|Year : 2012 | Volume
| Issue : 4 | Page : 217-221
A study of the epidemiologic distribution of renal tumors in Tirupati, Andhra Pradesh
N Bayapa Reddy1, K Narayana Reddy2, Pallavi Madithati3, N Nagarjuna Reddy4, C Sainarasimha Reddy4, RK Singh1
1 Department of Community Medicine, Chennai Medical College Hospital and Research Centre, Irungalur, Trichy, India
2 Department of Pathology, Chennai Medical College Hospital and Research Centre, Irungalur, Trichy, India
3 Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
4 Department of Pediatrics, Kanchi Kamakoti Child Trust Hospital, Nungambakkam, Chennai, Tamil Nadu, India
|Date of Web Publication||27-Dec-2012|
N Bayapa Reddy
Department of Community Medicine, Chennai Medical College Hospital and Research Centre, Irungalur, Trichy - 621105,Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: The introduction of nephrectomy and other subsequent surgical interventions for renal diseases provided the clinical information and histopathological insight that form the basis of current concepts of renal tumors.
Materials and Methods: A sixteen years retrospective record analysis study on kidney tumors was conducted during the period of October 2010 to May 2011. Biopsies registered between Jan 1994 to December 2010 in the Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati were analyzed. A total of 52,339 samples were studied With the Aim to know the epidemiologic distribution of renal tumor cases. The data was statistically analysed by using Microsoft excel.
Results: In the present study Out of the 113 renal neoplastic tumors 106 (93.8%) were malignant tumors and 7(6.19%) were benign. Clear cell variant of renal cell carcinoma (RCC) was most common subtype (90.5%) followed by papillary and collecting duct cell variant (4.7%).
Conclusions: The renal tumors were distributed more common in the males in the sixth followed by seventh decade of life, and commonly on right kidney. Majority of the malignant renal tumors were primary type, most common presentation was hematuria followed by flank pain.
Keywords: Renal tumors, renal carcinoma, Tirupati
|How to cite this article:|
Reddy N B, Reddy K N, Madithati P, Reddy N N, Reddy C S, Singh R K. A study of the epidemiologic distribution of renal tumors in Tirupati, Andhra Pradesh. J NTR Univ Health Sci 2012;1:217-21
|How to cite this URL:|
Reddy N B, Reddy K N, Madithati P, Reddy N N, Reddy C S, Singh R K. A study of the epidemiologic distribution of renal tumors in Tirupati, Andhra Pradesh. J NTR Univ Health Sci [serial online] 2012 [cited 2020 Jul 10];1:217-21. Available from: http://www.jdrntruhs.org/text.asp?2012/1/4/217/105105
| Introduction|| |
The evolution of knowledge about renal tumors is in actuality the history of surgical daring in a microcosm. The first documented nephrectomy was apparently accomplished by Wolcott, who operated with the mistaken assumption that the tumor mass was a Hepatoma. The modern era of renal surgery began on August 2, 1869, just 141 years ago, when Gustav Simon, the Professor of Surgery at Heidelberg, performed the first planned nephrectomy on a living human being. With surgical intervention, tissue became available to pathologists for histological interpretation. The incidence of Renal cell carcinoma (RCC) accounts for 2-3% of all new cancers diagnosed and 85% of all primary renal neoplasm's in adults.  Renal tumors comprise a diverse spectrum of neoplastic lesions with patterns that are relatively distinct for children and adults.  There is risk of malignancy and causing premature deaths of individuals suffering with renal tumor and malignancy. Twenty-five to thirty percent of renal tumors are asymptomatic, and are found on incidental radiologic study. Renal cell carcinoma (RCC) may remain clinically occult for most of its course. The classic triad includes hematuria (40%), flank pain (40%), and a palpable mass in the flank or abdomen (25%). Other signs and symptoms include weight loss (33%), fever (20%), hypertension (20%), hypercalcemia (5%), night sweats, malaise, and a varicocele, usually left sided, due to obstruction of the testicular vein (2% of males).  The autopsy information relative to renal disorders was also meagre. The introduction of nephrectomy and other subsequent surgical interventions for renal diseases provided the clinical information and histopathological insight that form the basis of current concepts of renal tumors. Factors that are considered include the patient's age and overall health and the extent to which the cancer has spread. It is important that the patient and physician make an informed decision together after considering all possible options, side effects, and outcomes.
| Materials and Methods|| |
A sixteen years retrospective record analysis study on kidney tumors was conducted during the period of October 2010 to May 2011. Biopsies registered between Jan 1994- December 2010 in the Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati were analyzed A Purposive non representative sampling method was used, a total of 52,339 samples were studied. Study epidemiological data regard to the kidney tumors was collected in a detailed manner taking into account factors like Age, sex, signs and symptoms, gross appearance of the tumor, etc. from the corresponding patient's case sheets from the record section.
