PATHOLOGICAL FINDINGS AT THE TIME OF NEPHRECTOMY FOR RENAL MASS

Background: Ultrasound (US) and computed tomography (CT) have improved the diagnosis of solid renal masses. Nevertheless, some patients stil l undergo exploration for a presumptive diagnosis of renal cell carcin oma (RCC) and are found to have other pathology. We report a contempor ary series of non-RCC renal masses (both incidental and symptomatic) a mong nephrectomies performed for suspected RCC. Materials and Methods: All nephrectomies performed by the Urology Service at the Memorial Sl oan-Kettering Cancer Center from July of 1989 through July of 1996 for a parenchymal renal mass were reviewed, and patients without a final diagnosis of RCC were identified. Cases were excluded if RCC was not s uspected preoperatively. Presentation, preoperative radiographic evalu ation, type of operation, and pathologic features were assessed. Resul ts: Of the 636 nephrectomies performed, 108 patients (16.9%) had a dia gnosis other than RCC. Conclusions: Of patients undergoing nephrectomy for renal masses, 16.9% have other pathologic diagnoses. Sixty-six pe rcent of these non-RCC masses are discovered incidentally, and the maj ority are treated with radical nephrectomy. Preoperative radiographic evaluation reflects both clinical presentation, with IVP used to evalu ate symptomatic tumors, and diagnostic uncertainty, with multiple moda lities used to evaluate cystic lesions. This information has important implications for preoperative counseling and surgical planning.