Incidence of benign pathologic findings at partial nephrectomy for solitary renal mass presumed to be renal cell carcinoma on preoperative imaging.
OBJECTIVE
To determine the incidence of benign pathologic findings at partial nephrectomy for a solitary renal lesion when preoperative imaging is reviewed by an experienced team of academic genitourinary radiologists.


METHODS
From 1996 to 2004, 143 patients underwent resection of a solitary renal lesion for presumed renal cell carcinoma amenable to partial nephrectomy. Our experienced team of genitourinary radiologists interpreted all preoperative imaging scans. Of the 143 patients, 44 underwent partial nephrectomy for a solitary lesion less than 2 cm, 85 for a lesion 2 to 4 cm, and 14 for a lesion greater than 4 cm.


RESULTS
Of the 143 solitary masses resected, 23 revealed benign pathologic findings (16.1%). Ten lesions (43.5%) were angiomyolipomas (AMLs), eight (34.8%) were oncocytomas, three (13.0%) were benign Bosniak-type cysts, and one each was a low-grade spindle cell lesion most consistent with mesoblastic nephroma, and a metanephric adenoma.


CONCLUSIONS
A significant fraction of small solitary renal masses presumed to be renal cell carcinoma had benign pathologic findings on resection, despite thorough expert radiologic review. Management should favor parenchyma-sparing approaches, because resection serves not only a therapeutic but also a diagnostic function. Patients should be counseled accordingly when faced with the diagnosis of renal mass.
Kutikov
Alexander
A
Department of Surgery, Division of Urology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Fossett
Lindsay K
LK
Ramchandani
Parvati
P
Tomaszewski
John E
JE
Siegelman
Evan S
ES
Banner
Marc P
MP
Van Arsdalen
Keith N
KN
Wein
Alan J
AJ
Malkowicz
S Bruce
SB
D000236:Adenoma / Q000453:epidemiology / Q000473:pathology; D018249:Adenoma, Oxyphilic / Q000453:epidemiology / Q000473:pathology; D000328:Adult; D018207:Angiomyolipoma / Q000453:epidemiology / Q000473:pathology; D002292:Carcinoma, Renal Cell / Q000453:epidemiology* / Q000473:pathology* / Q000601:surgery; D003560:Cysts / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000601:surgery; D009392:Nephrectomy; D018201:Nephroma, Mesoblastic / Q000453:epidemiology / Q000473:pathology