After fixing the specimen in 10% buffered neutral formalin for 24 h, the gross appearance of the specimen was studied. These tissue blocks were processed and embedded in paraffin wax. The paraffin embedded blocks were cut into 4 microns thin sections and stained with hematoxylin and eosin (H and E). In addition to H and E, Periodic Acid Schiff's stain, Masson's trichrome stain, Van Gieson's stain and Immunohistochemistry were done wherever necessary. The particular tumor diagnosis reached by nuclear and cytoplasmic futures of cell and positivity in histochemical and immunohistochemical stains. These methods were followed has a general protocol in the department of pathology SVIMS.
| Results|| |
Out of 52,339 registered biopsies specimens of all types (neoplastic and non-neoplastic) 21,225 (40.5%) were tumor specimens and 1604 (3.06%) were nephrectomy specimens. Among the nephrectomy specimens 113 (7.05%) were renal tumor specimens and remaining 1491 (92.95%) were non-neoplastic. Out of the 113 renal neoplastic tumors 106 (93.8%) were malignant tumors and 7(6.19%) were benign. Majority of the malignant renal tumors were primary type 104 (98.11%) and only two (1.89%) were secondary type by the origin. Most common presentation was hematuria (64.7%), followed by flank pain (54.1%). The classic triad of hematuria, flank pain, and abdominal mass was seen in 16.5% (20) of cases.
The renal tumors was distributed with a ratio of 1.1:1 Right and Left kidneys respectively. The most common site of metastasis was noted in regional lymph nodes (Para-aortic) 10 (9.4%) followed by Perinephric pad of fat and renal vein involvement, involving 5 (4.7%) cases each. Out of the 106 malignant renal tumors 85 (80.1%) were renal cell carcinomas followed by Wilms' tumors 10 (8.85%) and transitional cell tumors 5 (4.7%). Among these 85 renal cell carcinomas, majority 77 (90.6%) were clear cell and 4 (4.7%) each of papillary and collecting duct carcinomas. Angiomyolipoma 2(1.77%) occurred with the same frequency in both sexes with male to female ratio of 1:1 and multicystic nephroma 2(1.77) occurred in female only. Chromophobe renal cell carcinoma was not found in this study. Most of the kidney cancers 71.6% (76/106) was observed in the age group between 40-70 years; in this most of them were in the 6 th decade 31(29.2%) and 7 th decade 26(24.5%): majority of the kidney tumors was observed in the male 66.9% (71). Details have been provided in the [Table 1] and [Table 2]. Incidence of Wilm's tumor was 9.4 % (10/106) among the malignant tumors. Among the ten Wilms' tumor most of them occurred in males, with a ratio of male female was 3:2. The age distribution of Wilms' tumor was noted as young as 11 months and 22 years. A bilateral Wilm's tumor was observed in only one case (4 year male child). Majority of the Wilms' tumors were triphasic Wilms' tumors 7 (70.0%). In our study majority of tumors are confined to renal pelvis with distortion of corticomedullary junction and a few with dilated pelvicalyceal system and filled with material. In secondary type of renal tumors Two cases were identified with choriocarcinomatous metastasis, one case occurred in 2 nd and other in 5 th decades (Both of these cases records revealed that both them were hysterectomized and the histopathological diagnosis was choriocarcinoma of endometrium). IHC revealed positivity of β-HCG of tumor cells. Detailed distribution of different types of renal tumors has been provided in the [Table 3].
|Table 3: Gender distribution of different type of renal tumors (n = 113)|
Click here to view
| Discussion|| |
The renal tumors noted in 113 specimens out of all types 21,225 tumors of the body. The renal tumors constituted 0.53%, where as in other similar studies they noted about 2-3% of all malignancies, which was higher than the present study. , The frequency of malignant renal tumors was more common than benign renal tumors,with a ratio of 15:1. Earlier studies like Amin et al,  Eggener et al,  Hatimota et al and Soroush et al also had shown similar findings. The peak incidence of benign tumors was observed in fifth and sixth decades and malignant was sixth and seventh decades. The renal tumors in this study occurred in a wide range of age from 11 months to 82 years. In earlierr studies, Soroush et al noticed in the 6 th decade where as Alana et al and Rou Wang et al observed in 7 th decade. The present study revealed that males were more commonly affected with renal tumors than female, similar to Eggener et al and Soroush et al. 
