scholarly journals Radiologic Evaluation of Small Renal Masses (I): Pretreatment Management

2008 ◽  
Vol 2008 ◽  
pp. 1-16 ◽  
Author(s):  
A. Marhuenda ◽  
M. I. Martín ◽  
C. Deltoro ◽  
J. Santos ◽  
Jose Rubio Briones
Keyword(s):  
Renal Mass ◽  
Relevant Literature ◽  
Main Question ◽  
Small Renal Mass ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Detailed Review ◽  
Radiologic Evaluation ◽  
Followup Studies ◽  
Ct And Mri

When characterizing a small renal mass (SRM), the main question to be answered is whether the mass represents a surgical or nonsurgical lesion or, in some cases, if followup studies are a reasonable option. Is this a task for a urologist or a radiologist? It is obvious that in the increasing clinical scenario where this decision has to be made, both specialists ought to work together. This paper will focus on the principles, indications, and limitations of ultrasound, CT, and MRI to characterize an SRM in 2008 with a detailed review of relevant literature. Special emphasis has been placed on aspects regarding the bidirectional information between radiologists and urologists needed to achieve the best radiological approach to an SRM.

scholarly journals Small Renal Mass with Sarcomatoid Features

2020 ◽  
Vol 14 (1) ◽  
pp. 54-56
Author(s):  
Anthony D. Oberle ◽  
James A. Brown
Keyword(s):  
Renal Cell Carcinoma ◽  
Renal Mass ◽  
Small Renal Mass ◽  
Common Pathway ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Threshold Size ◽  
Sarcomatoid Renal Cell Carcinoma ◽  
Worse Prognosis ◽  
Sarcomatoid Differentiation

Interest in surveillance for small renal masses has expanded exponentially due to incidental detection with increased imaging. However, some of these small renal masses behave aggressively. Sarcomatoid pathology is associated with a worse prognosis. Traditionally, it has been thought of as a common pathway of dedifferentiation once a renal malignancy of any histology reaches a threshold size of approximately 3 cm. We report a case of a 65-year-old male with a 2 cm sarcomatoid renal cell carcinoma. To our knowledge, this is the smallest tumor with sarcomatoid differentiation reported in the literature.

Management of Small Renal Masses

2018 ◽  
Author(s):  
Keith A Lawson ◽  
Antonio Finelli
Keyword(s):  
Natural History ◽  
Renal Mass ◽  
The Body ◽  
Renal Tumors ◽  
Small Renal Mass ◽  
Small Renal Masses ◽  
Tumor Biopsy ◽  
Renal Masses ◽  
History Of

The rise in incidentally discovered enhancing solid renal tumors has spurred the development of new approaches to managing this unique clinical entity known as the small renal mass (SRM). These approaches are grounded on a better understanding of the natural history of SRM, with the goal to reduce the morbidity associated with their management and avoid overtreatment. In this chapter, we review the body of evidence pertaining to the classification and clinical management of SRMs with respect to diagnosis, treatment, and follow-up. In addition, we discuss the controversies and active areas of development for this rapidly evolving field that strides towards a precision medicine paradigm.  This review contains 6 figures, 6 tables and 63 references Keywords: Small renal mass, renal cell carcinoma, radical nephrectomy, renal tumor biopsy, active surveillance, natural history, oncocytoma, robotic surgery, partial nephrectomy

scholarly journals The Past, Present, and Future in Management of Small Renal Masses

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Sarah C. Ha ◽  
Haley A. Zlomke ◽  
Nicholas Cost ◽  
Shandra Wilson
Keyword(s):  
Renal Mass ◽  
Treatment Modalities ◽  
Small Renal Mass ◽  
Consensus Guidelines ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Cross Sectional ◽  
The Past ◽  
Cross Sectional Imaging ◽  
Ablative Techniques

Management of small renal masses (SRMs) is currently evolving due to the increased incidence given the ubiquity of cross-sectional imaging. Diagnosing a mass in the early stages theoretically allows for high rates of cure but simultaneously risks overtreatment. New consensus guidelines and treatment modalities are changing frequently. The multitude of information currently available shall be summarized in this review. This summary will detail the historic surgical treatment of renal cell carcinoma with current innovations, the feasibility and utility of biopsy, the efficacy of ablative techniques, active surveillance, and use of biomarkers. We evaluate how technology may be used in approaching the small renal mass in order to decrease morbidity, while keeping rates of overtreatment to a minimum.

