title: Multiple Discordant Histology After Nephrectomy: Descriptive Analysis and Outcomes.
abstract: BACKGROUND
  While RCC is the most common primary renal neoplasm, few cases of ipsilateral renal lesions of different RCC histologic subtypes have been described. The objective of this study was to evaluate our experience with synchronous, histologically unique, primary renal neoplasms within the same kidney.
  
  
  METHODS
  We retrospectively analyzed 2 institutional nephrectomy databases from 2000 to 2013. The study cohort comprised 15 patients with multiple, discordant renal histology after partial or radical nephrectomy. Demographic data, immunohistochemical analysis, and clinical course were assessed and analyzed.
  
  
  RESULTS
  Eight patients (53%) were black, 10 (60%) were male, and 5 (36%) were tobacco users. Median follow-up time was 13 months (range, 1-62 months), and 9 patients (56%) underwent radical nephrectomy. Among 36 tumors, the median tumor size was 2.3 cm (range, 0.4-9 cm). The most common combination of discordant tumor histology among patients with ≥ 2 tumors was clear-cell (cc) renal-cell carcinoma (RCC) with chromophobe RCC (3 cases, 19%). In 3 patients (19%), a single tumor was noted to have 2 distinct patterns; all patients had ccRCC with papillary RCC. Three (20%) of 15 patients developed metastatic disease. The median cancer-free survival time for patients with metastasis was 2 months.
  
  
  CONCLUSIONS
  Multiple, discordant renal pathology represents a rarely reported entity in patients receiving nephrectomy. We introduce the largest cohort of synchronous renal tumors, of which ccRCC/chromophobe RCC was the most common pairing.
authors.affiliation: Department of Surgery, Section of Urology, Medical College of Georgia, Georgia Regents University, Augusta, GA.
authors.forename: Brittani L
authors.initials: BL
authors.lastname: Harlow
authors.affiliation: Department of Surgery, Section of Urology, Medical College of Georgia, Georgia Regents University, Augusta, GA.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Klaassen
authors.affiliation: Department of Urology, Emory University, Atlanta, GA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Holzman
authors.affiliation: Department of Surgery, Section of Urology, Medical College of Georgia, Georgia Regents University, Augusta, GA.
authors.forename: Lael
authors.initials: L
authors.lastname: Reinstatler
authors.affiliation: Department of Pathology, Medical College of Georgia, Georgia Regents University, Augusta, GA.
authors.forename: Alicia A
authors.initials: AA
authors.lastname: Franken
authors.affiliation: Department of Pathology, Medical College of Georgia, Georgia Regents University, Augusta, GA.
authors.forename: Sravan K
authors.initials: SK
authors.lastname: Kavuri
authors.affiliation: Department of Surgery, Section of Urology, Medical College of Georgia, Georgia Regents University, Augusta, GA.
authors.forename: Martha K
authors.initials: MK
authors.lastname: Terris
authors.affiliation: Department of Urology, Emory University, Atlanta, GA.
authors.forename: Viraj A
authors.initials: VA
authors.lastname: Master
authors.affiliation: Department of Surgery, Section of Urology, Medical College of Georgia, Georgia Regents University, Augusta, GA. Electronic address: kelvin.a.moses@vanderbilt.edu.
authors.forename: Kelvin A
authors.initials: KA
authors.lastname: Moses
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000208:ethnology / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000208:ethnology / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Clear-cell renal-cell carcinoma; Histology; Papillary renal-cell carcinoma; Pathology; Renal-cell carcinoma