Just got pathology report for wife - Staging question

JaMoKiMo

Hi all - My wife's pathology report (after radical nephrectomy of right kidney) had info in two places that confused me. Can you help me better understand?

 

DIAGNOSIS section says: UCC (2 x 1.8 x 1.5 cm) involving renal pelvicalcyceal system. High grade. Invasive into renal parenchyma. Extensive UCC in-situ involving renal pelvis and ureter.

Primary Tumor PT3

GROSS DESCRIPTION secitons says: Tumor is non-invasive into wall of renal pelvis. (does not mention ureter at all).

My question - from all of my reading on staging, if the tumor hadn't spread beyond the kidney into fatty tiissue or vein, then it would be a T2 or T1. If it is less than 7cm and in-situ, shouldnt it be a T1?

We'll talk to our MD Anderson urologist when he goes over the report, but wanted to make sure I wasnt missing something obvious.

 

Thanks for any help!

todd121

Stage T3

Is this the entire wording of the pathology report? My tumor was < 7 cm, and I was expecting a Stage 1 diagnosis, but my pathology came back T3 also. For me, it was because there was invasion of some of the very small veins inside the kidney. Is there any mention of microvascular invasion? Even a small tumor, if it's located in the center of the kidney where the veins and arteries all congregate, there is often an invasion of some of the veins/arteries, and any invasion of the blood supply will move the staging from 1-2 to 3.

I didn't think this extended to the invasion of the ureter/renal pelvis. Was the pathology done by a pathologist that looks at a lot of RCC? It might be worth sending the slides to a cancer center where they look at a lot of cancer/RCC. I had my slides re-read at City of Hope with the same result, and felt better about the report having more experienced pathologists look at it. I think it cost me 2-300 to have it re-done, but that was ok.

Todd 

JaMoKiMo

todd121 said:

Stage T3

Is this the entire wording of the pathology report? My tumor was < 7 cm, and I was expecting a Stage 1 diagnosis, but my pathology came back T3 also. For me, it was because there was invasion of some of the very small veins inside the kidney. Is there any mention of microvascular invasion? Even a small tumor, if it's located in the center of the kidney where the veins and arteries all congregate, there is often an invasion of some of the veins/arteries, and any invasion of the blood supply will move the staging from 1-2 to 3.

I didn't think this extended to the invasion of the ureter/renal pelvis. Was the pathology done by a pathologist that looks at a lot of RCC? It might be worth sending the slides to a cancer center where they look at a lot of cancer/RCC. I had my slides re-read at City of Hope with the same result, and felt better about the report having more experienced pathologists look at it. I think it cost me 2-300 to have it re-done, but that was ok.

Todd 

Pathology report

Thanks for the response Todd. The enire report was only 1-page (at least the online one, will see the urologist on 10th). MD Anderson pathologists see a lot of UCC/RCC, so I am hoping their reading was fine. I will ask further questions of the doc.

DIAGNOSIS
(A) RIGHT PELVIC LYMPH NODES:
One lymph node, no tumor present (0/1).
(A) RIGHT KIDNEY, URETER AND LYMPH NODES:
UROTHELIAL CARCINOMA (2 X 1.8 X 1.5 CM) INVOLVING RENAL PELVICALYCEAL SYSTEM, HIGH GRADE,
INVASIVE INTO RENAL PARENCHYMA.
No definitive lymphovascular invasion identified.
EXTENSIVE UROTHELIAL CARCINOMA IN-SITU INVOLVING RENAL PELVIS AND URETER.
Renal parenchyma with interstitial inflammation.
Foreign body giant cells with amorphous material, suggestive of suture-granulomas in distal ureter and bladder cuff.
Margins of resection (ureter, vascular and soft tissue), free of tumor.
Five lymph nodes, no tumor present.

PATHOLOGIC STAGE BASED ON PATHOLOGY MATERIAL REVIEWED IN THIS ACCESSION
Primary tumor: pT3
Regional lymph nodes: pN0
Distant metastases: pMx
(American Joint Committee on Cancer, 7th Edition, 2010)

GROSS DESCRIPTION
(A) RIGHT PELVIC LYMPH NODES - A yellow-tan single lymph node measuring 1.5 x 0.8 x 0.5 cm.
The specimen is serially sectioned and entirely submitted in cassette A1. ML/jfj
(B) RIGHT KIDNEY, URETER AND LYMPH NODES - A nephroureterectomy specimen (14.1 x 10.0 x 5.1 cm) including the right kidney
(9.8 x 4.8 x 3.3 cm), ureter (27.2 cm in length, 0.6 cm in average diameter), cuff of urinary bladder (2.1 x 1.3 x 0.8 cm). The adrenal gland is not present.
There is a 1.1 x 1.0 x 0.2 cm papillary tumor located in the upper renal pelvis. The tumor is located 30.0 cm from the
ureteral/bladder cuff margin. The tumor is non-invasive into the wall of the renal pelvis. The tumor does not extend to Gerota's fascia.
Also located in the upper pole of the kidney is a 2 x 1.8 x 1.5 cm gray-white destructive well-defined nodule which does not appear
to be directly connected with the pelvis tumor. This tumor does not appear to invade through the kidney and does not involve the
perinephric fat.
The remainder of the urothelium of the pelvicaliceal system/ureter is gray-white, smooth and devoid of any additional lesions. The
remaining renal parenchyma is unremarkable. There are five possible lymph nodes identified in the hilum of the kidney.
INK CODE: Black - bladder cuff margin.
SECTION CODE: B1, renal artery and vein, margins en face; B2, bladder cuff/ureteral margin, radially sectioned; B3, lower ureter;
B4, mid ureter; B5, upper ureter; B6, renal pelvis lesion; B7, grossly normal appearing renal pelvis adjacent to the lesion; B8, B9, the upper pole intraparenchymal tumor with adjacent sinus and renal pelvis; B10, uninvolved kidney; B11, three possible lymph nodes; B12, two
possible lymph nodes; B13, additional section of upper pole intraparenchymal tumor. BM/rgw

