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Difference between revisions of "Kidney tumours"
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'''Kidney tumours''' - includes '''malignant kidney tumours''' and '''benign kidney tumours'''. Medical renal diseases are dealt with in the [[medical renal diseases]] article. | '''Kidney tumours''' - includes '''malignant kidney tumours''' and '''benign kidney tumours'''. Medical renal diseases are dealt with in the [[medical renal diseases]] article. | ||
=Renal specimens= | |||
*Renal biopsy - usually for renal onocytoma vs. renal cell carcinoma (RCC) ''or'' medical diseases - see ''[[medical kidney]]''. | *Renal biopsy - usually for renal onocytoma vs. renal cell carcinoma (RCC) ''or'' medical diseases - see ''[[medical kidney]]''. | ||
*Partial nephrectomy. | *Partial nephrectomy. | ||
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In excisions done for tumours, a comment should be made about kidney distant from the tumour. People with less renal mass, i.e. less kidney, are predisposed to focal segmental glomerulosclerosis (FSGS).<ref>NEED REF.</ref> | In excisions done for tumours, a comment should be made about kidney distant from the tumour. People with less renal mass, i.e. less kidney, are predisposed to focal segmental glomerulosclerosis (FSGS).<ref>NEED REF.</ref> | ||
= | =Tabular comparison (selected tumours)= | ||
Selected common tumours of the kidney:<ref>{{Ref GUP|281-304}}</ref><ref name=pmid19494850>{{Cite journal | last1 = Srigley | first1 = JR. | last2 = Delahunt | first2 = B. | title = Uncommon and recently described renal carcinomas. | journal = Mod Pathol | volume = 22 Suppl 2 | issue = | pages = S2-S23 | month = Jun | year = 2009 | doi = 10.1038/modpathol.2009.70 | PMID = 19494850 }}</ref> | Selected common tumours of the kidney:<ref>{{Ref GUP|281-304}}</ref><ref name=pmid19494850>{{Cite journal | last1 = Srigley | first1 = JR. | last2 = Delahunt | first2 = B. | title = Uncommon and recently described renal carcinomas. | journal = Mod Pathol | volume = 22 Suppl 2 | issue = | pages = S2-S23 | month = Jun | year = 2009 | doi = 10.1038/modpathol.2009.70 | PMID = 19494850 }}</ref> | ||
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| [http://commons.wikimedia.org/wiki/File:Renal_oncocytoma2.jpg Oncocytoma (WC)] | | [http://commons.wikimedia.org/wiki/File:Renal_oncocytoma2.jpg Oncocytoma (WC)] | ||
|} | |} | ||
=Renal cell carcinoma= | |||
==Overview== | |||
===General=== | |||
*Relatively common form of cancer. | |||
*Often abbreviated '''RCC'''. | |||
===Origin=== | |||
*Proximal renal tubule. | |||
===Clinical=== | |||
*Classically described as a triad:<ref name=schmid>{{cite journal |author=Schmid HP, Szabo J |title=[Renal cell carcinoma--a current review] |language=German |journal=Praxis (Bern 1994) |volume=86 |issue=20 |pages=837?3 |year=1997 |month=May |pmid=9312811 |doi= |url=}}</ref> | |||
**Hematuria (most common symptom). | |||
**Abdominal mass. | |||
**Flank pain. | |||
*Frequently picked-up on imaging (incidentaloma) ~ 1/3 of cases. | |||
===Risk factors=== | |||
*Smoking. | |||
*Some chemicals. | |||
*Hemodialysis. | |||
*Male>female (~2:1). | |||
*Hereditary - familial syndromes (see [[Hereditary RCC]]). | |||
===Subtypes of RCC=== | |||
