Histopathological Spectrum of Lesions in Nephrectomy Specimens in Northwest Rajasthan

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Abstract (English)

Background: The kidneys are vital for excretion and hormone production, impacting blood pressure regulation and red blood cell production. Pathological processes, including end-stage renal disease (ESRD) and cancer, may require nephrectomy. Non-neoplastic indications for nephrectomy include ESRD complications, hypertension, and infections. Renal cell carcinoma (RCC) is prevalent, especially in the Asian region, albeit underreported. Histopathological evaluation post-nephrectomy aids in diagnosing renal tumors, crucial for treatment planning. Methods: This is a retrospective study for the period of two years from Jan 2021 to Dec 2022. We included all the nephrectomy specimens from patients aged above 18 years, received during the study period. Clinical data was collected from patient’s records. Autolysed specimen, Inadequate and improperly fixed specimens and specimens of pediatric patients were excluded from this study. Biopsy specimens were processed as per routine histopathological technique. The specimens received were fixed in 10% buffered formalin. Gross examination was done, and findings recorded. The tissues were sectioned as per protocol and processed by wax block method. Slides were stained with hematoxylin and eosin (H&E) stain and examined under a light microscope. Results: In the present study, we received a total of 86 nephrectomy specimens. Out of 86, 23 (26.74%) were simple nephrectomies and 63 (73.26%) were radical nephrectomies. We observed 61 (70.93%) neoplastic lesions and the remaining 25 (29.07%) were non neoplastic. The most common clinical presentation was pain in the flank region in 59 (68.67%) cases, while hematuria was present in 24 (27.91%) of cases. The age of the patients ranged from 22-76 years of age (mean ± std. dev.  58.14 ± 8.78 years). We observed slight female predominance with 45 (52.33%) patients were females and 41 (47.67%) were males with a male to female (M:F) ratio of 0.91:1. There was clustering of cases in the sixth and seventh decade of life with 27 (31.40%) and 24 (27.91%) cases respectively. Out of 25 (29.07%) non neoplastic lesions, on histopathological examination, chronic pyelonephritis was the most common type of lesion constituting 13 (15.12%) of all cases. Second most common lesions encountered were Xanthogranulomatous pyelonephritis and hydronephrosis due to renal stones with 3 (3.49%) and 4 (4.65%) cases. Others were cystic kidney disease with 3 (3.49%) cases and pyonephrosis with 2 (2.33%) case. Out of the 61 neoplastic lesions of various histomorphological categories, there were 7 cases of benign lesions and 54 malignant lesions. The most common lesion encountered was renal cell carcinoma with 46 cases (53.49%), in which different histological differentiations found were, clear cell type with 33 (38.37%) cases, 8 (9.3%) papillary type, 4 (4.65%) chromophobe type and 2 (2.33%) sarcomaoid type.  Other than renal cell carcinoma, there were 5 (5.81%) cases of adenosquamous carcinoma, 2 (2.33%) cases of primitive neuroendocrine tumor, and 3 (3.49%) cases of transitional cell carcinoma. In benign lesions there were 4 (4.65%) cases of oncocytoma and 3 (3.49%) cases of angiomyolipoma. Conclusion: Nephrectomy specimens reveal a diverse array of lesions, some of which may be challenging to diagnose accurately through clinical and radiological means. Therefore, it is imperative that each nephrectomy specimen undergoes thorough histopathological examination to establish a correlation between clinical presentation and morphological features, ensuring appropriate management.