Difference between revisions of "Kidney tumours"

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Kidney tumours (view source)

Revision as of 02:19, 3 November 2013

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→‎Clear cell renal cell carcinoma: split-out
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==Clear cell renal cell carcinoma==
==Clear cell renal cell carcinoma==
*Abbreviated ''CRCC'' or ''CCRCC''.
{{Main|Clear cell renal cell carcinoma}}
 
===General===
*Most common subtype of RCC.
*May be associated with [[Von Hippel-Lindau syndrome]].
 
===Gross===
*Gold/yellow.
*+/-Haemorrhage (common).
*+/-Necrosis (common in large tumours).
*+/-Calcification.
*+/-Cysts.
 
===Microscopic===
Features:<ref name=Ref_PBoD1017-8>{{Ref PBoD|1017-8}}</ref>
*Solid or [[trabecular]] pattern.
*Polygonal cells.
*Clear cytoplasm.
*Central nucleus.
*Delicate branching vasculature.
**Often called "chicken wire-like" vasculature.
*+/-Rhabdoid cells:
**Eccentric nucleus.
**Abundant eosinophilic cytoplasma.
 
Notes:
*Cytoplasm may be eosinophilic.<ref name=Ref_WMSP291>{{Ref WMSP|291}}</ref>
**This change is typically focal - other areas have a classic appearance.
**Chicken wire-like vasculature present - helps distinguish from other tumours.
*[[Hyaline bodies]] common.<ref>AFIP Renal Tumours Book.</ref>
**Not common in papillary RCC.
*Clear cytoplasm - due to lipid content.
 
DDx:
*[[Chromophobe renal cell carcinoma]].
*[[Clear cell papillary renal cell carcinoma]].
*[[Xp11.2 translocation carcinoma]].
*[[Adrenocortical carcinoma]] (ACC)
**EMA -ve, CKs mostly -ve, inhibin +ve (neg. in RCC).<ref name=Ref_GUP285>{{Ref GUP|285}}</ref>
*[[Alveolar soft part sarcoma]].
*[[Adrenal gland]], normal.
 
====Images====
<gallery>
Image:Clear_cell_renal_cell_carcinoma_intermed_mag.jpg | CRCC - intermed. mag. (WC/Nephron)
Image:Clear_cell_renal_cell_carcinoma_high_mag.jpg | CRCC - high mag. (WC/Nephron)
</gallery>
===IHC===
*CK7 -ve.
*CK20 -ve.
*Hale's colloidal iron -ve.
**+ve in [[chromophobe RCC]].
 
Note: ''[[Hale's colloidal iron]]'' does not stain iron... it stains hemosiderin.<ref>Latta. 27 January 2009.</ref>
Clear cell vs. chromophobe:
*Chromophobe: "translucent" (NOT quite clear), reticulated, Hale's colloidal iron stain+, CK7+ (cell membrane).
 
===Sign out===
<pre>
KIDNEY, LEFT, NEPHRECTOMY:
- CLEAR CELL RENAL CELL CARCINOMA, FUHRMAN GRADE 2, pT1a, pNx.
-- MARGINS NEGATIVE FOR MALIGNANCY.
-- PLEASE SEE TUMOUR SUMMARY.
</pre>
 
<pre>
KIDNEY, RIGHT, RADICAL NEPHRECTOMY:
- CLEAR CELL RENAL CELL CARCINOMA, FUHRMAN GRADE 2, pT1a, pNx.
-- MARGINS NEGATIVE FOR MALIGNANCY.
-- PLEASE SEE TUMOUR SUMMARY.
- ADRENAL GLAND WITHIN NORMAL LIMITS.
</pre>
 
Note:
*The surgeon wants the diagnosis and margin status; thus, these are included in the diagnosis line with the tumour stage.
 
====Micro====
The sections show a tumour with a chicken wire-like vasculature composed of clear cells with basally stratified nuclei. Hemosiderin-laden macrophages are present. Necrosis is present. Abundant hyaline globules are present. 
 
There is no perinuclear clearing.  The cytoplasm is not whispy.  Collections of macrophages are not identified within the stroma of the tumour.  Papillae are not evident.
 
Rare, small nucleoli are visible with the 10x objective.  The tumour nuclei are approximately 15 micrometers.


==Multilocular cystic renal cell carcinoma==
==Multilocular cystic renal cell carcinoma==
Michael
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