todd121

JaMoKiMo said:

Pathology report

Thanks for the response Todd. The enire report was only 1-page (at least the online one, will see the urologist on 10th). MD Anderson pathologists see a lot of UCC/RCC, so I am hoping their reading was fine. I will ask further questions of the doc.

DIAGNOSIS
(A) RIGHT PELVIC LYMPH NODES:
One lymph node, no tumor present (0/1).
(A) RIGHT KIDNEY, URETER AND LYMPH NODES:
UROTHELIAL CARCINOMA (2 X 1.8 X 1.5 CM) INVOLVING RENAL PELVICALYCEAL SYSTEM, HIGH GRADE,
INVASIVE INTO RENAL PARENCHYMA.
No definitive lymphovascular invasion identified.
EXTENSIVE UROTHELIAL CARCINOMA IN-SITU INVOLVING RENAL PELVIS AND URETER.
Renal parenchyma with interstitial inflammation.
Foreign body giant cells with amorphous material, suggestive of suture-granulomas in distal ureter and bladder cuff.
Margins of resection (ureter, vascular and soft tissue), free of tumor.
Five lymph nodes, no tumor present.

PATHOLOGIC STAGE BASED ON PATHOLOGY MATERIAL REVIEWED IN THIS ACCESSION
Primary tumor: pT3
Regional lymph nodes: pN0
Distant metastases: pMx
(American Joint Committee on Cancer, 7th Edition, 2010)

GROSS DESCRIPTION
(A) RIGHT PELVIC LYMPH NODES - A yellow-tan single lymph node measuring 1.5 x 0.8 x 0.5 cm.
The specimen is serially sectioned and entirely submitted in cassette A1. ML/jfj
(B) RIGHT KIDNEY, URETER AND LYMPH NODES - A nephroureterectomy specimen (14.1 x 10.0 x 5.1 cm) including the right kidney
(9.8 x 4.8 x 3.3 cm), ureter (27.2 cm in length, 0.6 cm in average diameter), cuff of urinary bladder (2.1 x 1.3 x 0.8 cm). The adrenal gland is not present.
There is a 1.1 x 1.0 x 0.2 cm papillary tumor located in the upper renal pelvis. The tumor is located 30.0 cm from the
ureteral/bladder cuff margin. The tumor is non-invasive into the wall of the renal pelvis. The tumor does not extend to Gerota's fascia.
Also located in the upper pole of the kidney is a 2 x 1.8 x 1.5 cm gray-white destructive well-defined nodule which does not appear
to be directly connected with the pelvis tumor. This tumor does not appear to invade through the kidney and does not involve the
perinephric fat.
The remainder of the urothelium of the pelvicaliceal system/ureter is gray-white, smooth and devoid of any additional lesions. The
remaining renal parenchyma is unremarkable. There are five possible lymph nodes identified in the hilum of the kidney.
INK CODE: Black - bladder cuff margin.
SECTION CODE: B1, renal artery and vein, margins en face; B2, bladder cuff/ureteral margin, radially sectioned; B3, lower ureter;
B4, mid ureter; B5, upper ureter; B6, renal pelvis lesion; B7, grossly normal appearing renal pelvis adjacent to the lesion; B8, B9, the upper pole intraparenchymal tumor with adjacent sinus and renal pelvis; B10, uninvolved kidney; B11, three possible lymph nodes; B12, two
possible lymph nodes; B13, additional section of upper pole intraparenchymal tumor. BM/rgw

Urothelial Carcinoma

My reading of this is that this is not RCC, but what's called a transitional cell carcinoma. At first they thought my tumor might be this type. The cells in the ureter and in part of the kidney are similar to cells in the bladder (more than to kidney cells). I had been told this type of cancer responds better to conventional chemotherapy like bladder cancer does, and is very treatable (particularly compared to RCC).

Please let us know what the oncologist says. I don't know how they stage this type of cancer. It must be staged differently than RCC. I had an acquaintance with this type of tumor in his kidney, and he did some type of conventional chemotherapy and was given a good prognosis following his chemo and has been NED for many years.

I hope it's the treatable type.

Best wishes to you both.

Todd