Granulomas Associated with Renal Neoplasms: A Multi-Institutional Clinicopathologic Study of 92 Cases
Recommended Citation
Sangoi A, Maclean F, Daniel R, Lal P, Canete-Portillo S, Magi-Galluzzi C, Cornejo K, Collins K, Hwang M, Mohanty S, Falzarano S, Feely M, Dababneh M, Harik L, Tretiakova M, Akgul M, Chan E, Manucha V, Siadat F, Arora K, Barkan G, Cheng L, Hirsch M, Lei L, Wasco M, Williamson S, Acosta A. Granulomas Associated with Renal Neoplasms: A Multi-Institutional Clinicopathologic Study of 92 Cases. Mod Pathol 2022; 35(SUPPL 2):665-666.
Document Type
Conference Proceeding
Publication Date
3-19-2022
Publication Title
Mod Pathol
Abstract
Background: Formal depiction of granulomatous inflammation in association with renal neoplasms have mostly consisted of case reports and small series. Herein, we investigate the clinicopathologic features and potential significance of granulomas associated with renal tumors from a large multi-institutional cohort. Design: Database search was undertaken from 19 different institutions for cases of renal neoplasms containing either peritumoral or intratumoral granulomas from nephrectomy specimens. Cases were entirely reviewed with detailed clinicopathologic features recorded including follow-up investigation of sarcoidosis. Results: 92 study cases were collected, including 52 partial nephrectomies and 40 radical nephrectomies, of equal laterality distribution. Patient ages ranged from 27-85 years (average 59.9 years; male= 62%). Renal neoplasms were composed of clear cell renal cell carcinoma (RCC; 85%), papillary RCC (9%), chromophobe RCC (2%), clear cell papillary RCC (2%), mixed epithelial stromal tumor (1%), and oncocytoma (1%). RCC nuclear grades included grade 2 (52%), grade 3 (35%), grade 1 (7%), and grade 4 (6%). Most RCC cases were pathologic stage pT1a (50%) followed pT1b (22%), pT3a (22%), and pT2 (6%). Granulomas were peritumoral in 40% of cases, intratumoral in 17% of cases, and both in 43% cases. Total granuloma count per case ranged from 1 to 286 (median 15) with size of largest granuloma ranging from 0.15mm to 15mm (mean 1.9mm). Necrotizing granulomas were seen in 12% of cases. Histochemical stains for organisms were performed on 47% of cases (all negative). 16 cases (17%) had a prior biopsy/procedure performed, and 4 patients had neoadjuvant immunotherapy or chemotherapy. A total of 10 patients (11%) had a confirmed diagnosis of sarcoidosis, including 4 in whom sarcoidosis was diagnosed after nephrectomy. One patient presented with concurrent lung nodules at the time of nephrectomy (thought to be metastatic RCC), with histologic documentation of nephrectomy granulomas leading to timely clinical diagnosis of sarcoid. Conclusions: Based on this largest case series to date, peritumoral/intratumoral granulomas associated with renal neoplasms may be more common than initially perceived, and can be seen in both benign and malignant tumors. The extent of granulomatous inflammation can vary widely and may or may not have necrosis, with possible etiology from prior procedure. Although a clinical association with sarcoidosis is infrequent, it can still occur and warrants reporting.
PubMed ID
Not assigned.
Volume
35
Issue
SUPPL 2
First Page
665
Last Page
666
