ABSTRACT
Bilateral oncocytosis along with multiple tumours in both kidneys represents a very rare pathology that is accompanied by diagnostic and therapeutic challenges. We report the case of a 60-year old male patient who underwent computer tomography with incidental detection of multiple bilateral and contrast enhancing renal tumours of different size. Subsequently the patient underwent nephron-sparing tumor resection, first on the right side and 4 weeks later on the left side. The histology of all removed tumors showed evidence of pure oncocytoma. There were no postoperative complications and renal function reached a stable state within 6 months follow-up. The major challenge regarding diagnostic process and therapy of this pathology is to distinguish benign oncocytoma from chromophobe renal cell carcinoma and hybrid tumours, which can all be associated with renal oncocytosis. Because of limitations concerning imaging processes and biopsy, all patients should undergo nephron-sparing surgery as far as possible. On the other hand alternative therapies should - regarding to therapy-associated morbidity and the basically benign prognosis of oncocytoma - be well discussed to obtain informed consent. In this case report different therapy options and the international literature concerning renal oncocytosis will be discussed.
Subject(s)
Adenoma, Oxyphilic/diagnosis , Adenoma, Oxyphilic/therapy , Hepatectomy/methods , Kidney Neoplasms/diagnosis , Kidney Neoplasms/therapy , Neoplasms, Multiple Primary/diagnosis , Neoplasms, Multiple Primary/therapy , Organ Sparing Treatments/methods , Adenoma, Oxyphilic/pathology , Clinical Decision-Making/methods , Diagnosis, Differential , Evidence-Based Medicine , Humans , Kidney Neoplasms/pathology , Male , Middle Aged , Neoplasms, Multiple Primary/pathology , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
BACKGROUND: In various studies it has been shown that obesity enhances the risk for a unfavorable pathological tumour stages, higher Gleason scores (GS), positive surgical margins (PSM), and certain perioperative parameters (higher blood loss, higher length of surgery, higher complication rates) after radical prostatectomy. However, for robot-assisted radical prostatectomy (RARP) there are only a few studies addressing this topic with partially conflicting results. Furthermore, none of these studies actually represents the clinical practice pattern as performed in a European centre. MATERIAL AND METHODS: Beside further clinical and histopathological parameters, also body mass index (BMI) of patients undergoing RARP was recorded. The following categories were registered: BMI of < 25 kg/m², ≥ 25-29.9 kg/m², and ≥ 30 kg/m² defined as normal weight, overweight, and obesity, respectively. The potential correlation between BMI on the one hand and various criteria of aggressive tumour biology and specific perioperative parameters on the other hand has been examined on univariate and multivariable analyses. RESULTS: 22.8% (n=79), 59% (n=204), and 18.2% (n=63) of patients of the study group presented with normal weight, overweight, and obesity, respectively. Based on the results of various multivariable regression models there was no significant influence of obesity on pathological tumour stage, pN category, undifferentiated tumour growth (≥ GS7b), upgrading, or PSM rates. Furthermore, obese patients showed a significantly higher intraoperative blood loss and a higher length of surgery, which, however, did not result in a higher rate of grade 3a/b complications according to Clavien-Dindo classification after 90 days. CONCLUSIONS: In the present series of consecutive patients undergoing RARP there was no evidence for a more aggressive tumour biology or a higher complication rate in obese patients.
