Diagnosis of non-neoplastic kidney diseases in cancer nephroureterectomy specimens. Issue 1 (February 2020) - Tjota, Melissa Y
Purpose: Renal function preservation is an important objective for renal malignancies, and similar data are emerging for urothelial carcinoma. Non-neoplastic kidney diseases can be identified in up to 15% of tumor nephrectomy specimens, and to our knowledge this has not been studied in tumor nephroureterectomy specimens. Therefore, we conducted this single-center study to determine the frequency and spectrum of non-neoplastic kidney diseases that occur in nephroureterectomy specimens. Methods: We retrospectively reviewed our pathology database from 2014 to 2018 and identified 63 nephroureterectomy specimens in adults. Clinical data were obtained through electronic medical record review including age, sex, race, and co-morbidities. Results: Analysis of the 63 cases demonstrated the average age was 69.3 years (range: 22–94 years) with 41 males (65%) and 22 females (35%). Ethnically, there were 54 Caucasians (86%), 5 African Americans (7.9%), and 4 others/unknown (6.3%). After review of the hematoxylin and eosin slide and periodic acid-Schiff slide, seven cases (11%) had significant diffuse and/or nodular mesangial sclerosis that was consistent with diabetic nephropathy. For these seven cases, one case was stage pTis, two cases were pT1, three cases were pT3, and one case was pT4. In five cases (8% of total cases), diabetic nephropathy had not been included in the original report. Conclusion: Analysis of the non-neoplastic renal parenchyma in nephroureterectomy specimens is not routinely performed by most pathologists, and this simple act can identify patients at risk for developing chronic kidney disease following surgery and improve coordination of care between urology, oncology, and nephrology. Specifically, diabetic nephropathy is common in this clinical setting and prompt treatment may result in additional gains in clinical outcomes, especially given the generally good and continually improving 5-year survival rates for urothelial neoplasms.