Difference between revisions of "Kidney tumours"

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Kidney tumours (view source)

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===Sign out===
===Sign out===
====Missed renal biopsy====
====Missed renal biopsy====
<pre>
{{Main|Missed renal biopsy}}
KIDNEY (LESION), LEFT, CORE BIOPSY:
- RENAL PARENCHYMA.
- NEGATIVE FOR MASS LESION, SEE COMMENT.
 
COMMENT:
No mass lesion is apparent in the tissue sampled. A re-biopsy should be considered.
 
Renal parenchyma:
- Glomeruli: seven glomeruli sampled, no apparent glomerular pathology on the H&E sections.
- Interstitium: interstitial fibrosis is not identified.
- Tubules: no pathology is apparent.
- Vessels: mild atherosclerosis, no hyalinization of arterioles apparent.
</pre>


=Tabular comparison (selected tumours)=  
=Tabular comparison (selected tumours)=  
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**[[t(6;11) renal cell carcinoma]].
**[[t(6;11) renal cell carcinoma]].


"Emerging" entities are:
"Emerging" entities (as per Vancouver) are:
*[[Thyroid-like follicular renal cell carcinoma]].
*[[Thyroid-like follicular renal cell carcinoma]].
*[[Succinate dehydrogenase-deficient renal cell carcinoma]].
*[[Succinate dehydrogenase-deficient renal cell carcinoma]].
*[[ALK translocation renal cell carcinoma]].
*[[ALK translocation renal cell carcinoma]].
==An entity proposed after Vancouver==
*[[Eosinophilic, solid and cystic renal cell carcinoma]].
*[[Biphasic hyalinizing psammomatous renal cell carcinoma]].
*[[Papillary renal neoplasm with reverse polarity]].
*[[Low-grade oncocytic renal tumour]].


=Renal cell carcinoma=
=Renal cell carcinoma=
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*Male>female (~2:1).
*Male>female (~2:1).
*Hereditary - familial syndromes (see [[Hereditary RCC]]).
*Hereditary - familial syndromes (see [[Hereditary RCC]]).
*[[Obesity]].<ref name=pmid8770461>{{Cite journal  | last1 = Chow | first1 = WH. | last2 = McLaughlin | first2 = JK. | last3 = Mandel | first3 = JS. | last4 = Wacholder | first4 = S. | last5 = Niwa | first5 = S. | last6 = Fraumeni | first6 = JF. | title = Obesity and risk of renal cell cancer. | journal = Cancer Epidemiol Biomarkers Prev | volume = 5 | issue = 1 | pages = 17-21 | month = Jan | year = 1996 | doi =  | PMID = 8770461 }}</ref>


===Subtypes of RCC===
===Subtypes of RCC===
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==Renal cell carcinoma grading==
==Renal cell carcinoma grading==
===General===
{{Main|Renal cell carcinoma grading}}
There are two systems:
*''Fuhrman grading'':
**Older and more complicated.
**Based on nuclear size and shape, chromatin pattern and [[nucleoli|nucleolar size]].<ref name=Ref_GUP282>{{Ref GUP|282}}</ref>
*''[[ISUP]] grading'':<ref name=pmid24025520>{{cite journal |author=Delahunt B, Cheville JC, Martignoni G, ''et al.'' |title=The International Society of Urological Pathology (ISUP) grading system for renal cell carcinoma and other prognostic parameters |journal=Am. J. Surg. Pathol. |volume=37 |issue=10 |pages=1490–504 |year=2013 |month=October |pmid=24025520 |doi=10.1097/PAS.0b013e318299f0fb |url=}}</ref>
**Newer and less complicated.
**Mostly based on [[nucleoli|nucleolar size]] and to a much lesser degree on size and morphology
**Developed based on ''Fuhrman grading''.
 
===ISUP grading===
Criteria:<ref name=pmid24025520/>
*Grade 1 - nucleoli absent/very small at 400x. §
*Grade 2 - nucleoli seen with 400x, but not at 100x. §§
*Grade 3 - nucleoli seen at 100x, i.e. with the 10x objective.
*Grade 4 - extreme nuclear pleomorphism (esp. nuclear enlargement) ''or'' [[renal cell carcinoma with sarcomatoid differentiation|sarcomatoid differentiation]] ([[spindle cell]]s<ref name=pmid15763002>{{Cite journal  | last1 = Dall'Oglio | first1 = MF. | last2 = Lieberknecht | first2 = M. | last3 = Gouveia | first3 = V. | last4 = Sant'Anna | first4 = AC. | last5 = Leite | first5 = KR. | last6 = Srougi | first6 = M. | title = Sarcomatoid differentiation in renal cell carcinoma: prognostic implications. | journal = Int Braz J Urol | volume = 31 | issue = 1 | pages = 10-6 | month =  | year =  | doi =  | PMID = 15763002 }}</ref> or [[Renal cell carcinoma with rhabdoid morphology|rhabdoid cells]]).
 
