Difference between revisions of "Renal cell carcinoma with sarcomatoid differentiation"
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[[Image: | [[Image:Chromophobe renal cell carcinoma with sarcomatoid differentiation -- high mag.jpg|thumb|right|Sarcomatoid differentiation in a [[chromophobe renal cell carcinoma]]. [[H&E stain]].]] | ||
'''Renal cell carcinoma with sarcomatoid differentiation''' is a malignant epithelial derived [[kidney tumour]] with malignant mesenchymal differentiation. | '''Renal cell carcinoma with sarcomatoid differentiation''' is a malignant epithelial derived [[kidney tumour]] with malignant mesenchymal differentiation. | ||
These tumours are '''not''' recognized as a distinct type of renal cell carcinoma; they are classified by the non-sarcomatous component. If a renal tumour is purely sarcomatous it is ''[[renal cell carcinoma, unclassified]]''. | These tumours are '''not''' recognized as a distinct type of renal cell carcinoma;<ref name=pmid22234634>{{Cite journal | last1 = Shuch | first1 = B. | last2 = Bratslavsky | first2 = G. | last3 = Linehan | first3 = WM. | last4 = Srinivasan | first4 = R. | title = Sarcomatoid renal cell carcinoma: a comprehensive review of the biology and current treatment strategies. | journal = Oncologist | volume = 17 | issue = 1 | pages = 46-54 | month = | year = 2012 | doi = 10.1634/theoncologist.2011-0227 | PMID = 22234634 }}</ref> they are classified by the non-sarcomatous component. If a renal tumour is purely sarcomatous it is ''[[renal cell carcinoma, unclassified]]''. | ||
'''Sarcomatoid renal cell carcinoma''', abbreviated '''sarcomatoid RCC''', redirects here. | '''Sarcomatoid renal cell carcinoma''', abbreviated '''sarcomatoid RCC''', redirects here. | ||
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==General== | ==General== | ||
Features:<ref name=pmid11224597>{{Cite journal | last1 = de Peralta-Venturina | first1 = M. | last2 = Moch | first2 = H. | last3 = Amin | first3 = M. | last4 = Tamboli | first4 = P. | last5 = Hailemariam | first5 = S. | last6 = Mihatsch | first6 = M. | last7 = Javidan | first7 = J. | last8 = Stricker | first8 = H. | last9 = Ro | first9 = JY. | title = Sarcomatoid differentiation in renal cell carcinoma: a study of 101 cases. | journal = Am J Surg Pathol | volume = 25 | issue = 3 | pages = 275-84 | month = Mar | year = 2001 | doi = | PMID = 11224597 }}</ref> | Features:<ref name=pmid11224597>{{Cite journal | last1 = de Peralta-Venturina | first1 = M. | last2 = Moch | first2 = H. | last3 = Amin | first3 = M. | last4 = Tamboli | first4 = P. | last5 = Hailemariam | first5 = S. | last6 = Mihatsch | first6 = M. | last7 = Javidan | first7 = J. | last8 = Stricker | first8 = H. | last9 = Ro | first9 = JY. | title = Sarcomatoid differentiation in renal cell carcinoma: a study of 101 cases. | journal = Am J Surg Pathol | volume = 25 | issue = 3 | pages = 275-84 | month = Mar | year = 2001 | doi = | PMID = 11224597 }}</ref> | ||
*Not recognized as a distinct entity in 2004 WHO classification | *'''Not''' recognized as a distinct entity in 2004 WHO classification<ref name=pmid16442207>{{Cite journal | last1 = Lopez-Beltran | first1 = A. | last2 = Scarpelli | first2 = M. | last3 = Montironi | first3 = R. | last4 = Kirkali | first4 = Z. | title = 2004 WHO classification of the renal tumors of the adults. | journal = Eur Urol | volume = 49 | issue = 5 | pages = 798-805 | month = May | year = 2006 | doi = 10.1016/j.eururo.2005.11.035 | PMID = 16442207 }}</ref> and after. | ||
