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Bradley C Leibovich - One of the best experts on this subject based on the ideXlab platform.
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prognostic evaluation of perinephric fat Renal Sinus fat and Renal vein invasion for patients with pathological stage t3a clear cell Renal cell carcinoma
BJUI, 2019Co-Authors: Paras H Shah, Christine M Lohse, Bradley C Leibovich, John C Cheville, Timothy D Lyon, Stephen A Boorjian, Houston R ThompsonAbstract:OBJECTIVE To investigate the prognostic significance of various patterns of extraRenal extension that comprise pathological stage T3a clear-cell Renal cell carcinoma (ccRCC) amongst patients undergoing nephrectomy for non-metastatic disease. PATIENTS AND METHODS A retrospective review of 563 patients who underwent radical nephrectomy for pathologically confirmed T3aN0/NxM0 ccRCC between 1970 and 2011 was performed. All pathological slides were re-reviewed by one urological pathologist. Associations of patterns of extraRenal extension (perinephric fat [PF], Renal Sinus fat [SF], and Renal vein [RV], in isolation or in any combination) with disease progression, cancer-specific mortality (CSM), and all-cause mortality were evaluated on multivariable analyses. RESULTS Overall, PF invasion, Renal SF invasion, and RV tumour thrombus were present in 144 (26%), 51 (9%), and 163 (29%) patients, respectively, with multiple patterns of extraRenal extension identified in 205 (36%) patients. There were no significant differences in survival outcomes for isolated involvement of PF, Renal SF, or RV. However, patients with multiple patterns of extraRenal extension were at significantly increased risk of disease progression (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.04-1.65; P = 0.020), CSM (HR 1.64, 95% CI 1.27-2.12; P < 0.001), and all-cause mortality (HR 1.32, 95% CI 1.08-1.61; P = 0.008). CONCLUSIONS The presence of multiple patterns of extraRenal extension is associated with a higher risk of disease progression and cancer-related death after radical nephrectomy compared to isolated involvement of the PF, Renal SF, or RV, which carry similar prognostic weight. If validated, these findings may help refine risk stratification of non-metastatic T3a RCC by distinguishing patients with multiple vs one pattern of extraRenal extension.
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percutaneous cryoablation of Renal cell carcinoma with Sinus vein involvement based on preprocedural imaging
Journal of Vascular and Interventional Radiology, 2017Co-Authors: Thomas D Atwell, Bradley C Leibovich, Houston R Thompson, Stephen A Boorjian, Nicholas A Kurup, John J Schmitz, Grant D SchmitAbstract:Abstract Purpose To assess feasibility, safety, and oncologic outcomes of cryoablation in treatment of Renal cell carcinoma (RCC) with extension into adjacent Renal Sinus vein. Materials and Methods Review of an internally maintained Renal ablation registry identified 7 patients (4 men and 3 women; median age 62 y; age range, 45–91 y) who underwent percutaneous cryoablation of RCC with imaging consistent with extension of tumor into an immediately adjacent Renal Sinus vein. Four of 7 (57%) patients had recurrent tumors following prior partial nephrectomy. Three of 7 patients (43%) had solitary kidneys. Results Median tumor size was 4.3 cm (range, 1.9–5.0 cm). Biopsy showed RCC in 6 of 7 patients. Technical success was achieved in 6 of 7 tumors (86%) There was a single Clavien grade 3 major complication. Median hospital stay was 1 night (range, 1–3 nights). Follow-up imaging performed in the 6 successfully treated patients at median 11 months (range, 2–101 months) showed no local tumor progression. In 2 patients with solitary kidneys, estimated glomerular filtration rate declined from 63 mL/min/1.73 m 2 to 45 mL/min/1.73 m 2 and 67 mL/min/1.73 m 2 to 40 mL/min/1.73 m 2 at 101 months and 12 months following treatment, respectively. Estimated glomerular filtration rate remained > 60 mL/min/1.73 m 2 in the remaining patients. Conclusions In this small select group of patients, percutaneous cryoablation afforded a safe and, based on early outcomes, effective means of providing local control of locally invasive RCC. Percutaneous cryoablation may obviate the need for nephrectomy in similar patients.
