Prognostic relevance of extensive necrosis in renal cell carcinoma

Abstract

Aims: Evidence suggests that the presence of tumour necrosis is an adverse prognostic factor in renal cell carcinoma (RCC). However, it has also been shown that tumour regression, a microscopic feature associated with necrosis, may be a favourable short term prognostic factor in RCC. Methods: Pathology reports of 253 RCCs from 1992 to 2001 were reviewed, and identified 37 tumours with substantial macroscopic or microscopic necrosis. Microscopic pathology, TNM 1997 tumour stage, and clinical follow up were reviewed and correlated with pathological findings. Three cases were rejected because two were diagnosed at necropsy, and a third was the result of renal arterial embolisation. Results: Twenty of the 34 cases showed ,50% necrosis, 10 showed 50-94% tumour necrosis, and four showed .95% tumour necrosis. Follow up data were unavailable in three cases. Nine of the remaining 31 tumours progressed; six were group 3 tumours showing ,50% necrosis, three were group 2 tumours showing 50-94% necrosis, and none was a group 1 tumour showing .95% necrosis. Conclusions: Extensive necrosis (.95% necrosis) is rare in RCC, accounting for only 1.6% of those diagnosed during eight years in this unselected hospital series. The microscopic pattern of necrosis was typical, requiring extensive tumour sampling for definitive tumour diagnosis. Although there were only four patients with extensive necrosis, none developed recurrent or metastatic carcinoma, or died from RCC. Although extensive (.95%) necrosis may imply better short term prognosis after adjusting for tumour pathological TNM stage, it is probably not a prognostic variable in RCC. and any evidence of tumour necrosis. 1 2 5-8 However, the importance of extensive necrosis, which is rare in RCC, is not entirely clear.9 10 A recent study suggested that RCC with very extensive necrosis may be capable of aggressive behaviour. 8Necrosis is commonly seen in RCC and necrosis has been shown to be an adverse prognostic factor in certain subtypes of RCC, if any necrosis at all is present in the tumour sections.1 2 5-8The pathology reports of all cases of RCC diagnosed over an eight year period were retrieved from our laboratory files to identify tumours showing extensive necrosis. The clinical follow up data of these patients were then obtained. MATERIALS AND METHODSThe pathology reports of all 253 RCCs diagnosed between 1992 and 2001 at the department of pathology at Queen Alexandra Hospital, Portsmouth, UK, were reviewed after they were identified by searching the laboratory computer database using a SNOMED search for all RCCs. We identified 37 tumours where the pathologist had commented that there was evidence of either macroscopic or microscopic necrosis at the time of originally reporting the case. The gross descriptions and all available slides from these 37 cases were then reviewed in detail, without prior knowledge of the clinical follow up data or patient prognostic information. The overall percentage of necrosis in each case was assessed from all the available haematoxylin and...

Evaluation of CD31 (PECAM-1) Expression Using Tissue Microarray in Patients with Renal Cell Carcinoma

“…Due to the limited number of tumours, it was impossible to draw any conclusions concerning the potential prognostic information of necrosis. An inadequate blood sup-ply is probably the most likely reason for tumour necrosis, but there are also other plausible mechanisms such as immune reactions [31] . In the present study no evaluation of necrosis was performed; actually, with the limited material assessed by TMA we tried to avoid necrotic parts of the tumours.…”

“…Furthermore, they identified Ki67 expression as a surrogate marker for necrosis. Foria et al [31] assessed patients with RCC and found that tumours with extensive necrosis were rare. Due to the limited number of tumours, it was impossible to draw any conclusions concerning the potential prognostic information of necrosis.…”

Grading of renal cell carcinoma

“…These terms are unfortunate, as it is not coagulative necrosis. Further, while thrombo‐embolic coagulative necrosis is usually macroscopic and may be extensive, tumour‐related necrosis may be macroscopic or microscopic . The aetiology of this form of necrosis is unknown, although an immune reaction or microvascular changes have been postulated .…”

Recommendations from the 2012 International Society of Urological Pathology Vancouver Consensus Conference on Renal Tumors

“…Sarkomatoid ve rabdoid diferansiasyon gösteren tümörlerde rekürrens ve metastaz oranının fazla olduğu ve bu tümörlerde orijinal tümör tipinin de raporda belirtilmesi gerektiği vurgulanmıştır. Son çalışmalar RHK'larda koagülatif tümör nekrozunun prognostik önemi olduğunu ortaya koymaktadır (34,35). Makroskopik ve mikroskopik tümör nekrozunun ve nekroz oranının raporlarda yer alması gerektiği konusunda da görüş birliği sağlanmıştır.…”