Morphological and Histological Features of Nephrectomy Materials: A Single-Center Experience and Short Review of the Literature

Öz

Objective: To determine the demographic characteristics of patients undergoing nephrectomy at a tertiary care hospital and to analyze the spectrum of renal tumors based on histopathological findings of nephrectomy specimens by current literature. Material and Method: The results of nephrectomy materials admitted to the pathology clinic between January 2019 and December 2023 were included in the study. The demographic characteristics of the included patients, presenting complaints, reasons for nephrectomy, surgical method, nephrectomy area, tumor dimension, and histopathological reports were recorded in a standard data form. Results: A total of 325 nephrectomy materials were included in the study. 61.5% of the patients were male. The mean age of the patients was 54.5±20.2 years (min:3 max:91). The most common presenting complaints were flank pain (28.3%). The most commonly observed pathological malignancy was clear cell carcinoma (32%), and it was found to be significantly higher in male patients (38.5%) (p=0.001). The most frequently detected pathological TNM grade of the patients was grade 1, and the histological WHO/ISUP grade was 2. 28.9% of the patients (n:94) received a diagnosis incidentally. Among those incidentally diagnosed patients, 87.2% (n:82) were histopathologically malignant. When benign pathological diagnoses were examined, the most common diagnosis was pyelonephritis, followed by oncocytoma, benign cystic disease, and angiomyolipoma, respectively. Conclusion: According to our study results, malignant tumors are more commonly observed than benign neoplasms. Despite advancements in imaging technologies, the histopathological diagnosis of renal masses cannot be determined preoperatively, and surgical intervention is required for diagnosis

Anahtar Kelimeler

• Nephrectomy
• tumor
• histopathology
• clear cell carcinoma
• oncocytoma
• and pyelonephritis

Nefrektomi Materyallerinin Morfolojik ve Histolojik Özellikleri: Tek Merkez Deneyimi ve Literatürün Kısa Gözden Geçirilmesi

Öz

Amaç: Üçüncü basamak bir hastanede nefrektomi yapılan hastaların demografik özelliklerini belirlemek ve güncel literatür doğrultusunda nefrektomi örneklerinin histopatolojik bulgularına dayanarak böbrek tümörleri spektrumunu analiz etmek. Gereç ve ve Yöntem: Çalışmaya Ocak 2019 ile Aralık 2023 tarihleri arasında patoloji kliniğine başvuran nefrektomi materyallerinin sonuçları dahil edildi. Çalışmaya dahil edilen hastaların demografik özellikleri, başvuru şikayetleri, nefrektomi nedenleri, cerrahi yöntem, nefrektomi bölgesi, tümör boyutu ve histopatolojik raporları standart bir veri formuna kaydedildi. Bulgular: Çalışmaya toplam 325 nefrektomi materyali dahil edildi. Hastaların %61,5’i erkekti. Hastaların ortalama yaşı 54,5±20,2 yıl (min:3 max:91) idi. En sık başvuru yakınması yan ağrısı (%28,3) idi. En sık görülen patolojik malignite berrak hücreli karsinom (%32) olup, erkek hastalarda (%38,5) anlamlı olarak daha yüksek olduğu görüldü (p=0,001). Hastaların en sık saptanan patolojik TNM derecesi derece 1, histolojik WHO/ISUP derecesi ise 2 idi. Hastaların %28,9’una (n:94) tesadüfen tanı konuldu. Tesadüfen tanı konulan hastaların %87,2’si (n:82) histopatolojik olarak malign idi. Benign patolojik tanılar incelendiğinde en sık görülen tanı piyelonefrit olup, bunu sırasıyla onkositoma, benign kistik hastalık ve anjiyomiyolipom izlemektedir. Sonuç: Çalışmamızın sonuçlarına göre malign tümörler benign neoplazmlara göre daha sık görülmektedir. Görüntüleme teknolojilerindeki ilerlemelere rağmen böbrek kitlelerinin histopatolojik tanısı ameliyat öncesi net olarak belirlenememekte ve tanı için cerrahi müdahale gerekmektedir.

