Renal oncocytoma natural history, complications and prognosis: Difference between revisions
Homa Najafi (talk | contribs) No edit summary |
Homa Najafi (talk | contribs) |
||
| Line 32: | Line 32: | ||
===Prognosis=== | ===Prognosis=== | ||
*Prognosis is generally | *Prognosis is generally good, There are only two cases of metastatic renal . | ||
*Depending on the extent of the [tumor/disease progression] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent. | *Depending on the extent of the [tumor/disease progression] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent. | ||
*The presence of [characteristic of disease] is associated with a particularly [good/poor] prognosis among patients with [disease/malignancy]. | *The presence of [characteristic of disease] is associated with a particularly [good/poor] prognosis among patients with [disease/malignancy]. | ||
*[Subtype of disease/malignancy] is associated with the most favorable prognosis. | *[Subtype of disease/malignancy] is associated with the most favorable prognosis. | ||
*The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis. | *The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis. | ||
Renal oncocytoma is regarded as a benign neoplasia. Although some malignant oncocytomas with local organ invasion and metastases have been described in early reports,20,8,105,4 those cases examined could be confused with eosinophilic variants of chromophobe RCC, because Hale’s colloidal iron stain and electron microscopy were not applied.106 However, despite the strict histological criteria, two oncocytomas that caused liver metastasis confirmed by needle biopsy or metastatic (liver and bone) death have been reported.6 Unfortunately, no genetic material from such cases was available for analysis to confirm the original histological diagnosis. | |||
Today, the vast majority of oncocytomas are operated upon. There are several reasons for this policy. First, definitive preoperative diagnosis is not, at present, possible. As such, the differential diagnosis of RCC cannot be excluded. Furthermore, as was discussed previously, oncocytoma and RCC may exist concomitantly. Second, the natural evolution of renal oncocytomas is not known. There are not many articles in the English literature that address the issue of nonoperative management of oncocytomas [70,78,79]. Romis et al. made a retrospective review of patients with oncocytoma and their management. One patient out of 32 with oncocytoma was not operated because he had a previous contralateral nephrectomy for nephrolithiasis. This patient was diagnosed with percutaneous biopsy of the renal tumor. In order to avoid hemodialysis, he was followed with ultrasound (US) and CT scans for 30 months. The tumor was 6 cm in diameter and stable throughout the follow-up period [70]. Neuzillet et al. retrospectively analyzed 15 cases of asymptomatic oncocytomas in their institute, diagnosed by percutaneous core biopsy. The authors decided to monitor the patients with Doppler ultrasound or CT scans for the first 6 month after the diagnosis, and biannually thereafter. Mean follow-up time was 40.1 months. Four patients were operated upon during the follow-up period because of fast tumor growth (mean growth rate 2.4 cm/y). | |||
The average delay time for the operation was 16.5 months. Final pathologic report confirmed oncocytoma in all 4 cases. Nine patients (60%) were only followed. In this group of patients the mean growth rate of the tumor was 0.7 cm/y. The authors concluded that high initial tumor volume (greater than 5 cm) or fast-growing oncocytoma (greater than 0.5 cm/y) are indications for surgery [78]. Spring et al. reported on a patient with oncocytoma who was wrongly diagnosed with renal cyst and followed for 18 years. The patient was followed with US during this period. During the follow-up period, the renal mass did not change in appearance or size. Finally, a CT scan was performed and a solid mass was demonstrated. The mass was resected and the diagnosis of renal oncocytoma was made. During the operation, vascular and perinephric fat infiltration were noted [79]. | |||
Typical renal oncocytomas, as defined by modern pathologic criteria, almost invariably appear to have benign clinical behavior [7,25]. In the most recent review of the Mayo Clinic database no patient with oncocytoma developed metastases (mean follow-up, 41 months). Another recent large series documented two patients (out of 70) with apparent metastases, one of whom had liver and bone involvement and died of disease (not biopsy-confirmed as oncocytoma), and another with a solitary biopsy-proven liver metastasis who was followed expectantly and did not progress [4]. Older reports of “metastatic oncocytoma” could certainly represent chromophobe RCCs incorrectly diagnosed as oncocytoma, or metastases from synchronous or metachronous RCCs | |||
Revision as of 16:50, 6 May 2019
|
Renal oncocytoma Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Renal oncocytoma natural history, complications and prognosis On the Web |
|
American Roentgen Ray Society Images of Renal oncocytoma natural history, complications and prognosis |
|
FDA on Renal oncocytoma natural history, complications and prognosis |
|
CDC on Renal oncocytoma natural history, complications and prognosis |
|
Renal oncocytoma natural history, complications and prognosis in the news |
|
Blogs on Renal oncocytoma natural history, complications and prognosis |
|
Risk calculators and risk factors for Renal oncocytoma natural history, complications and prognosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2] Shanshan Cen, M.D. [3]
Overview
Prognosis of renal oncocytoma is generally excellent.[1]
Prognosis
Prognosis of renal oncocytoma is generally excellent.[1]
Overview
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
OR
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
OR
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
Natural History, Complications, and Prognosis
Natural History
- The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___.
