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RESIDENT’S CORNER

Bilateral oncocytoma and the value of needle biopsy

Bert S. Ivey, Karthik Devarajan, Chandru P. Sundaram

Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
Address correspondence to Dr. Chandru P. Sundaram, Department of Urology, Indiana University School of Medicine, 535 North Barnhill Drive, Suite 420, Indianapolis, IN 46202 USA

Canadian Journal of Urology 2010, 17(2), 5131-5134.

Abstract

Introduction: Renal oncocytoma represents a diagnostic challenge to urologists. We present three patients with bilateral renal oncocytomas.
Cases: All three patients presented with bilateral renal masses and through surgical means, were diagnosed with oncocytoma. Renal biopsies were used to diagnose oncocytoma in the contralateral kidney.
Discussion: Considering oncocytoma represents up to 16% of renal masses, there is overtreatment of benign disease due the difficulty in distinguishing between histologies on radiographs. Even when the diagnosis of oncocytoma is made, concurrent renal cell carcinoma can be found in a small subset of patients. The value of renal biopsy in these patients thus becomes increasingly important. The accuracy of needle biopsy has improved and is relatively safe. Accuracy in establishing a diagnosis is better than 70% in most series. Tissue acquisition remains a barrier to accurate diagnosis. Although not routine, patients with bilateral masses or impaired renal function may be candidates for renal biopsy.
Conclusions: Oncocytoma in the setting of bilateral renal masses presents a difficult clinical scenario. The clinician must exclude renal cell carcinoma from the differential diagnosis. Renal biopsy represents a safe and accurate method towards that end so that patients can be followed radiographically.

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