Cystic Renal Cell Carcinoma Is Cured by Resection: A Study of 24 Cases With Long-Term Followup

Corica, Federico A.; Iczkowski, Kenneth A.; Liu, Cheng; Zincke, Horst; Blute, Michael L.; Wendel, Amy J.; Sebo, Thomas J.; Neumann, Roxann M.; Bostwick, David G.

doi:10.1016/s0022-5347(01)61903-7

Cited by 120 publications

(68 citation statements)

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“…This observed growth rate was similar to those of other series with smaller mean lesion sizes. Additionally, the presence of cystic components did not predict future tumor growth when compared to solid lesions despite their potentially improved prognosis (10,(13)(14)(15)(16)(17). This is the first report to our knowledge that compares the growth rates of multifocal and solitary renal lesions under surveillance.…”

Section: Discussionmentioning

confidence: 97%

Predicting growth of solid renal masses under active surveillance

Crispen

Wong

Greenberg

et al. 2008

Urologic Oncology: Seminars and Original Investigations

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Objectives-The natural history and growth rates of untreated solid enhancing renal tumors is being defined through active surveillance series. Serial radiographic evaluation of patients who are not surgical candidates or refuse surgical treatment provides an opportunity to characterize the growth of untreated enhancing renal tumors. Here we evaluate factors which may help predict for radiographic growth during observation.Methods and Materials-We reviewed our renal cancer database for enhancing renal masses that were radiographically observed for a period of at least 12 months. Variables examined included patient age, gender, lesion size on presentation, radiographic tumor characteristics, duration of active surveillance, linear growth rate, surgical pathology, development of new renal tumors, and stage progression.Results-109 patients with 124 sporadic enhancing renal tumors were identified undergoing a period of active surveillance of at least 12 months. Median patient age was 73 years (mean 69.8, range 35-87). 72% (78/109) of patients were males. Median duration of active surveillance was 26 months (mean 33.4, range 12-156). Multifocal disease was present in 9% (10/109) patients on presentation, accounting for 20% (25/124) of all tumors. Tumor size on presentation was a median of 2.0 cm (mean 2.61, range 0.4 -12.0). Overall median tumor growth rate was 0.21cm/yr (mean 0.28, range −1.4 -2.47). Observed linear growth rates were independent of patient age, gender, tumor size on presentation, multifocality, and radiographic characteristics (solid versus cystic), p > 0.05. Of the patients initiating a period of active surveillance 36% (39/109) eventually underwent definitive therapy. Malignant pathology was present in 90% (35/39) of patients undergoing treatment. In patients continuing active surveillance (64% (70/109)), 2.9% (2/70) developed de novo renal lesions and 1.4% (1/70) developed metastatic disease.Conclusions-Currently, no clinical predictors of tumor growth or disease progression have been identified; although, the risk of developing progressive disease over the short term appears low. Clinical and molecular markers of disease progression are needed prior to offering active surveillance to otherwise acceptable surgical candidates.

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Section: Discussionmentioning

confidence: 97%

Predicting growth of solid renal masses under active surveillance

Crispen

Wong

Greenberg

et al. 2008

Urologic Oncology: Seminars and Original Investigations

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“…1,22 Multilocular cystic renal cell carcinoma is almost always discovered incidentally before the onset of symptoms. 23 The differential diagnosis of this entity consists of other cystic lesions of the kidney, primarily cystic nephroma, extensively cystic clear cell renal cell carcinoma, clear cell papillary renal cell carcinoma, and tubulocystic carcinoma. While cystic nephroma may have at least some clear cells lining the septa, the lining clear cells tend to be focally rather than diffusely distributed, and there are no clusters of clear cells in the walls.…”

Section: Discussionmentioning

confidence: 99%

Multilocular cystic renal cell carcinoma is a subtype of clear cell renal cell carcinoma

et al. 2010

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Multilocular cystic renal cell carcinoma is an uncommon low grade renal cell carcinoma with unique morphologic features. Its cytogenetic characteristics have not been fully investigated. Its relationship to typical clear cell renal cell carcinoma is uncertain. We evaluated 19 cases of multilocular cystic renal cell carcinoma diagnosed by strict morphologic criteria using the 2004 WHO classification system. The control group consisted of 19 low grade (Fuhrman grades 1 or 2) clear cell renal cell carcinomas. Chromosome 3p deletion status was determined by dual color interphase fluorescence in situ hybridization analysis. Chromosome 3p deletion was identified in 17 out of 19 (89%) of the clear cell renal cell carcinoma cases and 14 out of 19 (74%) of the multilocular cystic renal cell carcinoma cases, respectively. There was no difference in the status of chromosome 3p deletion between clear cell renal cell carcinoma and multilocular cystic renal cell carcinoma (P ¼ 0.40). These results support the concept that multilocular cystic renal cell carcinoma as a subtype of clear cell renal cell carcinoma.

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“…63 Although the suggested treatment of choice for these lesions remains surgical excision, there is increasing evidence that they have relatively low metastatic potential and carry an excellent prognosis. [63][64][65][66][67] To the best of our knowledge, there is yet to be a report demonstrating metastases or recurrence of these lesions. To reflect this indolent behaviour, the International Society of Urological Pathology (ISUP) has recently modified its terminology and now recommends calling these lesions multilocular cystic renal neoplasm with low malignant potential.…”

Section: Bosniak Category IVmentioning

confidence: 99%