Anahtar Kelimeler

• Nefrektomi,
• tümör,
• histopatoloji,
• berrak hücreli karsinom,
• onkositoma
• piyelonefrit

Kaynakça

1. Miller KD, Goding Sauer A, Ortiz AP, Fedewa SA, Pinheiro PS, Tortolero-Luna G, et al. Cancer Statistics for Hispanics/Latinos, 2018. CA Cancer J Clin. 2018;68(6):425-45. doi: 10.3322/caac.21494.
2. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. doi: 10.3322/caac.21492.
3. Ljungberg B, Campbell SC, Choi HY, Jacqmin D, Lee JE, Weikert S, Kiemeney LA. The epidemiology of renal cell carcinoma. Eur Urol. 2011;60(4):615-21. doi: 10.1016/j.eururo.2011.06.049.
4. Rossi SH, Klatte T, Usher-Smith J, Stewart GD. Epidemiology and screening for renal cancer. World J Urol. 2018;36(9):1341-53. doi: 10.1007/s00345-018-2286-7.
5. Lindblad P. Epidemiology of renal cell carcinoma. Scandinavian journal of surgery: SJS: official organ for the Finnish Surgical Society and the Scandinavian Surgical Society. 2004;93(2):88-96.
6. Rosenkrantz AB, Hindman N, Fitzgerald EF, Niver BE, Melamed J, Babb JS. MRI features of renal oncocytoma and chromophobe renal cell carcinoma. AJR Am J Roentgenol. 2010;195(6):W421-7. doi: 10.2214/AJR.10.4718.
7. Hindman N, Ngo L, Genega EM, Melamed J, Wei J, Braza JM, Rofsky NM, Pedrosa I. Angiomyolipoma with minimal fat: can it be differentiated from clear cell renal cell carcinoma by using standard MR techniques? Radiology. 2012 Nov;265(2):468-77. doi: 10.1148/radiol.12112087.
8. Moch H, Humphrey PA, Ulbright TM, Reuter VE, editors. WHO Classification of Tumours of the Urinary System and Male Genital Organs. 4th ed. Lyon: IARC; 2016.

