CLINICOPATHOLOGICAL FACTORS INFLUENCING SURVIVAL IN RENAL MUCINOUS TUBULAR AND SPINDLE CELL CARCINOMA: A SINGLE CENTER EXPERIENCE FOR 18 YEARS

Öz

Objective: Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare, indolent renal cell carcinoma variant, rarely showing unusual histology and aggressive behavior. We aimed to document histopathological and clinical characteristics and their relation to survival.

Materials and Methods: We retrospectively identified 20 cases diagnosed as MTSCC between 2007-2024 and documented the relationship between clinicopathological features and follow-up.

Results: There were 9 males and 11 females with a mean age of 54.6±11.1 (range: 28-72). Twelve (60%) underwent radical nephrectomy, 5 (25%) partial nephrectomy, 3 (15%) tru-cut biopsy. Eight (40%) were consultation cases, 12 (60%) were in-house material. The median tumor diameter was 70.4 (IQR: 4.88-9.03) mm. The presence of hemorrhage was observed in 2 (10%), necrosis in 4 (20%), sarcomatous transformation in 2 (10%). Median number of tissue blocks per case was 13 (IQR: 8-17.5) and correlated with the presence of sarcomatous differentiation (r=0.561, p=0.019). Mean follow-up time was 82.9±63.9 months. Four patients succumbed to disease with distant metastasis and two to other causes. One showed local recurrence. Remaining patients showed no recurrence or metastasis. Among four patients who died of disease, two showed sarcomatous transformation. Sarcomatous transformation showed worse prognostic significance in univariate analysis for overall survival (p=0.028), although not validated in multivariate Cox regression model (HR: 0.607, 95% CI: 0.030-12.120, p=0.744). Kaplan-Meier analysis showed that survival probability was lower in patients with sarcomatous transformation (0% vs 88.9%, p=0.008).

Conclusion: MTSCC is a distinct renal neoplasm typically with an indolent prognosis, though rarely metastasizes, causing death. Meticulous histopathological assessment and close follow-up is essential.

Anahtar Kelimeler

• kidney
• mucinous tubular and spindle cell carcinoma
• renal cell carcinoma
• sarcomatous transformation
• survival

BÖBREĞİN MÜSİNÖZ TÜBÜLER VE İĞSİ HÜCRELİ KARSİNOMUNDA SAĞKALIMI ETKİLEYEN KLİNİKOPATOLOJİK FAKTÖRLER: 18 YILLIK TEK MERKEZ DENEYİMİ

Öz

Amaç: Müsinoz tübüler ve iğsi hücreli karsinom (MTİHK), nadir görülen, indolan seyirli bir renal hücreli karsinom varyantıdır; nadiren farklı histolojik özellikler ve agresif davranış gösterebilir. Bu çalışmada histopatolojik ve klinik özellikler ile sağkalım arasındaki ilişkiyi belirlemeyi amaçladık.

Gereç ve Yöntemler: 2007–2024 yılları arasında MTİHK tanısı alan 20 olgu retrospektif olarak incelendi ve klinikopatolojik özellikler ile takip verileri arasındaki ilişki değerlendirildi.

Bulgular: Dokuz erkek ve 11 kadın hastanın yaş ortalaması 54,6±11,1 idi (28–72). On iki (%60) radikal nefrektomi, 5 (%25) parsiyel nefrektomi, 3 (%15) tru-cut biyopsi değerlendirilmişti. Sekiz olgu (%40) konsültasyon materyali, 12 olgu (%60) kurum içi materyaldi. Medyan tümör çapı 70,4 mm idi (IQR: 4,88–9,03). İki olguda (%10) hemoraji, 4’ünde (%20) nekroz ve 2’sinde (%10) sarkomatöz transformasyon gözlendi. Örneklenen medyan blok sayısı 13 (IQR: 8–17,5) olup bu sayı sarkomatöz diferansiyasyon varlığı ile anlamlı korelasyon gösterdi (r=0,561, p=0,019). Ortalama takip süresi 82,9±63,9 aydı. Dört hasta uzak metastaz sonucu, iki hasta diğer nedenlerle kaybedildi. Bir olguda lokal nüks izlendi. Diğer hastalarda nüks veya metastaz saptanmadı. Tümör nedeniyle kaybedilen dört hastanın ikisinde sarkomatöz transformasyon mevcuttu. Sarkomatöz transformasyon, tek değişkenli analizlerde genel sağkalım açısından olumsuz prognostik öneme sahipti (p=0,028); ancak bu bulgu çok değişkenli Cox regresyon analizinde doğrulanmadı (HR: 0,607, %95 GA: 0,030–12,120, p=0,744). Kaplan-Meier analizine göre, sarkomatöz transformasyonu olan hastalarda sağkalım olasılığı belirgin olarak daha düşüktü (%0 vs. %88,9, p=0,008).

Sonuç: MTİHK genellikle indolan seyirli, nadiren metastaz yaparak ölüme yol açabilen bir böbrek tümörüdür. Ayrıntılı histopatolojik değerlendirme ve hastaların yakın takibi büyük önem taşımaktadır

Anahtar Kelimeler

• böbrek
• böbrek hücreli karsinom
• müsinoz tubuler ve iğsi hücreli karsinom
• sarkomatöz transformasyon
• sağkalım

Kaynakça

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