**It is considered an indicator of progression. | **It is considered an indicator of progression. | ||
**Previously considered a distinct entity.<ref name=pmid16442207/><ref name=pmid10080595>{{Cite journal | last1 = Cangiano | first1 = T. | last2 = Liao | first2 = J. | last3 = Naitoh | first3 = J. | last4 = Dorey | first4 = F. | last5 = Figlin | first5 = R. | last6 = Belldegrun | first6 = A. | title = Sarcomatoid renal cell carcinoma: biologic behavior, prognosis, and response to combined surgical resection and immunotherapy. | journal = J Clin Oncol | volume = 17 | issue = 2 | pages = 523-8 | month = Feb | year = 1999 | doi = | PMID = 10080595 | URL = http://jco.ascopubs.org/content/17/2/523.full }}</ref> | **Previously considered a distinct entity.<ref name=pmid22234634/><ref name=pmid16442207/><ref name=pmid10080595>{{Cite journal | last1 = Cangiano | first1 = T. | last2 = Liao | first2 = J. | last3 = Naitoh | first3 = J. | last4 = Dorey | first4 = F. | last5 = Figlin | first5 = R. | last6 = Belldegrun | first6 = A. | title = Sarcomatoid renal cell carcinoma: biologic behavior, prognosis, and response to combined surgical resection and immunotherapy. | journal = J Clin Oncol | volume = 17 | issue = 2 | pages = 523-8 | month = Feb | year = 1999 | doi = | PMID = 10080595 | URL = http://jco.ascopubs.org/content/17/2/523.full }}</ref> | ||
*Tend to present at higher stage. | *Tend to present at higher stage. | ||
*Worse prognosis when adjusted for [[cancer staging|stage]]. | *Worse prognosis when adjusted for [[cancer staging|stage]]. | ||
*[[ISUP nucleolar grade]] ([[Fuhrman grade]]) 4 by definition. | *[[ISUP nucleolar grade]] ([[Fuhrman grade]]) 4 by definition. | ||
*Most commonly seen in association with [[clear cell renal cell carcinoma]]<ref name=pmid22234634/> or [[chromophobe RCC]].<ref name=pmid15087662>{{Cite journal | last1 = Cheville | first1 = JC. | last2 = Lohse | first2 = CM. | last3 = Zincke | first3 = H. | last4 = Weaver | first4 = AL. | last5 = Leibovich | first5 = BC. | last6 = Frank | first6 = I. | last7 = Blute | first7 = ML. | title = Sarcomatoid renal cell carcinoma: an examination of underlying histologic subtype and an analysis of associations with patient outcome. | journal = Am J Surg Pathol | volume = 28 | issue = 4 | pages = 435-41 | month = Apr | year = 2004 | doi = | PMID = 15087662 }}</ref><ref name=pmid9331291>{{Cite journal | last1 = Akhtar | first1 = M. | last2 = Tulbah | first2 = A. | last3 = Kardar | first3 = AH. | last4 = Ali | first4 = MA. | title = Sarcomatoid renal cell carcinoma: the chromophobe connection. | journal = Am J Surg Pathol | volume = 21 | issue = 10 | pages = 1188-95 | month = Oct | year = 1997 | doi = | PMID = 9331291 }}</ref> | |||
==Gross== | |||
*White solid area. | |||
DDx: | |||
*Degenerative changes. | |||
==Microscopic== | ==Microscopic== | ||
Features:<ref name=pmid11224597/> | Features:<ref name=pmid11224597/> | ||
# | #Identifiable subtype of [[renal cell carcinoma]], e.g. [[clear cell renal cell carcinoma]], [[chromophobe renal cell carcinoma]], others. | ||
#Sarcomatoid component: | #Sarcomatoid component: | ||
#*[[Fibrosarcoma]] - most common. | #*[[Fibrosarcoma]] - most common. | ||
