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Multifocality in renal cell carcinoma: A bilateral event?
H Wunderlich1, A Schlichter, D Zermann
1Department of Urology, Friedrich Schiller University, Jena, Germany.
Urologia Internationalis
|March 30, 2000
Summary
Multifocal renal cell carcinoma (RCC) nodules are common, with nearly 90% occurring bilaterally. Predicting multifocality in RCC is challenging, though certain factors like papillary histology may indicate higher risk.
Area of Science:
- Urology
- Oncology
- Pathology
Background:
- Nephron-sparing surgery for renal cell carcinoma (RCC) carries a risk of local recurrence.
- Recurrence is often due to undetected small tumors in the remaining kidney tissue.
- Understanding multifocal tumor patterns is crucial for surgical planning and recurrence risk assessment.
Purpose of the Study:
- To determine the incidence and characteristics of unilateral and bilateral multifocal tumors in renal cell carcinoma.
- To investigate factors associated with multifocality in renal cell carcinoma.
Main Methods:
- An autopsy study involving 14,793 cases from 1985 to 1995.
- Systematic 5 mm serial sectioning of kidneys to identify small renal lesions in all cases of renal cell carcinoma.
- Detailed examination for multifocal malignant and/or benign nodules.
Main Results:
- 36 out of 260 renal cell carcinomas (13.85%) exhibited multifocal nodules.
- Additional nodules ranged from 2 to 18 per case.
- 88% of multifocal renal cell carcinomas were bilateral, with an average lesion size of 8.7 x 9.0 x 9.5 mm.
- Higher incidence of multifocal nodules was observed in low-stage, good-grade, and chromophilic renal cell carcinomas.
Conclusions:
- Multifocality in renal cell carcinoma is difficult to predict reliably.
- Papillary histology, good tumor grade, and low stage are associated with a higher incidence of multifocal nodules.
- The majority (nearly 90%) of multifocal renal cell carcinoma nodules are bilateral.