Patients with pT1 renal cell carcinoma who die from disease after nephrectomy may have unrecognized renal sinus fat invasion

Robert Houston Thompson, Michael L. Blute, Amy E. Krambeck, Christine M. Lohse, James S. Magera, Bradley C. Leibovich, Eugene D Kwon, Igor Frank, John C. Cheville

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Prior studies suggest that the renal sinus permits early tumor spread in otherwise localized renal cell carcinoma (RCC) tumors. We hypothesized that renal sinus fat invasion may be unrecognized in pT1 patients who subsequently die from RCC. Between 1985 and 2002, we identified 577 patients who underwent radical nephrectomy for localized pT1 clear cell RCC as reviewed by a single urologic pathologist (J.C.C.). Among these patients, 49 died from RCC including 33 who had their original nephrectomy specimen stored in formalin. These specimens were then resectioned with thin cuts of the renal sinus and reviewed by the same pathologist. For comparison, 33 patients who did not die from RCC (controls) also had their original nephrectomy specimen resectioned. Among the 33 patients who died from seemingly localized RCC, 14 (42%) had previously unrecognized renal sinus fat invasion compared with 2 (6%) of the controls (P<0.001). In addition, 19 (58%) patients who died from RCC had renal sinus small vein (microscopic venous) invasion, a pathologic feature not currently incorporated into the TNM staging system for RCC. This feature was present in 7 (21%) of the controls (P=0.003). In total, 22 (67%) patients who died from RCC had unrecognized renal sinus fat or small vein invasion compared with 7 (21%) of the controls (P<0.001). We conclude that renal sinus fat invasion is an important adverse pathologic feature that is clearly underreported in the literature. Appropriate assessment of nephrectomy specimens should include proper sampling of the renal sinus even for seemingly localized tumors.

Original languageEnglish (US)
Pages (from-to)1089-1093
Number of pages5
JournalAmerican Journal of Surgical Pathology
Volume31
Issue number7
DOIs
StatePublished - Jul 2007

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Nephrectomy
Renal Cell Carcinoma
Fats
Kidney
Veins
Neoplasms
Neoplasm Staging
Formaldehyde

Keywords

  • Kidney neoplasms
  • Lymphatic metastasis
  • Neoplasm staging
  • Prognosis
  • Specimen handling

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine

Cite this

Houston Thompson, R., Blute, M. L., Krambeck, A. E., Lohse, C. M., Magera, J. S., Leibovich, B. C., ... Cheville, J. C. (2007). Patients with pT1 renal cell carcinoma who die from disease after nephrectomy may have unrecognized renal sinus fat invasion. American Journal of Surgical Pathology, 31(7), 1089-1093. https://doi.org/10.1097/PAS.0b013e31802fb4af

Patients with pT1 renal cell carcinoma who die from disease after nephrectomy may have unrecognized renal sinus fat invasion. / Houston Thompson, Robert; Blute, Michael L.; Krambeck, Amy E.; Lohse, Christine M.; Magera, James S.; Leibovich, Bradley C.; Kwon, Eugene D; Frank, Igor; Cheville, John C.

In: American Journal of Surgical Pathology, Vol. 31, No. 7, 07.2007, p. 1089-1093.

Research output: Contribution to journalArticle

Houston Thompson, R, Blute, ML, Krambeck, AE, Lohse, CM, Magera, JS, Leibovich, BC, Kwon, ED, Frank, I & Cheville, JC 2007, 'Patients with pT1 renal cell carcinoma who die from disease after nephrectomy may have unrecognized renal sinus fat invasion', American Journal of Surgical Pathology, vol. 31, no. 7, pp. 1089-1093. https://doi.org/10.1097/PAS.0b013e31802fb4af
Houston Thompson, Robert ; Blute, Michael L. ; Krambeck, Amy E. ; Lohse, Christine M. ; Magera, James S. ; Leibovich, Bradley C. ; Kwon, Eugene D ; Frank, Igor ; Cheville, John C. / Patients with pT1 renal cell carcinoma who die from disease after nephrectomy may have unrecognized renal sinus fat invasion. In: American Journal of Surgical Pathology. 2007 ; Vol. 31, No. 7. pp. 1089-1093.
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abstract = "Prior studies suggest that the renal sinus permits early tumor spread in otherwise localized renal cell carcinoma (RCC) tumors. We hypothesized that renal sinus fat invasion may be unrecognized in pT1 patients who subsequently die from RCC. Between 1985 and 2002, we identified 577 patients who underwent radical nephrectomy for localized pT1 clear cell RCC as reviewed by a single urologic pathologist (J.C.C.). Among these patients, 49 died from RCC including 33 who had their original nephrectomy specimen stored in formalin. These specimens were then resectioned with thin cuts of the renal sinus and reviewed by the same pathologist. For comparison, 33 patients who did not die from RCC (controls) also had their original nephrectomy specimen resectioned. Among the 33 patients who died from seemingly localized RCC, 14 (42{\%}) had previously unrecognized renal sinus fat invasion compared with 2 (6{\%}) of the controls (P<0.001). In addition, 19 (58{\%}) patients who died from RCC had renal sinus small vein (microscopic venous) invasion, a pathologic feature not currently incorporated into the TNM staging system for RCC. This feature was present in 7 (21{\%}) of the controls (P=0.003). In total, 22 (67{\%}) patients who died from RCC had unrecognized renal sinus fat or small vein invasion compared with 7 (21{\%}) of the controls (P<0.001). We conclude that renal sinus fat invasion is an important adverse pathologic feature that is clearly underreported in the literature. Appropriate assessment of nephrectomy specimens should include proper sampling of the renal sinus even for seemingly localized tumors.",
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AU - Lohse, Christine M.

AU - Magera, James S.

AU - Leibovich, Bradley C.

AU - Kwon, Eugene D

AU - Frank, Igor

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