PTU - Polskie Towarzystwo Urologiczne
list of articles:

Oncological characteristic of incidental renal tumors
Article published in Urologia Polska 2005/58/4.

authors

Jakub Dobruch 1, Andrzej Borówka 1, Tomasz Dzik 2, Roman Sosnowski 3, Przemysław Szostek 1
1 Klinika Urologii Centrum Medycznego Kształcenia Podyplomowego, I Zespół Dydaktyki Urologicznej ? Oddział Urologii Międzyleskiego Szpitala Specjalistycznego w Warszawie
Kierownik kliniki i ordynator oddziału: prof. dr hab. Andrzej Borówka
2 Zakład Anatomii Patologicznej, Międzyleski Szpital Specjalistyczny w Warszawie
Kierownik zakładu: dr med. Tomasz Dzik
3 Klinika Nowotworów Układu Moczowego, Centrum Onkologii ? Instytut w Warszawie
Kierownik kliniki: doc. dr hab. Tomasz Demkow

keywords

kidney, renal tumor, histopathological examination, diagnosis

summary

introduction and the aim of the study
Incidence of renal cancer especially renal cancer confound to the kidney gradually rose in recent years. It is most probably associated with wide spread of ultrasound scans. The aim of the present study was to compare oncological characteristics of incidental renal tumors with renal tumors diagnosed because of symptoms and signs suggestive of renal mass.
material and method
Charts of all patients operated on renal tumor from January 2002 and May 2004 were reviewed. Patients were divided into two groups. In Group I renal tumors were diagnosed incidentally whereas in Group II renal tumors were diagnosed because of symptoms and signs suggestive of renal mass. In both Groups the following parameters were analyzed: age, sex, site of the tumor, way of treatment, pathological stage and histological type of tumor.
results
116 patients, 46 (40%) women and 70 (60%) men were operated on renal tumor. In 87 of them (75%), (35 (40.2%) women and 52 (59.8%) men) renal tumors were diagnosed incidentally. In 29 of them (25%), (11 (37.9%) women and 18 (62.1%) men) tumors were diagnosed because of symptoms and signs associated with them. Average age was 61 years (from 25 to 85) and 57 years (from 20 to 84) in Group I and II respectively. Tumors invading right kidney were more frequently diagnosed in both Groups (54% Group I vs 62% Group II). Average maximal diameter of excised tumor was significantly greater in Group II then in Group I (7.90 cm vs 4.27 cm, p<0.001). Nephron sparing surgery was carried out in 22 patients (25.3%) of Group I and in none of Group II. Histopathological evaluation revealed that clear cell carcinoma predominated in both Groups - it was found in 68 (78%) patients from Group I and in 24 (83%) from Group II. 12 (15%) tumors in Group I and 12 tumors (41%) in Group II were classified as Grade 3 and 1 (1%) in Group I as G4.
conclusions
Oncological characteristic of incidental renal tumors is more favorable then tumors diagnosed due to symptoms and signs. Incidental renal cancers are also smaller and therefore more suitable for nephron sparing surgery.

