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2009, Volume 25, Number 1, Page(s) 005-018
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DOI: 10.5146/tjpath.2009.00956 |
Needle core biopsies for renal masses and diagnostic difficulties |
Sait ŞEN1, Banu SARSIK1, Adnan ŞİMŞİR2, Erkan KISMALI3, Erhan GÖKMEN4 |
1Ege Üniversitesi Tıp Fakültesi, Patoloji Anabilim Dalı, İZMİR, TÜRKİYE 2Ege Üniversitesi Tıp Fakültesi, Üroloji Anabilim Dalı, İZMİR, TÜRKİYE 3Ege Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, İZMİR, TÜRKİYE 4Ege Üniversitesi Tıp Fakültesi, Onkoloji Bilim Dalı, İZMİR, TÜRKİYE |
Keywords:
Kidney, renal cell carcinoma, immunohistochemistry, needle core biopsy, metastasis |
Aim: Renal needle core biopsies for mass lesions are
being used frequently in advanced renal cell carcinoma
or multipl mass lesions (e.g., primary renal cell carcinoma
or metastatic renal mass). The problems and clues
of core biopsy interpretation from a pathologist's perspective
have not been fully reported. Current study
aims to document our experience.
Materials and Methods: Cases with renal needle core
biopsies from 2000 to 2008 were retrospectively evaluated
and categorized in 9 groups based on histologic
pattern: Category 1-Clear cell lesions; Category
2-Eosinophilic granular cell lesions; Category
3-Tubulopapillary lesions; Category 4-Spindle cell lesions;
Category 5-Infiltrating tumors; Category 6-Small
blue cell tumors; Category 7-Cystic lesions; Category
8-Necrotic and/or fibrohistiocytic lesions; and Category
9-Inadequate materials. Different immunohistochemical
stain panels for each category were used.
Results: In this study, 52 core biopsies from 47 cases
were evaluated. An adequate sample was obtained in 46
(88%). Renal cell carcinoma (49%) was most common
followed by metastatic tumors (15%) lymphoma (9%)
and urothelial carcinoma (4%). Benign tumors were
identified in 3 cases (6%). 19% of the biopsies were
non-diagnostic. Most of the cases need immunohistochemical
panels for differential diagnosis. Category 2 and
5 was the most problematic, requiring frequently immunohistochemistry
and clinical correlation.
Conclusion: A wide spectrum of neoplasms is encountered
and diagnosable by renal needle core biopsy. The
above- mentioned categories would facilitate the approach
to the biopsy and provide a diagnostic tool. Clinical
correlation and contemporary immunohistochemistry
work-up is often essential in eosinophilic-granular cell
lesions and infiltrating tumors and would allow more
accurate diagnosis.
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