Thompson Robert Houston, Blute Michael L, Krambeck Amy E, Lohse Christine M, Magera James S, Leibovich Bradley C, Kwon Eugene D, Frank Igor, Cheville John C
Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN 55905, USA.
Am J Surg Pathol. 2007 Jul;31(7):1089-93. doi: 10.1097/PAS.0b013e31802fb4af.
Prior studies suggest that the renal sinus permits early tumor spread in otherwise localized renal cell carcinoma (RCC) tumors. We hypothesized that renal sinus fat invasion may be unrecognized in pT1 patients who subsequently die from RCC. Between 1985 and 2002, we identified 577 patients who underwent radical nephrectomy for localized pT1 clear cell RCC as reviewed by a single urologic pathologist (J.C.C.). Among these patients, 49 died from RCC including 33 who had their original nephrectomy specimen stored in formalin. These specimens were then resectioned with thin cuts of the renal sinus and reviewed by the same pathologist. For comparison, 33 patients who did not die from RCC (controls) also had their original nephrectomy specimen resectioned. Among the 33 patients who died from seemingly localized RCC, 14 (42%) had previously unrecognized renal sinus fat invasion compared with 2 (6%) of the controls (P<0.001). In addition, 19 (58%) patients who died from RCC had renal sinus small vein (microscopic venous) invasion, a pathologic feature not currently incorporated into the TNM staging system for RCC. This feature was present in 7 (21%) of the controls (P=0.003). In total, 22 (67%) patients who died from RCC had unrecognized renal sinus fat or small vein invasion compared with 7 (21%) of the controls (P<0.001). We conclude that renal sinus fat invasion is an important adverse pathologic feature that is clearly underreported in the literature. Appropriate assessment of nephrectomy specimens should include proper sampling of the renal sinus even for seemingly localized tumors.
先前的研究表明，肾窦可使原本局限的肾细胞癌（RCC）肿瘤早期发生扩散。我们推测，在随后死于RCC的pT1期患者中，肾窦脂肪浸润可能未被识别。1985年至2002年间，我们确定了577例因局限性pT1期透明细胞RCC接受根治性肾切除术的患者，这些病例由一位泌尿外科病理学家（J.C.C.）进行回顾性分析。在这些患者中，49例死于RCC，其中33例的原始肾切除标本保存在福尔马林中。然后，这些标本被切成薄片对肾窦进行重新切片，并由同一位病理学家进行复查。作为对照，33例未死于RCC的患者（对照组）也对其原始肾切除标本进行了重新切片。在33例看似局限性RCC而死亡的患者中，14例（42%）之前未被识别出存在肾窦脂肪浸润，而对照组中有2例（6%）出现这种情况（P<0.001）。此外，19例（58%）死于RCC的患者存在肾窦小静脉（显微镜下静脉）浸润，这一病理特征目前未纳入RCC的TNM分期系统。对照组中有7例（21%）出现这一特征（P=0.003）。总体而言，22例（67%）死于RCC的患者存在未被识别出的肾窦脂肪或小静脉浸润，而对照组中有7例（21%）出现这种情况（P<0.001）。我们得出结论，肾窦脂肪浸润是一种重要的不良病理特征，在文献中明显报告不足。对肾切除标本的适当评估应包括对肾窦进行适当采样，即使对于看似局限性的肿瘤也是如此。
