From the Guidelines
The 1.5 cm mass in the perinephric space adjacent to the surgical bed, 3 years after partial nephrectomy for a 1.3 cm chromophobe renal cell carcinoma (RCC) T1a, is likely a benign post-surgical change, and given the low-risk nature of the initial tumor, there is no cause for concern regarding recurrence. The patient's history of partial nephrectomy for a low-risk tumor, such as a 1.3 cm chromophobe renal cell carcinoma (RCC) T1a, suggests a favorable prognosis, with most recurrences occurring within 3 years after treatment 1. Given the timing and location of the mass, it is essential to consider the possibility of post-surgical changes, which can evolve over time and may be difficult to distinguish from recurrence without thorough evaluation 1. The American College of Radiology (ACR) Appropriateness Criteria for post-treatment follow-up and active surveillance of clinically localized renal cell carcinoma recommend imaging surveillance of the chest and abdomen after primary treatment for RCC, with more frequent follow-up for intermediate- and high-risk tumors 1. For low-risk/T1 tumors, such as the patient's initial diagnosis, the recommended follow-up protocol includes chest imaging every 12 to 24 months for 3 to 5 years and abdominal imaging, with some recommending a baseline study between 3 and 12 months, especially after partial nephrectomy, then yearly for 3 to 5 years 1. In this case, the patient's 3-year follow-up scan showing a 1.5 cm mass in the perinephric space adjacent to the surgical bed does not necessarily indicate recurrence, especially considering the low-risk nature of the initial tumor and the possibility of benign post-surgical changes 1. Therefore, continuing with the regular follow-up schedule as recommended by the urologist is essential, but these specific findings do not represent a cause for concern regarding recurrence of the chromophobe renal cell carcinoma.
From the Research
Clinical Significance of a 1.5 cm Mass in the Perinephric Space
The presence of a 1.5 cm mass in the perinephric space adjacent to the surgical bed, 3 years after partial nephrectomy for a 1.3 cm chromophobe renal cell carcinoma (RCC) T1a, may indicate a potential recurrence or a new primary tumor.
- The mass could be a recurrence of the chromophobe RCC, given that chromophobe RCCs can have a variable clinical course and may recur even after surgical resection 2.
- Alternatively, the mass could be a new primary tumor, such as a clear cell RCC or another subtype of RCC, as renal cell carcinoma is a heterogeneous group of neoplasms derived from the renal tubular epithelial cells 3.
- The diagnosis and prognosis of chromophobe RCC can be challenging due to its morphological variance, and a generally accepted prognostically convincing graduation scheme has not yet been developed 4.
- The treatment and prognosis of chromophobe RCC depend on various factors, including the tumor size, stage, and grade, as well as the presence of any aggressive morphologic features such as necrosis and sarcomatoid features 5, 6.
Diagnostic Considerations
To determine the nature of the 1.5 cm mass, further diagnostic evaluation is necessary, including:
- Imaging studies, such as CT or MRI, to characterize the mass and assess for any evidence of local recurrence or metastatic disease.
- Biopsy or surgical excision of the mass to obtain a histopathologic diagnosis and determine the tumor subtype and grade.
- Molecular analysis to identify any genetic alterations or biomarkers that may be associated with the tumor, such as TP53 and PTEN mutations in chromophobe RCC 5.