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patients with pt1 Renal cell carcinoma who die from disease after nephrectomy may have unrecognized Renal Sinus fat invasion
The American Journal of Surgical Pathology, 2007Co-Authors: Robert Houston Thompson, Michael L Blute, Amy E Krambeck, Christine M Lohse, James S Magera, Bradley C Leibovich, Eugene D Kwon, Igor Frank, John C ChevilleAbstract:Prior studies suggest that the Renal Sinus permits early tumor spread in otherwise localized Renal cell carcinoma (RCC) tumors. We hypothesized that Renal Sinus fat invasion may be unrecognized in pT1 patients who subsequently die from RCC. Between 1985 and 2002, we identified 577 patients who underwent radical nephrectomy for localized pT1 clear cell RCC as reviewed by a single urologic pathologist (J.C.C.). Among these patients, 49 died from RCC including 33 who had their original nephrectomy specimen stored in formalin. These specimens were then resectioned with thin cuts of the Renal Sinus and reviewed by the same pathologist. For comparison, 33 patients who did not die from RCC (controls) also had their original nephrectomy specimen resectioned. Among the 33 patients who died from seemingly localized RCC, 14 (42%) had previously unrecognized Renal Sinus fat invasion compared with 2 (6%) of the controls (P < 0.001). In addition, 19 (58%) patients who died from RCC had Renal Sinus small vein (microscopic venous) invasion, a pathologic feature not currently incorporated into the TNM staging system for RCC. This feature was present in 7 (21%) of the controls (P = 0.003). In total, 22 (67%) patients who died from RCC had unrecognized Renal Sinus fat or small vein invasion compared with 7 (21 %) of the controls (P < 0.001). We conclude that Renal Sinus fat invasion is an important adverse pathologic feature that is clearly underreported in the literature. Appropriate assessment of nephrectomy specimens should include proper sampling of the Renal Sinus even for seemingly localized tumors.
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is Renal Sinus fat invasion the same as perinephric fat invasion for pt3a Renal cell carcinoma
The Journal of Urology, 2005Co-Authors: Houston R Thompson, Christine M Lohse, Bradley C Leibovich, Eugene D Kwon, Igor Frank, John C Cheville, Scott W Webster, Horst Zincke, Michael L BluteAbstract:ABSTRACTPurpose: Perinephric and Renal Sinus fat invasion are classified as pT3a Renal cell carcinoma (RCC) according to the 2002 American Joint Committee on Cancer. We investigated the prognostic significance of each of these pathological features using a cohort of pT3a patients.Materials and Methods: Between 1970 and 2002, 205 patients without direct adRenal invasion underwent nephrectomy for pT3a clear cell RCC. The associations of fat invasion with death from RCC were evaluated using Cox proportional hazards regression models.Results: Of the 162 patients with perinephric fat invasion and 43 patients with Renal Sinus fat invasion 95 (59%) and 31 (72%), respectively, died of RCC. Patients with Renal Sinus fat invasion were 63% more likely to die of RCC compared with those with perinephric fat invasion (RR 1.63, 95% CI 1.09–2.46, p=0.018). In addition, the risk of death persisted in multivariate analysis after adjusting for regional lymph nodes and distant metastases (RR 1.91, 95% CI 1.26–2.89, p=0.002) ...
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tnm t3a Renal cell carcinoma adRenal gland involvement is not the same as Renal fat invasion
The Journal of Urology, 2003Co-Authors: Kenryu Han, Bradley C Leibovich, Matthew H T Bui, Allan J Pantuck, Danielo G Freitas, Frederick J Dorey, Amnon Zisman, Nicolette Janzen, Hideki Mukouyama, Robert A FiglinAbstract:ABSTRACTPurpose: Upper pole tumors with direct extension into the adRenal gland are currently staged as pT3a tumors in the 1997 TNM staging system. To determine whether the clinical behavior of pT3a adRenal tumors differs from that of tumors with perinephric fat invasion (also stage pT3a) a retrospective analysis was performed.Materials and Methods: Of 1,087 patients who underwent nephrectomy 27 were identified with direct adRenal involvement and 187 were identified with perinephric fat or Renal Sinus involvement. Variables and outcomes analyzed in each group included the percent of patients with metastatic disease at presentation, lymph node involvement, Eastern Cooperative Oncology Group score, response to immunotherapy, and median and overall survival using Kaplan-Meier curves.Results: Median survival for patients with pT3a disease and perinephric or Renal Sinus fat involvement was 36 months with a 36% 5-year cancer specific survival rate. In contrast, patients with adRenal gland invasion had significa...
