Renal lymphatics, and lymphatic involvement in sinus vein invasive (pT3b) clear cell renal cell carcinoma: a study of 40 cases

Bonsib, Stephen M.

doi:10.1038/modpathol.3800589

Cited by 64 publications

(58 citation statements)

References 20 publications

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“…The intravenous tumor typically had a delicate supporting capillary lattice, identical to the primary tumor, and characteristic of CC in general. The presence of a capillary lattice is diagnostically useful, as recently shown by Bonsib,7 because it distinguishes a vein from a lymphatic, a distinction also possible with IH. This capillary lattice is nourished by numerous venous pedicles that sprout from the media at numerous foci along the intravenous extension.…”

Section: Renal Sinus Involvement In Clear Cell Renal CCmentioning

confidence: 84%

“…Some of these small, involved spaces lacking a capillary plexis may represent lymphatic involvement as reported previously, easily addressed with an immunohistochemical stain for a lymphatic endothelial cell marker. 7 Not all discrete nodules of tumor within the sinus were recognizable as intravenous tumor on H&E-stained sections. Some required immunohistochemistry (IH) for confirmation.…”

Section: Renal Veins and Venous Extension In Renal CCmentioning

confidence: 98%

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Renal veins and venous extension in clear cell renal cell carcinoma

Bonsib

2007

Modern Pathology

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The 2002 TNM formulation defines a pT3b tumor as one that 'extends into the renal vein or its segmental (muscle containing) branches.' This definition elicits uncertainty when veins with little muscle are involved or the relationship to the main renal vein is unknown. The diameter and medial thickness of 10 normal renal venous systems were studied and compared to sinus veins involved in 54 pT3b clear cell renal cell carcinomas (CC). All tumors were grossly examined and sampled for histology by the author. An immunoperoxidase cocktail containing CD 31 and actin, Masson trichrome and elastic stains were employed to aid identification of intravenous tumor. The venous dissections showed variable numbers of primary and secondary divisions with substantial overlap in diameter and medial thickness. The medial thickness decreased with each proximal division and ranged from being nonexistent to being thick. Study of the 54 pT3b CC revealed that the initial phase of extrarenal extension involved large caliber veins draining the primary tumor. With extensive venous involvement, tumor invaded through the vein wall into sinus fat or demonstrated retrograde venous extension into adjacent cortex. Correlation between gross and histology revealed that most nodules of tumor within the sinus fat contained evidence of pre-existing veins. The following observations were made: (1) the diameter of a sinus vein or the quantity of muscle is a poor indicator of vein segment or relationship to the main renal vein; therefore, the wording used to define pT3b should be clarified; (2) extrarenal spread in CC begins with intravenous extension whereas sinus fat invasion is usually secondary; (3) retrograde venous extension occurs in cases with massive renal vein involvement; and (4) nodules within the sinus fat usually represent venous involvement. Modern Pathology (2007) 20, 44-53.

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Section: Renal Sinus Involvement In Clear Cell Renal CCmentioning

confidence: 84%

Section: Renal Veins and Venous Extension In Renal CCmentioning

confidence: 98%

Renal veins and venous extension in clear cell renal cell carcinoma

Bonsib

2007

Modern Pathology

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“…84 Separate reports have also shown infiltration of lymphatics and small blood vessels in the renal sinus to have prognostic significance. 85,86 From these studies it appears that tumor size predicts renal sinus invasion, as this is seen in 97% of tumors 47 cm in diameter. These observations have been confirmed for clear cell RCC, papillary RCC, and chromophobe RCC, although involvement of the renal sinus was found to be less frequent in the latter two tumor subtypes.…”

Section: Regional Spread Of Tumor (Tnm Category T3)mentioning

confidence: 99%

Advances and controversies in grading and staging of renal cell carcinoma

2009

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Despite the considerable progress made in our understanding of the pathogenesis, genetics, and pathology of renal cell carcinoma (RCC), difficulties remain relating to the prediction of clinical outcome for individual cases. Although there is evidence to show that high-grade tumors have a poorer prognosis when compared to those of low grade, debate remains regarding the predictive value of grading, especially for those tumors classified into the intermediate grades. Numerous composite morphologic and nuclear grading systems have been proposed for RCC and although that of the Fuhrman classification have achieved widespread usage, the validity of the grading criteria of this classification has been questioned. In addition, there are few studies that have attempted to validate the Fuhrman system for RCCs beyond that of the clear cell subtype. Recent studies have indicated that grading of papillary RCC should be based on nucleolar prominence alone and that the components of the Fuhrman grading classification do not provide prognostic information for chromophobe RCC. Independent of tumor grade, the prognostic importance of tumor stage for RCC is well recognized. The Union Internationale Contre le Cancer/American Joint Committee for Cancer Staging and End Results Reporting TNM staging system is now in its sixth edition (2002) and recent refinements have focused on defining size cut points that will identify apparently localized tumors that will develop recurrence and/or metastases despite attempted curative surgery. In parallel with these studies it has been shown that infiltration of the renal sinus is an important prognostic factor, being observed in almost all tumors 47 cm in diameter. Questions remain as to the appropriate stratification of regional extension of RCC, as defined in the T3 tumor-staging category. Recent modifications to this category have been suggested combining the level of infiltration of the venous outflow tract with the presence or absence of infiltration of the adrenal gland and/or perirenal fat. Similarly, the utility of classifying lymph node involvement by tumor is debated, although it is well recognized that lymph node infiltration is associated with a poor prognosis. Although the current TNM classification does provide useful prognostic information it would appear that further modifications are justified to enhance the predictive value of staging for RCC.

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“…The correct pathological staging is the basis for every clinical decision [86]. In the last years, it has been demonstrated that invasion of the sinus fat tissue is more frequent than expected and is associated with greater tumor aggressiveness [87][88][89]. This sinus fat tissue contains a number of large thin-walled veins and lymphatics and it is not separated from the renal cortex by a fibrous capsule.…”

Section: Prognosis Of Renal Cell Carcinoma and The Use Of Biomarkersmentioning

confidence: 99%