What is the significance of a 3 mm nodule near the left kidney in a patient with a history of partial nephrectomy for Chromophobe renal cell carcinoma (RCC)?

From the Guidelines

The 3 mm nodule near the left kidney in a patient with a history of partial nephrectomy for Chromophobe renal cell carcinoma (RCC) is likely a benign finding, given the low recurrence risk and excellent prognosis associated with this type of cancer, as supported by the European Association of Urology guidelines on renal cell carcinoma: the 2022 update 1. The patient's history of partial nephrectomy for Chromophobe RCC, a type of cancer with a low recurrence risk, suggests that the nodule is more likely to be a benign finding rather than a recurrence of cancer.

• The European Association of Urology guidelines on renal cell carcinoma: the 2022 update 1 recommend active surveillance for small renal masses, with a mean growth rate of 3 mm/yr, and progression to metastatic RCC is rare (1-2%).
• The guidelines also suggest that a renal biopsy is recommended before surveillance, but in this case, the stability of the nodule over time is reassuring.
• The American College of Radiology Appropriateness Criteria for post-treatment follow-up and active surveillance of clinically localized renal cell carcinoma: 2021 update 1 also support the use of imaging examinations for asymptomatic patients who have been treated for RCC, but do not provide specific guidance on the management of small nodules near the kidney.
• The European Association of Urology guidelines on renal cell carcinoma: the 2022 update 1 emphasize the importance of preserving renal function and quality of life in patients with localized RCC, and suggest that partial nephrectomy is the preferred treatment for localized T1 RCCs. Given the patient's history and the low recurrence risk associated with Chromophobe RCC, continued surveillance imaging is appropriate to monitor both the surgical site and the nodule, but the stability over time is reassuring, and the nodule is likely a benign finding rather than recurrent cancer 1.
• If the patient experiences any new symptoms such as flank pain, blood in urine, or unexplained weight loss, they should contact their urologist promptly.
• However, based on the information provided, the nodule appears to be a benign finding rather than recurrent cancer, and the patient can be reassured that the risk of recurrence is low 1.

From the Research

Clinical Significance of a 3 mm Nodule near the Left Kidney

The presence of a 3 mm nodule near the left kidney in a patient with a history of partial nephrectomy for Chromophobe renal cell carcinoma (RCC) is a significant finding that requires careful evaluation.

• The nodule could be a benign lesion, but given the patient's history of RCC, it is essential to consider the possibility of a recurrent or metastatic tumor 2, 3.
• Chromophobe RCC is a rare subtype of renal cell carcinoma, accounting for 4% to 6% of RCC subtypes, and typically has a good prognosis 4.
• However, the presence of a nodule near the left kidney could indicate local recurrence or metastasis, which would require prompt attention and possible intervention 5.
• The size of the nodule (3 mm) is relatively small, but it is crucial to monitor its growth and characteristics over time to determine the best course of action 6.

Diagnostic Considerations

To determine the nature of the nodule, further diagnostic tests may be necessary, such as:

• Imaging studies (e.g., CT or MRI scans) to evaluate the size, location, and characteristics of the nodule 2, 4.
• Biopsy or fine-needle aspiration to obtain a tissue sample for histological examination 3, 6.
• Laboratory tests to assess the patient's overall health and detect any potential markers of recurrence or metastasis 5.

Management and Follow-up

The management of the patient will depend on the results of the diagnostic tests and the clinical evaluation. Possible approaches may include:

• Active surveillance with regular imaging studies to monitor the growth and characteristics of the nodule 4, 6.
• Surgical intervention (e.g., partial nephrectomy or radical nephrectomy) if the nodule is suspected to be malignant or is causing symptoms 2, 5.
• Adjuvant therapy (e.g., chemotherapy or targeted therapy) if the nodule is confirmed to be a recurrent or metastatic tumor 3, 5.