INTRODUCTION AND OBJECTIVES: The oncological safety of blunt tumor enucleation (TE) of renal cell carcinoma (RCC) depends on the presence of a continuous pseudocapsule (PS) around the tumor, and on the possibility of obtaining negative surgical margins (SM). The objective of the study is to investigate the PS and SM after TE to define the real need to take a rim of healthy parenchyma around the tumor to avoid the risk of positive SM. METHODS: Between September 2006 and December 2007, data were gathered prospectively from 90 consecutive patients who had TE for RCC. After formalin fixation (10%), all specimens were stepsectioned a 5-mm intervals and the entire specimen analyzed by a dedicated uropathologist (CDC). TE was done by blunt dissection using the natural cleavage plane between the tumor and normal parenchyma. PS, SM and routinely available clinical and pathological variables were recorded. RESULTS: At the pathological examination, the mean (range, SD, median, IQR) tumor greatest dimension was 3.1 (0.5-12.5, 1.7, 2.9, 2.1-3.8) cm. The pathological analysis according to the 2002 TNM classification showed that 75.6% of tumors were pT1a, 16.7% pT1b, 2.2% pT2, 4.4% pT3a and 1.1% pT3b. On the basis of Fuhrman nuclear grading, 20% of tumors were G1, 65.6% G2 and 14.4% G3. All RCCs were surrounded by a continuous (not fenestrated) fibrous pseudocapsule, irrespective of tumor size, with a mean (range) pseudocapsule thickness of 0.39 (0.048-0.798) mm. In 60 RCCs (67%) the PS was intact and free from invasion (PS-) while in 30 (33%) there were signs of penetration within its layers, with or with no invasion beyond it. Indeed, 26.6% had PS penetrated on the parenchymal side and 6.6% on the perirenal fat tissue side. In all cases the SM were negative after TE. In case of microscopic penetration of PS, a minimal layer of kidney tissue with a mean (range) thickness of 1.05 (0.38-1.60) mm invariably ensured negative SMs. This thin rim of normal parenchymal tissue with signs of lymphoplasmocytic inflammation was present as ‘leopard spots’ on the intact pseudocapsule, and it was always present in case of neoplastic penetration of the PS into the kidney tissue. CONCLUSIONS: We confirm that to stay close to the tumor can minimize the risk of positive SMs. Our study clearly represents a rationale for adopting the TE technique as the standard procedure for the excision of pT1a and pT1b RCC tumors, in conformity with the EAU guidelines.

HIYSTOPATHOLOGICAL ANALYSIS OF PERITUMORALPSEUDOCAPSULE AND SURGICAL MARGINS STATUS IN RCCAFTER TUMOR ENUCLEATION: PROSPECTIVE SINGLE CENTERSTUDY / A. Minervini; C. Di Cristofano; A. Lapini; M. Mancini; F. Lanzi; A. Tuccio; G. Siena; M. Lanciotti; N. Tosi; L. Masieri; Gi. Vittori; C. Della Rocca; S.Serni; M. Carini.. - In: THE JOURNAL OF UROLOGY. - ISSN 0022-5347. - STAMPA. - 181:(2009), pp. 471-471. (Intervento presentato al convegno AUA tenutosi a Chicago nel 25-30 aprile) [doi: 10.1016/j.eururo.2008.07.038].

HIYSTOPATHOLOGICAL ANALYSIS OF PERITUMORALPSEUDOCAPSULE AND SURGICAL MARGINS STATUS IN RCCAFTER TUMOR ENUCLEATION: PROSPECTIVE SINGLE CENTERSTUDY

MINERVINI, ANDREA;LANCIOTTI, MICHELE;L. Masieri;SERNI, SERGIO;CARINI, MARCO
2009

Abstract

INTRODUCTION AND OBJECTIVES: The oncological safety of blunt tumor enucleation (TE) of renal cell carcinoma (RCC) depends on the presence of a continuous pseudocapsule (PS) around the tumor, and on the possibility of obtaining negative surgical margins (SM). The objective of the study is to investigate the PS and SM after TE to define the real need to take a rim of healthy parenchyma around the tumor to avoid the risk of positive SM. METHODS: Between September 2006 and December 2007, data were gathered prospectively from 90 consecutive patients who had TE for RCC. After formalin fixation (10%), all specimens were stepsectioned a 5-mm intervals and the entire specimen analyzed by a dedicated uropathologist (CDC). TE was done by blunt dissection using the natural cleavage plane between the tumor and normal parenchyma. PS, SM and routinely available clinical and pathological variables were recorded. RESULTS: At the pathological examination, the mean (range, SD, median, IQR) tumor greatest dimension was 3.1 (0.5-12.5, 1.7, 2.9, 2.1-3.8) cm. The pathological analysis according to the 2002 TNM classification showed that 75.6% of tumors were pT1a, 16.7% pT1b, 2.2% pT2, 4.4% pT3a and 1.1% pT3b. On the basis of Fuhrman nuclear grading, 20% of tumors were G1, 65.6% G2 and 14.4% G3. All RCCs were surrounded by a continuous (not fenestrated) fibrous pseudocapsule, irrespective of tumor size, with a mean (range) pseudocapsule thickness of 0.39 (0.048-0.798) mm. In 60 RCCs (67%) the PS was intact and free from invasion (PS-) while in 30 (33%) there were signs of penetration within its layers, with or with no invasion beyond it. Indeed, 26.6% had PS penetrated on the parenchymal side and 6.6% on the perirenal fat tissue side. In all cases the SM were negative after TE. In case of microscopic penetration of PS, a minimal layer of kidney tissue with a mean (range) thickness of 1.05 (0.38-1.60) mm invariably ensured negative SMs. This thin rim of normal parenchymal tissue with signs of lymphoplasmocytic inflammation was present as ‘leopard spots’ on the intact pseudocapsule, and it was always present in case of neoplastic penetration of the PS into the kidney tissue. CONCLUSIONS: We confirm that to stay close to the tumor can minimize the risk of positive SMs. Our study clearly represents a rationale for adopting the TE technique as the standard procedure for the excision of pT1a and pT1b RCC tumors, in conformity with the EAU guidelines.
2009
J.Urology
AUA
Chicago
A. Minervini; C. Di Cristofano; A. Lapini; M. Mancini; F. Lanzi; A. Tuccio; G. Siena; M. Lanciotti; N. Tosi; L. Masieri; Gi. Vittori; C. Della Rocca; S.Serni; M. Carini.
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/734726
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