Difference between revisions of "Unclassified renal cell carcinoma"
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = | | Image = Unclassified_renal_cell_carcinoma_-_thyroid-like_and_clear_cell-like_--_low_mag.jpg | ||
| Width = | | Width = | ||
| Caption = | | Caption = Unclassified renal cell carcinoma with thyroid-like and clear cell-like areas. [[H&E stain]]. | ||
| Synonyms = | | Synonyms = | ||
| Micro = One of the following: (1) a combination of other RCC histologic types, (2) "non-identifiable" pattern/unrecognizable cell type (3) pure [[sarcomatoid RCC]] without an identifiable (epithelioid) RCC subtype | | Micro = One of the following: (1) a combination of other RCC histologic types, (2) "non-identifiable" pattern/unrecognizable cell type (3) pure [[sarcomatoid RCC]] without an identifiable (epithelioid) RCC subtype | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = [[clear cell renal cell carcinoma]], [[collecting duct carcinoma]], undifferentiated carcinoma extending into kidney, [[kidney metastasis]], retroperitoneal [[sarcoma]], newly described renal tumour or emerging entity - see ''[[Vancouver classification]]'' | | LMDDx = [[clear cell renal cell carcinoma]], [[collecting duct carcinoma]], undifferentiated carcinoma extending into kidney, [[kidney metastasis]], retroperitoneal [[sarcoma]], newly described renal tumour or emerging entity - see ''[[Vancouver classification]]'', [[collision tumour]] | ||
| Stains = | | Stains = | ||
| IHC = | | IHC = | ||
| Line 14: | Line 14: | ||
| IF = | | IF = | ||
| Gross = kidney mass | | Gross = kidney mass | ||
| Grossing = | | Grossing = [[partial nephrectomy grossing]], [[total nephrectomy for tumour grossing]] | ||
| Staging = [[kidney cancer staging]] | |||
| Site = [[kidney]] - see ''[[kidney tumours]]'' | | Site = [[kidney]] - see ''[[kidney tumours]]'' | ||
| Assdx = | | Assdx = | ||
| Line 56: | Line 57: | ||
*Retroperitoneal [[sarcoma]], e.g. [[pleomorphic undifferentiated sarcoma]]. | *Retroperitoneal [[sarcoma]], e.g. [[pleomorphic undifferentiated sarcoma]]. | ||
*Newly described renal tumour or emerging entity - see ''[[Vancouver classification]]''. | *Newly described renal tumour or emerging entity - see ''[[Vancouver classification]]''. | ||
*Collision tumour, e.g. [[urothelial carcinoma]] and identifiable [[renal cell carcinoma]]. | *[[Collision tumour]], e.g. [[urothelial carcinoma]] and identifiable [[renal cell carcinoma]]. | ||
===Images=== | |||
====Case 1==== | |||
<gallery> | |||
Image: Unclassified renal cell carcinoma - thyroid-like with myomatous stroma -- low mag.jpg | URCC - low mag. | |||
Image: Unclassified renal cell carcinoma - thyroid-like -- intermed mag.jpg | URCC - intermed. mag. | |||
Image: Unclassified renal cell carcinoma - thyroid-like -- high mag.jpg | URCC - high mag. | |||
Image: Unclassified renal cell carcinoma - thyroid-like and clear cell-like -- low mag.jpg | URCC - low mag. | |||
Image: Unclassified renal cell carcinoma - thyroid-like and clear cell-like -- intermed mag.jpg | URCC - intermed. mag. | |||
Image: Unclassified renal cell carcinoma - thyroid-like and clear cell-like - alt -- intermed mag.jpg | URCC - intermed. mag. | |||
Image: Unclassified renal cell carcinoma - mixed clear cell and thyroid-like -- low mag.jpg | URCC - low mag. | |||
Image: Unclassified renal cell carcinoma - mixed clear cell and thyroid-like -- intermed mag.jpg | URCC - intermed. mag. | |||
Image: Unclassified renal cell carcinoma - mixed clear cell and thyroid-like -- high mag.jpg | URCC - high mag. | |||
</gallery> | |||
====Case 2==== | |||
<gallery> | |||
Image: Unclassified renal cell carcinoma in BHD -- low mag.jpg | URCC in [[BHD]] - low mag. | |||
Image: Unclassified renal cell carcinoma in BHD -- intermed mag.jpg | URCC in [[BHD]] - intermed. mag. | |||
Image: Unclassified renal cell carcinoma in BHD -- high mag.jpg | URCC in BHD - high mag. | |||
Image: Unclassified renal cell carcinoma in BHD -- very high mag.jpg | URCC in BHD - very high mag. | |||
Image: Unclassified renal cell carcinoma in BHD - b -- intermed mag.jpg | URCC in BHD - intermed. mag. | |||
Image: Unclassified renal cell carcinoma in BHD - b -- high mag.jpg | URCC in BHD - high mag. | |||
Image: Unclassified renal cell carcinoma in BHD - b -- very high mag.jpg | URCC in BHD - very high mag. | |||
</gallery> | |||
==IHC== | ==IHC== | ||
*Pankeratin +ve. | *Pankeratin +ve. | ||
* | *[[PAX8]] +ve. | ||
*Vimentin +ve/-ve. | *Vimentin +ve/-ve. | ||
