Difference between revisions of "Kidney tumours"

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301 bytes added ,  03:54, 20 June 2010
GUP
(GUP)
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===Tabular comparison===
===Tabular comparison===


Selected common tumours of the kidney:<ref>GUP PP.281-304.</ref><ref name=pmid19494850>PMID 19494850.</ref>
Selected common tumours of the kidney:<ref>{{Ref GUP|281-304}}</ref><ref name=pmid19494850>PMID 19494850.</ref>
{| class="wikitable"
{| class="wikitable"
| ||'''Clear cell RCC''' ||'''Papillary RCC<br>type 1''' ||'''Papillary RCC<br>type 2''' ||'''Chromophobe RCC<br>classic variant''' || '''Chromophobe RCC<br>eosinophilic variant''' || '''Oncocytoma'''
| ||'''Clear cell RCC''' ||'''Papillary RCC<br>type 1''' ||'''Papillary RCC<br>type 2''' ||'''Chromophobe RCC<br>classic variant''' || '''Chromophobe RCC<br>eosinophilic variant''' || '''Oncocytoma'''
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==Grading==
==Grading==
Grading based on '''Fuhrman system''' which considers:<ref>GUP P.282.</ref>
Grading based on '''Fuhrman system''' which considers:<ref name=Ref_GUP282>{{Ref GUP|282}}</ref>
*Nuclear pleomorphism (size, shape),
*Nuclear pleomorphism (size, shape),
*Chromatin pattern,
*Chromatin pattern,
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Clear cell vs. [[adrenocortical carcinoma]]:
Clear cell vs. [[adrenocortical carcinoma]]:
*ACC: EMA- (epithelial membrane antigen), cytokeratin mostly neg., inhibin+ (neg. in RCC).<ref>GUP P.285.</ref>
*ACC: EMA- (epithelial membrane antigen), cytokeratin mostly neg., inhibin+ (neg. in RCC).<ref name=Ref_GUP285>{{Ref GUP|285}}</ref>


==Papillary RCC==
==Papillary RCC==
===General===
===General===
*Often subclassified<ref>GUP P.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.
*May be abbreviated ''PRCC''.
*May be abbreviated ''PRCC''.


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Mnemonic ''HIP'':  '''h'''ighly vascular, '''i'''nterstitial foam cells, '''p'''apillae.
Mnemonic ''HIP'':  '''h'''ighly vascular, '''i'''nterstitial foam cells, '''p'''apillae.


Histological subtyping:<ref>GUP P.289.</ref>
Histological subtyping:<ref name=Ref_GUP289>{{Ref GUP|289}}</ref>
*''Type 1'' - single layer of cells on basement membrane.
*''Type 1'' - single layer of cells on basement membrane.
** usually low grade nuclear features, i.e. low Fuhrman grade.
** usually low grade nuclear features, i.e. low Fuhrman grade.
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===IHC===
===IHC===
Features:<ref>GUP P. 289.</ref>
Features:<ref name=Ref_GUP289>{{Ref GUP|289}}</ref>
*AMACR +ve.<ref>ALS Feb 9, 2009.</ref>
*AMACR +ve.<ref>ALS Feb 9, 2009.</ref>
*HMWCK (34betaE12) +ve.
*HMWCK (34betaE12) +ve.
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*Sometimes abbreviated ''ChRCC''.
*Sometimes abbreviated ''ChRCC''.


There are two subtypes:<ref>GUP P.293.</ref>
There are two subtypes:<ref name=Ref_GUP293>{{Ref GUP|293}}</ref>
*Classic.
*Classic.
*Eosinophilic variant.
*Eosinophilic variant.
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===Microscopy===
===Microscopy===
Classic Histo.<ref>PBoD P.1016-7</ref><ref>GUP P.293.</ref>, 3 P's [[mnemonic]]:
Classic Histo.<ref>PBoD P.1016-7</ref><ref name=Ref_GUP293>{{Ref GUP|293}}</ref>, 3 P's [[mnemonic]]:
*Pale cytoplasm, with wisps of eosinophilic material; the cells are not completely clear, they have "cobwebs".
*Pale cytoplasm, with wisps of eosinophilic material; the cells are not completely clear, they have "cobwebs".
*Perinuclear clearing, i.e. a pale halo surrounds the nucleus - '''key feature'''.  
*Perinuclear clearing, i.e. a pale halo surrounds the nucleus - '''key feature'''.  
*Periphery of cell distinct, i.e. cell membrane is easy to discern.
*Periphery of cell distinct, i.e. cell membrane is easy to discern.


Eosinophilic variant:<ref>GUP P.293.</ref>
Eosinophilic variant:<ref name=Ref_GUP293>{{Ref GUP|293}}</ref>
*Eosinophilic (finely granular) cytoplasm.
*Eosinophilic (finely granular) cytoplasm.
*Perinuclear clearing - '''key feature'''.
*Perinuclear clearing - '''key feature'''.
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===IHC===
===IHC===
*CK7+ cell membrane<ref>GUP P.293.</ref>
*CK7 +ve cell membrane.<ref name=Ref_GUP293>{{Ref GUP|293}}</ref>


DDx:
DDx:
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===Microscopy===
===Microscopy===
Features:<ref>GUP P.295.</ref>
Features:<ref name=Ref_GUP295>{{Ref GUP|295}}</ref>
*Tubular structures with tapered ends.
*Tubular structures with tapered ends.
*High grade nuclear features (nuclear pleomorphism).
*High grade nuclear features (nuclear pleomorphism).
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===Gross===
===Gross===
*Brown, mahogany brown.
*Brown, mahogany brown.
*1/3 have a characteristic central scar.<ref>GUP P.302.</ref>
*1/3 have a characteristic central scar.<ref name=Ref_GUP302>{{Ref GUP|302}}</ref>


Image: [http://en.wikipedia.org/wiki/File:Renal_oncocytoma.jpg Renal oncocytoma with central scar (wikipedia.org)].
Image: [http://en.wikipedia.org/wiki/File:Renal_oncocytoma.jpg Renal oncocytoma with central scar (wikipedia.org)].
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*Cells arranged in nests.
*Cells arranged in nests.
*Slightly enlarged nuclei, but no significant pleomorphism (size variation).
*Slightly enlarged nuclei, but no significant pleomorphism (size variation).
*Nuclei uniform and round.<ref>GUP P.302.</ref>
*Nuclei uniform and round.<ref name=Ref_GUP302>{{Ref GUP|302}}</ref>


Notes:
Notes:
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===IHC===
===IHC===
*Melanocytic markers +ve<ref>GUP P.324.</ref> (e.g. HMB-45 +ve).
*Melanocytic markers +ve<ref name=Ref_GUP324>{{Ref GUP|324}}</ref> (e.g. HMB-45 +ve).
*Epithelial markers -ve.<ref>GUP P.324.</ref>
*Epithelial markers -ve.<ref name=Ref_GUP324>{{Ref GUP|324}}</ref>
*SMA +ve.
*SMA +ve.
*CD117 +/-.
*CD117 +/-.
48,833

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