Skip to main content

Advertisement

SpringerLink
Log in

Evaluation and Management of Small Renal Masses: Looking Beyond the Tumor Margin

  • Kidney Diseases (G Ciancio, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

In an effort to preserve renal function, nephron-sparing approaches such as partial nephrectomy are now routinely performed for the treatment of small renal masses (SRMs). To date, several groups have studied the utility of examining the renal parenchyma contained beyond the tumor margin of partial nephrectomy specimens for histopathologic evidence of non-neoplastic disease processes. The diagnosis of progressive renal disease through the study of this tissue allows for early medical intervention with possible further preservation of renal function. In this review, we discuss the management of SRMs with an emphasis on the emerging role of evaluating tumor specimens for non-neoplastic pathologic abnormalities. We believe that the thorough study of tissue contained beyond the tumor margin of partial nephrectomy specimens is the next step in preserving renal function and improving survival for patients with SRMs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60:277–300.

    Article  PubMed  Google Scholar 

  2. Lipworth L, Tarone RE, McLaughlin JK. The epidemiology of renal cell carcinoma. J Urol. 2006;176:2353–8.

    Article  PubMed  Google Scholar 

  3. Hock LM, Lynch J, Balaji KC. Increasing incidence of all stages of kidney cancer in the last 2 decades in the United States: an analysis of surveillance, epidemiology and end results program data. J Urol. 2002;167:57–60.

    Article  PubMed  Google Scholar 

  4. Volpe A, Panzarella T, Rendon RA, Haider MA, Kondylis FI, Jewett MA. The natural history of incidentally detected small renal masses. Cancer. 2004;100:738–45.

    Article  PubMed  Google Scholar 

  5. O’Connor SD, Pickhardt PJ, Kim DH, Oliva MR, Silverman SG. Incidental finding of renal masses at unenhanced CT: prevalence and analysis of features for guiding

  6. •• Campbell SC, Novick AC, Belldegrun A, et al. Guideline for management of the clinical T1 renal mass. J. Urol. 2009;182:1271–9. Guidelines on the management of small renal masses from the American Urological Association.

    Article  PubMed  Google Scholar 

  7. •• Ljungberg B, Cowan NC, Hanbury DC, et al. EAU guidelines on renal cell carcinoma: the 2010 update. Eur. Urol. 2010;58:398–406. Guidelines on the management of renal cell carcinoma from the European Association of Urology.

    Article  PubMed  Google Scholar 

  8. Rubio Briones J, Algaba F. Management of small renal masses. Adv Urol. 2008;2008:1–2.

    Google Scholar 

  9. Gill IS, Aron M, Gervais DA, Jewett MA. Clinical practice. Small renal mass. N Engl J Med. 2010;362:624–34.

    Article  PubMed  CAS  Google Scholar 

  10. Thompson RH, Siddiqui S, Lohse CM, Leibovich BC, Russo P, Blute ML. Partial versus radical nephrectomy for 4 to 7 cm renal cortical tumors. J Urol. 2009;182:2601–6.

    Article  PubMed  Google Scholar 

  11. Deklaj T, Lifshitz DA, Shikanov SA, Katz MH, Zorn KC, Shalhav AL. Laparoscopic radical versus laparoscopic partial nephrectomy for clinical T1bN0M0 renal tumors: comparison of perioperative, pathological, and functional outcomes. J Endourol. 2010;24:1603–7.

    Article  PubMed  Google Scholar 

  12. Weight CJ, Larson BT, Gao T, et al. Elective partial nephrectomy in patients with clinical T1b renal tumors is associated with improved overall survival. Urology. 2010;76:631–7.

    Article  PubMed  Google Scholar 

  13. Choueiri TK, Schutz FA, Hevelone ND, et al. Thermal Ablation vs Surgery for Localized Kidney Cancer: a Surveillance, Epidemiology, and End Results (SEER) Database Analysis. Urology. 2011;78:93–8.

    Article  PubMed  Google Scholar 

  14. Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H. Solid renal tumors: an analysis of pathological features related to tumor size. J Urol. 2003;170:2217–20.

    Article  PubMed  Google Scholar 

  15. Eble JN, Sauter G, Epstein JI, Sesterhenn IA. World health organization classification of tumours: pathology and genetics of tumours of the urinary system and male genital organs. 1st ed. Lyon: International Agency for Research on Cancer; 2004.

