|
|
(5 intermediate revisions by the same user not shown) |
Line 23: |
Line 23: |
| ===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)= |
Line 252: |
Line 239: |
| ==An entity proposed after Vancouver== | | ==An entity proposed after Vancouver== |
| *[[Eosinophilic, solid and cystic renal cell carcinoma]]. | | *[[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= |
Line 277: |
Line 267: |
| *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=== |
Line 375: |
Line 366: |
|
| |
|
| ==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== |