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Pathology - Renal Cancer

  • Clear cell carcinoma: comprises >70% of renal lesions
    • VHL gene mutation principle event. Recent association between VHL protein and hypoxia inducing factor [HIF] protein ties pathology into angiogenesis cascade pathway.
  • Papillary carcinoma: comprises 10-15% of renal lesions
    • Sporadic and hereditary forms
    • Associated with alterations in chromosomes 7, 17, and Y
    • Generally better survival

    Read more on "A Molecular Classification of Papillary Renal Cell Carcinoma"

  • Chromophobe tumors: 5 % of cases
    • Loss on chromosome 1
  • Collecting duct carcinoma: one percent or less of cases
    • Can mimic transitional cell Ca
    • Generally poor outcome
  • Oncocytoma: 5 % of renal tumors
    • Generally localized and encapsulated. 5% bilaterality
    • Mahogany brown color, acidophilic cells secondary to dense mitochondrial hyperplasia
    • Distinction from renal cell cancer difficult on imaging or needle biopsy. Best treated with surgical removal
  • Angiomyolipoma: Renal Hamartomas comprised of fat, muscle and blood vessels. Tissue signature on CT by demonstration of negative Hounsfield units.
    • Sporadic, isolated lesions present age 35-50 with a 4:1 female ratio
    • Tuberous Sclerosis patients demonstrate multiple and bilateral lesions. 80% of patients will develop AML.
    • Treatment based on tumor size: those <4 cm are observed, those >4cm undergo selective angioembolization or partial nephrectomy
  • Renal Sarcoma
    • Pure sarcoma is rare and usually lieomyosarcoma
    • All tumor types can degenerate towards sarcoma
    • Generally poorer outcome
  • Rare Renal lesions

References

  • Bostwick DG, Eble JN: Diagnosis and classification of renal cell carcinoma. Urol Clin N Am 26:627-635, 1999.
  • Caddeddu JA, Ono Y, Clayman RV, et al: Laparoscopic nephrectomy for renal cell cancer: Evaluation of efficacy and safety: A multicenter experience. Urology 52:773-777, 1998.
  • Levy DA, Slaton JW, Swanson DA, Dinney CP: Stage specific guidelines for surveillance after radical nephrectomy for local renal cell carcinoma. J Urol 15:1163-1167, 1998.
  • Montie JM: Lymphadenectomy for renal cell carcinoma. Semin Urol 7:181-185, 1989.
  • Motzer RJ, Bander NH, Nanus DM: Renal-cell carcinoma. N Engl J Med 335:865-875, 1996.
  • Novick AC: Renal-sparing surgery for renal cell carcinoma. Urol Clin North Am 20:277-282, 1993.
  • Sagalowsky AI, Kadesky KT, Ewalt DM, Kennedy TJ: Factors influencing adrenal metastasis in renal cell carcinoma. J Urol 151:1181-1184, 1994.
  • Skinner DG, Pritchett RT, Lieskovsky G, Boyd SD, Stiles QR: Vena caval involvement by renal cell carcinoma. Surgical resection provides meaningful long-term survival. Ann Surg 210:387-394, 1989.
  • Sufrin G, Cashon S, Golio A, Murphy GP: Paraneoplastic and serologic syndromes of renal adenocarcinoma. Semin Urol 7:158-171, 1989.
  • Yang JC, Topalian SL, Parkinson D, et al: Randomized comparison of high-dose and low-dose intravenous interleukin 2 for the therapy of metastatic renal cell carcinoma: An interim report. J Clin Oncol 12:1572-1576, 1994.