    Google Scholar 

  16. Murphy WM, Grignon DJ, Perlman EJ. Armed Forces Institute of Pathology Atlas of Tumor Pathology: tumors of the kidney, bladder and related urinary structures. 4th ed. Washington DC: American Registry of Pathology; 2004.

    Google Scholar 

  17. Fujimoto H, Wakao F, Moriyama N, Tobisu K, Sakamoto M, Kakizoe T. Alveolar architecture of clear cell renal carcinomas (< or =5.0 cm) show high attenuation on dynamic CT scanning. Jpn J Clin Oncol. 1999;29:198–203.

    Article  PubMed  CAS  Google Scholar 

  18. Kim JK, Kim TK, Ahn HJ, Kim CS, Kim KR, Cho KS. Differentiation of subtypes of renal cell carcinoma on helical CT scans. AJR Am J Roentgenol. 2002;178:1499–506.

    PubMed  Google Scholar 

  19. Bird VG, Kanagarajah P, Morillo G, et al. Differentiation of oncocytoma and renal cell carcinoma in small renal masses (<4 cm): the role of 4-phase computerized tomography. World J Urol. 2010;in press.

  20. Alshumrani G, O’Malley M, Ghai S, et al. Small (< or =4 cm) cortical renal tumors: characterization with multidetector CT. Abdom Imaging. 2010;35:488–93.

    Article  PubMed  Google Scholar 

  21. Jinzaki M, Tanimoto A, Mukai M, et al. Double-phase helical CT of small renal parenchymal neoplasms: correlation with pathologic findings and tumor angiogenesis. J Comput Assist Tomogr. 2000;24:835–42.

    Article  PubMed  CAS  Google Scholar 

  22. Tanaka H, Yoshida S, Fujii Y, et al. Diffusion-weighted magnetic resonance imaging in the differentiation of angiomyolipoma with minimal fat from clear cell renal cell carcinoma. Int J Urol. 2011;18:727–30.

    Article  PubMed  Google Scholar 

  23. Yamaguchi Y, Simmons MN, Campbell SC. Small renal masses: risk prediction and contemporary management. Hematol Oncol Clin North Am. 2011;25:717–36.

    Article  PubMed  Google Scholar 

  24. Thomas AA, Campbell SC. Small renal masses: toward more rational treatment. Cleve Clin J Med. 2011;78:539–47.

    Article  PubMed  Google Scholar 

  25. Lane BR, Samplaski MK, Herts BR, Zhou M, Novick AC, Campbell SC. Renal mass biopsy–a renaissance? J Urol. 2008;179:20–7.

    Article  PubMed  Google Scholar 

  26. Leveridge MJ, Finelli A, Kachura JR, et al. Outcomes of small renal mass needle core biopsy, nondiagnostic percutaneous biopsy, and the role of repeat biopsy. Eur Urol. 2011;60:578–84.

    Article  PubMed  Google Scholar 

  27. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296–305.

    Article  PubMed  CAS  Google Scholar 

  28. Huang WC, Levey AS, Serio AM, et al. Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol. 2006;7:735–40.

    Article  PubMed  Google Scholar 

  29. Patard JJ, Shvarts O, Lam JS, et al. Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol. 2004;171:2181–5.

    Article  PubMed  Google Scholar 

  30. Gill IS, Kavoussi LR, Lane BR, et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol. 2007;178:41–6.

    Article  PubMed  Google Scholar 

  31. Lane BR, Gill IS. 7-year oncological outcomes after laparoscopic and open partial nephrectomy. J Urol. 2010;183:473–9.

    Article  PubMed  Google Scholar 

  32. Kunkle DA, Egleston BL, Uzzo RG. Excise, ablate or observe: the small renal mass dilemma–a meta-analysis and review. J Urol. 2008;179:1227–33.

    Article  PubMed  Google Scholar 

  33. Jewett MA, Mattar K, Basiuk J, et al. Active surveillance of small renal masses: progression patterns of early stage kidney cancer. Eur Urol. 2011;60:39–44.