Mitual B Amin - One of the best experts on this subject based on the ideXlab platform.
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myelolipoma of the Renal Sinus
2009Co-Authors: Daniel Schultz, Satish K Tickoo, Mitual B AminAbstract:Abstract Extra-adRenal myelolipomas are rare; approximately 36 cases have been reported to date. We document a case of myelolipoma presenting as a localized mass in the Renal Sinus of a 66-year-old man. The chief clinical and radiologic differential diagnostic considerations in this case included a malignant Renal tumor arising in the hilum. The patient was being investigated for recurrent urinary tract infections and vague abdominal pains. Histologically, the lesion showed features characteristic of a myelolipoma. There was also marked chronic inflammation in and around the mass. The uneventful follow-up of 62 months is in keeping with the benign nature of this lesion. This report expands the possibilities of the differential diagnoses of Renal hilar neoplasms, particularly in view of the increased use of imaging techniques that are bound to detect many incidental lesions in this region. (Arch Pathol Lab Med.1999;123:631–634)
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myelolipoma of the Renal Sinus an unusual site for a rare extra adRenal lesion
Archives of Pathology & Laboratory Medicine, 1999Co-Authors: Daniel Schultz, Satish K Tickoo, Mitual B AminAbstract:○ Extra-adRenal myelolipomas are rare; approximately 36 cases have been reported to date. We document a case of myelolipoma presenting as a localized mass in the Renal Sinus of a 66-year-old man. The chief clinical and radiologic differential diagnostic considerations in this case included a malignant Renal tumor arising in the hilum. The patient was being investigated for recurrent urinary tract infections and vague abdominal pains. Histologically, the lesion showed features characteristic of a myelolipoma. There was also marked chronic inflammation in and around the mass. The uneventful follow-up of 62 months is in keeping with the benign nature of this lesion. This report expands the possibilities of the differential diagnoses of Renal hilar neoplasms, particularly in view of the increased use of imaging techniques that are bound to detect many incidental lesions in this region.
John C Cheville - One of the best experts on this subject based on the ideXlab platform.
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prognostic evaluation of perinephric fat Renal Sinus fat and Renal vein invasion for patients with pathological stage t3a clear cell Renal cell carcinoma
BJUI, 2019Co-Authors: Paras H Shah, Christine M Lohse, Bradley C Leibovich, John C Cheville, Timothy D Lyon, Stephen A Boorjian, Houston R ThompsonAbstract:OBJECTIVE To investigate the prognostic significance of various patterns of extraRenal extension that comprise pathological stage T3a clear-cell Renal cell carcinoma (ccRCC) amongst patients undergoing nephrectomy for non-metastatic disease. PATIENTS AND METHODS A retrospective review of 563 patients who underwent radical nephrectomy for pathologically confirmed T3aN0/NxM0 ccRCC between 1970 and 2011 was performed. All pathological slides were re-reviewed by one urological pathologist. Associations of patterns of extraRenal extension (perinephric fat [PF], Renal Sinus fat [SF], and Renal vein [RV], in isolation or in any combination) with disease progression, cancer-specific mortality (CSM), and all-cause mortality were evaluated on multivariable analyses. RESULTS Overall, PF invasion, Renal SF invasion, and RV tumour thrombus were present in 144 (26%), 51 (9%), and 163 (29%) patients, respectively, with multiple patterns of extraRenal extension identified in 205 (36%) patients. There were no significant differences in survival outcomes for isolated involvement of PF, Renal SF, or RV. However, patients with multiple patterns of extraRenal extension were at significantly increased risk of disease progression (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.04-1.65; P = 0.020), CSM (HR 1.64, 95% CI 1.27-2.12; P < 0.001), and all-cause mortality (HR 1.32, 95% CI 1.08-1.61; P = 0.008). CONCLUSIONS The presence of multiple patterns of extraRenal extension is associated with a higher risk of disease progression and cancer-related death after radical nephrectomy compared to isolated involvement of the PF, Renal SF, or RV, which carry similar prognostic weight. If validated, these findings may help refine risk stratification of non-metastatic T3a RCC by distinguishing patients with multiple vs one pattern of extraRenal extension.
