Renal Oncocytosis: Management and Clinical Outcomes
ABSTRACT Renal oncocytosis is a rare pathological condition in which renal parenchyma is diffusely involved by numerous oncocytic nodules in addition to showing a spectrum of other oncocytic changes. We describe our experience with renal oncocytosis, focusing on management and outcomes.
A total of 20 patients with a final pathological diagnosis of renal oncocytosis from July 1995 through June 2009 were included in the analysis. Patient demographics, intraoperative variables and postoperative outcomes are reported.
Median age at nephrectomy was 71 years (IQR 59-75). Of the patients 15 (75%) had bilateral disease. There were 23 operations (9 right side, 14 left side) performed on 20 patients, and of these procedures 13 (57%) were partial nephrectomies and 10 (43%) were radical nephrectomies. Median dominant tumor mass diameter was 4.1 cm (IQR 3-6.4, range 1 to 14.6). The most common dominant tumor histology was hybrid tumor between oncocytoma and chromophobe renal cell carcinoma in 13 of 23 specimens (57%), followed by chromophobe renal cell carcinoma in 6 (26%), oncocytoma in 3 (13%) and conventional renal cell carcinoma in 1 (4%). Ten patients (50%) had preexisting chronic kidney disease before nephrectomy and chronic kidney disease developed in 5 more after surgery. After a median followup of 35 months no patients had metastatic disease.
Patients with renal oncocytosis usually present with multiple and bilateral renal nodules. Half of the patients had chronic kidney disease at diagnosis and 25% had new onset of chronic kidney disease. No patient had distant metastatic disease during followup. Our management approach is to perform partial nephrectomy when possible and then use careful surveillance of the remaining renal masses.
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ABSTRACT: Secondary to the widespread use of the modern imaging techniques of computed tomography, magnetic resonance imaging, and ultrasound, 70% of renal tumors today are detected incidentally with a median tumor size of less than 4 cm. Twenty years ago, all renal tumors, regardless of size were treated with radical nephrectomy (RN). Elective partial nephrectomy (PN) has emerged as the treatment of choice for small renal tumors. The basis of this paradigm shift is three major factors: (1) cancer specific survival is equivalent for T1 tumors (7 cm or less) whether treated by PN or RN; (2) approximately 45% of renal tumors have indolent or benign pathology; and (3) PN prevents or delays the onset of chronic kidney disease, a condition associated with increased cardiovascular morbidity and mortality. Although PN can be technically demanding and associated with potential complications of bleeding, infection, and urinary fistula, the patient derived benefits of this operation far outweigh the risks. We have developed a "mini-flank" open surgical approach that is highly effective and, coupled with rapid recovery postoperative care pathways associated with a 2-day length of hospital stay.Nature Clinical Practice Urology 02/2006; 3(1):2-3. DOI:10.1038/ncpuro0382 · 4.07 Impact Factor
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ABSTRACT: Oncocytosis (oncocytomatosis) is a rare condition characterized by the presence of innumerable oncocytic nodules in one or both kidneys, usually associated with the presence of a dominant nodule. An incidental detection of a renal tumor in a renal biopsy performed for the diagnosis of a medical disease of the kidney is exceptional. We report herein a case of a 58-year-old woman presenting with idiopathic nephrotic syndrome. Histological examination of the percutaneous renal core biopsy revealed a minimal-change glomerular lesion and oncocytosis. A contrast-enhanced abdominal CT scan showed two solid round masses, one in each kidney, measuring 1.5 and 2 cm. The nephrotic syndrome was responsive first to prednisone and finally to cyclosporine. Pathological study of both renal dominant masses confirmed that they were oncocytomas. As far as we are aware, renal oncocytosis incidentally discovered in a biopsy performed for the diagnosis of a medical disease of the kidney has not been reported.Pathology - Research and Practice 11/2011; 207(11):733-6. DOI:10.1016/j.prp.2011.09.002 · 1.56 Impact Factor
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ABSTRACT: Although the management of sporadic renal tumors is challenging enough, dealing with those with bilateral, multifocal, and hereditary kidney cancer adds an additional level of complexity. A clinician managing this patient population must understand the hereditary syndromes and the genetic testing available. Treating physicians must be familiar with enucleative surgery, complex or multiple tumor partial nephrectomy, complex renal reconstruction, re-operative renal surgery, and active surveillance strategies. With proper management, most patients affected with bilateral, multifocal, or hereditary RCC can have a long life expectancy while maintaining adequate renal function.Urologic Clinics of North America 05/2012; 39(2):133-48, v. DOI:10.1016/j.ucl.2012.01.006 · 1.35 Impact Factor