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Differentiation of oncocytoma from chromophobe renal cell carcinoma (RCC): can novel molecular biomarkers help solve an old problem?
  1. Keng Lim Ng1,2,3,
  2. Retnagowri Rajandram1,3,4,
  3. Christudas Morais1,
  4. Ning Yi Yap3,
  5. Hema Samaratunga5,
  6. Glenda C Gobe1,
  7. Simon T Wood2
  1. 1Centre for Kidney Disease Research, School of Medicine, The University of Queensland, Translational Research Institute, Brisbane, Australia
  2. 2Department of Urology, Princess Alexandra Hospital, Brisbane, Australia
  3. 3Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  4. 4University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
  5. 5Aquesta Pathology, Brisbane, Australia
  1. Correspondence to A/Professor Glenda Gobe, Centre for Kidney Disease Research, School of Medicine, Translational Research Institute, Kent Street, Woolloongabba, Brisbane 4102, Australia; g.gobe{at}uq.edu.au

Abstract

Standard treatment of renal neoplasms remains surgical resection, and nephrectomy for localised renal cell carcinoma (RCC) still has the best chance of cure with excellent long-term results. For smaller renal masses, especially stage T1a tumours less than 4 cm, nephron-sparing surgery is often employed. However, small incidentally detected renal masses pose an important diagnostic dilemma as a proportion of them may be benign and could be managed conservatively. Renal oncocytoma is one such lesion that may pose little risk to a patient if managed with routine surveillance rather than surgery. Additionally, lower-risk RCC, such as small chromophobe RCC, may be managed in a similar way, although with more caution than the renal oncocytomas (RO). The ability to differentiate ROs from chromophobe RCCs, and from other RCCs with a greater chance of metastasis, would guide the physician and patient towards the most appropriate management, whether nephron-sparing surgical resection or conservative surveillance. Consistent accurate diagnosis of ROs is likely to remain elusive until modern molecular biomarkers are identified and applied routinely. This review focuses on the differentiation of renal oncocytomas and chromophobe RCCs. It summarises the history, epidemiology and clinical presentation of the renal neoplasms, explains the diagnostic dilemma, and describes the value, or not, of current molecular markers that are in development to assist in diagnosis of the renal neoplasms.

  • Renal Cancer
  • Molecular Pathology
  • Urinary Tract Tumours

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