Management of Small Renal Masses

2018 ◽  
Author(s):  
Keith A Lawson ◽  
Antonio Finelli
Keyword(s):  
Natural History ◽  
Renal Mass ◽  
The Body ◽  
Renal Tumors ◽  
Small Renal Mass ◽  
Small Renal Masses ◽  
Tumor Biopsy ◽  
Renal Masses ◽  
History Of

The rise in incidentally discovered enhancing solid renal tumors has spurred the development of new approaches to managing this unique clinical entity known as the small renal mass (SRM). These approaches are grounded on a better understanding of the natural history of SRM, with the goal to reduce the morbidity associated with their management and avoid overtreatment. In this chapter, we review the body of evidence pertaining to the classification and clinical management of SRMs with respect to diagnosis, treatment, and follow-up. In addition, we discuss the controversies and active areas of development for this rapidly evolving field that strides towards a precision medicine paradigm.  This review contains 6 figures, 6 tables and 63 references Keywords: Small renal mass, renal cell carcinoma, radical nephrectomy, renal tumor biopsy, active surveillance, natural history, oncocytoma, robotic surgery, partial nephrectomy

scholarly journals Extensive renal infarction following percutaneous biopsy of a small renal mass: A case report

2013 ◽  
Vol 7 (1-2) ◽  
pp. 118
Author(s):  
Samuel Abourbih ◽  
Saad Aldousari ◽  
Fadi Brimo ◽  
Atilla Omeroglu ◽  
Wassim Kassouf
Keyword(s):  
Renal Mass ◽  
Laryngeal Squamous Cell Carcinoma ◽  
Percutaneous Biopsy ◽  
Renal Infarction ◽  
Small Renal Mass ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Percutaneous Renal Biopsy ◽  
Nephron Sparing ◽  
Solid Renal Mass

Percutaneous renal biopsy has become increasingly utilized particularly in patients undergoing active surveillance for small renal masses. We present a case of a significant complication following biopsy of a solid renal mass in a patient who was recently diagnosed with laryngeal squamous cell carcinoma. The patient was planned for nephron sparing surgery that was converted to radical nephrectomy due to extensive renal infarction secondary to significant subcapsular hemorrhage inflicted by the biopsy.

scholarly journals The Natural History and Predictors for Intervention in Patients with Small Renal Mass Undergoing Active Surveillance

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Zaher Bahouth ◽  
Sarel Halachmi ◽  
Gil Meyer ◽  
Ofir Avitan ◽  
Boaz Moskovitz ◽  
...  
Keyword(s):  
Natural History ◽  
Active Surveillance ◽  
Renal Mass ◽  
Nephron Sparing Surgery ◽  
Small Renal Mass ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Nephron Sparing ◽  
The Mean

Aim. To describe the natural history of small renal mass on active surveillance and identify parameters that could help in predicting the need for intervention in patients with small renal masses undergoing active surveillance. We also discuss the need for renal biopsy in the management of these patients.Methods. A retrospective analysis of 78 renal masses ≤4 cm diagnosed at our Urology Department at Bnai Zion Medical Center between September 2003 and March 2012.Results. Seventy patients with 78 small renal masses were analyzed. The mean age at diagnosis was 68 years (47–89). The mean follow-up period was 34 months (12–112). In 54 of 78 masses there was a growth of at least 2 mm between imaging on last available follow-up and diagnosis. Eight of the 54 (15%) masses which grew in size underwent a nephron-sparing surgery, of which two were oncocytomas and six were renal cell carcinoma. Growth rate and mass diameter on diagnosis were significantly greater in the group of patients who underwent a surgery.Conclusions. Small renal masses might eventually be managed by active surveillance without compromising survival or surgical approach. All masses that were eventually excised underwent a nephron-sparing surgery. None of the patients developed metastases.

