AIMS: Formal depiction of granulomatous inflammation associated with renal neoplasms has mainly consisted of case reports. Herein, we investigate the clinicopathological features and potential significance of granulomas associated with renal tumours from a large multi-institutional cohort. METHODS AND RESULTS: One hundred and eleven study cases were collected from 22 institutions, including 57 partial nephrectomies and 54 radical nephrectomies. Patient ages ranged from 27 to 85 years (average = 60.1 years; male = 61%). Renal neoplasms included clear cell renal cell carcinoma (RCC; 86%), papillary RCC (8%), chromophobe RCC (3%), clear cell papillary RCC (1%), mixed epithelial stromal tumour (1%) and oncocytoma (1%). Granulomas were peritumoral in 36%, intratumoral in 24% and both in 40% of cases. Total granuloma count per case ranged from one to 300 (median = 15) with sizes ranging from 0.15 to 15 mm (mean = 1.9 mm). Necrotising granulomas were seen in 14% of cases. Histochemical stains for organisms were performed on 45% of cases (all negative). Sixteen cases (14%) had a prior biopsy/procedure performed, and eight patients had neoadjuvant immunotherapy or chemotherapy. Eleven patients (10%) had a confirmed diagnosis of sarcoidosis, including five in whom sarcoidosis was diagnosed after nephrectomy. CONCLUSION: Based on this largest case-series to date, peri-/intratumoral granulomas associated with renal neoplasms may be more common than initially perceived. The extent of granulomatous inflammation can vary widely and may or may not have necrosis with possible aetiologies, including prior procedure or immunotherapy/chemotherapy. Although a clinical association with sarcoidosis is infrequent it can still occur, and the presence of granulomas warrants mention in pathology reports.

Department of Anatomic Pathology Douglass Hanly Moir Pathology Sonic Healthcare Macquarie Park Australia

Department of Pathology and Laboratory Medicine Advanced Medical Research Institute Bhubaneswar India

Department of Pathology and Laboratory Medicine Albany Medical Center Albany NY USA

Department of Pathology and Laboratory Medicine Cumming School of Medicine University of Calgary Calgary AL Canada

Department of Pathology and Laboratory Medicine Emory University Atlanta GA USA

Department of Pathology and Laboratory Medicine University of California Davis Health System Sacramento CA USA

Department of Pathology Brigham and Women's Hospital Harvard Medical School Boston MA USA

Department of Pathology Charles University Hospital and Medical Facility Plzen Plzen Czech Republic

Department of Pathology Cleveland Clinic Cleveland OH USA

Department of Pathology Henry Ford Hospital Detroit MI USA

Department of Pathology Immunology and Laboratory Medicine University of Florida Gainesville FL USA

Department of Pathology Massachusetts General Hospital and Harvard Medical School Boston MA USA

Department of Pathology University of Alabama at Birmingham Birmingham AL USA

Department of Pathology University of California San Francisco San Francisco CA USA

Department of Pathology University of Mississippi Medical Center Jackson MS USA

Department of Pathology University of Pennsylvania Philadelphia PA USA

El Camino Hospital Pathology Mountain View CA USA

Indiana University Pathology Indianapolis IN USA

Loyola University Healthcare Center Department of Pathology Maywood IL USA

St Joseph Mercy Hospital Ann Arbor MI USA

Stanford Medical Center Stanford CA USA

University of Washington Department of Laboratory Medicine and Pathology Seattle WA USA

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