962 PATHOLOGIC CONCORDANCE OF SYNCHRONOUS UNILATERAL MULTIFOCAL RENAL MASSES

Abstract

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging1 Apr 2011962 PATHOLOGIC CONCORDANCE OF SYNCHRONOUS UNILATERAL MULTIFOCAL RENAL MASSES Jay Simhan, Daniel Canter, Kevin Tsai, Marc Smaldone, Ervin Tepper, Tianyu Li, Alexander Kutikov, Rosalia Viterbo, David Chen, Richard Greenberg, and Robert G. Uzzo Jay SimhanJay Simhan Philadelphia, PA More articles by this author , Daniel CanterDaniel Canter Philadelphia, PA More articles by this author , Kevin TsaiKevin Tsai Philadelphia, PA More articles by this author , Marc SmaldoneMarc Smaldone Philadelphia, PA More articles by this author , Ervin TepperErvin Tepper Philadelphia, PA More articles by this author , Tianyu LiTianyu Li Philadelphia, PA More articles by this author , Alexander KutikovAlexander Kutikov 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 , and Robert G. UzzoRobert G. Uzzo Philadelphia, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.930AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with bilateral synchronous renal masses (BSRMs) or ipsilateral synchronous multifocal renal masses represent unique populations of RCC. While pathologic concordance data has been published for BSRMs, few data exists for ipsilateral synchronous multifocal tumors. We reviewed our institutional kidney cancer database to determine malignant, histologic, and grade concordance rates in patients with synchronous multifocal masses arising in the same kidney. METHODS Patients undergoing partial nephrectomy between 2000 and 2010 for synchronous ipsilateral multifocal renal masses were identified from our institutional kidney cancer database. Cases of hereditary RCC were excluded. Malignant/benign concordance rates were defined as identical histologic subtypes within a single renal unit. Nuclear grades were concordant if all tumors excised were low (Fuhrman grades 1 or 2) or high (Fuhrman grades 3 or 4) grade. RESULTS 61 patients (mean age 62.8±8.7 yrs, 77.1% male) with 193 ipsilateral multifocal renal masses (mean pathologic tumor size 2.75, range 0.1-19 cm) were identified (mean tumors per patient 3.3 +/− 1.7). Pathological staging based on diameter of largest tumor revealed 4 (7%) patients with pT0, 38 (62%) patients with pT1a, 8 (13%) patients with pT1b, 8 (13%) patients with pT2, and 3 (5%) patients with pT3a disease. Malignant histologies included clear cell (34%), papillary (28%) and chromophobe (2.6%) RCC. Less common subtypes included cystic clear cell RCC (4.1%) and mixed papillary and clear cell RCC (4.1%). Benign histologies included oncocytoma (17.6%), angiomyolipoma (5.2%), and other (3.6%). The malignant concordance rate among ipsilateral synchronous multifocal tumors was 73.4%; although the histologic concordance rate (i.e, all multifocal clear cell) was only 54.1%. The benign concordance rate was 41.2%. Grade concordance was only 42.0%. The clear cell, papillary, and oncocytoma concordance rates were 61.3%, 36.4%, and 38.9% respectively. CONCLUSIONS In a recent SEER analysis, the bilateral synchoronous renal masses' malignant, histological and grade concordance rates were reported to be 99%, 93%, and 85%. (JUrol: 181, 2009) Here we report a lower pathologic concordance rate between individual ipsilateral multifocal synchronous renal masses, demonstrating a considerable disparity between malignancy, histological subtype, and grade. In light of these findings, percutaneous biopsy of a single renal mass in the setting of ipsilateral multifocal disease may not provide reliable data to inform risk stratification and guide treatment decision-making. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e388 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jay Simhan Philadelphia, PA More articles by this author Daniel Canter Philadelphia, PA More articles by this author Kevin Tsai Philadelphia, PA More articles by this author Marc Smaldone Philadelphia, PA More articles by this author Ervin Tepper Philadelphia, PA More articles by this author Tianyu Li Philadelphia, PA More articles by this author Alexander Kutikov 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 Robert G. Uzzo Philadelphia, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...