@UrologyQuiz Quiz1 Answer: Renal Cell Carcinoma (RCC) Left laparoscopic nephrectomy - clear cell RCC; Fuhrman grade

3, 75mm, invading into venous tributaries (not renal vein), into sinus fat, clear of margins: Pathologic stage: pT3a. Expected this to have sarcomatoid or rhabdoid features based on gross appearance- it did not. Looks like the tumor is very close to capsule but centrally is actually where it invades fat which is quite obvious in the picture (see arrow). Sinus fat invasion was likely perhaps worse than pericapsular type [http://www.ncbi.nlm.nih.gov/pubmed/16145373] leading to a TNM change in its classification to T3a [pT3a: Tumor grossly extends into the renal vein or its segmental (muscle containing) branches, or tumor invades perirenal and/or renal sinus fat but not beyond Gerotas fascia] Prognosis: 5-year cancer-specific survival rate for T3 disease ranges from 37% to 67% [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2808645] MSKCC nomogram [http://nomograms.mskcc.org/Renal/PostSurgery.aspx] progression-free survival about 80% Further therapies- in this case nil as no metastases and no evidence in this group for TKI etc Follow-up: As per CUA guidelines [http://www.kidneycancercanada.ca] at 6 months with History, Exam, Electrolytes, CXR (or CT) and CT abdomen. Note how little follow-up required for T1 tumors:

Teaching Points: 1) Renal sinus fat invasion may portend a worse prognosis amongst the T3a group. Tumour type however still very important. Significant variation in prognosis amongst this heterogeneous group. 2) Follow-up is probably less stringent than one may consider for lower stage tumours- but not for T3 as in this case.