Henriksen Kammi J, Meehan Shane M, Chang Anthony
Department of Pathology, The University of Chicago, Chicago, IL 60637, U SA.
Am J Surg Pathol. 2007 Nov;31(11):1703-8. doi: 10.1097/PAS.0b013e31804ca63e.
The pathologic evaluation of tumor nephrectomy specimens focuses on the diagnosis, grading, and staging of the neoplasm. The presence of coincidental non-neoplastic diseases in these specimens may have significant implications for patient outcomes. The purpose of this study is to determine the spectrum of non-neoplastic disease processes that may be overlooked in tumor nephrectomies, and to ascertain the extent to which surgical pathologists are trained to recognize these lesions. We reviewed the hematoxylin and eosin-stained slides of 246 adult tumor nephrectomy specimens with an emphasis on the non-neoplastic renal parenchyma. Further analysis of cases with pathologic alterations included special stains and direct immunofluorescence microscopy. The surgical pathology reports were reviewed to determine whether the non-neoplastic lesions were originally identified. We also surveyed United States pathology residency programs to determine how many require training in medical renal pathology. Forty-one cases (16.7%) had alterations, such as diffuse and/or nodular mesangial sclerosis, mesangial hypercellularity, or glomerular basement membrane thickening that warranted further study. After further work-up and clinical correlation, the pathologic changes in 24 cases were categorized as follows: diabetic nephropathy (19 cases) of which one demonstrated atheroembolic disease, thrombotic microangiopathy (3 cases), sickle cell nephropathy (1 case), and focal segmental glomerulosclerosis (1 case). Twenty-one (88%) of these diagnoses were not identified at initial pathologic evaluation. Only 35 of 98 pathology residency programs that responded to our survey require any formal training in medical renal pathology. Although accurate pathologic evaluation of renal neoplasms remains essential, surgical pathologists should be aware that coincidental non-neoplastic renal diseases are common, often not recognized, and may have important implications for patient care. Further consideration should be given to the training requirements of pathology residents and the guidelines for evaluation of nephrectomy specimens to avoid missing non-neoplastic renal lesions.
肿瘤肾切除标本的病理评估主要集中在肿瘤的诊断、分级和分期。这些标本中并存的非肿瘤性疾病可能对患者的预后产生重大影响。本研究的目的是确定在肿瘤肾切除术中可能被忽视的非肿瘤性疾病谱，并确定外科病理学家识别这些病变的培训程度。我们回顾了246例成人肿瘤肾切除标本的苏木精和伊红染色切片，重点关注非肿瘤性肾实质。对有病理改变的病例进行进一步分析，包括特殊染色和直接免疫荧光显微镜检查。回顾手术病理报告以确定非肿瘤性病变最初是否被识别。我们还对美国病理住院医师培训项目进行了调查，以确定有多少项目要求进行医学肾脏病理学培训。41例（16.7%）有改变，如弥漫性和/或结节性系膜硬化、系膜细胞增多或肾小球基底膜增厚，需要进一步研究。经过进一步检查和临床关联，24例病例的病理变化分类如下：糖尿病肾病（19例），其中1例显示动脉粥样硬化栓塞性疾病、血栓性微血管病（3例）、镰状细胞肾病（1例）和局灶节段性肾小球硬化（1例）。这些诊断中21例（88%）在初次病理评估时未被识别。在回复我们调查的98个病理住院医师培训项目中，只有35个要求进行任何形式的医学肾脏病理学培训。虽然对肾肿瘤进行准确的病理评估仍然至关重要，但外科病理学家应意识到并存的非肿瘤性肾脏疾病很常见，往往未被识别，可能对患者护理有重要影响。应进一步考虑病理住院医师的培训要求以及肾切除标本的评估指南，以避免遗漏非肿瘤性肾脏病变。