RCC (renal cell carcinoma) comes in different subtypes:<ref name=Ref_PBoD1016>{{Ref PBoD|1016}}</ref> | |||
*Clear cell carcinoma (70-80% of RCC) -- abbrev. CCRCC, | |||
*Papillary renal cell carcinoma (10-15% of RCC) -- abbrev. PRCC, | |||
*Chromophobe renal carcinoma (5% of RCC) -- abbrev. ChRCC, | |||
*Collecting duct (Bellini duct) carcinoma (1% of RCC). | |||
Notes: | |||
*Subtype is an independent predictor of mortality - but adds very little to multivariate models with staging information.<ref name=pmid19076149>{{Cite journal | last1 = Capitanio | first1 = U. | last2 = Cloutier | first2 = V. | last3 = Zini | first3 = L. | last4 = Isbarn | first4 = H. | last5 = Jeldres | first5 = C. | last6 = Shariat | first6 = SF. | last7 = Perrotte | first7 = P. | last8 = Antebi | first8 = E. | last9 = Patard | first9 = JJ. | title = A critical assessment of the prognostic value of clear cell, papillary and chromophobe histological subtypes in renal cell carcinoma: a population-based study. | journal = BJU Int | volume = 103 | issue = 11 | pages = 1496-500 | month = Jun | year = 2009 | doi = 10.1111/j.1464-410X.2008.08259.x | PMID = 19076149 }}</ref> | |||
*CCRCC tends to be worse than ChRCC and PRCC, probably due to higher incidence of mets.<ref name=pmid17886093>{{Cite journal | last1 = Delahunt | first1 = B. | last2 = Bethwaite | first2 = PB. | last3 = Nacey | first3 = JN. | title = Outcome prediction for renal cell carcinoma: evaluation of prognostic factors for tumours divided according to histological subtype. | journal = Pathology | volume = 39 | issue = 5 | pages = 459-65 | month = Oct | year = 2007 | doi = 10.1080/00313020701570061 | PMID = 17886093 }}</ref> | |||
===IHC - is it RCC?=== | |||
*RCC Ma (+), CD10 (+) -- specific for RCC<ref>{{cite journal |author=Zhou M, Roma A, Magi-Galluzzi C |title=The usefulness of immunohistochemical markers in the differential diagnosis of renal neoplasms |journal=Clin. Lab. Med. |volume=25 |issue=2 |pages=247?7 |year=2005 |month=June |pmid=15848735 |doi=10.1016/j.cll.2005.01.004 |url=}}</ref> | |||
===IHC - differentiation of types=== | |||
*Clear cell RCC vs. papillary RCC: | |||
** CK7 (-ve CCRCC), AMACR (+ve in PRCC).<ref name=pmid15848735>{{cite journal |author=Zhou M, Roma A, Magi-Galluzzi C |title=The usefulness of immunohistochemical markers in the differential diagnosis of renal neoplasms |journal=Clin. Lab. Med. |volume=25 |issue=2 |pages=247?7 |year=2005 |month=June |pmid=15848735 |doi=10.1016/j.cll.2005.01.004 |url=}}</ref> | |||
*Papillary RCC type 1 vs. papillary RCC type 2: | |||
** E-cadherin +ve in PRCC type 2.<ref name=pmid14657952>{{cite journal |author=Langner C, Ratschek M, Rehak P, Schips L, Zigeuner R |title=Expression of MUC1 (EMA) and E-cadherin in renal cell carcinoma: a systematic immunohistochemical analysis of 188 cases |journal=Mod. Pathol. |volume=17 |issue=2 |pages=180? |year=2004 |month=February |pmid=14657952 |doi=10.1038/modpathol.3800032 |url=}}</ref> | |||
**EMA (MUC1) +ve in PRCC type 1.<ref name=pmid14657952/> | |||
*ChRCC vs. oncocytoma (ONC): | |||