9. Bahadoram S, Davoodi M, Hassanzadeh S, Bahadoram M, Barahman M, Mafakher L. Renal cell carcinoma: an overview of the epidemiology, diagnosis, and treatment. G Ital Nefrol. 2022;39(3):2022-vol3.
10. Bukavina L, Bensalah K, Bray F, Carlo M, Challacombe B, Karam JA, et al. Epidemiology of Renal Cell Carcinoma: 2022 Update. Eur Urol. 2022;82(5):529-42. doi: 10.1016/j.eururo.2022.08.019.
11. Tsui KH, Shvarts O, Smith RB, Figlin R, de Kernion JB, Belldegrun A. Renal cell carcinoma: prognostic significance of incidentally detected tumors. J Urol. 2000;163(2):426-30. doi: 10.1016/s0022-5347(05)67892-5.
12. Rini BI, Campbell SC, Escudier B. Renal cell carcinoma. Lancet. 2009;373(9669):1119-32. doi: 10.1016/S0140-6736(09)60229-4.
13. Prasad SR, Surabhi VR, Menias CO, Raut AA, Chintapalli KN. Benign renal neoplasms in adults: cross-sectional imaging findings. AJR Am J Roentgenol. 2008;190(1):158-64. doi: 10.2214/AJR.07.2724.
14. Gutiérrez FJQ, Panizo Á, Tienza A, Rodriguez I, Sola JJ, Temprana-Salvador J, de Torres I, Pardo-Mindán J. Cytogenetic and immunohistochemical study of 42 pigmented microcystic chromophobe renal cell carcinoma (PMChRCC). Virchows Arch. 2018;473(2):209-17. doi: 10.1007/s00428-018-2389-y.
15. Furge KA, Lucas KA, Takahashi M, Sugimura J, Kort EJ, Kanayama HO, et al. Robust classification of renal cell carcinoma based on gene expression data and predicted cytogenetic profiles. Cancer Res. 2004;64(12):4117-21. doi: 10.1158/0008-5472.CAN-04-0534.
16. Eble JN, Grignon DJ, Young RH. Tumours of the urinary tract, Chapter 12. In: Fletcher CDM, editor. Diagnostic Histopathology of Tumours. 4th ed. p. 559-657
17. Sheenu VS, Paul RS, Pushpa M, Ami EM, Rashmi R, Iona ML, Elizabeth M. Histopathological spectrum of adult renal tumours: A single center experience and review of literature. Indian J Pathol Microbiol. 2023;66(2):307-13. doi: 10.4103/ijpm.ijpm_53_21.
18. Alaghehbandan R, Perez Montiel D, Luis AS, Hes O. Molecular Genetics of Renal Cell Tumors: A Practical Diagnostic Approach. Cancers (Basel). 2019;12(1):85. doi: 10.3390/cancers12010085.
19. Delahunt B, Eble JN, Egevad L, Samaratunga H. Grading of renal cell carcinoma. Histopathology. 2019;74(1):4-17. doi: 10.1111/his.13735.
20. Ademola BL, Atanda AT, Aji SA, Abdu A. Clinical, morphologic and histological features of chronic pyelonephritis: An 8-year review. Niger Postgrad Med J. 2020;27(1):37-41. doi: 10.4103/npmj.npmj_109_19.
21. HuangJJ, TsengCC. Emphysematous pyelonephritis: Clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med 2000;160:797-805.
22. Ulasi II, Ijoma CK. The enormity of chronic kidney disease in Nigeria: the situation in a teaching hospital in South-East Nigeria. J Trop Med. 2010;2010:501957:1-6. doi: 10.1155/2010/501957.
23. Divyashree BN, Kusuma V, Madhusudhan HR, Hanumantha Raju BK. Pathological spectrum of non-neoplastic diseases in the nephrectomy specimens. J Evid Based Med 2014;1:1909-20.
24. Aiman A, Singh K, Yasir M. Histopathological spectrum of lesions in nephrectomy specimens: A five year experience in a tertiary care hospital. J Sci Soc 2013;40:148-54.
25. Awasthi N. Chronic pyelonephritis continues to be the leading cause of nephrectomies. Chrismed J Health Res 2015;2:308.
26. Narang V, Garg B, Walia A, Sood N, Malhotra V. Histomorphological spectrum of nephrectomy specimens – A tertiary care centre experience. Nat J Lab Med 2016;5:51-4. Doi: NJLM/2016/18261:2112
27. Sahin MO, Canda AE, Mungan MU, Kırkalı Z, Sade M. Benign lesions underwent radical nephrectomy for renal cancer. Turkish Journal of Urology 2004; 30 (4): 405-9.
28. Tamboli P, Ro JY, Amin MB, Ligato S, Ayala AG. Benign tumors and tumor-like lesions of the adult kidney. Part II: Benign mesenchymal and mixed neoplasms, and tumor-like lesions. Adv Anat Pathol. 2000;7(1):47-66. doi: 10.1097/00125480-200007010-00007.
29. Skolarus TA, Serrano MF, Grubb RL 3rd, Katz MD, Bullock TL, Gao F, Humphrey PA, Kibel AS. Effect of reclassification on the incidence of benign and malignant renal tumors. J Urol. 2010;183(2):455-8. doi: 10.1016/j.juro.2009.10.045.