This study found that renal cell carcinoma was the most common malignant renal tumor. Eggener et al and Houston et al had reported higher incidence of renal cell carcinoma than the present study. Right kidney was most commonly involved than the left with the ratio of 1.1:1 in contrast to the findings of Latif et al who found 54% (27/50) of all tumors in left kidney and 46% (23/50) in the right kidney. Most common presentation was hematuria (64.7%), followed by flank pain (54.1%). The classic triad of hematuria, pain, and abdominal mass was seen in 17.7% (20) of cases. In a study done by Skinner et al the incidence of classical triad was 9% which was slightly lower than our study.
Clear cell variant of renal cell carcinoma (RCC) was most common subtype (90.5%) followed by papillary and collecting duct cell variant (4.7%). The study done by Eggener et al and Houston et al also documented clear cell RCC as a predominant variant followed by papillary. Chromophobe renal cell carcinoma was not found in this study, but Murphy et al and Houston et al reported in 5% and 9% of renal cell carcinomas respectively. Most common site of metastasis was in the regional lymph nodes (9.4%) followed by Perinephric pad of fat and renal vein involvement were 4.7% each. In this study two cases of Angiomyolipoma were reported. Similar findings was documented by Hatimota et al.  One case of dual malignancy with clear cell RCC and moderately differentiated adenocarcinoma of ileocecal junction was observed.
We found that Wilms' tumor was second most common renal tumor (8.85%) and it observed commonly in 1 st decade(80%) followed by third decade(( 20%). Study done by Suzigan et al had found in the first and the second decades of life, with a greater frequency in both females and right kidneys.  Out of all Wilm's tumor 10% of cases had shown bilateral renal involvement. According to Sebire, et al l the incidence of Bilateral Wilms' was 5-10 percent which coincides with our study.  Triphasic Wilms' tumor was commonest.
According to Srivastava et al and Pollack et al the incidence of metastasis to kidney from any primary was 8 to 20%. Cut section of the kidney revealed soft fleshy yellowish white hemorrhagic and necrotic lesion areas with foci of cystic change involving upper and lower poles. One case with bilateral clear cell RCC with von Hippel-Lindau syndrome also observed. Similar study by Reza et al documented that the incidence of bilateral RCC in von Hippel-Lindau syndrome was 75% in contrast to 1.8% among patients without von Hippel-Lindau syndrome.
| Conclusions|| |
In India, RCCs afflict the patients two decades earlier than western counterpart, the prognosis depends on the type and stage of the tumors and the treatment modalities are different for different type of RCC. There is no reliable screening test for renal tract cancer, so most diagnoses are likely to be made in symptomatic patients. Once a diagnosis of renal cell cancer has been confirmed and the disease's stage determined, physician and patient decide on a treatment plan. A confident, positive outlook can help the patient cope with the physical demands of surgery and/or therapy and can improve the chances for recovery. Transitional cell carcinoma have a 90% cure rate, if found early. Wilms' tumor is one of the most curable of all childhood cancers. The 5-year survival rate approaches 90%. Renal Sarcomas will grow and spread to adjacent organs, bones, and lymph nodes if left untreated. The only potentially curative form of treatment is surgery, if found early. There is scope to do further research on renal tumors, about aetiological factors like environmental and lifestyle factors, prognosis based on the stage and type of treatment.
