Histopathological study of nephrectomy specimens in a tertiary care hospital

Authors : Nilay Shah, Sunita Goyal

DOI : 10.18231/2581-3706.2019.0007

Volume : 4

Issue : 1

Year : 2019

Page No : 39-44

Introduction

Conventional (clear cell) Renal cell carcinoma was the leading variant of Renal cell carcinoma in our study (8 cases; 57.14%). We found 3 cases(14.29%) of Chromophobe type; and 2 cases(14.29%) of Papillary Renal cell carcinoma and 1 case of multilocular cystic Renal cell carcinoma.

 

The main pathologic prognostic parameters which are important in Clear Cell RCC, are mention in Table-5.The maximum diameter of primary tumor was 16 cm, as seen in 1 case (12.25%) and the least 1.5 cm, seen in 1case (12.25%). Capsular invasion was seen in 3 cases (37.5%). Renal vein invasion was seen in 2(25%) cases, while renal sinus invasion present microscopically in 2(25%) cases. Involvement of perinephric fat was observed in 2 cases
(25%) While Fascia of Gerota was involved in one case (12.25%) only. Lymph nodes were received in 3(37.5%) cases. Lymph node metastases were not present in any case.

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Fig. 3: Angiomyolipoma of Kidney_showing angio adipose tissue, smooth muscle, and thick-walled blood vessels H & tain, Fig. 4: Wilm’s tumor: H & E stain (40x)

Discussion

Out of total 74 nephrectomies 46 (62.1%) patients were male and 28 (37.9%) were females (Male: Female ratio 1.63:1). Male:female ratio was comparable to Eke N.et al,^[9]Mahesh Kumar et al,^[17] Fauzia Latif et al,^[18] Datta et al.^[16]In Rafique M. et al^[15] series male female ratio was 1:1.06. [Table 6] Age of the patients ranged from 1day to 80 years (Mean age 38.34±22.28 years).

Pyelonephritis was the leading pathological entity in our nephrectomies (52.7%), which is compatible with the report by Kubba, et al,^[19] and Malik et al^[14]but different from that of Schiff and Glazier^[20]. In these latter studies, RCC and TCC combined were the leading pathological findings.

Six(8%) of the removed kidneys in our series contained stones, which is comparable to the 6% in a large adult series of nephrectomies by Schiff and Glazier^[20] and 11% in a pediatric series by Adamson et al and different from the 37% in Malik et al series^[14]

Renal tuberculosis is an infection worth of mentioning in India as three cases (5.45%) of tuberculosis were found in our study among the nephrectomies carried out for benign conditions as compared to 7.62% in the report of Rafique M. et al^[15] and 16.36% in report of Datta et al^[16] In Kubba, et al^[19]and Malik et al^[14]there were no tuberculosis cases. Beisland et al^[10] found that five (2.4%) tuberculous kidneys were removed out of 209 nephrectomies carried out for benign conditions during 20 years at two Norwegian hospitals. Another report from Ghalayini et al^[13] showed that tuberculosis accounted for nine (3%) nephrectomies performed for benign conditions, whereas patients with renal tuberculosis are uncommon in developed countries.

Renal tumors in adults are increasing in incidence throughout the world, partly as a result of widespread use of cross sectional imaging modalities and ultrasonography. Both benign and malignant tumors occur in the kidney. Because of the relative rarity of benign renal tumors, it is a common practice for urologists to consider any renal mass that enhances with intravenous contrast on computed tomography (CT) scan as a malignancy. If it is localized,

they tend to treat such masses radically unless there is
definite evidence of a benign pathology. Most common malignant tumor in adults is renal cell carcinoma (RCC) and Wilm’s tumor in childhood. Rare are urothelial tumors of calyces and pelvis.

