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Difference between revisions of "Kidney tumours"
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→Renal cell carcinoma: +translocations
(→Renal cell carcinoma: +translocations) |
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*3 vs. 4: grade 4 has pleomorphism/hyperchromasia. | *3 vs. 4: grade 4 has pleomorphism/hyperchromasia. | ||
==Clear cell carcinoma== | ==Clear cell renal cell carcinoma== | ||
*Often abbreviated ''CRCC''. | |||
===Gross=== | ===Gross=== | ||
*Gold/yellow. | *Gold/yellow. | ||
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===Microscopic=== | ===Microscopic=== | ||
Features:<ref>{{Ref PBoD|1017-8}}</ref> | Features:<ref name=Ref_PBoD1017-8>{{Ref PBoD|1017-8}}</ref> | ||
*Clear cells. | *Clear cells. | ||
*Solid or [[trabecular]] pattern. | *Solid or [[trabecular]] pattern. | ||
*Delicate branching vasculature. | *Delicate branching vasculature. | ||
Notes: | |||
*[[Hyaline bodies]] common.<ref>AFIP Renal Tumours Book.</ref> | *[[Hyaline bodies]] common.<ref>AFIP Renal Tumours Book.</ref> | ||
**Not common in papillary RCC. | **Not common in papillary RCC. | ||
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*ACC: EMA- (epithelial membrane antigen), cytokeratin mostly neg., inhibin+ (neg. in RCC).<ref name=Ref_GUP285>{{Ref GUP|285}}</ref> | *ACC: EMA- (epithelial membrane antigen), cytokeratin mostly neg., inhibin+ (neg. in RCC).<ref name=Ref_GUP285>{{Ref GUP|285}}</ref> | ||
==Papillary | ==Papillary renal cell carcinoma== | ||
*Abbreviated ''PRCC'' and ''papillary RCC''. | |||
===General=== | ===General=== | ||
*Often subclassified<ref name=Ref_GUP289>{{Ref GUP|289}}</ref> into ''type 1'' and ''type 2'' -- see below. | *Often subclassified<ref name=Ref_GUP289>{{Ref GUP|289}}</ref> into ''type 1'' and ''type 2'' -- see below. | ||
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*Associated with ''dialysis associated cystic disease''.<ref>{{Ref PBoD|1017-8}}</ref> | *Associated with ''dialysis associated cystic disease''.<ref>{{Ref PBoD|1017-8}}</ref> | ||
=== | ===Microsopic=== | ||
Features:<ref>{{Ref PBoD|1017-8}}</ref> | Features:<ref name=Ref_PBoD1017-8>{{Ref PBoD|1017-8}}</ref> | ||
*Cuboidal or low columnar cell in papillae. | *Cuboidal or low columnar cell in papillae. | ||
*Interstitial foam cells in vascular cores - '''key feature'''.<ref>ALS Feb 9, 2009.</ref> | *Interstitial foam cells in vascular cores - '''key feature'''.<ref>ALS Feb 9, 2009.</ref> | ||
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*[http://www.e-immunohistochemistry.info/web/Papillary_renal_cell_carcinoma.htm e-immunohistochemistry.info] | *[http://www.e-immunohistochemistry.info/web/Papillary_renal_cell_carcinoma.htm e-immunohistochemistry.info] | ||
===Clear cell vs. papillary=== | ===Clear cell RCC vs. papillary RCC=== | ||
*Papillary: +histiocytes, +intracellular hemosiderin, [[CK7]]+. | *Papillary: +histiocytes, +intracellular hemosiderin, [[CK7]]+. | ||
==Chromophobe | ==Chromophobe renal cell carcinoma== | ||
*Sometimes abbreviated ''ChRCC''. | |||
===General=== | ===General=== | ||
There are two subtypes:<ref name=Ref_GUP293>{{Ref GUP|293}}</ref> | There are two subtypes:<ref name=Ref_GUP293>{{Ref GUP|293}}</ref> | ||
*Classic. | *Classic. | ||
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**Perinuclear clearing is ''not'' seen in clear cell RCC. | **Perinuclear clearing is ''not'' seen in clear cell RCC. | ||
**ChRCC has wisps in the cytoplasm | **ChRCC has wisps in the cytoplasm | ||
=Renal translocation carcinomas= | |||
==Renal tumour with Xp11.2 translocation== | |||
===General=== | |||
*Defined by the presence of a fusion gene form with TFE3 @ Xp11.2. | |||
*TFE3 is the gene involved in the translocation seen in [[alveolar soft part sarcoma]] (ASPS). | |||
===Microscopic=== | |||
Features:<ref name=Ref_WMSP285>{{Ref WMSP|285}}</ref> | |||
*Large cells. | |||
*Clear or eosinophilic cytoplasm. | |||
*Papillae or nests. | |||
*[[Psammoma bodies]] - common. | |||
*[[Hyaline bodies]] - common. | |||
Notes: | |||
*Looks clear cell RCC ''or'' papillary RCC ''or'' a hybrid between the two. | |||
*May resemble [[ASPS]]. | |||
DDx: | |||
*Clear cell RCC. | |||
*Papillary RCC. | |||
*Epithelioid angiomyolipoma. | |||
===IHC=== | |||
*TFE3 +ve (nucleus) - '''key feature'''.<ref name=Ref_WMSP285>{{Ref WMSP|285}}</ref> | |||
Others: | |||
*HMB-45 & Melan A -ve. | |||
**Positive in ''epithelioid angiomyolipoma''. | |||
===Molecular=== | |||
*Translocation involving TFE3, e.g. t(X;1)(p11.2;q21).<ref name=Ref_WMSP285>{{Ref WMSP|285}}</ref> | |||
==Renal tumour with t(6;11) translocation== | |||
===General=== | |||
*Not common. | |||
*[[Lymph node metastases]] are common. | |||
===Microscopic=== | |||
Features: | |||
*Hyaline material between nests. | |||
*Large cells with clear to eosinophilic cytoplasm. | |||
===Molecular=== | |||
*t(6;11)(p21;q12) Alpha/TFEB.<ref name=Ref_WMSP281>{{Ref WMSP|281}}</ref> | |||
=Benign tumours= | =Benign tumours= | ||