What is you opinion about such situation:
Male, 63 y.o. Left kidney cancer.
In the upper pole there is a tumor 8x6x6 cm with invasion into the perirenal fat (sarcomatoid CCRCC, Fuhrman G-4). Separetely from the primary tumor there are several tumor nodules in the perirenal fat. Vessels, adrenal, perihilar fat, hilar lymph nodes - without tumor growth.
How shoud we stage it? Are these separate tumor nodules pN1? Or they fall into pT3a?
Although the malignancy may be pT3a, it could also be pT4 depending on whether or not the nodules are external to Gerota's fascia (see AJCC 7th Edition Cancer Staging Manual). That would change the overall stage from Stage III to Stage IV.
I think I would rather stage this case as pT3a if I do not find any evidence that the separate nodules once were lymph nodes. However, I am only a resident. I sometimes use the TNM Helpdesk (available from their homepage) for unclear staging issues. In my experience their comments are helpful and quite quick.
My impression is that it should be T3a and not pN1, since there is no definitive lymph node involvement. However, such categories are dynamic and more specific studies may be available in future to address such issues.
Thank You for your answers. I think in the same way. But there are no clear information about such nodules in the literature. Severeal times in the perirenal fat I've found lymph nodes with reactive changes. So perhaps these nodules are like tumor deposits in a case of colorectal cancer? I mean totally replaced metastatic lymph nodes.
pT3a should be correct. Still do write to TNM helpdesk with details, they do help precisely, I experienced it!
I had a similar case, which with additional sectioning and more careful examination turned out to be the extention of the main tumor mass with very thin renal capsule surrounding the mass .. just a reminder, before considering it as a separate nodule...
Although the malignancy may be pT3a, it could also be pT4 depending on whether or not the nodules are external to Gerota's fascia (see AJCC 7th Edition Cancer Staging Manual). That would change the overall stage from Stage III to Stage IV.
I think pT3a is correct but the observation by Roland Engel would be more appropriate
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