    Article  PubMed  Google Scholar 

  34. Srigley JR, Amin MB, Delahunt B, et al. Protocol for the examination of specimens from patients with invasive carcinoma of renal tubular origin. Arch Pathol Lab Med. 2010;134:e25–30.

    PubMed  Google Scholar 

  35. Association of Directors of Anatomic and Surgical Pathology. ADASP checklists and guidelines for surgical pathology reports of malignant neoplasms: renal tubular. Available at http://www.adasp.org/Checklists/checklists/RENAL%20TUBULAR%20-%20CHECKLIST%20-%20v1.1.pdf. Accessed August 2011.

  36. Rodriguez-Covarrubias F, Castillejos-Molina R, Sotomayor M, et al. Impact of lymph node invasion and sarcomatoid differentiation on the survival of patients with locally advanced renal cell carcinoma. Urol Int. 2010;85:23–9.

    Article  PubMed  Google Scholar 

  37. Whitson JM, Reese AC, Meng MV. Population based analysis of survival in patients with renal cell carcinoma and venous tumor thrombus. Urol Oncol. 2011;in press.

  38. Chromecki TF, Bensalah K, Remzi M, et al. Prognostic factors for upper urinary tract urothelial carcinoma. Nat Rev Urol. 2011;8:440–7.

    Article  PubMed  CAS  Google Scholar 

  39. Katz MD, Serrano MF, Humphrey PA, et al. The role of lymphovascular space invasion in renal cell carcinoma as a prognostic marker of survival after curative resection. Urol Oncol. 2009;in press.

  40. Fuhrman SA, Lasky LC, Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol. 1982;6:655–63.

    Article  PubMed  CAS  Google Scholar 

  41. Nishikimi T, Tsuzuki T, Fujita T, et al. The post-operative pathological prognostic parameters of clear cell renal cell carcinoma in pT1a cases. Pathol Int. 2011;61:116–21.

    Article  PubMed  Google Scholar 

  42. Paner GP, Amin MB, Alvarado-Cabrero I, et al. A novel tumor grading scheme for chromophobe renal cell carcinoma: prognostic utility and comparison with Fuhrman nuclear grade. Am J Surg Pathol. 2010;34:1233–40.

    Article  PubMed  Google Scholar 

  43. Truong LD, Shen SS. Immunohistochemical diagnosis of renal neoplasms. Arch Pathol Lab Med. 2011;135:92–109.

    PubMed  Google Scholar 

  44. Li G, Barthelemy A, Feng G, et al. S100A1: a powerful marker to differentiate chromophobe renal cell carcinoma from renal oncocytoma. Histopathology. 2007;50:642–7.

    Article  PubMed  CAS  Google Scholar 

  45. Henriksen KJ, Meehan SM, Chang A. Non-neoplastic renal diseases are often unrecognized in adult tumor nephrectomy specimens: a review of 246 cases. Am J Surg Pathol. 2007;31:1703–8.

    Article  PubMed  Google Scholar 

  46. Bijol V, Mendez GP, Hurwitz S, Rennke HG, Nose V. Evaluation of the nonneoplastic pathology in tumor nephrectomy specimens: predicting the risk of progressive renal failure. Am J Surg Pathol. 2006;30:575–84.

    Article  PubMed  Google Scholar 

  47. • Garcia-Roig M, Gorin MA, Parra-Herran C, et al. Pathologic evaluation of non-neoplastic renal parenchyma in partial nephrectomy specimens. World J Urol. 2011;in press. This retrospective study demonstrated that a large percentage of patients undergoing partial nephrectomy without a known past medical history harbor pathologic changes suggestive of medical renal disease.

Download references

Disclosures

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Department of Urology, University of Miami Miller School of Medicine, 501 Dominion Towers, 1400 Northwest 10th Avenue, Miami, FL, 33136, USA

    Michael Garcia-Roig & Michael A. Gorin

  2. Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, USA

    Merce Jorda

Authors
  1. Michael Garcia-Roig
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael A. Gorin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Merce Jorda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael Garcia-Roig.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Garcia-Roig, M., Gorin, M.A. & Jorda, M. Evaluation and Management of Small Renal Masses: Looking Beyond the Tumor Margin. Curr Urol Rep 13, 1–7 (2012). https://doi.org/10.1007/s11934-011-0228-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-011-0228-7

Keywords

Search

Navigation