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patients with pt1 Renal cell carcinoma who die from disease after nephrectomy may have unrecognized Renal Sinus fat invasion
The American Journal of Surgical Pathology, 2007Co-Authors: Robert Houston Thompson, Michael L Blute, Amy E Krambeck, Christine M Lohse, James S Magera, Bradley C Leibovich, Eugene D Kwon, Igor Frank, John C ChevilleAbstract:Prior studies suggest that the Renal Sinus permits early tumor spread in otherwise localized Renal cell carcinoma (RCC) tumors. We hypothesized that Renal Sinus fat invasion may be unrecognized in pT1 patients who subsequently die from RCC. Between 1985 and 2002, we identified 577 patients who underwent radical nephrectomy for localized pT1 clear cell RCC as reviewed by a single urologic pathologist (J.C.C.). Among these patients, 49 died from RCC including 33 who had their original nephrectomy specimen stored in formalin. These specimens were then resectioned with thin cuts of the Renal Sinus and reviewed by the same pathologist. For comparison, 33 patients who did not die from RCC (controls) also had their original nephrectomy specimen resectioned. Among the 33 patients who died from seemingly localized RCC, 14 (42%) had previously unrecognized Renal Sinus fat invasion compared with 2 (6%) of the controls (P < 0.001). In addition, 19 (58%) patients who died from RCC had Renal Sinus small vein (microscopic venous) invasion, a pathologic feature not currently incorporated into the TNM staging system for RCC. This feature was present in 7 (21%) of the controls (P = 0.003). In total, 22 (67%) patients who died from RCC had unrecognized Renal Sinus fat or small vein invasion compared with 7 (21 %) of the controls (P < 0.001). We conclude that Renal Sinus fat invasion is an important adverse pathologic feature that is clearly underreported in the literature. Appropriate assessment of nephrectomy specimens should include proper sampling of the Renal Sinus even for seemingly localized tumors.
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is Renal Sinus fat invasion the same as perinephric fat invasion for pt3a Renal cell carcinoma
The Journal of Urology, 2005Co-Authors: Houston R Thompson, Christine M Lohse, Bradley C Leibovich, Eugene D Kwon, Igor Frank, John C Cheville, Scott W Webster, Horst Zincke, Michael L BluteAbstract:ABSTRACTPurpose: Perinephric and Renal Sinus fat invasion are classified as pT3a Renal cell carcinoma (RCC) according to the 2002 American Joint Committee on Cancer. We investigated the prognostic significance of each of these pathological features using a cohort of pT3a patients.Materials and Methods: Between 1970 and 2002, 205 patients without direct adRenal invasion underwent nephrectomy for pT3a clear cell RCC. The associations of fat invasion with death from RCC were evaluated using Cox proportional hazards regression models.Results: Of the 162 patients with perinephric fat invasion and 43 patients with Renal Sinus fat invasion 95 (59%) and 31 (72%), respectively, died of RCC. Patients with Renal Sinus fat invasion were 63% more likely to die of RCC compared with those with perinephric fat invasion (RR 1.63, 95% CI 1.09–2.46, p=0.018). In addition, the risk of death persisted in multivariate analysis after adjusting for regional lymph nodes and distant metastases (RR 1.91, 95% CI 1.26–2.89, p=0.002) ...
Michael L Blute - One of the best experts on this subject based on the ideXlab platform.
