MUHSİN BALABAN, Rahim HORUZ, Oktay AKÇA, Selami ALBAYRAK

Cerrahi olarak tedavi edilen böbrek kitlelerinin histopatolojisi: 178 vakanın analizi

Amaç: Malignite şüphesiyle cerrahi olarak tedavi edilen böbrek kitlelerinin patolojik değerlendirmesini yaparak serimizdeki benign lezyonların sıklığını ve uygulanan tedavi yöntemlerini tespit etmek.Gereç ve Yöntemler : Şubat 2005 ile Aralık 2010 arasında malignite şüphesi nedeniyle ameliyat edilen 188 böbrek kitleli hastanın 120 erkek,68 kadın hasta kayıtları retrospektif olarak incelendi.Bulgular: Toplam 188 hastanın 178’inin kayıt bilgileri eksiksizdi. Bu hastalardan 142’sine radikal nefrektomi % 79 , 28’ine nefron koruyucu cerrahi %15 , 4’üne sadece böbrek biyopsisi %3 ve 4’üne de nefroüreterektomi %3 yapıldı. 178 tümörün 66’sının 37% tanısı insidental olarak konuldu. İnsidental saptanan kitlelerin 43’ünün %66 boyutu 7 cm’den küçüktü. Patolojik değerlendirmede 156 %88 hastada malignite saptanırken, 22 %12 hastada benign patolojiler bulundu. Benign kitleler sırasıyla onkositom n=11 , anjiomiyolipom n=6 , kistik nefroma n=2 , ksantogranülomatöz pyelonefrit n=2 ve metanefrik adenom n=1 idi. 7’cm den küçük 91 böbrek kitlesinin 22’sinde %24 benign patoloji saptandı. Benign kitlelerin hiçbiri 7 cm’den büyük değildi.Sonuç: Preoperatif malign olarak şüphe edilen kitleler, radyolojik görüntüleme yöntemlerindeki teknolojik gelişmelere rağmen, benign çıkabilmektedir. İnsidental olarak saptanan ve boyutu 7 cm’den küçük olan böbrek kitlelerinde nefron koruyucu cerrahi ön planda tutulmalıdır

Anahtar Kelimeler:

Benign patoloji, böbrek kitlesi, nefron koruyucu cerrahi

Histopathology of surgically managed renal tumors: analysis of 178 cases

Objective: To review the pathologic findings of a contemporary series of surgically treated renal tumors suspicious for malignancy to assess the frequency of benign disease and treatment modality.Materials and Methods: The records of 188 patients 120 male, 68 female underwent surgery for suspicious renal mass for malignancy between February 2005 and December 2010 were reviewed retrospectively.Results: Of 188 cases, records of a total of 178 cases were available for analysis. 142 patients underwent radical nephrectomy 79% , 28 nephron sparing surgery 15% , 4 renal biopsy 3% and 4 nephroureterectomy 3% . Of 178 tumors, 66 37% were discovered incidentally. Forty three 66% of incidentally diagnosed renal masses size were less than 7 cm. The pathologic evaluation demonstrated malignancy in 156 88% and benign disease in 22 12% .Benign masses were oncocytoma n=11 , angiomyolipoma n=6 , cystic nephroma n=2 , xanthogranulomatous pyelonephritis n=2 and metanephric adenoma n=1 . Of 91 renal masses with size of less than 7 cm, 22 24% had benign pathology and none of benign masses were bigger than 7 cm.Conclusion: Inspite of great technological development in the radiological imaging modalities, benign lesions may still be detected pathologically in the patients with preoperative diagnosis of renal cancer. Nephron sparing surgery should be kept in mind for the renal masses less than 7 cm, if possible

Keywords:

Benign pathology, renal mass, nephron sparing surgery,

PDF

___

Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2006. CA Cancer J Clin 2006;56:106-130.
Parkin DM, Bray F, Ferlay J, et al. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74-108.
Hock LM, Lynch J, Balaji KC. Increasing incidence of all stages of kidney cancer in the last 2 decades in the United States: an analysis of surveillance, epidemiology and end re- sults program data. J Urol 2002;167:57-60.
Silver DA, Morash C, Brenner, et al. Pathological findings at the time of nephrectomy for renal mass. Ann Surg Oncol 1997;4:570-574.
Remzi M, Katzenbeisser D, Waldert M, et al. Renal tumour size measured radiologically before surgery is an unreliab- le variable for predicting histopathologic features, benign tumours are not necessarily small. BJU Int 2007;99:1002-6.
Lopez-Beltran A, Scarpelli M, Montironi R, Kirkali Z. 2004 WHO classification of the renal tumors of the adults. Eur Urol 2006 ;49:798-805
Wilkinson C, Palit V, Bardapure M, et al. Adult multilocu- lar cystic nephroma: Report of six cases with clinical, radio- pathologic correlation and review of literature. Urol Ann 2013 ;5:13-7
Lee CT, Katz J, Shi W, et al. Surgical management of re- nal tumors 4 cm or less in a contemporary cohort. J Urol 2000;163:730-6.
Saranchuk JW, Touijer AK, Hakimian P,et al. Partial neph- rectomy for patients with a solitary kidney: the Memorial Sloan-Kettering experience. BJU Int 2004;94:1323-8.
Gill IS, Matin SF, Desai MM, et al. Comparative analysis of laparoscopic versus open partial nephrectomy for renal tu- mors in 200 patients. J Urol 2003;170:64-8.
Abouassaly R, Lane BR, Novick AC. Active surveillance of renal masses in elderly patients. J Urol 2008;180: 505-8.
Luciani LG, Cestari R, and Tallarigo C. Incidental renal cell carcinoma—age and stage characterization and clinical implications: study of 1092 patients (1982–1997). Urology 2000;56:58–64.
Kessler O, Mukamel E, Hadar H, et al. Effect of improved di- agnosis of renal cell carcinoma on the course of the disease. J Surg Oncol 1994;57:201–204.
Konnak JW, and Grossman HB: Renal cell carcinoma as an incidental finding. J Urol 1985;134:1094–1096.
Thompson RH, Kurta JM, Kaag M: Tumor size is associa- ted with malignant potential in renal cell carcinoma. J Urol 2009;181:2033-6.
Mustafa G, Ilhan G, Necip P, et al. Nature of lesions un- dergoing radical nephrectomy for renal cancer. Asian Pac J Cancer Prev 2012;13:4431-3.
Divgi CR, Pandit-Taskar N, Jungbluth AA, et al. Preope- rative characterisation of clear-cell renal carcinoma using iodine-124-labelled antibody chimeric G250 (124I-cG250) and PET in patients with renal masses: a phase I trial. Lan- cet Oncol 2007;8: 304-10.
Dechet CB, Sebo T, Farrow G, Blute ML, Engen DE, Zincke H. Prospective analysis of intraoperative frozen needle bi- opsy of solid renal masses in adults. J Urol 1999;162:1282-4.
Schmidbauer J, Remzi M, Memarsadeghi M, et al. Diagnos- tic accuracy of computed tomography-guided percutaneous biopsy of renal masses. Eur Urol 2008;53: 1003-11.
Kurta JM, Thompson RH, Kundu S, et al. Contempo- rary imaging of patients with a renal mass: Does size on Computed Tomography equal pathological size? BJU Int 2009;103:24-7.
Fergany AF, Hafez KS, and Novick AC: Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year followup. J Urol 2000;163: 442–445.