BÖBREK TÜMÖRÜ VAKALARININ RETROSPEKTİF OLARAK DEĞERLENDİRİLMESİ

Yıl 2019, Cilt: 21 Sayı: 2, 212 - 217, 31.08.2019

Tuba Devrim

https://doi.org/10.24938/kutfd.552211

Cited By: 1

Öz

Amaç: Böbreğin
epitelyal karsinomu olan renal hücre kanseri, yetişkin tümörlerin yaklaşık
%2-4’ünü oluşturmaktadır. Renal hücre kanseri vakalarının yaklaşık %80’i berrak hücreli renal hücreli karsinom (RHK)
olarak tanımlanmaktadır. Bu çalışma ile böbrek
tümörleri sınıflamasındaki bilgilerin revize edilerek böbrek tümör arşivimizin
gruplandırılması ve elde edilmiş verilerle literatüre katkı sağlanması
amaçlanmıştır.

Gereç ve
Yöntemler: Patoloji laboratuvarımızda, 2010-2019 yılları arasında tanı alan 52 böbrek tümörü vakası
histopatolojik tanı, tümör çapı ve nükleer dereceleri açısından retrospektif
olarak tekrar gözden geçirildi.

Bulgular: Vakaların 34’ü (%65)
erkek, 18’i (%34) kadındı. Yaş aralığı, 33-85 arasında değişmekte olup,
ortalama yaş 58 olarak tespit edildi. Elli iki böbrek tümörünün 34’ü (%65)
berrak hücreli renal hücre karsinomu, 5’i (%10) kromofob renal hücre karsinomu,
5’i (%10) papiller renal hücre karsinomu, 2’si (%3) onkositom ve 6’sı (%12) ise
sınıflandırılamayan renal hücre karsinomu idi. Tümörlerin 15’i (%34.1) nükleer
derece (ND) 1, 13’ü (%29.5) ND 2, 12’si (%27.3) ND 3 ve 4’ü (%9) ise ND 4
olarak tespit edildi. En büyük tümör çapına sahip histolojik alt tip 10.5 cm
ile berrak hücreli renal hücre karsinom iken, en küçük çapa (1 cm) sahip
histolojik tipin papiller renal hücre karsinom olduğu tespit edildi.

Sonuç: Renal hücre karsinomunda tümör tipi,
sarkomatoid/rabdoid farklılaşması, tümör nekrozu ve derecelendirmesi,
potansiyel prognostik parametreler olarak kabul edilmektedir. Papiller renal
hücre karsinomu alt tiplerinin (Tip 1 ve 2) belirlenmesi ek prognostik bilgi
sağlamakta olup, berrak hücreli tubulopapiller renal hücre karsinomu daha iyi
bir prognoz ile ilişkilendirilmiştir. Sarkomatoid veya rabdoid farklılaşması
gösteren tümörler minimum bir tümör oranına bakılmaksızın belirtilmelidir.
Makroskopik ve mikroskobik incelemeye dayalı değerlendirme ile tümör nekrozunun
prognostik önemi olduğu bildirilmektedir. Nükleol belirginliği, berrak hücreli
ve papiller RHK’lerin 1 ila
3’lük derecelerini tanımlamaktadır. Aşırı nükleer pleomorfizm veya sarkomatoid
ve/veya rabdoid farklılaşma ise 4. derecedeki tümörleri göstermektedir. Ayrıca
pT evreleme kategorisinin ise prognostik önemlerini koruduğu bildirilmektedir.

Anahtar Kelimeler

Böbrek, tümör, karsinom, retrospektif, sınıflama

Retrospective Evaluation of Renal Tumor Cases

Öz

Objective: Renal cell
carcinoma (RCC) of the kidney constitutes approximately 2-4%of adult tumors.
Approximately 80%of renal cell cancer cases are defined as clear cell renal
cell carcinoma. The aim of this study was to review the renal cell carcinoma
cases in our archive to provide additional information to the literature.

Material and Methods: 52 cases of
renal tumors diagnosed in our pathology laboratory between 2010-2019 were
reviewed retrospectively for histopathological diagnosis, tumor size and
nuclear grade.

Results: 34 (65%) of
the cases were male and 18 (34 %) were female. The age of the cases ranged
between 33 and 85 years, with a mean age of 58 years. Of the fifty-two kidney
tumors, 34 (65%) were clear cell renal cell carcinoma, 5 (10%) were chromophobe
renal cell carcinoma, 5 (10%) were papillary renal cell carcinoma, 2 (3%) were
oncocytoma and 6 (12%). was unclassified renal cell carcinoma. Fifteen (34.1%)
of the tumors were nuclear grade (NG) 1, 13 (29.5%) were NG 2, 12 (27.3%) were
NG 3 and 4 (9%) were NG 4. The histological subtype with the largest (10.5 cm)
tumor diameter was clear cell renal cell carcinoma, while papillary renal cell
carcinoma was with the smallest (1 cm) tumor diameter.