** CK7 (ChRCC +ve membrane), CK20, CD15.<ref name=pmid15848735/> | |||
** CK7 -- ChRCC 86% +ve vs. ONC 0% +ve.<ref name=pmid17683191>{{cite journal |author=Liu L, Qian J, Singh H, Meiers I, Zhou X, Bostwick DG |title=Immunohistochemical analysis of chromophobe renal cell carcinoma, renal oncocytoma, and clear cell carcinoma: an optimal and practical panel for differential diagnosis |journal=Arch. Pathol. Lab. Med. |volume=131 |issue=8 |pages=1290? |year=2007 |month=August |pmid=17683191 |doi= |url=http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=131&page=1290 }}</ref> | |||
** CD15 -- ChRCC 11% +ve vs. ONC 57% +ve.<ref name=pmid15500648>{{cite journal |author=Pan CC, Chen PC, Ho DM |title=The diagnostic utility of MOC31, BerEP4, RCC marker and CD10 in the classification of renal cell carcinoma and renal oncocytoma: an immunohistochemical analysis of 328 cases |journal=Histopathology |volume=45 |issue=5 |pages=452? |year=2004 |month=November |pmid=15500648 |doi=10.1111/j.1365-2559.2004.01962.x |url=}}</ref> | |||
** Hale's colloidal iron +ve in ChRCC, usually neg. in ONC.<ref name=pmid18603673>{{cite journal |author=Geramizadeh B, Ravanshad M, Rahsaz M |title=Useful markers for differential diagnosis of oncocytoma, chromophobe renal cell carcinoma and conventional renal cell carcinoma |journal=Indian J Pathol Microbiol |volume=51 |issue=2 |pages=167?1 |year=2008 |pmid=18603673 |doi= |url=http://www.ijpmonline.org/article.asp?issn=0377-4929;year=2008;volume=51;issue=2;spage=167;epage=171;aulast=Geramizadeh }}</ref> | |||
** PAX2 -- ChRCC (1/11) +ve vs. ONC (20/23) +ve.<ref name=pmid17210525>{{cite journal |author=Memeo L, Jhang J, Assaad AM, ''et al.'' |title=Immunohistochemical analysis for cytokeratin 7, KIT, and PAX2: value in the differential diagnosis of chromophobe cell carcinoma |journal=Am. J. Clin. Pathol. |volume=127 |issue=2 |pages=225–9 |year=2007 |month=February |pmid=17210525 |doi=10.1309/9KWEA4W9Y94D1AEE |url=http://ajcp.ascpjournals.org/cgi/pmidlookup?view=long&pmid=17210525}}</ref> | |||
**Kidney-specific cadherin (Ksp-cadherin) -- ChRCC 97% +ve (distinctive membrane pattern) vs. ONC only 3% +ve.<ref name=pmid15712178>{{cite journal |author=Mazal PR, Exner M, Haitel A, ''et al.'' |title=Expression of kidney-specific cadherin distinguishes chromophobe renal cell carcinoma from renal oncocytoma |journal=Hum. Pathol. |volume=36 |issue=1 |pages=22–8 |year=2005 |month=January |pmid=15712178 |doi=10.1016/j.humpath.2004.09.011 |url=}}</ref> | |||
*ChRCC & renal oncocytoma vs. others: | |||
** CD117 (ckit) +ve (100% membrane, ~75% cytoplasmic).<ref>{{cite journal |author=Krueger S, Sotlar K, Kausch I, Horny HP |title=Expression of KIT (CD117) in renal cell carcinoma and renal oncocytoma |journal=Oncology |volume=68 |issue=2-3 |pages=269-75 |year=2005 |pmid=16015044 |doi=10.1159/000086783 |url=}}</ref> | |||
*Clear cell RCC vs. chromophobe RCC: | |||
**Hale's colloidal iron (+ve in ChRCC).<ref name=pmid18603673/> | |||
**CK7 (cell membrane +ve in ChRCC). | |||
Notes: | |||
*One paper<ref>{{cite journal |author=Martignoni G, Brunelli M, Gobbo S, ''et al'' |title=Role of molecular markers in diagnosis and prognosis of renal cell carcinoma |journal=Anal. Quant. Cytol. Histol. |volume=29 |issue=1 |pages=41? |year=2007 |month=February |pmid=17375873 |doi= |url=}}</ref> describes CD10, parvalbumin, AMACR, CK7 and S100A1 as being useful. | |||