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*In essence, any kidney tumour with [[spindle cell]]s should make one think of this.<ref name=pmid15763002/> | *In essence, any kidney tumour with [[spindle cell]]s should make one think of this.<ref name=pmid15763002/> | ||
*[[Renal cell carcinoma with rhabdoid morphology|Rhabdoid change in renal cell carcinoma]] is probably analogous to sarcomatoid change.<ref name=pmid21665507>{{Cite journal | last1 = Chapman-Fredricks | first1 = JR. | last2 = Herrera | first2 = L. | last3 = Bracho | first3 = J. | last4 = Gomez-Fernandez | first4 = C. | last5 = Leveillee | first5 = R. | last6 = Rey | first6 = L. | last7 = Jorda | first7 = M. | title = Adult renal cell carcinoma with rhabdoid morphology represents a neoplastic dedifferentiation analogous to sarcomatoid carcinoma. | journal = Ann Diagn Pathol | volume = 15 | issue = 5 | pages = 333-7 | month = Oct | year = 2011 | doi = 10.1016/j.anndiagpath.2011.03.002 | PMID = 21665507 }}</ref> | *[[Renal cell carcinoma with rhabdoid morphology|Rhabdoid change in renal cell carcinoma]] is probably analogous to sarcomatoid change.<ref name=pmid21665507>{{Cite journal | last1 = Chapman-Fredricks | first1 = JR. | last2 = Herrera | first2 = L. | last3 = Bracho | first3 = J. | last4 = Gomez-Fernandez | first4 = C. | last5 = Leveillee | first5 = R. | last6 = Rey | first6 = L. | last7 = Jorda | first7 = M. | title = Adult renal cell carcinoma with rhabdoid morphology represents a neoplastic dedifferentiation analogous to sarcomatoid carcinoma. | journal = Ann Diagn Pathol | volume = 15 | issue = 5 | pages = 333-7 | month = Oct | year = 2011 | doi = 10.1016/j.anndiagpath.2011.03.002 | PMID = 21665507 }}</ref> | ||
DDx: | |||
*Retroperitoneal [[sarcoma]]. | |||
*[[Renal mucinous tubular and spindle cell carcinoma]]. | |||
===Images=== | ===Images=== | ||
====Case 1==== | |||
<gallery> | <gallery> | ||
Image: Sarcomatoid differentiation in renal cell carcinoma -- intermed mag.jpg | RCC with sarc. diff. - intermed. mag. (WC) | Image: Sarcomatoid differentiation in renal cell carcinoma -- intermed mag.jpg | RCC with sarc. diff. - intermed. mag. (WC) | ||
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Image: Clear cell renal cell carcinoma - 2 -- very high mag.jpg | CCRCC - very high mag. (WC) | Image: Clear cell renal cell carcinoma - 2 -- very high mag.jpg | CCRCC - very high mag. (WC) | ||
</gallery> | </gallery> | ||
====Case 2==== | |||
<gallery> | |||
Image: Chromophobe renal cell carcinoma with sarcomatoid differentiation -- low mag.jpg | ChRCC with SD - low mag. | |||
Image: Chromophobe renal cell carcinoma with sarcomatoid differentiation -- intermed mag.jpg | ChRCC with SD - intermed. mag. | |||
Image: Chromophobe renal cell carcinoma with sarcomatoid differentiation -- high mag.jpg | ChRCC with SD - high mag. | |||
Image: Chromophobe renal cell carcinoma with sarcomatoid differentiation - alt -- intermed mag.jpg | ChRCC with SD - intermed. mag. | |||
Image: Chromophobe renal cell carcinoma with sarcomatoid differentiation - alt -- high mag.jpg | ChRCC with SD - high mag. | |||
</gallery> | |||
====www==== | |||
