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ORIGINAL ARTICLE
Year : 2016  |  Volume : 53  |  Issue : 1  |  Page : 124-126
 

Histopathological evaluation of surgically treated adult renal tumors: Report from a tertiary care center in India


1 Department of Urology, North Bengal Medical College, Sushruta Nagar, Darjeeling, India
2 Department of Pathology, North Bengal Medical College, Sushruta Nagar, Darjeeling, India

Date of Web Publication28-Apr-2016

Correspondence Address:
B Datta
Department of Urology, North Bengal Medical College, Sushruta Nagar, Darjeeling
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.180837

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 » Abstract 

Background: This retrospective study was performed in a tertiary care center from India analyzing the histopathological reports and the clinical data of the adult patients admitted in this institute with a diagnosis of renal tumors and had undergone nephrectomy for the disease. Objective: The objective of this study is to determine the relative frequencies of different renal tumors in adults (above the age of 16 years) and to analyze the histopathological characters of the tumors. Materials and Methods: In this retrospective study, we have analyzed the histopathology reports along with the demographic and clinical data of the adult patients who had undergone nephrectomy for renal tumors in our institute from January 2005 to December 2011. Results: A total 113 adult patients underwent tumor nephrectomy during the last 7 years in our institute. Mean age of the patients was 54.5 years (range 16-69 years). Male:Female ratio was 1.9:1. Out of 131 cases of adult renal tumors, 91.6% cases were malignant and 8.45 cases were benign tumors. Among the malignant tumors, renal cell carcinoma was the most common type. There were 2 cases of renal primitive neuroectodermal tumors and one case of renal myofibroblastoma in our series. Conclusion: The spectrum of adult renal tumors in this series is consistent with the other series of cases reported by different authors. Only few cases of the renal tumors were diagnosed incidentally among our patients which is just opposite to the rate of renal tumors diagnosed incidentally in the developed countries. Myofibroblastoma, a benign kidney tumor diagnosed in our series is probably the first reported case in the world.


Keywords: Adult, benign, kidney, malignant, tumor


How to cite this article:
Datta B, Giri A, Halder B. Histopathological evaluation of surgically treated adult renal tumors: Report from a tertiary care center in India. Indian J Cancer 2016;53:124-6

How to cite this URL:
Datta B, Giri A, Halder B. Histopathological evaluation of surgically treated adult renal tumors: Report from a tertiary care center in India. Indian J Cancer [serial online] 2016 [cited 2019 Aug 21];53:124-6. Available from: http://www.indianjcancer.com/text.asp?2016/53/1/124/180837



 » Introduction Top


Primary renal tumors comprises a wide spectrum of neoplastic lesions of the kidney with patterns, which are relatively distinct among children and adults. Primary renal tumors may be benign or malignant. A wide variety of both benign and malignant renal tumors may arise from the different components of the renal parenchyma, mostly from the tubular epithelium. With the widespread use of cross sectional imaging modalities such as ultrasonography and computerized tomography scan, the incidence of renal tumors has been increased throughout the world during the last few decades. Until now, the gold standard treatment for most of the renal tumors is their surgical removal, either by radical nephrectomy or partial nephrectomy. Acute histopathological diagnosis of all renal tumors is not possible before their surgical removal. Hence, meticulous histopathological examination of the removed surgical specimen is necessary for proper diagnosis and further treatment.

In this retrospective study, we have determined the different histopathological varieties of renal tumors among the adult patients (above the age of 16 years) who underwent nephrectomy in our institute over a period of 6 years.


 » Materials and Methods Top


The histopathological reports of all the adult patients who have undergone surgical treatment for renal tumors in our institute from January 2005 to December 2011 were studied. In addition to this, their age, sex, laterality of the tumor was also analyzed from the patient data record.

