To analyze the full spectrum of patients presenting with radiologically-identified infiltrative renal masses (IRMs), including those managed surgically or otherwise, with focus on clinical presentation/prognosis.
All 280 patients presenting with radiologically-identified renal mass with infiltrative features (2008-2017) were retrospectively reviewed. Poorly-defined interface between tumor and parenchyma and irregular shape (nonelliptical) in one or more distinct/unequivocal areas were required for classification as IRM. IRM was confirmed in 265 and clinical characteristics and outcomes were assessed.
Median age/tumor size were 65-years/6.9 cm, respectively, and 225 patients (85%) were R.E.N.A.L. = 10-12. Overall, 181 patients (68%) presented symptomatically, locally-advanced cancer (cT3-T4) was observed in 176 (66%) and disseminated disease and/or lymphadenopathy (>2 cm) in 181(68%). Clinical/radiographic findings were suggestive of etiology and could direct evaluation, but were nonspecific for definitive diagnosis. Renal-mass biopsy was performed in 103 patients and diagnostic in 97 (94%). Renal surgery was only performed in 82 patients (31%) and partial nephrectomy in 3 (1.1%). Overall, 72 patients (27%) received systemic chemotherapy and 59 (22%) targeted therapy. Final-diagnosis was renal cell carcinoma in 94 patients (35%), including 49 with highly-aggressive histology (sarcomatoid/rhabdoid/collecting-duct/medullary/unclassified). High-grade urothelial-carcinoma was found in 70 (26%), and lymphoma/metastatic cancer in 26 (10%)/25 (9%), respectively. Overall, 153 patients (58%) died; 138 (52%) cancer-related at median of 5 months. The majority of patients with renal cell carcinoma, urothelial-carcinoma, and renal metastasis died, almost exclusively cancer-related, at medians of 8, 3, and 2 months, respectively.
Our series includes the full spectrum of IRMs and confirms predominance of symptomatic, poorly-differentiated, highly-lethal malignancies. Our study highlights the overriding importance of identifying infiltrative features, a simple radiologic diagnosis, during assessment of renal masses.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Urology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Renal mass and localized renal cancer: AUA Guideline.J Urol. 2017; 198: 520-529
- Nephron sparing surgery for renal cell carcinoma with normal contralateral kidney: 25 years of experience.J Urol. 2006; 175: 2027-2031
- From the archives of the AFIP. Infiltrative renal lesions: radiologic-pathologic correlation. Armed forces institute of pathology.Radiographics. 2000; 20: 215-243
- CT imaging spectrum of infiltrative renal diseases.Abdom Radiol. 2017; 42: 2700-2709
- Preoperative lymphocyte-monocyte ratio ameliorates the accuracy of differential diagnosis in non-metastatic infiltrative renal masses.Yonsei Med J. 2017; 58: 388-394
- Centrally infiltrating renal masses on CT: differentiating intrarenal transitional cell carcinoma from centrally located renal cell carcinoma.AJR Am J Roentgenol. 2012; 198: 846-853
- Sarcomatoid renal cell carcinoma and collecting duct carcinoma: discrimination from common renal cell carcinoma subtypes and benign RCC mimics on multiphasic MDCT.Acad Radiol. 2017; 24: 1226-1232
- Renal medullary carcinoma: CT and MRI features.AJR Am J Roentgenol. 2005; 185: 268-272
- Intrarenal urothelial cancers confused as infiltrative renal masses: report of 22 cases and literature review.Oncol Lett. 2018; 16: 1912-1916
- Multidetector CT imaging features of invasive renal parenchyma urothelial carcinoma.Br J Radiol. 2016; 8920151068
- Urothelial cancer of the renal pelvicaliceal system: unusual imaging manifestations..Radiographics. 2010; 30: 1553-1566
- Renal Masses detected on FDG PET/CT in patients with lymphoma: imaging features differentiating primary renal cell carcinomas from renal lymphomatous involvement.AJR Am J Roentgenol. 2017; 208: 849-853
- CT of renal lymphoma in children.AJR Am J Roentgenol. 2003; 180: 429-431
- Imaging features of primary renal lymphoma.Acta Radiol. 2018; 59: 114-120
- Renal cell carcinoma: correlation of CT findings with nuclear morphologic grading in 100 tumors.Abdom Imaging. 1994; 19: 262-266
- Renal cell carcinoma of clear type: correlation of CT features with tumor size, architectural patterns, and pathologic staging.Eur Radiol. 1997; 7: 224-229
- Prognostic factors and survival of patients with sarcomatoid renal cell carcinoma.J Urol. 2002; 167: 65-70
- Sarcomatoid differentiation in renal cell carcinoma: a study of 101 cases.Am J Surg Pathol. 2001; 25: 275-284
- Carcinoma of the collecting ducts of Bellini and renal medullary carcinoma: clinicopathologic analysis of 52 cases of rare aggressive subtypes of renal cell carcinoma with a focus on their interrelationship.Am J Surg Pathol. 2012; 36: 1265-1278
- Renal medullary carcinoma: clinical, pathologic, immunohistochemical, and genetic analysis with pathogenetic implications.Urology. 2002; 60: 1083-1089
- Collecting duct carcinoma of the kidney: CT and pathologic correlation.Eur J Radiol. 2006; 57: 453-460
- Standardized report templates for indeterminant renal masses at CT and MRI: a collaborative product of the SAR disease-focused panel on renal cell carcinoma.Abdom Radiol. 2019; 44: 1423-1429
- Reporting standards for the imaging-based diagnosis of renal masses on CT and MRI: a national survey of academic abdominal radiologists and urologists.Abdom Radiol. 2017; 42: 1229-1240
- Multi-institutional analysis of CT and MRI reports evaluating indeterminate renal masses: comparison to a national survey investigating desired report elements.Abdom Radiol. 2018; 43: 3493-3502
- The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth.J Urol. 2009; 182: 844-853
- The cancer genome atlas comprehensive molecular characterization of renal cell carcinoma.Cell Rep. 2018; 23 (e5): 313-326
- Comprehensive molecular characterization of papillary renal-cell carcinoma.N Engl J Med. 2016; 374: 135-145
- 2017 AUA Renal Mass and Localized Renal Cancer Guidelines: imaging implications.Radiographics. 2018; 38: 2021-2033
- Cystic renal cell carcinoma carries an excellent prognosis regardless of tumor size.Urol Oncol. 2015; 33 (e9-13): 505
- Cystic Renal cell carcinoma: a report on outcomes of surgery and active surveillance in patients retrospectively identified on pretreatment imaging.J Urol. 2018; 200: 275-282
Published online: May 07, 2019
Accepted: April 27, 2019
Received: March 4, 2019
Financial Disclosures: None of the authors have any disclosures or conflicts of interest to report.
Funding: Dr. Wang is funded by China Scholarship Council (grant 201706175045). Dr. Tanaka is funded by the Mochida Memorial Foundation for Medical and Pharmaceutical Research (grant 2017-StudyAbroad4-2).
© 2019 Elsevier Inc. All rights reserved.