronous, histologically unique, primary renal neoplasms within the same kidney.

PATIENTS AND METHODS - We retrospectively analyzed 2 institutional nephrectomy databases from 2000 to 2013. The study cohort comprised 15 patients with multiple, discordant renal histology after partial or radical nephrectomy. Demographic data, immunohistochemical analysis, and clinical course were assessed and analyzed.

RESULTS - Eight patients (53%) were black, 10 (60%) were male, and 5 (36%) were tobacco users. Median follow-up time was 13 months (range, 1-62 months), and 9 patients (56%) underwent radical nephrectomy. Among 36 tumors, the median tumor size was 2. 3 cm (range, 0. 4-9 cm). The most common combination of discordant tumor histology among patients with ≥ 2 tumors was clear-cell (cc) renal-cell carcinoma (RCC) with chromophobe RCC (3 cases, 19%). In 3 patients (19%), a single tumor was noted to have 2 distinct patterns; all patients had ccRCC with papillary RCC. Three (20%) of 15 patients developed metastatic disease. The median cancer-free survival time for patients with metastasis was 2 months.

CONCLUSIONS - Multiple, discordant renal pathology represents a rarely reported entity in patients receiving nephrectomy. We introduce the largest cohort of synchronous renal tumors, of which ccRCC/chromophobe RCC was the most common pairing.

Clinical genitourinary cancer. 2015 Nov 02 [Epub ahead of print]

Brittani L Harlow, Zachary Klaassen, Sarah Holzman, Lael Reinstatler, Alicia A Franken, Sravan K Kavuri, Martha K Terris, Viraj A Master, Kelvin A Moses

Department of Surgery, Section of Urology, Medical College of Georgia, Georgia Regents University, Augusta, GA. , Department of Surgery, Section of Urology, Medical College of Georgia, Georgia Regents University, Augusta, GA. , Department of Urology, Emory University, Atlanta, GA. , Department of Surgery, Section of Urology, Medical College of Georgia, Georgia Regents University, Augusta, GA. , Department of Pathology, Medical College of Georgia, Georgia Regents University, Augusta, GA. , Department of Pathology, Medical College of Georgia, Georgia Regents University, Augusta, GA. , Department of Surgery, Section of Urology, Medical College of Georgia, Georgia Regents University, Augusta, GA. , Department of Urology, Emory University, Atlanta, GA. , Department of Surgery, Section of Urology, Medical College of Georgia, Georgia Regents University, Augusta, GA.

PubMed

E-Newsletters

Newsletter subscription

Free Daily and Weekly newsletters offered by content of interest

The fields of GU Oncology and Urology are rapidly advancing. Sign up today for articles, videos, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.

Subscribe