After the nephrectomy is done, we are sending the specimen to our pathology department in 10% formalin solution. Gross handling of the specimen is done according to the standard protocol.[1],[2],[3] After gross macroscopic examination of the specimen, representative tissue blocks are taken, processed for paraffin embedding, hematoxylin and eosin stained and examined by two pathologists of the department. Special stain and immunohistochemistry (IHC) is done in selected cases as and when required. World Health Organization classification of renal tumors was followed for the histopathological diagnostic categorization of the tumors.[4] Fuhrman et al. nuclear grading system was done for grading the conventional clear cell and papillary variants of renal cell carcinoma (RCC).[5]


 » Results Top


A total of 131 adult patients underwent nephrectomy for their renal tumors in the last 7 years. The mean age was 47.5 years (range: 17-69 years). There were 86 (65.6%) male patients and 45 (34.4%) female patients, the male to female ratio was 1.9:1 [Table 1].
Table 1: Histopathological types of renal tumors in 131 adult patients undergoing tumor nephrectomy

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In nine patients, tumor was diagnosed on routine abdominal ultrasonographic screening for some other complains. Flank pain was the most common presenting symptom observed in 73% of the patients, followed by hematuria in 61% patients [Table 1].

Lump in the flank region was noticed by 20 patients. On abdominal palpation, renal tumors was palpable in 47 cases.

Analysis of the histopathological diagnoses of 131 nephrectomy specimens is given in [Table 2].
Table 2: Main demographic and clinical features of 131 patients of adult renal tumors

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On histopathological examination, 19 (14.5%) were benign renal tumors and 112 (85.5%) were malignant. Overall, RCC was the most common renal tumor. On the other hand, RCC was found to be the most common malignant renal tumor. Among the RCC, conventional, clear cell variety was found to be the most common histopathological variety followed by the papillary type.


 » Comments Top


This is a single center study from a tertiary care center in India catering a huge population. Only 7% of the renal tumors were diagnosed incidentally during the investigation of patients by imaging for some other physical complains. This incidence is significantly lower as compared with the incidence in the western countries where incidental detection rates of renal tumors are varying from 35% to 75% of the patients.[6],[7],[8] But our rate of incidental diagnosis of renal tumors can be compared with the report from Pakistan by Mubarak et al.[9] It is probably due to the fact that in developing countries, most of the patients are seeking medical advice after being symptomatic and there is scarcity of health-care services in peripheral rural area.

In our series, both benign and malignant tumors were more common in the left kidney; though, it has no clinical significance. We have not found any case of bilateral renal tumors.

In our series, malignant renal tumor is more common (91.6%) than the benign tumor (8.4%). This is again supporting the different study reports from the developed countries.[9],[10],[11],[12],[13]

Among the cases of malignant renal tumors, RCC was the commonest (94%) type in our series. RCC is obviously the most common malignant renal tumor diagnosed throughout the world. RCC is a heterogeneous group of tumors with different histopathological and genetic features. Prognosis of the disease also depends upon the different subtypes of the RCC. In our series, conventional clear cell RCC was the most common histopathological variant followed by papillary RCC. The result of our series in this regard is generally comparable with the previous reports by different authors.[6],[8],[9] No genetic study was done in any case of RCC in our patients.

Transitional cell carcinoma (TCC) was found in 5 (4%) cases of our series, which is also comparable to the other reports.[4],[10] TCC of the kidney arises from the urothelial lining of the renal pelvis involving the kidneys. In all of our cases, TCC was localized to the kidney.

Primitive neuroectodermal tumor (PNET) was found in 2 (2%) cases both patients were under the age of 20 years and female. It is a rare malignant tumor of the kidney with aggressive behavior and poor prognosis of patients.[14],[15] About 50 cases are reported throughout the world, the largest number of cases have been reported from India.[16] Ewing's sarcoma(EWS) gene on chromosome 22 and FLI1 gene on chromosome 11 are fused in Ewing's sarcoma and PNET cells. Translocation results in an EWS-FLI1 fusion gene, made up of the 5/ half of the EWS gene on chromosome 22 fused to the 3/ half of the FLI1 gene on chromosome 11. IHC is very important for the histopathological diagnosis of PNET and we have done IHC in both of our cases. Molecular diagnostic method like reverse transcriptase polymerase chain reaction for the EWS-FLI1 fusion transcript is also an important tool for its pathological diagnosis,[17] but the facility is not available in our center.

