Clinicopathologic Characteristics of Renal Cell Carcinoma in Patients 45 Years of Age and Younger
Ryan Carr, Alison Van Dyke, Guoping Cai, Kenneth Haines, Adebowale J Adeniran. Yale University School of Medicine, New Haven, CT
Background: Renal cell carcinoma (RCC) occurs mainly in older people and is infrequently diagnosed in children and young adults. Limited studies have been conducted on RCC in the younger age group, hence the clinical and morphologic spectrum remain incompletely defined, and the behavior is poorly understood. The aim of this study was to analyse the clinicopathologic characteristics of RCC in patients 45 years old and younger.
Design: Based on the retrospective review of our files, cases diagnosed as renal cell carcinoma in patients 45 years old and younger in our institution between 1985 and 2011 were identified. Slides in our files were reviewed on all cases. Gross findings were obtained from pathology reports. Follow-up data was obtained from the clinical database.
Results: We identified a total of 102 cases of RCC in patients aged 45 years and younger (63 males and 39 females). Age range: 3-45 years, median age: 40 years. Median tumor size: 3.7cm (range, 0.5-27cm). Laterality of tumor was evenly split between right and left but tumor most commonly located in the lower pole. Histological types: 58 clear cell, 24 papillary, 11 chromophobe, 5 translocation-associated, 2 multilocular cystic, 1 medullary and 1 mixed. Sixty-six patients underwent radical resections, 33 had partial resections while three had percutaneous needle biopsies. Tumor was unifocal in 94 cases while 8 had multifocal tumors. Approximately 50% of the tumors had Fuhrman nuclear grade 2. Pathologic stage at diagnosis: 53 pT1a, 17 pT1b, 14 pT2a, 5 pT2b, 9 pT3a and 1 pT3b. At the time of diagnosis, lymph node involvement, renal sinus fat invasion, main renal vein invasion, perinephric fat invasion and microvascular angiolymphatic invasion were identified in 5, 5, 5, 9 and 11 cases, respectively. Microscopic coagulative necrosis was identified in 33 cases, while sarcomatoid differentiation was present in 7 cases. Distant metastasis was present in 8 cases. Clinical outcome data: 4 alive with disease, 57 alive no disease, 25 alive NOS, 7 dead of disease (10 months average survival; 7 months median survival; 5 male; 3 female).
Conclusions: Although uncommon in children and young adults, RCC is predominantly clear cell type, occurs more commonly in males and mostly has an indolent course. Clear cell and translocation-associated subtypes account for the clinically aggressive cases.
Category: Genitourinary (including renal tumors)
Tuesday, March 20, 2012 9:30 AM
Poster Session III # 144, Tuesday Morning