The pathologic examination of a renal cell carcinoma (RCC) should involve a careful examination of the renal sinus of the affected kidney.
Involvement of the renal sinus may involve:
(1) invasion of the perinephric sinus fat
(2) invasion of small sinus lymphatics
(3) invasion of small sinus veins
The presence of renal sinus involvement indicates that a tumor is no longer renal limited, irregardless of size. This changes the T code to pT3 and indicates a risk of a more aggressive course.
The risk of sinus involvement:
(1) increases with tumor size (very high if diameter > 7 cm, high if > 4 cm)
(2) is high if there is capsular penetration elsewhere
Detection is improved if the histologic examination of the renal sinus is comprehensive..
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