BÖBREK TÜMÖRÜ VAKALARININ RETROSPEKTİF OLARAK DEĞERLENDİRİLMESİ

Amaç: Böbreğin epitelyal karsinomu olan renal hücre kanseri, yetişkin tümörlerin yaklaşık %2-4’ünü oluşturmaktadır. Renal hücre kanseri vakalarının yaklaşık %80’i berrak hücreli renal hücreli karsinom (RHK) olarak tanımlanmaktadır. Bu çalışma ile böbrek tümörleri sınıflamasındaki bilgilerin revize edilerek böbrek tümör arşivimizin gruplandırılması ve elde edilmiş verilerle literatüre katkı sağlanması amaçlanmıştır.Gereç ve Yöntemler: Patoloji laboratuvarımızda, 2010-2019 yılları arasında tanı alan 52 böbrek tümörü vakası histopatolojik tanı, tümör çapı ve nükleer dereceleri açısından retrospektif olarak tekrar gözden geçirildi.Bulgular: Vakaların 34’ü (%65) erkek, 18’i (%34) kadındı. Yaş aralığı, 33-85 arasında değişmekte olup, ortalama yaş 58 olarak tespit edildi. Elli iki böbrek tümörünün 34’ü (%65) berrak hücreli renal hücre karsinomu, 5’i (%10) kromofob renal hücre karsinomu, 5’i (%10) papiller renal hücre karsinomu, 2’si (%3) onkositom ve 6’sı (%12) ise sınıflandırılamayan renal hücre karsinomu idi. Tümörlerin 15’i (%34.1) nükleer derece (ND) 1, 13’ü (%29.5) ND 2, 12’si (%27.3) ND 3 ve 4’ü (%9) ise ND 4 olarak tespit edildi. En büyük tümör çapına sahip histolojik alt tip 10.5 cm ile berrak hücreli renal hücre karsinom iken, en küçük çapa (1 cm) sahip histolojik tipin papiller renal hücre karsinom olduğu tespit edildi.Sonuç: Renal hücre karsinomunda tümör tipi, sarkomatoid/rabdoid farklılaşması, tümör nekrozu ve derecelendirmesi, potansiyel prognostik parametreler olarak kabul edilmektedir. Papiller renal hücre karsinomu alt tiplerinin (Tip 1 ve 2) belirlenmesi ek prognostik bilgi sağlamakta olup, berrak hücreli tubulopapiller renal hücre karsinomu daha iyi bir prognoz ile ilişkilendirilmiştir. Sarkomatoid veya rabdoid farklılaşması gösteren tümörler minimum bir tümör oranına bakılmaksızın belirtilmelidir. Makroskopik ve mikroskobik incelemeye dayalı değerlendirme ile tümör nekrozunun prognostik önemi olduğu bildirilmektedir. Nükleol belirginliği, berrak hücreli ve papiller RHK’lerin 1 ila 3’lük derecelerini tanımlamaktadır. Aşırı nükleer pleomorfizm veya sarkomatoid ve/veya rabdoid farklılaşma ise 4. derecedeki tümörleri göstermektedir. Ayrıca pT evreleme kategorisinin ise prognostik önemlerini koruduğu bildirilmektedir.

Anahtar Kelimeler:

Böbrek, tümör, karsinom, retrospektif, sınıflama

Retrospective Evaluation of Renal Tumor Cases

Objective: Renal cell carcinoma (RCC) of the kidney constitutes approximately 2-4%of adult tumors. Approximately 80%of renal cell cancer cases are defined as clear cell renal cell carcinoma. The aim of this study was to review the renal cell carcinoma cases in our archive to provide additional information to the literature.Material and Methods: 52 cases of renal tumors diagnosed in our pathology laboratory between 2010-2019 were reviewed retrospectively for histopathological diagnosis, tumor size and nuclear grade.Results: 34 (65%) of the cases were male and 18 (34 %) were female. The age of the cases ranged between 33 and 85 years, with a mean age of 58 years. Of the fifty-two kidney tumors, 34 (65%) were clear cell renal cell carcinoma, 5 (10%) were chromophobe renal cell carcinoma, 5 (10%) were papillary renal cell carcinoma, 2 (3%) were oncocytoma and 6 (12%). was unclassified renal cell carcinoma. Fifteen (34.1%) of the tumors were nuclear grade (NG) 1, 13 (29.5%) were NG 2, 12 (27.3%) were NG 3 and 4 (9%) were NG 4. The histological subtype with the largest (10.5 cm) tumor diameter was clear cell renal cell carcinoma, while papillary renal cell carcinoma was with the smallest (1 cm) tumor diameter.Conclusion: Tumor type, sarcomatoid / rhabdoid differentiation, tumor necrosis and grading in RCC are considered as potential prognostic parameters. Determination of papillary renal cell cancer subtypes (type 1 and 2) provides additional prognostic information and clear cell tubulopapillary renal cell cancer has been associated with a better prognosis. Tumors showing sarcomatoid or rhabdoid differentiation should be indicated regardless of the percentage of these histopathological features. It is reported that tumor necrosis has a prognostic significance by the evaluation based on macroscopic and microscopic examination. Nucleolar prominence defines grade 1 to 3 in clear cell and papillary renal cell carcinomas. Extreme nuclear pleomorphism or sarcomatoid and/or rhabdoid differentiation showing tumors are graded as grade 4. In addition to the grading, pT stage is reported to maintain its prognostic significance.