Of 23 renal tumors in this series four (17.3%) were benign as compared to a recent report on Saudi patients by Talik RF et al^[21]where 14% of renal tumors were benign and Mahesh Kumar et al³⁹ where 16.6% cases were benign.This is in marked contrast with 5% of Malik et al,^[14] 0% of Rafique M. et al,^[15] 8% of Datta et al^[16] and 6% of Fauzia Latif et al^[18]

RCC is the most common primary malignant tumor of the kidney (85%) worldwide and constitutes 2-3% of all visceral malignancies in adults. The classification of renal cell neoplasms has been extensively studied in the last two decades and is based on a combination of histological, genetic and immunohistochemical features.

The incidence of renal cell carcinoma according to Datta et al^[16]is about 69.6%, Fauzia Latif et al^[18] is 87.2%, Rafique M. et al^[15] is 100%, Eble et al^[22]is about 90%, McLaughlin JK et al^[23] is about 85% and in our study it is 73.68%.

Fuhrman's nuclear grading system was applied in our study. Nuclear grade II (5 cases 62.5%) was the most common presentation, while both grade I and higher grades (III and IV) were rare in our study. The results were similar to Fauzia Latif et al.^[18] Which noted 63.3% cases in grade II, while both grade 1 and higher grades (III and IV) were rare.

Conclusion

This was a three and a half year study of 74 nephrectomy specimens in histopathology Department NHL Municipal medical college Ahmedabad from June 2009 to October 2012.

1. Maximum (22.97%) nephrectomies were done in age group 51-60 years.
2. The peak incidence of malignant lesions was in 6^th decade (36.84%).
3. Among them, 46 were males and 28 were females with male, female ratio of 1.63:1 showing male preponderance.
4. Out of 74, 35 (47.29%) specimens were of left nephrectomy whereas 37 (50%) specimens were of right nephrectomy. In one case bilateral kidneys were removed for renal dysplasia. In another case horse shoe kidney was the indication for nephrectomy.
5. Out of 74 nephrectomies, 55 (74.33%) cases were of benign lesions while 19 (25.67%) cases were of malignant lesions.
6. Among the benign lesions, Chronic inflammatory causes (54.90%) was the leading cause for nephrectomy followed by renal calculus related hypofunctioning kidneys trauma and congenital diseases of kidney (11.76%) each cases.
7. Among the 4 cases of benign neoplasms 3 (75%) were of Angiomyolipoma and 1 (25%) case was of Cystic nephroma.
8. On the other hand Renal cell carcinoma (73.68%) was the most common etiology among the malignant lesions followed by Wilm’s tumor (21.05%) and urothelial carcinoma(5.26%)
9. We found 6 cases of congenital kidney diseases, among which maximum cases were of multicystic renal dysplasia(50%), followed by bilateral renal dysplasia, horse shoe kidney and duplex kidney (16.66% each).
10. Conventional (clear cell) Renal cell carcinoma was the most common type of Renal cell carcinoma in our study accounting 57.14% cases, followed by Chromophobe type which were 14.29%, Papillary Renal cell carcinoma 14.29% and multilocular cystic Renal cell carcinoma which are 7.14% cases.
11. In 21.42% cases, the tumor occupied more or less the entire kidney. Also in 21.42% cases it occupied the upper pole, in 28.57% the lower pole, and in 28.57% the mid region.
12. Regarding Clear Cell RCC, the mean maximum diameter of the primary tumor was 6.6±4.9 cm. Capsular invasion was observed in 37.5% cases. Renal vein invasion was found in 25% cases, while renal sinus invasion was observed microscopically in 25% cases. Perinephric fat invasion was seen in 25% cases while Fascia of Gerota was involed in 12.25% cases. Adrenal gland involvement and lymph node metastases were not present in any case.
13. Fuhrman's nuclear grading system was applied. Among 8 cases of CCRCC, 12.25% showed grade I, 62.5% grade II, 2.25% grade III and 12.25% grade IV. It is evident that majority of CCRCC exhibited nuclear grade II.
14. Among PRCC, 50% exhibited low grade (1 and 2) nuclear features and one 50% showed high grade (grade 3).

 

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