Cavets:<ref name=pmid24025520/>
*Higher grade component trumps lower grade component.
**No agreed upon minimum quantity of high grade component for upgrading.
***37% use 1 field of view with the x10 objective. †
***41% use 1 field of view with the x40 objective. ‡
*Grading system ''not'' used for ''[[chromophobe RCC]]''.
**The experience with the ''Fuhrman grading'' system showed it is ''not'' prognostic for chromophobe RCC.<ref name=pmid17527087>{{Cite journal  | last1 = Delahunt | first1 = B. | last2 = Sika-Paotonu | first2 = D. | last3 = Bethwaite | first3 = PB. | last4 = McCredie | first4 = MR. | last5 = Martignoni | first5 = G. | last6 = Eble | first6 = JN. | last7 = Jordan | first7 = TW. | title = Fuhrman grading is not appropriate for chromophobe renal cell carcinoma. | journal = Am J Surg Pathol | volume = 31 | issue = 6 | pages = 957-60 | month = Jun | year = 2007 | doi = 10.1097/01.pas.0000249446.28713.53 | PMID = 17527087 }}</ref>
 
Notes:
*† Suffers from [[IPFitis]].
*‡ Suffers from [[HPFitis]].
*§ Some describe Grade 1 nuclei as ''lymphocyte-like''.{{fact}}
*§§ Some suggest the following relationship between grading/nucleoli:{{fact}}  
**Grade 1 = nucleoli seen at 400x.
**Grade 2 = nucleoli seen at 200x.
**Grade 3 = nucleoli seen at 100x.


==Renal cell carcinoma staging==
==Renal cell carcinoma staging==
Tumour stage - notes:
{{Main|Kidney cancer staging}}
*Most cases are pT1a or pT3a.
**pT2 is very rare and pT1b is uncommon for [[CCRCC]].<ref name=pmid16145369>{{Cite journal  | last1 = Bonsib | first1 = SM. | title = T2 clear cell renal cell carcinoma is a rare entity: a study of 120 clear cell renal cell carcinomas. | journal = J Urol | volume = 174 | issue = 4 Pt 1 | pages = 1199-202; discussion 1202 | month = Oct | year = 2005 | doi =  | PMID = 16145369 }}</ref>
 
Lymph node stage - notes:
*Previously divided into N1 (one lymph node positive) and N2 (multiple lymph nodes positive).
**Now only ''N1'' - was changed in 2009.<ref name=pmid21927698>{{Cite journal  | last1 = Lee | first1 = C. | last2 = You | first2 = D. | last3 = Park | first3 = J. | last4 = Jeong | first4 = IG. | last5 = Song | first5 = C. | last6 = Hong | first6 = JH. | last7 = Ahn | first7 = H. | last8 = Kim | first8 = CS. | title = Validation of the 2009 TNM Classification for Renal Cell Carcinoma: Comparison with the 2002 TNM Classification by Concordance Index. | journal = Korean J Urol | volume = 52 | issue = 8 | pages = 524-30 | month = Aug | year = 2011 | doi = 10.4111/kju.2011.52.8.524 | PMID = 21927698 }}</ref>
***There is data to suggest N1 and N2 behave differently;<ref name=pmid16469567>{{Cite journal  | last1 = Canfield | first1 = SE. | last2 = Kamat | first2 = AM. | last3 = Sánchez-Ortiz | first3 = RF. | last4 = Detry | first4 = M. | last5 = Swanson | first5 = DA. | last6 = Wood | first6 = CG. | title = Renal cell carcinoma with nodal metastases in the absence of distant metastatic disease (clinical stage TxN1-2M0): the impact of aggressive surgical resection on patient outcome. | journal = J Urol | volume = 175 | issue = 3 Pt 1 | pages = 864-9 | month = Mar | year = 2006 | doi = 10.1016/S0022-5347(05)00334-4 | PMID = 16469567 }}</ref> however, it is disputed.<ref name=pmid17070225>{{Cite journal  | last1 = Dimashkieh | first1 = HH. | last2 = Lohse | first2 = CM. | last3 = Blute | first3 = ML. | last4 = Kwon | first4 = ED. | last5 = Leibovich | first5 = BC. | last6 = Cheville | first6 = JC. | title = Extranodal extension in regional lymph nodes is associated with outcome in patients with renal cell carcinoma. | journal = J Urol | volume = 176 | issue = 5 | pages = 1978-82; discussion 1982-3 | month = Nov | year = 2006 | doi = 10.1016/j.juro.2006.07.026 | PMID = 17070225 }}</ref><ref name=pmid19955666>{{Cite journal  | last1 = Lam | first1 = JS. | last2 = Klatte | first2 = T. | last3 = Breda | first3 = A. | title = Staging of renal cell carcinoma: Current concepts. | journal = Indian J Urol | volume = 25 | issue = 4 | pages = 446-54 | month =  | year =  | doi = 10.4103/0970-1591.57906 | PMID = 19955666 }}</ref>


===Renal sinus invasion===
===Renal sinus invasion===
Renal sinus invasion is when any of the following are present:<ref name=pmid24025521>{{Cite journal  | last1 = Trpkov | first1 = K. | last2 = Grignon | first2 = DJ. | last3 = Bonsib | first3 = SM. | last4 = Amin | first4 = MB. | last5 = Billis | first5 = A. | last6 = Lopez-Beltran | first6 = A. | last7 = Samaratunga | first7 = H. | last8 = Tamboli | first8 = P. | last9 = Delahunt | first9 = B. | title = Handling and staging of renal cell carcinoma: the International Society of Urological Pathology Consensus (ISUP) conference recommendations. | journal = Am J Surg Pathol | volume = 37 | issue = 10 | pages = 1505-17 | month = Oct | year = 2013 | doi = 10.1097/PAS.0b013e31829a85d0 | PMID = 24025521 }}</ref>
{{Main|Kidney cancer staging}}
#Tumour in an endothelial lined space of the renal sinus.
#Tumour touching renal sinus fat.
#Tumour within the loose connective tissue of the renal sinus.


==Clear cell renal cell carcinoma==
==Clear cell renal cell carcinoma==
Michael
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