Low local metastatic rate may widen indication of nephron-sparing
surgery for renal cell carcinoma
, Jie Zheng
, Chen-chen Feng
, Yun Bao
, Qiang Ding
, Zu-jun Fang
Department of Urology, Huashan Hospital, Fudan University, 12 Central Urumqi Rd, Shanghai 200040, PR China
Department of Pathology, Huashan Hospital, Fudan University, 12 Central Urumqi Rd, Shanghai 200040, PR China
Abstract To explore the rationale for renal-sparing surgery as an alternative method to radical nephrectomy in
the treatment of renal cell carcinoma (RCC), we analyzed clinical data from 94 patients diagnosed as
having RCC. They were divided into 3 groups based on the maximum diameter of their tumor
specimens. Group A had tumors size ranging from 0 to 4 cm, group B had tumors size ranging from
4 to 7 cm, and group C had tumors size greater than 7 cm. Tissue samples (5 cm) were taken from the
upper pole side, lower pole side, and renal pelvic side of the tumor pseudocapsule; if the tumor was
located on 1 pole of the kidney, samples were collected from 2 directions. The specimens were then
embedded in paraffin and cut serially at segments 0 to 1, 1 to 3, and 3 to 5 cm. Staining with
hematoxylin and eosin, anti-pancytokeratin, and vimentin was performed to determine tumor type
and tumor infiltration. From the 94 patients analyzed, 2 patients in group A had RCC metastasis
within 1 cm of tissue around the pseudocapsule, and 4 patients in groups B and C had lymph node
metastasis without metastasis in the tissue 1 cm outside the pseudocapsule in all 3 directions
described. There was no statistical significant difference found between the incidence of local
metastasis of the various tumor sizes, suggesting that local metastasis of RCC is not associated with
the size of the tumor. Based on the observation that incidences of local metastasis were low in early-
stage RCC, we came to the conclusion that pseudocapsule of RCC tumor might have growth-limiting
effect on the tumor enclosed. It is theoretically a safer and better surgical option for patients with
RCC with a smaller size of tumor and indications for radical nephrectomy to undergo renal-sparing
surgery with an excision margin of 1 cm of normal tissue around the pseudocapsule of the tumor.
© 2012 Elsevier Inc. All rights reserved.
Keywords: Renal cell carcinoma; Nephrectomy; Vimentin; Anti-pancytokeratin immunoglobulin
Renal cell carcinoma (RCC) is the most common
malignant tumor arising from the kidney and accounts for
2% of all new malignant cancers diagnosed in the world .
In 2010, 3% (female) to 4% (male) of the new cases of
malignant cancers were diagnosed to be RCC in North
America. Out of a total of 58 240 new cancer cases (35 370
in men and 22 870 in women), 8210 deaths in men occurred
. In North America, based on statistical data collected
from 1992 to 2006, RCC accounted for 85% of all renal
neoplasms, whereas other types included 15% of renal pelvic
carcinomas and 2% of rare forms of malignant tumors .
Early diagnosis and treatment are important in managing
RCC, and surgery is the standard method for treating RCC
until now. These surgical options include radical nephrec-
tomy (RN) and nephron-sparing surgery (NSS) [3-5]. The
NSS has been used to treat RCC in patients with only 1
remaining functional kidney; however, the main controversy
remains in weighting options between RN and NSS for
treating other patients with RCC. A limited number of past
studies have shown that the results of NSS and RN were
similar based on the use of hematoxylin and eosin (H&E)
staining to determine the extent of local metastasis without
further investigations into other histologic changes [6-8].
In the present study, we want to analyze past studies by
using immunohistochemistry staining using pancytokeratin
Available online at www.sciencedirect.com
Annals of Diagnostic Pathology 16 (2012) 190 – 195
Corresponding author. Department of Urology, Huashan Hospital,
Fudan University, Shanghai 200040, PR China. Fax: +86 62489191.
E-mail address: firstname.lastname@example.org (Z. Fang).
1092-9134/$ – see front matter © 2012 Elsevier Inc. All rights reserved.