Pseudocapsule of Small Renal Cell Tumors: CT Imaging Spectrum and Correlated Histopathological Features
Urology Journal,
,
5 January 2019
,
Page 5907
https://doi.org/10.22037/uj.v16i7.5907
Abstract
Purpose: To systematically analyze histopathologic features of pseudocapsule in small renal cell tumor (diameter≤4cm), assess the integrity of pseudocapsules by Computed Tomography (CT), and provide theoretical basis for the safety of nephron sparing surgery.
Materials and Methods: The pathological data of 116 patients who underwent surgery with clear cell renal cell carcinoma admitted from May 2010 to October 2017 were retrospectively analyzed. All patients underwent a CT scan of the abdomen including an unenhanced and triple-phase (arterial, nephrographic and excretory) post contrast series."All patients underwent a CT scan of the abdomen including an unenhanced and triple-phase (arterial, nephrographic and excretory) post contrast series."All patients underwent a CT scan of the abdomen including an unenhanced and triple-phase (arterial, nephrographic and excretory) post contrast seriesAll patients underwent a CT scan of the abdomen including an unenhanced and three-phase (arterial, nephrographic and excretory) post contrast series. Thorough gross examination and histological sections were used to determine the integrity of the pseudocapsule by two uropathologists. The consistency between pathological findings and CT imaging were evaluated by Kappa consistency test.
Results: The mean diameter of tumor was 3.0cm, range (2.6 ± 0.8) cm. On CT the pseudocapsule can present with one of the three following feathers:1) A regular and distinct halo; 2)lobulated clear margins;3) blurred margins. On histopathology, complete psuedocapsule was found in 85 tumors, incomplete psuedocapsule in 25 and no psuedocapsule was found in 6 tumors; CT scan findings demonstrated a regular halo in 82 tumors, lobulated clear margins in 26 and blurred margins in 8 tumors(Kappa=0.833,P=0.000).
Conclusions: Most small renal cell tumors have an obvious psuedocapsule. Preoperative determination of the psuedocapsule’s integrity is particularly important. CT scan can reliably evaluate the tumor margins and demonstrate the psuedocapsule when present. The imaging results are well correlated with the pathologic findings.
- pseudocapsule; small renal carcinoma; pathology; CT; surgery
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References
References:
Novara G, Ficarra V, Antonelli A, Artibani W, Bertini R, Carini M, et al. Validation of the 2009 TNM version in a large multi-institutional cohort of patients treated for renal cell carcinoma: are further improvements needed? Eur Urol, 2010. 58(4): p. 588-95.
Sheth S, Scatarige J C, Horton K M, Corl F M, Fishman E K. Current concepts in the diagnosis and management of renal cell carcinoma: role of multidetector ct and three-dimensional CT. Radiographics, 2001. 21 Spec No: p. S237-54.
Chow W H, Devesa S S. Contemporary epidemiology of renal cell cancer. Cancer J, 2008. 14(5): p. 288-301.
Curry N S. Imaging the small solid renal mass. Abdom Imaging, 2002. 27(6): p. 629-36.
Chow W H, Devesa S S, Warren J L, Fraumeni J J. Rising incidence of renal cell cancer in the United States. JAMA, 1999. 281(17): p. 1628-31.
Reddan D N, Raj G V, Polascik T J. Management of small renal tumors: an overview. Am J Med, 2001. 110(7): p. 558-62.
Abouassaly R, Lane B R, Novick A C. Active surveillance of renal masses in elderly patients. J Urol, 2008. 180(2): p. 505-8; discussion 508-9.
Ljungberg B, Bensalah K, Canfield S, Dabestani S, Hofmann F, Hora M, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol, 2015. 67(5): p. 913-24.
Capitanio U, Terrone C, Antonelli A, Minervini A, Volpe A, Furlan M,et al. Nephron-sparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a-T1b renal mass and normal preoperative renal function. Eur Urol, 2015. 67(4): p. 683-9.
Minervini A, di Cristofano C, Lapini A, Marchi M, Lanzi F, Giubilei G, et al. Histopathologic analysis of peritumoral pseudocapsule and surgical margin status after tumor enucleation for renal cell carcinoma. Eur Urol, 2009. 55(6): p. 1410-8.
Krejci K G, Blute M L, Cheville J C, Sebo T J, Lohse C M, Zincke H. Nephron-sparing surgery for renal cell carcinoma: clinicopathologic features predictive of patient outcome. Urology, 2003. 62(4): p. 641-6.
Roy C S, El G S, Buy X, Lindner V, Lang H, Saussine C, et al. Significance of the pseudocapsule on MRI of renal neoplasms and its potential application for local staging: a retrospective study. AJR Am J Roentgenol, 2005. 184(1): p. 113-20.
Ascenti G, Gaeta M, Magno C, Mazziotti S, Blandino A, Melloni D, et al. Contrast-enhanced second-harmonic sonography in the detection of pseudocapsule in renal cell carcinoma. AJR Am J Roentgenol, 2004. 182(6): p. 1525-30.
Hedgire S S, Elmi A, Nadkarni N D, Cao K, Mcdermott S, Harisinghani M G. Preoperative evaluation of perinephric fat invasion in patients with renal cell carcinoma: correlation with pathological findings. Clin Imaging, 2013. 37(1): p. 91-6.
Yamashita Y, Honda S, Nishiharu T, Urata J, Takahashi M. Detection of pseudocapsule of renal cell carcinoma with MR imaging and CT. AJR Am J Roentgenol, 1996. 166(5): p. 1151-5.
Park B K, Kim S H, Choi H J. Characterization of renal cell carcinoma using agent detection imaging: comparison with gray-scale US. Korean J Radiol, 2005. 6(3): p. 173-8.
. Jacob J M, Williamson S R, Gondim D D, Leese J A, Terry C, Grignon D J, et al. Characteristics of the Peritumoral Pseudocapsule Vary Predictably With Histologic Subtype of T1 Renal Neoplasms. Urology, 2015. 86(5): p. 956-61.
Frank I, Blute M L, Cheville J C, Lohse C M, Weaver A L, Leibovich B C, et al. A multifactorial postoperative surveillance model for patients with surgically treated clear cell renal cell carcinoma. J Urol, 2003. 170(6 Pt 1): p. 2225-32.
Xi W, Wang J, Liu L, Xiong Y, Qu Y, Lin Z, et al. Evaluation of Tumor Pseudocapsule Status and Its Prognostic Significance in Renal Cell Carcinoma. J Urol, 2017.
Hricak H, Demas B E, Williams R D, Mcnamara M T, Hedgcock M W, Amparo E G, et al. Magnetic resonance imaging in the diagnosis and staging of renal and perirenal neoplasms. Radiology, 1985. 154(3): p. 709-15.
Tsili A C, Argyropoulou M I, Gousia A, Kalef-Ezra J, Sofikitis N, Malamou-Mitsi V, et al. Renal cell carcinoma: value of multiphase MDCT with multiplanar reformations in the detection of pseudocapsule. AJR Am J Roentgenol, 2012. 199(2): p. 379-86.
Wang L, Feng J, Alvarez H, Snarskis C, Gupta G, Picken M M. Critical histologic appraisal of the pseudocapsule of small renal tumors. Virchows Arch, 2015. 467(3): p. 311-7.
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