In data collection we were unable to find the data related to size of the tumor, history of lifestyle and environmental causes and finally more than 30% of the cases were lost on follow up; due to this reasons we were unable to see the prognosis of those cases.
| References|| |
|1.||Jemal A, Murray T, Ward E, Samuels A, Tiwari RC, Ghafoor A, et al. Cancer statistics. CA Cancer J Clin 2005;55:10-30. |
|2.||Godley PA, Ataga KL. Renal cell carcinoma. Curr Opin Oncol 2000;12:260-4. |
|3.||Alpers CE. The Kidney. In: Kumar V, Abbas AK, Fausto N, Aster JC, editors. Robbins and Cotran pathologic basis of disease. 8th ed. Philadelphia: WB Saunders; 2010. p. 905-70. |
|4.||Börje L, Campbell SC, Han Yong Cho, Didier J, Lee JE, Steffen W, et al. The Epidemiology of Renal Cell Carcinoma. Eur Urol 2011;60:e29-36. |
|5.||Amin MB, Amin MB, Tamboli P, Javidan J, Striker H, de-Peralta Venturina M, et al. Prognostic impact of histologic subtyping of adult renal epithelial neoplasms: An experience of 405 cases. Am J Surg Pathol 2002;26:281-91. |
|6.||Eggener SE, Rubenstein JR, Smith ND, Nadler RB, Kontak J, Flanigan RC, et al. Renal tumors in young adults. J Urol 2004;171:106. |
|7.||Hatimota P, Vashik S, Aggraval K, Kapoor A, Gupta NP. Spectrum of US and CT findings in renal neoplasms with pathologic correlation. Indian J Radiol Imag 2005;1:117-25. |
|8.||Rais-Bahrami S, Guzzo TJ, Jarrett TW, Kavoussi LR, Allaf ME. Incidentally discovered renal masses: Oncological and perioperative outcomes in patients with delayed surgical intervention. BJU Int 2009;10:1355-8. |
|9.||Murphy AM, Buck AM, Benson MC, McKiernan JM. Increasing detection rate of benign renal tumors: Evaluation of factors predicting for benign tumor histologic features during past two decades. Urology 2009;6:1293-9. |
|10.||Wang R, Wolf JS Jr, Wood DP Jr, Higgins EJ, Hafez KS. Accuracy of percutaneous core biopsy in management of small renal masses. Urology 2009;73:586-90. |
|11.||Houston RT, Jennifer RH, Babayev Y, Cronin A, Kaag M, Kundu S, et al. Metastatic renal cell carcinoma risk according to tumor size. J Urol 2009;182:41-5. |
|12.||Latif F, Mubarak M, Kazi JI. Histopathological characteristics of adult renal tumors:a preliminary report. J Pak Med Assoc 2011;61:224-8. |
|13.||Skinner DG, Colvin RB, Vermillion CD, Pfister RC, Leadbetter WF. Diagnosis and management of renal cell carcinoma: A clinical and pathologic study of 309 cases. Cancer 1971;28:1165-77. |
|14.||Murphy WM, Grignon DJ, Perlman EJ. Kidney tumors in adults. In: Murphy WM, Grignon DJ, Perlman EJ, editor. Tumors of the Kidney, Bladder and Related Urinary Structures. AFIP. Fourth series, Fascicle 1. Washington DC, 2004. p. 101-240. |
|15.||Suzigan S, Müller M El A, de Souza LW, Menezes-Verona CB, Filho MZ . Brazilian primary renal tumors: Clinical and pathological review of 137 cases with emphasis on renal cortical epithelial neoplasms. Institute of urology and nephrology. 2000. IV Congreso Virtual Hispano Americano De Anatomía Patológica. 2001. Accessed on 09/10/2012 available at http://conganat.uninet.edu/IVCVHAP/COMUNICACION-E/002/ |
|16.||Sebire NJ, Vujanic GM. Pediatric renal tumors: Recent developments, new entities and pathological features. Histopathology 2009:54:516-28. |
|17.||Srivastava A, Mandhani A, Kapoor R, Jain M, Dubey D, Srivastava A, et al. Prognostic factors in patients with renal cell carcinoma: Is TNM (1997) staging relevant in Indian subpopulation?. Indian J Cancer 2004;41:99-103. |
|18.||Pollack HM, Banner MP, Amendola MA. Other malignant neoplasms of the renal parenchyma. Semin Roentgenol 1987;22:260-74. |
|19.||Malek RS, Omess PJ, Benson RC Jr, Zincke H. Renal cell carcinoma in von Hippel- Lindau Syndrome. Am J Med 1987;82:236-38. |
[Table 1], [Table 2], [Table 3]