- The symptoms of (disease name) typically develop ___ years after exposure to ___.
- If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
Complications
- Common complications of [disease name] include:
- [Complication 1]
- [Complication 2]
- [Complication 3]
Prognosis
- Prognosis is generally good, There are only two cases of metastatic renal .
- Depending on the extent of the [tumor/disease progression] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent.
- The presence of [characteristic of disease] is associated with a particularly [good/poor] prognosis among patients with [disease/malignancy].
- [Subtype of disease/malignancy] is associated with the most favorable prognosis.
- The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis.
Renal oncocytoma is regarded as a benign neoplasia. Although some malignant oncocytomas with local organ invasion and metastases have been described in early reports,20,8,105,4 those cases examined could be confused with eosinophilic variants of chromophobe RCC, because Hale’s colloidal iron stain and electron microscopy were not applied.106 However, despite the strict histological criteria, two oncocytomas that caused liver metastasis confirmed by needle biopsy or metastatic (liver and bone) death have been reported.6 Unfortunately, no genetic material from such cases was available for analysis to confirm the original histological diagnosis.
Today, the vast majority of oncocytomas are operated upon. There are several reasons for this policy. First, definitive preoperative diagnosis is not, at present, possible. As such, the differential diagnosis of RCC cannot be excluded. Furthermore, as was discussed previously, oncocytoma and RCC may exist concomitantly. Second, the natural evolution of renal oncocytomas is not known. There are not many articles in the English literature that address the issue of nonoperative management of oncocytomas [70,78,79]. Romis et al. made a retrospective review of patients with oncocytoma and their management. One patient out of 32 with oncocytoma was not operated because he had a previous contralateral nephrectomy for nephrolithiasis. This patient was diagnosed with percutaneous biopsy of the renal tumor. In order to avoid hemodialysis, he was followed with ultrasound (US) and CT scans for 30 months. The tumor was 6 cm in diameter and stable throughout the follow-up period [70]. Neuzillet et al. retrospectively analyzed 15 cases of asymptomatic oncocytomas in their institute, diagnosed by percutaneous core biopsy. The authors decided to monitor the patients with Doppler ultrasound or CT scans for the first 6 month after the diagnosis, and biannually thereafter. Mean follow-up time was 40.1 months. Four patients were operated upon during the follow-up period because of fast tumor growth (mean growth rate 2.4 cm/y).
The average delay time for the operation was 16.5 months. Final pathologic report confirmed oncocytoma in all 4 cases. Nine patients (60%) were only followed. In this group of patients the mean growth rate of the tumor was 0.7 cm/y. The authors concluded that high initial tumor volume (greater than 5 cm) or fast-growing oncocytoma (greater than 0.5 cm/y) are indications for surgery [78]. Spring et al. reported on a patient with oncocytoma who was wrongly diagnosed with renal cyst and followed for 18 years. The patient was followed with US during this period. During the follow-up period, the renal mass did not change in appearance or size. Finally, a CT scan was performed and a solid mass was demonstrated. The mass was resected and the diagnosis of renal oncocytoma was made. During the operation, vascular and perinephric fat infiltration were noted [79].
Typical renal oncocytomas, as defined by modern pathologic criteria, almost invariably appear to have benign clinical behavior [7,25]. In the most recent review of the Mayo Clinic database no patient with oncocytoma developed metastases (mean follow-up, 41 months). Another recent large series documented two patients (out of 70) with apparent metastases, one of whom had liver and bone involvement and died of disease (not biopsy-confirmed as oncocytoma), and another with a solitary biopsy-proven liver metastasis who was followed expectantly and did not progress [4]. Older reports of “metastatic oncocytoma” could certainly represent chromophobe RCCs incorrectly diagnosed as oncocytoma, or metastases from synchronous or metachronous RCCs
References
- ↑ 1.0 1.1 Lieber MM (1990). "Renal oncocytoma: prognosis and treatment". European Urology. 18 Suppl 2: 17–21. PMID 2226597.