*[http://jco.ascopubs.org/content/27/2/235/F1.expansion Sarcomatoid changes in CCRCC (ascopubs.org)].<ref name=pmid19064974>{{Cite journal | last1 = Golshayan | first1 = AR. | last2 = George | first2 = S. | last3 = Heng | first3 = DY. | last4 = Elson | first4 = P. | last5 = Wood | first5 = LS. | last6 = Mekhail | first6 = TM. | last7 = Garcia | first7 = JA. | last8 = Aydin | first8 = H. | last9 = Zhou | first9 = M. | title = Metastatic sarcomatoid renal cell carcinoma treated with vascular endothelial growth factor-targeted therapy. | journal = J Clin Oncol | volume = 27 | issue = 2 | pages = 235-41 | month = Jan | year = 2009 | doi = 10.1200/JCO.2008.18.0000 | PMID = 19064974 }}</ref> | *[http://jco.ascopubs.org/content/27/2/235/F1.expansion Sarcomatoid changes in CCRCC (ascopubs.org)].<ref name=pmid19064974>{{Cite journal | last1 = Golshayan | first1 = AR. | last2 = George | first2 = S. | last3 = Heng | first3 = DY. | last4 = Elson | first4 = P. | last5 = Wood | first5 = LS. | last6 = Mekhail | first6 = TM. | last7 = Garcia | first7 = JA. | last8 = Aydin | first8 = H. | last9 = Zhou | first9 = M. | title = Metastatic sarcomatoid renal cell carcinoma treated with vascular endothelial growth factor-targeted therapy. | journal = J Clin Oncol | volume = 27 | issue = 2 | pages = 235-41 | month = Jan | year = 2009 | doi = 10.1200/JCO.2008.18.0000 | PMID = 19064974 }}</ref> | ||
*[http://www.scielo.br/img/revistas/ibju/v31n1/1a03f1.jpg Sarcomatoid changes in RCC (scielo.br)].<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> | *[http://www.scielo.br/img/revistas/ibju/v31n1/1a03f1.jpg Sarcomatoid changes in RCC (scielo.br)].<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> | ||
| Line 49: | Line 69: | ||
*[[Kidney tumours]]. | *[[Kidney tumours]]. | ||
*[[Renal cell carcinoma with rhabdoid change]]. | *[[Renal cell carcinoma with rhabdoid change]]. | ||
*[[Sarcomatoid carcinoma]]. | |||
==References== | ==References== | ||
Latest revision as of 02:50, 11 July 2015
Renal cell carcinoma with sarcomatoid differentiation is a malignant epithelial derived kidney tumour with malignant mesenchymal differentiation.
These tumours are not recognized as a distinct type of renal cell carcinoma;[1] they are classified by the non-sarcomatous component. If a renal tumour is purely sarcomatous it is renal cell carcinoma, unclassified.
Sarcomatoid renal cell carcinoma, abbreviated sarcomatoid RCC, redirects here.
General
Features:[2]
- Not recognized as a distinct entity in 2004 WHO classification[3] and after.
- Tend to present at higher stage.
- Worse prognosis when adjusted for stage.
- ISUP nucleolar grade (Fuhrman grade) 4 by definition.
- Most commonly seen in association with clear cell renal cell carcinoma[1] or chromophobe RCC.[5][6]
Gross
- White solid area.
DDx:
- Degenerative changes.
Microscopic
Features:[2]
- Identifiable subtype of renal cell carcinoma, e.g. clear cell renal cell carcinoma, chromophobe renal cell carcinoma, others.
- Sarcomatoid component:
- Fibrosarcoma - most common.
- Undifferentiated - common.
- Rhabdomyosarcoma - very rare.
Notes:
- In essence, any kidney tumour with spindle cells should make one think of this.[7]
- Rhabdoid change in renal cell carcinoma is probably analogous to sarcomatoid change.[8]
DDx:
- Retroperitoneal sarcoma.
- Renal mucinous tubular and spindle cell carcinoma.
Images
Case 1
RCC with sarc. diff. - intermed. mag. (WC)
RCC with sarc. diff - high mag. (WC)
RCC with sarc. diff. - very high mag. (WC)
CCRCC - intermed. mag. (WC)
CCRCC - high mag. (WC)
CCRCC - very high mag. (WC)
Case 2
ChRCC with SD - low mag.