Conclusion: Tumor type,
sarcomatoid / rhabdoid differentiation, tumor necrosis and grading in RCC are
considered as potential prognostic parameters. Determination of papillary renal
cell cancer subtypes (type 1 and 2) provides additional prognostic information
and clear cell tubulopapillary renal cell cancer has been associated with a
better prognosis. Tumors showing sarcomatoid or rhabdoid differentiation should
be indicated regardless of the percentage of these histopathological features.
It is reported that tumor necrosis has a prognostic significance by the
evaluation based on macroscopic and microscopic examination. Nucleolar
prominence defines grade 1 to 3 in clear cell and papillary renal cell
carcinomas. Extreme nuclear pleomorphism or sarcomatoid and/or rhabdoid
differentiation showing tumors are graded as grade 4. In addition to the
grading, pT stage is reported to maintain its prognostic significance.

Anahtar Kelimeler

Kidney, tumor, carcinoma, retrospective, classification

Kaynakça

• 1. Siegel R, Naishadham D, Jemal A. Cancer statistics. CA Cancer J Clin. 2013;63(1):11-30.
• 2. Dutcher JP. Update on the biology and management of renal cell carcinoma. J Investig Med. 2019;67(1):1-10.
• 3. Moch H, Cubilla AL, Humphrey PA, Reuter VE, Ulbright TM. The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part A: Renal, Penile, and Testicular Tumours. Eur Urol. 2016;70(1):93-105.
• 4. Moch H, Humphrey PA, Ulbright TM, Reuter VE. WHO Classification of Tumours. 4th ed. Lyon. IARC Ltd, 2016:14-7.
• 5. Stella M, Chinello C, Cazzaniga A, Smith A, Galli M, Piga I et al. Histology-guided proteomic analysis to investigate the molecular profiles of clear cell Renal Cell Carcinoma grades. J Proteomics. 2019;191:38-47.
• 6. Castillo RP, Santoscoy JF, Pisani L, Madrazo BL, Casillas VJ. Imaging of unusual renal tumors. Curr Urol Rep. 2019; 21;20(1):5.
• 7. Al-Bayati O, Hasan A, Pruthi D, Kaushik D, Liss MA. Systematic review of modifiable risk factors for kidney cancer. Urol Oncol. 2019;37(6):359-71.
• 8. Srigley JR, Delahunt B, Eble JN, Egevad L, Epstein JI, Grignon D et al. The ISUP renal tumor panel the International Society of Urological Pathology (ISUP). Vancouver classification of renal neoplasia. Am J Surg Pathol. 2013;37(10):1469-89.
• 9. Nguyen MM, Gill IS, Ellison LM. The evolving presentation of renal carcinoma in the United States: trends from the surveillance, epidemiology, and end results program. J Urol. 2006;176(6):2397-400.
• 10. Delahunt B, Cheville JC, Martignoni G, Humphrey PA, Magi-Galluzzi C, McKenney J et al. The International Society of Urological Pathology (ISUP) Grading System for Renal Cell Carcinoma and Other Prognostic Parameters. Am J Surg Pathol. 2013;37(10):1490-504.
• 11. Dagher J, Delahunt B, Rioux-Leclercq N, Egevad L, Srigley JR, Coughlinm G et al. Clear cell renal cell carcinoma: validation of World Health Organization/International Society of Urological Pathology grading. Histopathology. 2017;71(6):918-25.
• 12. Patel HD, Pierorazio PM. Active Surveillance of Renal Tumors. In: Gorin M, Allaf M, eds. Diagnosis and Surgical Management of Renal Tumors. 1st ed. New York. Springer, 2019:101-113.
• 13. Bianchi M, Sun M, Jeldres C, Shariat SF, Trinh QD, Briganti A et al. Distribution of metastatic sites in renal cell carcinoma: a population-based analysis. Ann Oncol. 2012;23(4):973-80.
• 14. Janzen NK, Kim HL, Figlin RA, Belldegrun AS. Surveillance after radical or partial nephrectomy for localized renal cell carcino-ma and management of recurrent disease. Urol Clin North Am. 2003;30(4):843-52.
• 15. Heng DY, Wells JC, Rini BI, Beuselinck B, Lee JL, Knox JJ et al. Cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma: results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur Urol. 2014;66(4):704-10.
• 16. Ulaş A, Bilgin B, Şener Dede D, Köş FT, Akıncı MB, Şendur MAN ve ark. Böbrek hücreli karsinomlu hastaların demografik özellikleri ve tedavi sonuçları: tek merkez deneyimi. Ankara Med J. 2016;16(2):149-62.