*Another paper I came across:<ref>{{cite journal |author=Avery AK, Beckstead J, Renshaw AA, Corless CL |title=Use of antibodies to RCC and CD10 in the differential diagnosis of renal neoplasms |journal=Am. J. Surg. Pathol. |volume=24 |issue=2 |pages=203?0 |year=2000 |month=February |pmid=10680888 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0147-5185&volume=24&issue=2&spage=203}}</ref> | |||
*c-kit (CD117) not useful for differentiating ONC and ChRCC.<ref name=pmid17210525>{{cite journal |author=Memeo L, Jhang J, Assaad AM, ''et al.'' |title=Immunohistochemical analysis for cytokeratin 7, KIT, and PAX2: value in the differential diagnosis of chromophobe cell carcinoma |journal=Am. J. Clin. Pathol. |volume=127 |issue=2 |pages=225–9 |year=2007 |month=February |pmid=17210525 |doi=10.1309/9KWEA4W9Y94D1AEE |url=http://ajcp.ascpjournals.org/cgi/pmidlookup?view=long&pmid=17210525}}</ref> | |||
*E-cadherin ''not'' useful for differentiating ChRCC and ONC.<ref name=pmid12613443>{{cite journal |author=Kim MK, Kim S |title=Immunohistochemical profile of common epithelial neoplasms arising in the kidney |journal=Appl. Immunohistochem. Mol. Morphol. |volume=10 |issue=4 |pages=332–8 |year=2002 |month=December |pmid=12613443 |doi= |url=}}</ref> | |||
==Hereditary RCC== | ==Hereditary RCC== | ||
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* Hereditary papillary carcinoma (TFE3 related translocations).<ref>URL: [http://www.ncbi.nlm.nih.gov/omim/314310 http://www.ncbi.nlm.nih.gov/omim/314310]. Accessed on: 16 June 2010.</ref> | * Hereditary papillary carcinoma (TFE3 related translocations).<ref>URL: [http://www.ncbi.nlm.nih.gov/omim/314310 http://www.ncbi.nlm.nih.gov/omim/314310]. Accessed on: 16 June 2010.</ref> | ||
==Grading== | ==Grading RCC== | ||
===General=== | ===General=== | ||
Some subtypes are graded based on the '''Fuhrman system''' which considers:<ref name=Ref_GUP282>{{Ref GUP|282}}</ref> | Some subtypes are graded based on the '''Fuhrman system''' which considers:<ref name=Ref_GUP282>{{Ref GUP|282}}</ref> | ||
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*Nucleoli prominence. | *Nucleoli prominence. | ||
The system was validated for clear cell RCC. Fuhrman nuclear grade is '''not''' prognostic in ''chromophobe RCC'' and should not be used in that context.<ref name=pmid1949485>{{cite journal |author=Brovkina AF, Val'skii VV |title=[Computer tomography in the diagnosis of intraocular melanomas] |language=Russian |journal=Vestn Oftalmol |volume=107 |issue=4 |pages=39–42 |year=1991 |pmid=1949485 |doi= |url=}}</ref> | Notes: | ||
*The system was validated for clear cell RCC. | |||
*Fuhrman nuclear grade is '''not''' prognostic in ''chromophobe RCC'' and should not be used in that context.<ref name=pmid1949485>{{cite journal |author=Brovkina AF, Val'skii VV |title=[Computer tomography in the diagnosis of intraocular melanomas] |language=Russian |journal=Vestn Oftalmol |volume=107 |issue=4 |pages=39–42 |year=1991 |pmid=1949485 |doi= |url=}}</ref> | |||
===Criteria & grades=== | ===Criteria & grades=== | ||
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*[[Hobnail pattern]] - cell width smaller at basement membrane than free surface ??? <ref>{{Ref PBoD|1018}}</ref> | *[[Hobnail pattern]] - cell width smaller at basement membrane than free surface ??? <ref>{{Ref PBoD|1018}}</ref> | ||
=Pediatric= | |||
==Wilms tumour== | ==Wilms tumour== | ||
*[[AKA]] nephroblastoma, AKA Wilms' tumour. | *[[AKA]] nephroblastoma, AKA Wilms' tumour. | ||