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patients with pt1 Renal cell carcinoma who die from disease after nephrectomy may have unrecognized Renal Sinus fat invasion
The American Journal of Surgical Pathology, 2007Co-Authors: Robert Houston Thompson, Michael L Blute, Amy E Krambeck, Christine M Lohse, James S Magera, Bradley C Leibovich, Eugene D Kwon, Igor Frank, John C ChevilleAbstract:Prior studies suggest that the Renal Sinus permits early tumor spread in otherwise localized Renal cell carcinoma (RCC) tumors. We hypothesized that Renal Sinus fat invasion may be unrecognized in pT1 patients who subsequently die from RCC. Between 1985 and 2002, we identified 577 patients who underwent radical nephrectomy for localized pT1 clear cell RCC as reviewed by a single urologic pathologist (J.C.C.). Among these patients, 49 died from RCC including 33 who had their original nephrectomy specimen stored in formalin. These specimens were then resectioned with thin cuts of the Renal Sinus and reviewed by the same pathologist. For comparison, 33 patients who did not die from RCC (controls) also had their original nephrectomy specimen resectioned. Among the 33 patients who died from seemingly localized RCC, 14 (42%) had previously unrecognized Renal Sinus fat invasion compared with 2 (6%) of the controls (P < 0.001). In addition, 19 (58%) patients who died from RCC had Renal Sinus small vein (microscopic venous) invasion, a pathologic feature not currently incorporated into the TNM staging system for RCC. This feature was present in 7 (21%) of the controls (P = 0.003). In total, 22 (67%) patients who died from RCC had unrecognized Renal Sinus fat or small vein invasion compared with 7 (21 %) of the controls (P < 0.001). We conclude that Renal Sinus fat invasion is an important adverse pathologic feature that is clearly underreported in the literature. Appropriate assessment of nephrectomy specimens should include proper sampling of the Renal Sinus even for seemingly localized tumors.
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is Renal Sinus fat invasion the same as perinephric fat invasion for pt3a Renal cell carcinoma
The Journal of Urology, 2005Co-Authors: Houston R Thompson, Christine M Lohse, Bradley C Leibovich, Eugene D Kwon, Igor Frank, John C Cheville, Scott W Webster, Horst Zincke, Michael L BluteAbstract:ABSTRACTPurpose: Perinephric and Renal Sinus fat invasion are classified as pT3a Renal cell carcinoma (RCC) according to the 2002 American Joint Committee on Cancer. We investigated the prognostic significance of each of these pathological features using a cohort of pT3a patients.Materials and Methods: Between 1970 and 2002, 205 patients without direct adRenal invasion underwent nephrectomy for pT3a clear cell RCC. The associations of fat invasion with death from RCC were evaluated using Cox proportional hazards regression models.Results: Of the 162 patients with perinephric fat invasion and 43 patients with Renal Sinus fat invasion 95 (59%) and 31 (72%), respectively, died of RCC. Patients with Renal Sinus fat invasion were 63% more likely to die of RCC compared with those with perinephric fat invasion (RR 1.63, 95% CI 1.09–2.46, p=0.018). In addition, the risk of death persisted in multivariate analysis after adjusting for regional lymph nodes and distant metastases (RR 1.91, 95% CI 1.26–2.89, p=0.002) ...
Houston R Thompson - One of the best experts on this subject based on the ideXlab platform.
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prognostic evaluation of perinephric fat Renal Sinus fat and Renal vein invasion for patients with pathological stage t3a clear cell Renal cell carcinoma
BJUI, 2019Co-Authors: Paras H Shah, Christine M Lohse, Bradley C Leibovich, John C Cheville, Timothy D Lyon, Stephen A Boorjian, Houston R ThompsonAbstract:OBJECTIVE To investigate the prognostic significance of various patterns of extraRenal extension that comprise pathological stage T3a clear-cell Renal cell carcinoma (ccRCC) amongst patients undergoing nephrectomy for non-metastatic disease. PATIENTS AND METHODS A retrospective review of 563 patients who underwent radical nephrectomy for pathologically confirmed T3aN0/NxM0 ccRCC between 1970 and 2011 was performed. All pathological slides were re-reviewed by one urological pathologist. Associations of patterns of extraRenal extension (perinephric fat [PF], Renal Sinus fat [SF], and Renal vein [RV], in isolation or in any combination) with disease progression, cancer-specific mortality (CSM), and all-cause mortality were evaluated on multivariable analyses. RESULTS Overall, PF invasion, Renal SF invasion, and RV tumour thrombus were present in 144 (26%), 51 (9%), and 163 (29%) patients, respectively, with multiple patterns of extraRenal extension identified in 205 (36%) patients. There were no significant differences in survival outcomes for isolated involvement of PF, Renal SF, or RV. However, patients with multiple patterns of extraRenal extension were at significantly increased risk of disease progression (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.04-1.65; P = 0.020), CSM (HR 1.64, 95% CI 1.27-2.12; P < 0.001), and all-cause mortality (HR 1.32, 95% CI 1.08-1.61; P = 0.008). CONCLUSIONS The presence of multiple patterns of extraRenal extension is associated with a higher risk of disease progression and cancer-related death after radical nephrectomy compared to isolated involvement of the PF, Renal SF, or RV, which carry similar prognostic weight. If validated, these findings may help refine risk stratification of non-metastatic T3a RCC by distinguishing patients with multiple vs one pattern of extraRenal extension.
