AI Summary & Key Takeaways
AI InsightBut, all renal masses should be regarded as malignant and should be managed surgically otherwise proven benign.
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Abstract
Introduction: Renal cell carcinoma (RCC) is the most common malignant disease of the kidney and radical nephrectomy is the standard treatment of choice. Although the classical symptom triad of RCC has been reported to be flank pain, mass and hematuria, this symptom complex is present only in a limited number of patients and the diagnosis of RCC is most frequently being made by clinical and particularly radiological evaluation modalities such as abdominal ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI). A variety of benign lesions have been detected in a group of patients after the surgical treatment of kidney tumors with the preoperative diagnosis of kidney cancer. The aim of the present study was to evaluate retrospectively the histopathologically diagnosed benign lesions that were detected in the kidney after radical nephrectomy with the preoperative diagnosis of kidney cancer. Materials and Methods: The medical records of 108 (73 male, 35 female) patients with the preoperative diagnosis of kidney cancer, who were treated surgically were included in our study. Preoperative staging was done including physical examination, blood hemogram and biochemistry, abdominal US, chest x-ray, intravenous urography, abdominal CT and abdominal MRI. Although 10% of the cases with RCC could have a hyperechoic appearance on US, iso or hypoechoic mass lesions compared with the normal kidney were considered as malignant. On CT evaluation, malignant lesions were considered as isodense or hypodense mass lesions, which might as well less frequently be hyperdense compared with the normal kidney. Regarding MRI evaluation, moderate intensity signals are detected on T1 images whereas high intensity signals are detected on T2 images of the suspected lesion. Hundred and one patients were underwent radical nephrectomy and 7 patients underwent nephron sparing surgery (NSS). The benign lesions that were detected after histopathological examination were evaluated retrospectively. The median age of the patients was 58 (min 20, max 82). Results: Of the 108 patients, 75 (69.4%) had renal cell carcinoma, 13 (12.1%) had squamous cell carcinoma, adenocarcinoma and Wilms’ tumor and 20 (18.5%) had a variety of benign lesions. Most frequently detected benign lesions were angiomyolipoma (5.6%), chronic pyelonephritis (2.8%), xanthogranulamatous pyelonephritis (2.8%) and oncoytoma (1.9%). Other less frequent benign lesions were metanephric adenoma (0.9%), Bertini duct hypertrophy (0.9%), hyalen arteriosclerosis (0.9%), cortical cyst (0.9%), cortical infarct (0.9%) and renal botryomycosis (0.9%). Of the 7 patients who underwent NSS, angiomyolipoma was detected histopathologically in one patient. Conclusion: In spite of great technological developments regarding the radiological imaging modalities such as US, CT and MRI, benign lesions might still be detected pathologically in patients who were underwent radical nephrectomy with the preoperative diagnosis of renal cancer. But, all renal masses should be regarded as malignant and should be managed surgically otherwise proven benign.
Özet
Böbrek hücreli karsinom (BHK) böbreğin en sık görülen malin hastalığıdır ve standart tedavisi cerrahidir. Böbrek tümörü ön tanısı ile cerrahi tedavi yapılan olguların bir kısmında çeşitli benin lezyonlar saptanmaktadır. Bu çalışmanın amacı, böbrek tümörü ön tanısı ile radikal nefrektomi yapılan ve patoloji sonucu benin lezyonlar saptanan olguları retrospektif olarak değerlendirmektir. Böbrek tümörü ön tanısı ile cerrahi tedavi yapılmış 108 (73 erkek, 35 kadın) olgunun dosyalarının retrospektif olarak değerlendirilmesi sonucu histopatolojik olarak saptanmış benin lezyonlar belirlenmiştir. Olguların ortanca yaşları 58 (20-82)’dir. Toplam 108 olgudan, 75’inde (%69.4) BHK, 13’ünde (%12.1) skuamöz hücreli karsinom, adenokarsinom ve Wilms tümörü, 20 olguda (%18.5) ise çeşitli benin lezyonlar saptanmıştır. En sık görülen benin lezyonlar anjiomiyolipom, kronik piyelonefritik böbrek, ksantogranülomatöz piyelonefrit ve onkositom olarak saptanmıştır. Tüm görüntüleme yöntemlerine ve gelişen teknolojiye karşın böbrek tümörü ön tanısı ile radikal nefrektomi yapılan olguların bir kısmında patolojik olarak çeşitli benin lezyonlar saptanabilmektedir. Ancak, benin olduğu kanıtlanamayan tüm böbrek kitleleri malin gibi değerlendirilerek cerrahi olarak tedavi edilmelidir.