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Clinicopathologic Features of Small Renal Masses Associated With Distant Metastatic Disease
Alexander J Gallan1, Tatjana Antic2
1Department of Pathology, Medical College of Wisconsin, Milwaukee.
Objectives:
To assess the clinicopathologic features of small renal masses (≤4 cm) associated with distant metastatic disease.
Methods:
We identified radical or partial nephrectomies with renal cell carcinomas (RCCs) measuring 4 cm or less in size (pT1a or pT3a) from 2005 to 2015. Clinicopathologic features were compiled.
Results:
A total of 590 RCCs 4 cm or less were identified, of which 3.9% were associated with distant metastatic RCC. Metastasis was more common in pT3a tumors 4 cm or less than pT1a tumors (19% vs 2.7%; P < .01). Seventy percent of tumors were clear cell RCCs. Overall, 43% of patients had previously (30%) or subsequently (13%) diagnosed RCC prior to development of metastasis, 80% of which were the same histologic subtype as the small renal mass.
Conclusions:
Distant metastatic disease was rarely encountered in patients with small renal masses. Many of the patients with distant metastases had previously or subsequently diagnosed RCC, which could represent the true source of metastatic disease.
Insights
Distant metastatic disease is rare in small renal masses (≤4 cm). Many metastatic cases involved prior or subsequent renal cell carcinoma (RCC), suggesting a potential primary source other than the small mass.
Area of Science:
- Urology
- Oncology
- Pathology
Background:
- Small renal masses (≤4 cm) are frequently detected.
- The risk of distant metastasis from these small tumors requires further characterization.
Purpose of the Study:
- To evaluate the clinicopathologic features of small renal masses (≤4 cm) associated with distant metastatic disease.
- To determine the incidence and characteristics of metastasis in small renal cell carcinomas (RCCs).
Main Methods:
- Retrospective review of radical or partial nephrectomies for renal cell carcinomas (RCCs) measuring ≤4 cm (pT1a or pT3a) between 2005 and 2015.
- Compilation and analysis of clinicopathologic features for identified cases.
Main Results:
- Of 590 small RCCs (≤4 cm), 3.9% showed distant metastasis.
- Metastasis was more frequent in pT3a (19%) than pT1a (2.7%) small tumors (P < .01).
- Forty-three percent of patients with metastasis had prior or subsequent RCC diagnoses, often of the same histologic subtype.
Conclusions:
- Distant metastatic disease is uncommon in small renal masses.
- A significant proportion of metastatic cases may originate from a different, previously or subsequently diagnosed RCC, highlighting the importance of patient history.
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