MS96-9955 (2slides)
KIDNEY
Clinical: 49 year old woman with bilateral renal masses who undergoes bilateral partial nephrectomies.
DX: #2 Papillary renal cell carcinoma (3.0cm)
#3 Renal papillary neoplasm of low malignant potential (2.0cm) see insert from report
Comment: The nomenclature of small renal cell neoplasms is not well sorted out at this time. Adenoma vs LMP vs small carcinoma is debated. Some call ALL renal cell neoplasms malignant because there are examples of small lesions that have metastasized in large series. Epstein prefers LMP for lesions smaller than 3.0 cms with no malignant features i.e., invasion, necrosis, hemorrhage or porminent atypia. Keep in mind that all stage 1 renal cell neoplasms are treated with surgery only, so calling a small benign appearing lesion a cortical adenoma or a small renal cell carcinoma won't affect treatment.
(insert)
Small lesions.
The diagnosis of renal cell lesions under 3 cm in diameter has been controversial. Most lesions under 3cm behave in a benign fasion. However, it is well documented that some lesions under 3cm will metastasize, although these cases may represent less than 5% of this group of lesions. We consider a non-oncocytic stage I, nuclear grade 1 or 2 lesion that is less than 3cm to be a renal cell lesion of low malignant potential, but would diagnose any tumor of higher stage or nuclear grade as carcinoma.
Review article Am. J. Clin. Path. 1995;103:624-635
KIDNEY
Clinical: 49 year old woman with bilateral renal masses who undergoes bilateral partial nephrectomies.
DX: #2 Papillary renal cell carcinoma (3.0cm)
#3 Renal papillary neoplasm of low malignant potential (2.0cm) see insert from report
Comment: The nomenclature of small renal cell neoplasms is not well sorted out at this time. Adenoma vs LMP vs small carcinoma is debated. Some call ALL renal cell neoplasms malignant because there are examples of small lesions that have metastasized in large series. Epstein prefers LMP for lesions smaller than 3.0 cms with no malignant features i.e., invasion, necrosis, hemorrhage or porminent atypia. Keep in mind that all stage 1 renal cell neoplasms are treated with surgery only, so calling a small benign appearing lesion a cortical adenoma or a small renal cell carcinoma won't affect treatment.
(insert)
Small lesions.
The diagnosis of renal cell lesions under 3 cm in diameter has been controversial. Most lesions under 3cm behave in a benign fasion. However, it is well documented that some lesions under 3cm will metastasize, although these cases may represent less than 5% of this group of lesions. We consider a non-oncocytic stage I, nuclear grade 1 or 2 lesion that is less than 3cm to be a renal cell lesion of low malignant potential, but would diagnose any tumor of higher stage or nuclear grade as carcinoma.
Review article Am. J. Clin. Path. 1995;103:624-635
