Prognostic Significance of Extensive Necrosis in Renal Cell Carcinoma

Publication date: Available online 29 June 2017
Source:Human Pathology
Author(s): Jennifer Collins, Jonathan I. Epstein
Few studies using the current classification of renal cell carcinoma (RCC) have looked at a large number of cases with near total necrosis. We identified 21 cases of resections of RCC with >90% necrosis from the archives of Johns Hopkins Hospital between 2000–2015. Patients' mean age was 59yrs. (43–77) with 16 (76%) males. 12 (57%) cases were papillary RCC, 4 (19%) clear cell papillary RCC, 4 (19%) clear cell RCC, 1 (5%) unclassified with sarcomatoid differentiation. International Society of Urological Pathology (ISUP) nucleolar grade was grade 1 (9 cases) or grade 2 (9 cases). Two cases were ISUP nucleolar grade 3 and 1 case was grade 4. Pathological stage was low (pT1–2) in 20 (95%) with the unclassified RCC with sarcomatoid differentiation RCC stage pT3a. Mean tumor size was 6.3cm. (1.2–17). In 52% (11) of cases, it was difficult to identify viable tumor requiring multiple sections; 4 cases of papillary RCC were diagnosed in part due to necrotic tumor “ghost” architecture. Follow-up was available in 17 (81%) cases with a mean follow-up of 59months. Thirteen (62%) patients are alive without disease. The patient with unclassified carcinoma with sarcomatoid differentiation died of cancer and 2 died due to causes unrelated to cancer. 1 patient (5%) with low grade clear cell RCC developed metastases, yet had a contralateral RCC. In the setting of a low grade RCC, extensive necrosis does not have an adverse prognosis.



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