ChRCC with SD - intermed. mag.
ChRCC with SD - high mag.
ChRCC with SD - intermed. mag.
ChRCC with SD - high mag.
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- Classified by the underlying renal cell carcinoma, e.g. clear cell renal cell carcinoma.
- If only a sarcomatous component is present these are labeled renal cell carcinoma, unclassified.
- Always ISUP nucleolar grade 4.
See also
References
- ↑ 1.0 1.1 1.2 Shuch, B.; Bratslavsky, G.; Linehan, WM.; Srinivasan, R. (2012). "Sarcomatoid renal cell carcinoma: a comprehensive review of the biology and current treatment strategies.". Oncologist 17 (1): 46-54. doi:10.1634/theoncologist.2011-0227. PMID 22234634.
- ↑ 2.0 2.1 de Peralta-Venturina, M.; Moch, H.; Amin, M.; Tamboli, P.; Hailemariam, S.; Mihatsch, M.; Javidan, J.; Stricker, H. et al. (Mar 2001). "Sarcomatoid differentiation in renal cell carcinoma: a study of 101 cases.". Am J Surg Pathol 25 (3): 275-84. PMID 11224597.
- ↑ 3.0 3.1 Lopez-Beltran, A.; Scarpelli, M.; Montironi, R.; Kirkali, Z. (May 2006). "2004 WHO classification of the renal tumors of the adults.". Eur Urol 49 (5): 798-805. doi:10.1016/j.eururo.2005.11.035. PMID 16442207.
- ↑ Cangiano, T.; Liao, J.; Naitoh, J.; Dorey, F.; Figlin, R.; Belldegrun, A. (Feb 1999). "Sarcomatoid renal cell carcinoma: biologic behavior, prognosis, and response to combined surgical resection and immunotherapy.". J Clin Oncol 17 (2): 523-8. PMID 10080595.
- ↑ Cheville, JC.; Lohse, CM.; Zincke, H.; Weaver, AL.; Leibovich, BC.; Frank, I.; Blute, ML. (Apr 2004). "Sarcomatoid renal cell carcinoma: an examination of underlying histologic subtype and an analysis of associations with patient outcome.". Am J Surg Pathol 28 (4): 435-41. PMID 15087662.
- ↑ Akhtar, M.; Tulbah, A.; Kardar, AH.; Ali, MA. (Oct 1997). "Sarcomatoid renal cell carcinoma: the chromophobe connection.". Am J Surg Pathol 21 (10): 1188-95. PMID 9331291.
- ↑ 7.0 7.1 Dall'Oglio, MF.; Lieberknecht, M.; Gouveia, V.; Sant'Anna, AC.; Leite, KR.; Srougi, M.. "Sarcomatoid differentiation in renal cell carcinoma: prognostic implications.". Int Braz J Urol 31 (1): 10-6. PMID 15763002.
- ↑ Chapman-Fredricks, JR.; Herrera, L.; Bracho, J.; Gomez-Fernandez, C.; Leveillee, R.; Rey, L.; Jorda, M. (Oct 2011). "Adult renal cell carcinoma with rhabdoid morphology represents a neoplastic dedifferentiation analogous to sarcomatoid carcinoma.". Ann Diagn Pathol 15 (5): 333-7. doi:10.1016/j.anndiagpath.2011.03.002. PMID 21665507.
- ↑ Golshayan, AR.; George, S.; Heng, DY.; Elson, P.; Wood, LS.; Mekhail, TM.; Garcia, JA.; Aydin, H. et al. (Jan 2009). "Metastatic sarcomatoid renal cell carcinoma treated with vascular endothelial growth factor-targeted therapy.". J Clin Oncol 27 (2): 235-41. doi:10.1200/JCO.2008.18.0000. PMID 19064974.