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percutaneous cryoablation of Renal cell carcinoma with Sinus vein involvement based on preprocedural imaging
Journal of Vascular and Interventional Radiology, 2017Co-Authors: Thomas D Atwell, Bradley C Leibovich, Houston R Thompson, Stephen A Boorjian, Nicholas A Kurup, John J Schmitz, Grant D SchmitAbstract:Abstract Purpose To assess feasibility, safety, and oncologic outcomes of cryoablation in treatment of Renal cell carcinoma (RCC) with extension into adjacent Renal Sinus vein. Materials and Methods Review of an internally maintained Renal ablation registry identified 7 patients (4 men and 3 women; median age 62 y; age range, 45–91 y) who underwent percutaneous cryoablation of RCC with imaging consistent with extension of tumor into an immediately adjacent Renal Sinus vein. Four of 7 (57%) patients had recurrent tumors following prior partial nephrectomy. Three of 7 patients (43%) had solitary kidneys. Results Median tumor size was 4.3 cm (range, 1.9–5.0 cm). Biopsy showed RCC in 6 of 7 patients. Technical success was achieved in 6 of 7 tumors (86%) There was a single Clavien grade 3 major complication. Median hospital stay was 1 night (range, 1–3 nights). Follow-up imaging performed in the 6 successfully treated patients at median 11 months (range, 2–101 months) showed no local tumor progression. In 2 patients with solitary kidneys, estimated glomerular filtration rate declined from 63 mL/min/1.73 m 2 to 45 mL/min/1.73 m 2 and 67 mL/min/1.73 m 2 to 40 mL/min/1.73 m 2 at 101 months and 12 months following treatment, respectively. Estimated glomerular filtration rate remained > 60 mL/min/1.73 m 2 in the remaining patients. Conclusions In this small select group of patients, percutaneous cryoablation afforded a safe and, based on early outcomes, effective means of providing local control of locally invasive RCC. Percutaneous cryoablation may obviate the need for nephrectomy in similar patients.
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is Renal Sinus fat invasion the same as perinephric fat invasion for pt3a Renal cell carcinoma
The Journal of Urology, 2005Co-Authors: Houston R Thompson, Christine M Lohse, Bradley C Leibovich, Eugene D Kwon, Igor Frank, John C Cheville, Scott W Webster, Horst Zincke, Michael L BluteAbstract:ABSTRACTPurpose: Perinephric and Renal Sinus fat invasion are classified as pT3a Renal cell carcinoma (RCC) according to the 2002 American Joint Committee on Cancer. We investigated the prognostic significance of each of these pathological features using a cohort of pT3a patients.Materials and Methods: Between 1970 and 2002, 205 patients without direct adRenal invasion underwent nephrectomy for pT3a clear cell RCC. The associations of fat invasion with death from RCC were evaluated using Cox proportional hazards regression models.Results: Of the 162 patients with perinephric fat invasion and 43 patients with Renal Sinus fat invasion 95 (59%) and 31 (72%), respectively, died of RCC. Patients with Renal Sinus fat invasion were 63% more likely to die of RCC compared with those with perinephric fat invasion (RR 1.63, 95% CI 1.09–2.46, p=0.018). In addition, the risk of death persisted in multivariate analysis after adjusting for regional lymph nodes and distant metastases (RR 1.91, 95% CI 1.26–2.89, p=0.002) ...