1643 PRESENCE OF COEXISTING HYBRID MALIGNANCY IN A SOLITARY SPORADIC SOLID BENIGN RENAL MASS: IMPLICATIONS FOR MANAGING PATIENTS FOLLOWING RENAL BIOPSY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized (IV)1 Apr 20131643 PRESENCE OF COEXISTING HYBRID MALIGNANCY IN A SOLITARY SPORADIC SOLID BENIGN RENAL MASS: IMPLICATIONS FOR MANAGING PATIENTS FOLLOWING RENAL BIOPSY Serge Ginzburg, Robert Uzzo, Tahseen Al-Saleem, Essel Dulaimi, John Walton, Christopher Miller, David Kurz, Awad Ahmed, Anthony Corcoran, Jeffrey Tomaszevski, Reza Mehrazin, Rosalia Viterbo, David Chen, Richard Greenberg, Marc Smaldone, and Alexaner Kutikov Serge GinzburgSerge Ginzburg Philadelphia, PA More articles by this author , Robert UzzoRobert Uzzo Philadelphia, PA More articles by this author , Tahseen Al-SaleemTahseen Al-Saleem Philadelphia, PA More articles by this author , Essel DulaimiEssel Dulaimi Philadelphia, PA More articles by this author , John WaltonJohn Walton Philadelphia, PA More articles by this author , Christopher MillerChristopher Miller Philadelphia, PA More articles by this author , David KurzDavid Kurz Philadelphia, PA More articles by this author , Awad AhmedAwad Ahmed Philadelphia, PA More articles by this author , Anthony CorcoranAnthony Corcoran Philadelphia, PA More articles by this author , Jeffrey TomaszevskiJeffrey Tomaszevski Philadelphia, PA More articles by this author , Reza MehrazinReza Mehrazin Philadelphia, PA More articles by this author , Rosalia ViterboRosalia Viterbo Philadelphia, PA More articles by this author , David ChenDavid Chen Philadelphia, PA More articles by this author , Richard GreenbergRichard Greenberg Philadelphia, PA More articles by this author , Marc SmaldoneMarc Smaldone Philadelphia, PA More articles by this author , and Alexaner KutikovAlexaner Kutikov Philadelphia, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3109AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urologic literature contends that up to 20% of oncocytomas coexist as hybrid tumors with adjacent malignant pathology. This claim deters renal biopsy and, when benign histology is found, undermines its validity. Nevertheless, incidence of hybrid pathology in a solitary sporadic solid benign renal mass is yet to be fully defined. We examined rates of coexisting malignant and high grade pathology in resected tumors that contained elements of oncocytoma, angiomyolipoma (AML) or other benign renal histology. METHODS We queried our prospectively maintained kidney cancer database to identify patients with solitary renal tumors who underwent surgical resection between 1994 and 2012(n=1829). Lesions containing elements of oncocytoma, AML or other benign pathology formed the basis of this analysis. Patients having an oncocytic malignancy, without presence of a classic oncocytoma, and those with known hereditary syndromes were excluded. Diagnosis of oncocytoma was based on histological features, with immunohistochemical and/or cytogenetic analyses performed in select cases as judged necessary by experienced uropathologists. RESULTS After excluding multifocal and cystic lesions, 148 patients (median age 62 years, 46% male, 83% Caucasian) with solitary solid renal lesions containing pathologically−proven elements of oncocytoma (65%), AML (30%), metanephric adenoma (1.4%), renomedullary interstitial cell tumor (0.7%), medullary fibroma (0.7%), juxtaglomerular cell tumor (0.7%), inflammatory pseudotumor (0.7%) and a hemangioma (0.7%) were identified. Median tumor size was 3.0 cm [1.0−30.0cm], while tumor anatomic complexity was low in 28%, moderate in 56%, and high in 16%, as quantified by the RENAL nephrometry score. Only 4 patients (2.7%) were documented as having hybrid malignant pathology, all involving a low grade chromophobe RCC in the setting of oncocytoma. After a mean follow−up of 27 months, no patients experienced regional or metastatic progression. CONCLUSIONS In our cohort of patients with a solitary, sporadic, solid benign renal mass, ≤3% of tumors exhibited coexisting hybrid malignancy. Importantly, no patients harbored coexisting high grade pathology. As such, uncertainty regarding hybrid malignant pathology coexisting with benign pathologic components should not deter renal biopsy nor undermine its validity. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e675-e676 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Serge Ginzburg Philadelphia, PA More articles by this author Robert Uzzo Philadelphia, PA More articles by this author Tahseen Al-Saleem Philadelphia, PA More articles by this author Essel Dulaimi Philadelphia, PA More articles by this author John Walton Philadelphia, PA More articles by this author Christopher Miller Philadelphia, PA More articles by this author David Kurz Philadelphia, PA More articles by this author Awad Ahmed Philadelphia, PA More articles by this author Anthony Corcoran Philadelphia, PA More articles by this author Jeffrey Tomaszevski Philadelphia, PA More articles by this author Reza Mehrazin Philadelphia, PA More articles by this author Rosalia Viterbo Philadelphia, PA More articles by this author David Chen Philadelphia, PA More articles by this author Richard Greenberg Philadelphia, PA More articles by this author Marc Smaldone Philadelphia, PA More articles by this author Alexaner Kutikov Philadelphia, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...