*p63 -ve.<ref>{{Cite journal | last1 = Carvalho | first1 = JC. | last2 = Thomas | first2 = DG. | last3 = McHugh | first3 = JB. | last4 = Shah | first4 = RB. | last5 = Kunju | first5 = LP. | title = p63, CK7, PAX8 and INI-1: an optimal immunohistochemical panel to distinguish poorly differentiated urothelial cell carcinoma from high-grade tumours of the renal collecting system. | journal = Histopathology | volume = 60 | issue = 4 | pages = 597-608 | month = Mar | year = 2012 | doi = 10.1111/j.1365-2559.2011.04093.x | PMID = 22260386 }}</ref> | *p63 -ve.<ref>{{Cite journal | last1 = Carvalho | first1 = JC. | last2 = Thomas | first2 = DG. | last3 = McHugh | first3 = JB. | last4 = Shah | first4 = RB. | last5 = Kunju | first5 = LP. | title = p63, CK7, PAX8 and INI-1: an optimal immunohistochemical panel to distinguish poorly differentiated urothelial cell carcinoma from high-grade tumours of the renal collecting system. | journal = Histopathology | volume = 60 | issue = 4 | pages = 597-608 | month = Mar | year = 2012 | doi = 10.1111/j.1365-2559.2011.04093.x | PMID = 22260386 }}</ref> | ||
Latest revision as of 20:55, 5 May 2016
| Unclassified renal cell carcinoma | |
|---|---|
| Diagnosis in short | |
 Unclassified renal cell carcinoma with thyroid-like and clear cell-like areas. H&E stain. | |
|
| |
| LM | One of the following: (1) a combination of other RCC histologic types, (2) "non-identifiable" pattern/unrecognizable cell type (3) pure sarcomatoid RCC without an identifiable (epithelioid) RCC subtype |
| LM DDx | clear cell renal cell carcinoma, collecting duct carcinoma, undifferentiated carcinoma extending into kidney, kidney metastasis, retroperitoneal sarcoma, newly described renal tumour or emerging entity - see Vancouver classification, collision tumour |
| Gross | kidney mass |
| Grossing notes | partial nephrectomy grossing, total nephrectomy for tumour grossing |
| Staging | kidney cancer staging |
| Site | kidney - see kidney tumours |
|
| |
| Prevalence | uncommon |
| Prognosis | poor |
| Clin. DDx | other renal tumours |
| Treatment | excision if feasible |
Unclassified renal cell carcinoma, abbreviated URCC, is a malignant epithelial tumour arising from the kidney parenchyma, i.e. a renal cell carcinoma, that cannot be further classified.
General
- Uncommon.
- A WHO classification diagnosis of exclusion.
- Worse prognosis than clear cell renal cell carcinoma.[1]
- High variation in the prevalence (when comparing institutions); this suggests a lack of uniformity in the diagnosis of this subtype.[1]
Gross
- Mass lesion arising from the kidney - solid and/or cystic.
- Confined to kidney or predominantly within the kidney.
Microscopic
Features:
- Malignant tumour that is one of the following:[2][3]
- A combination of other RCC histologic types (~35% of cases of URCC).
- Has a "non-identifiable" pattern/unrecognizable cell type (~60% of cases of URCC).
- Pure sarcomatoid RCC without an identifiable (epithelioid) RCC subtype (~5% of cases of URCC).[3]
DDx:
- Clear cell renal cell carcinoma.
- Collecting duct carcinoma.
- Undifferentiated carcinoma.
- Kidney metastasis - typically metastatic carcinoma.
- Retroperitoneal sarcoma, e.g. pleomorphic undifferentiated sarcoma.
- Newly described renal tumour or emerging entity - see Vancouver classification.
- Collision tumour, e.g. urothelial carcinoma and identifiable renal cell carcinoma.
Images
Case 1
URCC - low mag.
URCC - intermed. mag.
URCC - high mag.
URCC - low mag.
URCC - intermed. mag.
URCC - intermed. mag.
URCC - low mag.
URCC - intermed. mag.
URCC - high mag.
Case 2
URCC in BHD - low mag.
URCC in BHD - intermed. mag.
URCC in BHD - high mag.
URCC in BHD - very high mag.
URCC in BHD - intermed. mag.
URCC in BHD - high mag.
URCC in BHD - very high mag.
IHC
See also
References
- ↑ 1.0 1.1 Karakiewicz, PI.; Hutterer, GC.; Trinh, QD.; Pantuck, AJ.; Klatte, T.; Lam, JS.; Guille, F.; de La Taille, A. et al. (Oct 2007). "Unclassified renal cell carcinoma: an analysis of 85 cases.". BJU Int 100 (4): 802-8. doi:10.1111/j.1464-410X.2007.07148.x. PMID 17822461.
- ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 293. ISBN 978-0781765275.
- ↑ 3.0 3.1 Lopez-Beltran, A.; Kirkali, Z.; Montironi, R.; Blanca, A.; Algaba, F.; Scarpelli, M.; Yorukoglu, K.; Hartmann, A. et al. (Sep 2012). "Unclassified renal cell carcinoma: a report of 56 cases.". BJU Int 110 (6): 786-93. doi:10.1111/j.1464-410X.2012.10934.x. PMID 22404824.
- ↑ Carvalho, JC.; Thomas, DG.; McHugh, JB.; Shah, RB.; Kunju, LP. (Mar 2012). "p63, CK7, PAX8 and INI-1: an optimal immunohistochemical panel to distinguish poorly differentiated urothelial cell carcinoma from high-grade tumours of the renal collecting system.". Histopathology 60 (4): 597-608. doi:10.1111/j.1365-2559.2011.04093.x. PMID 22260386.