Keywords:

Kidney, tumor, carcinoma, retrospective, classification,

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1. Siegel R, Naishadham D, Jemal A. Cancer statistics. CA Cancer J Clin. 2013;63(1):11-30.
2. Dutcher JP. Update on the biology and management of renal cell carcinoma. J Investig Med. 2019;67(1):1-10.
3. Moch H, Cubilla AL, Humphrey PA, Reuter VE, Ulbright TM. The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part A: Renal, Penile, and Testicular Tumours. Eur Urol. 2016;70(1):93-105.
4. Moch H, Humphrey PA, Ulbright TM, Reuter VE. WHO Classification of Tumours. 4th ed. Lyon. IARC Ltd, 2016:14-7.
5. Stella M, Chinello C, Cazzaniga A, Smith A, Galli M, Piga I et al. Histology-guided proteomic analysis to investigate the molecular profiles of clear cell Renal Cell Carcinoma grades. J Proteomics. 2019;191:38-47.
6. Castillo RP, Santoscoy JF, Pisani L, Madrazo BL, Casillas VJ. Imaging of unusual renal tumors. Curr Urol Rep. 2019; 21;20(1):5.
7. Al-Bayati O, Hasan A, Pruthi D, Kaushik D, Liss MA. Systematic review of modifiable risk factors for kidney cancer. Urol Oncol. 2019;37(6):359-71.
8. Srigley JR, Delahunt B, Eble JN, Egevad L, Epstein JI, Grignon D et al. The ISUP renal tumor panel the International Society of Urological Pathology (ISUP). Vancouver classification of renal neoplasia. Am J Surg Pathol. 2013;37(10):1469-89.
9. Nguyen MM, Gill IS, Ellison LM. The evolving presentation of renal carcinoma in the United States: trends from the surveillance, epidemiology, and end results program. J Urol. 2006;176(6):2397-400.
10. Delahunt B, Cheville JC, Martignoni G, Humphrey PA, Magi-Galluzzi C, McKenney J et al. The International Society of Urological Pathology (ISUP) Grading System for Renal Cell Carcinoma and Other Prognostic Parameters. Am J Surg Pathol. 2013;37(10):1490-504.
11. Dagher J, Delahunt B, Rioux-Leclercq N, Egevad L, Srigley JR, Coughlinm G et al. Clear cell renal cell carcinoma: validation of World Health Organization/International Society of Urological Pathology grading. Histopathology. 2017;71(6):918-25.
12. Patel HD, Pierorazio PM. Active Surveillance of Renal Tumors. In: Gorin M, Allaf M, eds. Diagnosis and Surgical Management of Renal Tumors. 1st ed. New York. Springer, 2019:101-113.
13. Bianchi M, Sun M, Jeldres C, Shariat SF, Trinh QD, Briganti A et al. Distribution of metastatic sites in renal cell carcinoma: a population-based analysis. Ann Oncol. 2012;23(4):973-80.
14. Janzen NK, Kim HL, Figlin RA, Belldegrun AS. Surveillance after radical or partial nephrectomy for localized renal cell carcino-ma and management of recurrent disease. Urol Clin North Am. 2003;30(4):843-52.
15. Heng DY, Wells JC, Rini BI, Beuselinck B, Lee JL, Knox JJ et al. Cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma: results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur Urol. 2014;66(4):704-10.
16. Ulaş A, Bilgin B, Şener Dede D, Köş FT, Akıncı MB, Şendur MAN ve ark. Böbrek hücreli karsinomlu hastaların demografik özellikleri ve tedavi sonuçları: tek merkez deneyimi. Ankara Med J. 2016;16(2):149-62.