Raspollini Maria Rosaria, Montagnani Ilaria, Montironi Rodolfo, Cheng Liang, Martignoni Guido, Minervini Andrea, Serni Sergio, Nicita Giulio, Carini Marco, Lopez-Beltran Antonio
Histopathology and Molecular Diagnostics. University Hospital Careggi, Florence, Italy.
Section of Pathological Anatomy, Department of Biomedical Sciences and Public Health Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy.
Pathol Res Pract. 2017 Jul;213(7):804-808. doi: 10.1016/j.prp.2017.03.007. Epub 2017 Mar 12.
A number of new renal tumor entities have been recognized by the 2016 World Health Organization classification of urologic tumors. The classification includes tumors with different behavior and introduces one tumor with low malignant potential, the multilocular cystic clear cell renal cell neoplasm of low malignant potential (mcCCRCNLMP). However, some categories still labeled as "carcinoma", such as clear cell papillary renal cell carcinoma (CCPRCC), renal angioleiomyomatous tumor (RAT), and tubulocystic carcinoma (TCRCC), all with a particularly good prognosis when diagnosed as low stage, show no malignant behavior: in fact, no metastases have been reported in these categories when surgically excised. Current experience is limited to supporting these neoplasms as benign entities although, recent literature data is defining these entities as "low malignant potential tumors".
We conducted a search through our files on a consecutive series of 624 renal tumors diagnosed over a period of 2 years to address the incidence of this category of tumors.
Applying strict histological criteria, the "low malignant potential" tumors, comprised 7% of renal masses that are less than 4cm in size and 3.8% of renal masses measuring 4-7cm in the series of 624 renal tumors. When benign tumors are taken into considerations, the benign and "low malignant potential tumors" represent about one third of renal masses <4cm and one sixth of renal masses between 4 and 7cm. All these cases have not shown recurrence or metastasis at follow-up, mean follow-up of 18 months (range 6-30 months).
This information may assist urologists in developing guidelines for counseling and proper clinical management for patients with "low malignant potential" tumors or small renal masses.
2016年世界卫生组织泌尿系统肿瘤分类识别出了一些新的肾肿瘤实体。该分类包括具有不同行为特征的肿瘤,并引入了一种恶性潜能较低的肿瘤,即低度恶性潜能多房性囊性透明细胞肾细胞肿瘤(mcCCRCNLMP)。然而,一些仍被标记为“癌”的类别,如透明细胞乳头状肾细胞癌(CCPRCC)、肾血管平滑肌脂肪瘤(RAT)和肾小管囊性癌(TCRCC),在诊断为低分期时预后都特别好,没有恶性行为:事实上,手术切除这些类别的肿瘤时未见转移报告。目前的经验仅限于支持将这些肿瘤视为良性实体,尽管最近的文献数据将这些实体定义为“低度恶性潜能肿瘤”。
我们在连续两年诊断的624例肾肿瘤病例档案中进行检索,以探讨这类肿瘤的发病率。
应用严格的组织学标准,在这624例肾肿瘤系列中,“低度恶性潜能”肿瘤在大小小于4cm的肾肿块中占7%,在大小为4 - 7cm的肾肿块中占3.8%。若将良性肿瘤考虑在内,良性和“低度恶性潜能肿瘤”在大小<4cm的肾肿块中约占三分之一,在大小为4至7cm的肾肿块中约占六分之一。所有这些病例在随访中均未出现复发或转移,平均随访18个月(范围6 - 30个月)。
这些信息可能有助于泌尿外科医生制定针对“低度恶性潜能”肿瘤或小肾肿块患者的咨询和适当临床管理指南。