A renal mass in the setting of a nonrenal malignancy

Abstract

BACKGROUNDFrequently, a renal mass is identified when patients with cancer undergo studies for staging or surveillance. In determining whether it represents a metastasis, patients are frequently subjected to percutaneous renal biopsies. The authors evaluated their experience with this dilemma to formulate management guidelines.METHODSThe authors reviewed the medical records of 100 consecutive patients with nonrenal malignancies diagnosed with renal masses at presentation or follow‐up. Renal mass histology was available for all patients after nephrectomy or biopsy. Clinical characteristics were assessed to identify factors predictive for a renal metastasis versus a primary renal neoplasm.RESULTSThe only factors predictive of a metastasis to the kidney were progression of the nonrenal malignancy and lack of enhancement of the renal mass (P < 0.0001). Forty‐six patients (46%) had evidence of progression of their nonrenal malignancy in addition to the renal mass. In these patients, the probability of a metastasis to the kidney was 86% (95% confidence interval [CI], 57.2–98.2%) without renal mass enhancement and 32% (95% CI, 14–55%) with enhancing renal masses. None of the 54 patients without signs of progression of their nonrenal malignancy proved to have metastases to the kidney, regardless of the imaging characteristics of the mass (zero probability; 95% CI, 0–7%; P < 0.001).CONCLUSIONSIn patients presenting with renal masses and another clinically localized malignancy, renal mass biopsies were not indicated, as the mass rarely represented a metastasis. These patients may opt for close surveillance or extirpation based on the prognosis of their nonrenal malignancy. Cancer 2004. © 2004 American Cancer Society.

PAX-8 expression in renal tumours and distant sites: A useful marker of primary and metastatic renal cell carcinoma?

“…Currently the American Urologic Association guidelines suggest renal mass biopsy when there are clinical or radiological concerns for lymphoma or metastasis to the kidney from a different solid tumour 30. In the setting of a possible non-renal malignancy, a biopsy in conjunction with molecular markers could alter management, as a renal mass may represent a metastatic site of disease nearly 20% of the time 31. In other situations, such as prior to cytoreductive nephrectomy, some experts have suggested that tissue assessment of either the primary or a distant site may be useful to help defer surgery 32.…”

Renal metastasis from pancreatic adenocarcinoma: a rare case along with literature review

“…[1] Computed tomography (CT) is the primary diagnostic tool for renal metastases, revealing isodense masses that range from 5 to 30 Hounsfield units (HU). [3] Percutaneous renal biopsy performed on these masses provides pathological confirmation, [4] and these patients are usually treated with systemic treatment. In detected metastatic pancreatic cancer, survival can be prolonged up to 11.1 months by use of various chemotherapeutic agents.…”

Early renal cell cancer

“…Second, tissue obtained by needle biopsy does not provide sufficient pathological information. 29 Nevertheless, if there is a suspicion of metastasis originating from an other organ, 30 or preceding an ablative technique in RCC that requires a probe, needle biopsy is performed for pathological diagnosis.…”