The role of renal mass biopsy in the management of small renal masses – patterns of use and surgeon opinion

2020 ◽  
Vol 13 (5) ◽  
pp. 356-363
Author(s):  
Melinda M Protani ◽  
Andre Joshi ◽  
Victoria White ◽  
David JT Marco ◽  
Rachel E Neale ◽  
...  
Keyword(s):  
Medical Records ◽  
Renal Mass ◽  
Practice Variation ◽  
Small Renal Masses ◽  
Level Of Evidence ◽  
Renal Masses ◽  
Patterns Of Use ◽  
Renal Mass Biopsy ◽  
Pre Treatment

Aims: Renal mass biopsy (RMB) is advocated to improve management of small renal masses, however there is concern about its clinical utility. This study aimed to elicit opinions about the role of RMB in small renal mass management from surgeons managing renal cell carcinomas (RCC), and examine the frequency of pre-treatment biopsy in those with RCC. Methods: All surgeons in two Australian states (Queensland: n = 59 and Victoria: n = 108) who performed nephrectomies for RCC in 2012/2013 were sent questionnaires to ascertain views about RMB. Response rates were 54% for Queensland surgeons and 38% for Victorian surgeons. We used medical records data from RCC patients to determine RMB frequency. Results: Most Queensland (81%) and Victorian (59%) surgeons indicated they rarely requested RMB; however 34% of Victorians reported often requesting RMB, compared with no Queensland surgeons. This was consistent with medical records data: 17.6% of Victorian patients with T1a tumours received RMB versus 6.7% of Queensland patients ( p < 0.001). Surgeons’ principal concerns regarding RMB related to sampling reliability (90%) and/or histopathological interpretation (76%). Conclusions: Most surgeons report infrequent use of RMB for small renal masses, however we observed practice variation. The principal reasons for infrequent use were concerns about sampling reliability and histopathological interpretation, which may be valid in regions with less access to interventional radiologists and uropathologists. Further evidence is required to define patient groups for whom biopsy results will alter management. Level of evidence: Not applicable for this multicentre audit.

Treating the Two Extremes in Renal Cell Carcinoma: Management of Small Renal Masses and Cytoreductive Nephrectomy in Metastatic Disease

2014 ◽  
pp. e214-e221 ◽  
Author(s):  
Dae Y. Kim ◽  
Christopher G. Wood ◽  
Jose A. Karam
Keyword(s):  
Renal Cell Carcinoma ◽  
Targeted Therapy ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Renal Mass ◽  
Cytoreductive Nephrectomy ◽  
Renal Cell Carcinomas ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Renal Mass Biopsy

OVERVIEW: The incidental renal mass represents a heterogeneous group that contains both benign and malignant pathologies. The majority of renal cell carcinomas are discovered incidentally, without the presence of symptoms directly related to the mass, and are closely associated with the term small renal masses because of the discovery before the onset of symptoms. In general, small renal masses are defined as 4 cm or smaller, and may account for greater than half of renal cell carcinoma diagnosis. The use of renal mass biopsy may offer additional pathological information but the clinician must be reminded of the technical and diagnostic limitations of renal mass biopsy. Patient-dependent factors, such as life expectancy and comorbidities, guide the management of small renal masses, which include active surveillance, partial nephrectomy, radical nephrectomy, and ablative techniques (cryoablation and radiofrequency ablation). Partial nephrectomy has demonstrated durable oncologic control for small renal masses while preserving renal function and, if feasible, is the current treatment of choice. In the other extreme of the renal cell carcinomas spectrum and in the presence of metastatic disease, the removal of the renal primary tumor is termed cytoreductive nephrectomy. Two randomized trials (SWOG 8949 and EORTC 30947) have demonstrated a survival benefit with cytoreductive nephrectomy before the initiation of immunotherapy. These two studies have also been the motivation to perform cytoreductive nephrectomy in the targeted therapy era. Currently, there are two ongoing randomized prospective trials accruing to investigate the timing and relevance of cytoreductive nephrectomy in the contemporary setting of targeted therapy.

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