1983 Volume 74 Issue 5 Pages 840-846
Most renal cell carcinoma have a characteristic angiographic appearance, consisting of hypervascularity. Therefore, it has become one of the most useful tools in the diagnosis. But, about 5% of renal cell carcinoma lack neovascularity, and these tumors show a hypovascular or avascular angiographic pattern.
Between 1971 and 1980, 76 patients underwent nephrectomy for renal cell carcinoma, 5 of them were demonstrated a hypovascular or avascular angiographic pattern. The clinicopathologic features of these tumors were reviewed.
The age ranged from 58 to 76 years and the mean age was 64.2. 2 patients were male and 3 patients were female. Hematuria was the initial complaint in 3 patients. In 3 patients the tumor was located on the right side and in 2 on the left. By examination of the nephrectomy specimen, the tumors were restricted within the limits of the renal parenchyma (Robson's stage 1) in 4 patients, and only I patients had metastasis to the bone (stage 4B). The majority of hypovascular or avscular tumors (80%) were in the low pathologic stage.
Gross pathologic findings showed that in 3 cases of hypovascular or avsacular renal cell carcinoma, massive bleeding or necrosis was present. Microscopic pathologic findings showed that, 2 patients had an anaplastic histologic pattern, the other patients had a cystic histologic pattern or a solid histologic pattern, and in our series, only I patient had a papillary histologic pattern. It is important to emphasize that hypovascular or avascular renal cell carcinoma showed no alveolar pattern which is a usual histologic pattern of hypervascular renal cell carcinoma. There is no relationship among tumor vascularity, cell type, and histologic grading.
As to the prognosis of our 5 patients, 2 patients are without evidence of recurrence or metastasis from I year and II months to 6 years following nephrectomy. A patient with distant metastatic lesion died of pneumonia, 21 days following nephrectomy. Althourgh no evidence of tumor spread was noted at the operation, 2 patients died of D. I. C., and pneumonia from 7 months to I year and 2 months following nephrectomy. Considering histologic pattern and clinical course, a prolonged survival period can not be expected with these hypovascular or avascular renal cell carcinoma.