30. Kutikov A, Fossett LK, Ramchandani P, Tomaszewski JE, Siegelman ES, Banner MP, et al. Incidence of benign pathologic findings at partial nephrectomy for solitary renal mass presumed to be renal cell carcinoma on preoperative imaging. Urology. 2006 Oct;68(4):737-40. doi: 10.1016/j.urology.2006.04.011.
31. Lee SH, Park SU, Rha KH, Choi YD, Hong SJ, Yang SC, et al. Trends in the incidence of benign pathological lesions at partial nephrectomy for presumed renal cell carcinoma in renal masses on preoperative computed tomography imaging: a single institute experience with 290 consecutive patients. Int J Urol. 2010;17(6):512-6. doi: 10.1111/j.1442-2042.2010.02514.x.
32. Remzi M, Huri E, Marberger M. The importance of benign kidney tumors among small renal masses: diagnosis and treatment algorithms. Türk Üroloji Dergisi 2009;35:286- 92
33. Wei X, Wang Y, Fang Y, Chen L. Renal oncocytoma in a 13-year-old girl: A case report and literature review. Indian J Pathol Microbiol. 2023;66(4):868-70. doi: 10.4103/ijpm.ijpm_264_22.
34. Schatz SM, Lieber MM. Update on oncocytoma. Curr Urol Rep 2003;4:30-5.
35. Delongchamps NB, Peyromaure M. Cystic diseases of the kidney. Ann Urol (Paris). 2006;40(1):1-14.
36. Fittschen A, Wendlik I, Oeztuerk S, Kratzer W, Akinli AS, Haenle MM, Graeter T. Prevalence of sporadic renal angiomyolipoma: a retrospective analysis of 61,389 in- and out-patients. Abdom Imaging. 2014;39(5):1009-13. doi: 10.1007/s00261-014-0129-6.
37. Flum AS, Hamoui N, Said MA, Yang XJ, Casalino DD, McGuire BB, et al. Update on the Diagnosis and Management of Renal Angiomyolipoma. J Urol. 2016;195(4 Pt 1):834-46. doi: 10.1016/j.juro.2015.07.126.
38. Lane BR, Aydin H, Danforth TL, Zhou M, Remer EM, Novick AC, Campbell SC. Clinical correlates of renal angiomyolipoma subtypes in 209 patients: classic, fat poor, tuberous sclerosis associated and epithelioid. J Urol. 2008;180(3):836-43. doi: 10.1016/j.juro.2008.05.041.
39. Latif F, Mubarek M, Kazi JI. Histopathological characteristics of adult renal tumours: a preliminary report J Pak Med Assoc, 2011; 61:224-228.
40. Amanullah, Saleem MA, Khan I, Quadri MW, Khan FA. Incidental Detection of Renal Cell Carcinoma. Ann King Edward Med Uni 1999;5:196-8. Doi: 10.21649/akemu.v5i2.3348
41. Gudbjartsson T, Hardarson S, Petursdottir V, Thoroddsen A, Magnusson J, Einarsson GV. Histological subtyping and nuclear grading of renal cell carcinoma and their implications for survival: a retrospective nation-wide study of 629 patients. Eur Urol. 2005;48(4):593-600. doi: 10.1016/j.eururo.2005.04.016.
42. Siyal AR, Balouch QD, Shaikh SM, Surahio AW. Renal cell carcinoma. J Surg Pak 2000;5:36-8.
43. Srivastava A, Mandhani A, Kapoor R, Jain M, Dubey D, Srivastava A, et al. Prognosticfactors in patients with renal cell carcinoma: is TNM (1997) staging relevant in Indian subpopulation? Indian J Cancer. 2004 ;41(3):99-103.
44. Talic FR, El Faqih SR. Renal tumours in adult Saudi patients: A review of 43 cases. Ann Saud Med 1996;16:517-20.
45. Kassouf W, Aprikian AG, Laplante M, Tanguay S. Natural history of renal masses followed expectantly. J Urol. 2004 Jan;171(1):111-3. Doi: 10.1097/01.ju.0000102409.69570.f5.
46. Pantuck AJ, Zisman A, Belldegrun AS. The changing natural history of renal cell carcinoma. J Urol 2001;166:1611-23.
47. Rendon RA, Stanietzky N, Panzarella T, Robinette M, Klotz LH, Thurston W, Jewett MA. The natural history of small renal masses. J Urol. 2000;164(4):1143-7.
48. Kato M, Suzuki T, Suzuki Y, Terasawa Y, Sasano H, Arai Y. Natural history of small renal cell carcinoma: evaluation of growth rate, histological grade, cell proliferation and apoptosis. J Urol. 2004;172(3):863-6. doi: 10.1097/01.ju.0000136315.80057.99.
49. Duchene DA, Lotan Y, Cadeddu JA, Sagalowsky AI, Koeneman KS. Histopathology of surgically managed renal tumors: analysis of a contemporary series. Urology. 2003;62(5):827-30. Doi: 10.1016/s0090-4295(03)00658-7.
50. Fergany AF, Hafez KS, Novick AC. Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year followup. J Urol. 2000;163(2):442-5.