NDT Advance Access originally published online on October 4, 2005
Nephrology Dialysis Transplantation 2006 21(1):64-69; doi:10.1093/ndt/gfi149
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Original Articles: Clinical Nephrology
Incidental neoplasms in renal biopsies
1 Department of Nephrology, University Hospital Birmingham, Birmingham B15 2TH, 2 Department of Pathology, University College London, London WC1E 6BT and 3 Department of Urology, University Hospital Birmingham, Birmingham B15 2TH, UK
Correspondence and offprint requests to: Dr G. W. Lipkin, MD, Department of Nephrology, University Hospital Birmingham, Birmingham B15 2TH, UK. Email: Graham.Lipkin{at}uhb.nhs.uk
Background. Incidental neoplastic lesions are occasionally found in renal biopsy specimens, but there is no evidence to indicate how they should be managed.
Methods. A retrospective review was made of the management and clinical course of patients in whom an unsuspected neoplasm had been found in a renal biopsy.
Results. In 11 880 biopsies taken over 22 years, there were incidental neoplasms in 25 (0.2%). Twenty-three of the 25 patients were men, and the median age was 59 years (range, 42–83 years). All had chronic renal damage, with a median index of chronic damage of 37% (range, 10–83%; normal = 0%). Twenty-two neoplasms were papillary, two were clear cell renal carcinomas and one was in situ carcinoma in a collecting duct. The two clear cell carcinomas, three papillary neoplasms with residual masses after biopsy and the two papillary neoplasms in renal allografts were resected by nephrectomy or partial nephrectomy. Seven patients without resection were imaged with computerized tomography, six with magnetic resonance imaging and three with ultrasound scanning. Two were not imaged. None of the 11 patients who died, nor any of the other 14, had evidence of renal cell carcinoma at death or last follow-up respectively, at median 3.6 years after biopsy (range, 1 month–18.2 years).
Conclusions. When an incidental neoplasm is found, the pathological type should be defined, and imaging should be performed. Surgery should be considered in patients in whom there is a neoplasm of any type detectable by imaging, and limited resection may be possible. Neoplasms that are undetectable with imaging cannot be resected as the site of the lesion is unknown. We suggest surveillance of these, but whether this is necessary is undetermined. There is no evidence whether neoplasms undetectable with imaging in renal allografts require aggressive treatment.
Keywords: papillary adenoma; papillary carcinoma; renal allograft; renal biopsy; renal cell carcinoma; renal neoplasm