Among the benign renal tumors, angiomyolipoma (AML) was the most common histopathological diagnosis. There were 11 (8.4%) cases of AML. Among the AML patients, 8 cases were female and 3 cases were male. AML is a benign hamartomatous tumorusually seen in patients with tuberosclerosis. However, no clinical feature of tuberosclerosis was found in any of our patients with AML. This tumor is composed of spindle shaped smooth muscle cells, fat cells and epitheloid cells with clear eosinophilic cytoplasm. AML of the kidney is a prototype of the tumors that arises from the perivascular epithelioid cells.

There was one case of epitheloid AML (EAML) in 26-year-old female patient, presenting with a rapidly developing lump in the left side of the abdomen for the last 3 months with pain, anorexia, vomiting and loss of body weight. On histopathological examination, radical nephrectomy specimen revealed a well encapsulated tumor, 18 cm × 8 cm × 6.5 cm in size, almost occupying the entire kidney. On microscopy, the tumor was composed of spindle and polygonal cells with foci of adipocytes and abnormal thick walled blood vessels. The epithelioid cells on the vessel wall showed moderate pleomorphism, irregular nuclear membrane and intranuclear inclusion bodies. There were also areas of tumor necrosis. EAML of the kidney is considered to be a rapidly growing tumor with malignant potential and higher chance of tumor recurrence.[18],[19]

There was also a case of myofibroblastoma in the left kidney in a 16-year-old female patient. Patient also presented with pain abdomen and a rapidly enlarging lump in the left flank region. On gross examination of the nephrectomy specimen, the kidney was hugely enlarged 16 cm × 7.5 cm × 6.5 cm in size with reddish, fleshy surface. On microscopy, the tumor was composed of spindle cells arranged in haphazardly intersecting fascicles among the intervening collagen fibers. The tumor cells were monomorphic, bipolar with ill-defined cytoplasm, each containing a single round to oval nucleus with inconspicuous nucleolus and rare mitotic figure. On IHC, CD34, desmin was strongly positive; actin was focally positive and S100 negative.

Myofibroblastoma is a rare benign mesenchymal tumor first described by Wargotz et al. and commonly arises from the breast.[20] Although, myofibroblastoma of the seminal vesicle has also been reported. However to our knowledge, no case of renal myoblastoma has yet been reported in the literature. We also found a rare case of benign oncocytoma among our patients.

 
 » References Top

1.
Algaba F, Trias I, Scarpelli M, Boccon-Gibod L, Kirkali Z, Van Poppel H. Handling and pathology reporting of renal tumor specimens. Eur Urol 2004;45:437-43.  Back to cited text no. 1
    
2.
Rosai J. Guidelines for handling of most common and important surgical specimens. In: Rosai J, editor. Rosai and Ackerman's Surgical Pathology. 9th ed. St. Louis: Mosby; 2004. p. 2911-77.  Back to cited text no. 2
    
3.
Fleming S, Griffiths DF. Best practice no 180. Nephrectomy for renal tumour; dissection guide and dataset. J Clin Pathol 2005;58:7-14.  Back to cited text no. 3
    
4.
Eble JN, Sauter G, Epstein JI, Sesterhenn IA, editors. Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs. Lyon: IARC Press; 2004.  Back to cited text no. 4
    
5.
Fuhrman SA, Lasky LC, Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 1982;6:655-63.  Back to cited text no. 5
    
6.
López JI, Moreno V, García H, Antón I, Robles A, Oñate JM, et al. Renal cell carcinoma in young adults: A study of 130 cases and a review of previous series. Urol Int 2010;84:292-300.  Back to cited text no. 6
    