references

  1. Landis H, Murray T, Bolden S et al: Cancer statistics, 1998. CA Cancer J Clin 1998, 48, 6-29.
  2. Devasa S, Silverman D, McLaughlin J et al: Comparison of the descriptive epidemiology of urinary tract cancers. Cancer Causes Control 1990, 1, 1133-1141.
  3. Hellsten S, Johnsen J, Berge T et al: Clinically unrecognized renal cell carcinoma: diagnostic and pathological aspects. Eur Urol 1990, 18 (suppl 2), 2-3.
  4. Chow WH, Devesa SS, Warren JL, Fraumeni JF Jr: Rising incidence of renal cell cancer in the United States. JAMA 1999, 281, 1628-1631.
  5. Murai M, Oya M: Renal cell carcinoma: etiology, incidence and epidemiology. Curr Opin Urol 2004, 14, 229-233.
  6. Didkowska J, Wojciechowska U, Tarkowski W, Zatoński W: Nowotwory złośliwe w Polsce w 1991 roku. Krajowy Rejestr Nowotworów, Warszawa, 1994; 71-72.
  7. Didkowska J, Wojciechowska U, Tarkowski W, Zatoński W: Nowotwory złośliwe w Polsce w 2000 roku. Krajowy Rejestr Nowotworów, Warszawa, 2003; 100-103.
  8. Jayson M, Sanders H: Increased incidence of serendipitously discovered renal cell carcinoma. Urol 1998, 51, 203-205.
  9. Konnak JW, Grossman HB: Renal cell carcinoma as an incidental finding. J Urol 1985, 134, 1094-1096.
  10. Thrasher JB, Paulson DF: Prognostic factors in renal cancer. Urologic Clin N Am 1993, 20, 247-262.
  11. Belldegrun A, Tsui K, deKernion J et al: Efficacy of nephron sparing surgery for renal cell carcinoma, analysis based on the new 1997 tumor-node-metastasis system. J Clin Oncol 1999, 17, 2868-2875.
  12. Fleming ID: AJCC Cancer Staging Manual. Philadelphia 1997, 5-e wydanie, Fleming ID (red), Lippincott-Raven, 231-232.
  13. Fuhrman SA, Lasky K, Limas C: Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 1982, 6, 655-663.
  14. Ueda T, Yasumasu T, Uozumi J, Naito S: Comparison of clinical and pathological characteristics in incidentally detected and suspected renal carcinoma. Br J Urol 1991, 68, 470-472.
  15. Skinner DG, Colvin RB, Vermillion CD et al: Diagnosis and management of renal cell carcinoma. Clinical and pathologic study of 309 cases. Cancer 1971, 28, 1165.
  16. Smith SJ, Bosniak MA, Megibow AJ et al: Renal cell carcinoma: earlier discovery and increased detection. Radiology 1989, 170, 699.
  17. Ozen H, Colowick A, Freiha FS: Incidentally discovered solid renal masses: what are they? Br J Urol 1993, 72, 274-276.
  18. Nakano E, Iwasaki A, Seguchi T et al: Incidentally diagnosed renal cell carcinoma. Eur Urol 1992, 21, 294-298.
  19. Bretheau D, Lechevallier E, Eghazarian C et al: Prognostic significance of incidental renal cell carcinoma. Eur Urol 1995, 27, 319-323.
  20. Tsui K, Shvarts O, Smith RB et al: Renal cell carcinoma: prognostic significance of incidentally detected tumors. J Urol 2000, 163, 426-430.
  21. Bos SD, Mellema CT, Mensnk HJA: Increase in incidental renal cell carcinoma in the Northern Part of the Netherlands. Eur Urol 2000, 37, 267-70.
  22. Katusin D, Uzarevic B, Petrovecki M et al: Clinical, histopathological and flow-cytometric properties of incidental renal cell carcinomas. Urol Res 2000, 28, 52-56.
  23. Luciani LG, Cestari R, Tallarigo C: Incidental renal cell carcinoma. Age and stage characterization and clinical implications: study of 1092 patients (1982-1997). Urology 2000, 56, 58-62.
  24. Sweeney JP, Thornhill JA, Grainger R et al: Incidentally detected renal cell carcinoma: pathological features, survival trends and implications for treatment. Br J Urol 1996, 78, 351-353.
  25. Pantuck AJ, Zisman A, Rauch MK et al: Incidentalrenal tumors. Urology 2000, 56, 190-196.
  26. Parsons KJ, Schoeneberg MS, Carter BH: Incidental renal tumors: casting doubt on the efficacy of early intervention. Urol 2001, 57, 1013-1015.

correspondence

Jakub Dobruch
Oddział Urologii Międzyleskiego Szpitala Specjalistycznego
ul. Bursztynowa 2
04-749 Warszawa
kubadobr@amwaw.edu.pl
tel. 0 503 072 230