7.
Denzinger S, Otto W, Burger M, Hammerschmied C, Junker K, Hartmann A, et al. Sporadic renal cell carcinoma in young and elderly patients: Are there different clinicopathological features and disease specific survival rates? World J Surg Oncol 2007;5:16.  Back to cited text no. 7
    
8.
Goetzl MA, Desai M, Mansukhani M, Goluboff ET, Katz AE, Sawczuk IS, et al. Natural history and clinical outcome of sporadic renal cortical tumors diagnosed in the young adult. Urology 2004;63:41-5.  Back to cited text no. 8
    
9.
Mubarak M, Kazi JI, Mohsin R, Hashmi A, Naqvi SA, Ul Hassan Rizvi SA. Histopathology of surgically treated renal tumours in young adults: A developing country perspective. J Cancer Res Clin Oncol 2012;138:189-94.  Back to cited text no. 9
    
10.
Alpers CE. The kidney. In: Kumar V, Abbas AK, Fausto N, Aster JC, editors. Robbins and Kotran Pathologic Basis of Disease. 8th ed. Philadelphia: WB Saunders; 3009. p. 905-70.  Back to cited text no. 10
    
11.
Duchene DA, Lotan Y, Cadeddu JA, Sagalowsky AI, Koeneman KS. Histopathology of surgically managed renal tumors: Analysis of a contemporary series. Urology 2003;62:827-30.  Back to cited text no. 11
    
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Thompson RH, Ordonez MA, Iasonos A, Secin FP, Guillonneau B, Russo P, et al. Renal cell carcinoma in young and old patients: Is there a difference? J Urol 2008;180:1262-6.  Back to cited text no. 12
    
13.
Badmus TA, Salako AA, Arogundade FA, Sanusi AA, Adesunkanmi AR, Oyebamiji EO, et al. Malignant renal tumors in adults: A ten-year review in a Nigerian hospital. Saudi J Kidney Dis Transpl 2008;19:120-6.  Back to cited text no. 13
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Tsokos M. Peripheral primitive neuroectodermal tumors. Diagnosis, classification, and prognosis. Perspect Pediatr Pathol 1992;16:27-98.  Back to cited text no. 14
    
15.
Gupta NP, Singh BP, Raina V, Gupta SD. Primitive neuroectodermal kidney tumor: 2 case reports and review of the literature. J Urol 1995;153:1890-2.  Back to cited text no. 15
    
16.
Thyavihally YB, Tongaonkar HB, Gupta S, Kurkure PA, Amare P, Muckaden MA, et al. Primitive neuroectodermal tumor of the kidney: A single institute series of 16 patients. Urology 2008;71:292-6.  Back to cited text no. 16
    
17.
Rao RN, Sinha S, Babu S, Mehrotra R. Fine-needle aspiration cytology of primitive neuroectodermal tumor of the urinary bladder: A case report. Diagn Cytopathol 2011;39:924-6.  Back to cited text no. 17
    
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Ingle A, Kumar B, Menon S, Bakshi G, Desai S, Shet T. Epithelioid angiomyolipoma of kidney with atypical nuclear features and intranuclear inclusions on cytology. Diagn Cytopathol 2011;39:278-82.  Back to cited text no. 18
    
19.
Brimo F, Robinson B, Guo C, Zhou M, Latour M, Epstein JI. Renal epithelioid angiomyolipoma with atypia: A series of 40 cases with emphasis on clinicopathologic prognostic indicators of malignancy. Am J Surg Pathol 2010;34:715-22.  Back to cited text no. 19
    
20.
Wargotz ES, Weiss SW, Norris HJ. Myofibroblastoma of the breast. Sixteen cases of a distinctive benign mesenchymal tumor. Am J Surg Pathol 1987;11:493-502.  Back to cited text no. 20
    



 
 
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