Difference between revisions of "Papillary renal cell carcinoma"

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Papillary renal cell carcinoma (view source)

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 {{ Infobox diagnosis
 | Name       = {{PAGENAME}}
-| Image      = Papillary_renal_cell_carcinoma_intermed_mag.jpg
+| Image      = Papillary renal cell carcinoma -- very high mag.jpg
 | Width      =
 | Caption    = Papillary renal cell carcinoma. [[H&E stain]].
 | Micro      = cuboidal or low columnar cells (simple or pseudostratified) on papillae, interstitial foam cells in the vascular cores
-| Subtypes   = type 1, type 2, oncocytic variant
+| Subtypes   = no ''World Health Organization'' recognized subtypes; defunct subtypes: "type 1" and "type 2", oncocytic variant
-| LMDDx      = [[clear cell renal cell carcinoma]], [[clear cell papillary renal cell carcinoma]], [[metanephric adenoma]] (esp. solid PRCC type 1), [[collecting duct carcinoma]] (esp. PRCC type 2), [[renal papillary adenoma]]
+| LMDDx      = [[clear cell renal cell carcinoma]], [[clear cell papillary renal cell carcinoma]], [[metanephric adenoma]] (esp. solid PaRCC type 1), [[collecting duct carcinoma]] (esp. PaRCC type 2), [[renal papillary adenoma]], [[acquired cystic disease-associated renal cell carcinoma]], [[urothelial carcinoma]], [[renal mucinous tubular and spindle cell carcinoma]], [[ALK translocation renal cell carcinoma]], [[Xp11 translocation renal cell carcinoma]]
 | Stains     =
 | IHC        =
 | EM         =
-| Molecular  =
+| Molecular  = MET mutation (hereditary papillary renal cell carcinoma), FH mutation (hereditary leiomyomatosis and renal cell cancer)
 | IF         =
-| Gross      = may be multifocal, must be >0.5 cm (otherwise [[renal papillary adenoma]])
+| Gross      = may be multifocal, must be >1.5 cm (if low ISUP grade), often necrotic-appearing (brown, soft, friable)
-| Grossing   =
+| Grossing   = [[total nephrectomy for tumour grossing]], [[partial nephrectomy grossing]]
+| Staging    = [[kidney cancer staging]]
 | Site       = [[kidney]] - see [[kidney tumours]]
 | Assdx      = [[acquired renal cystic disease]] ([[end-stage renal disease]])
-| Syndromes  =
+| Syndromes  = hereditary papillary renal cell carcinoma, [[hereditary leiomyomatosis and renal cell cancer]]
 | Clinicalhx =
 | Signs      =
@@ Line 27: / Line 28: @@
 | Other      =
 | ClinDDx    = other [[kidney tumours]]
+| Tx         = surgical excision, ablation
 }}
 '''Papillary renal cell carcinoma''', abbreviated '''PRCC''', '''PaRCC''' and '''papillary RCC''', is the second most common type of [[renal cell carcinoma]].
 ==General==
-*Often subclassified<ref name=Ref_GUP289>{{Ref GUP|289}}</ref> into ''type 1'' and ''type 2'' -- see ''microscopic''.
+*Historically, PaRCC was subclassified<ref name=Ref_GUP289>{{Ref GUP|289}}</ref> into ''type 1'' and ''type 2''.
 **Type 1 and Type 2 are different on a cytogenetic and molecular basis.<ref>{{Cite journal  | last1 = Klatte | first1 = T. | last2 = Pantuck | first2 = AJ. | last3 = Said | first3 = JW. | last4 = Seligson | first4 = DB. | last5 = Rao | first5 = NP. | last6 = LaRochelle | first6 = JC. | last7 = Shuch | first7 = B. | last8 = Zisman | first8 = A. | last9 = Kabbinavar | first9 = FF. | title = Cytogenetic and molecular tumor profiling for type 1 and type 2 papillary renal cell carcinoma. | journal = Clin Cancer Res | volume = 15 | issue = 4 | pages = 1162-9 | month = Feb | year = 2009 | doi = 10.1158/1078-0432.CCR-08-1229 | PMID = 19228721 }}</ref>
 ===Epidemiology===
 *Associated with ''[[acquired renal cystic disease]]''.<ref name=Ref_DARP438>{{Ref DARP|438}}</ref>
-*May be familial.
+*May be familial - uncommon.<ref name=pmid12629341>{{Cite journal  | last1 = Czene | first1 = K. | last2 = Hemminki | first2 = K. | title = Familial papillary renal cell tumors and subsequent cancers: a nationwide epidemiological study from Sweden. | journal = J Urol | volume = 169 | issue = 4 | pages = 1271-5 | month = Apr | year = 2003 | doi = 10.1097/01.ju.0000052373.36963.12 | PMID = 12629341 }}</ref>
+**MET mutation<ref name=pmid22717761>{{Cite journal  | last1 = Wadt | first1 = KA. | last2 = Gerdes | first2 = AM. | last3 = Hansen | first3 = TV. | last4 = Toft | first4 = BG. | last5 = Friis-Hansen | first5 = L. | last6 = Andersen | first6 = MK. | title = Novel germline c-MET mutation in a family with hereditary papillary renal carcinoma. | journal = Fam Cancer | volume = 11 | issue = 3 | pages = 535-7 | month = Sep | year = 2012 | doi = 10.1007/s10689-012-9542-6 | PMID = 22717761 }}</ref> - autosomal dominant transmission (previously ''PaRCC type 1'').
+==Gross==
+*Renal cortical mass usually >1.5 cm.
+*May be multifocal. ‡
+*Often necrotic appearing - light-to-dark brown, soft/mushy, friable.
+Note:
+*‡ Approximately 10% of PaRCCs are multifocal (based on a set of 5378 patients);<ref name=pmid22502873>{{Cite journal  | last1 = Siracusano | first1 = S. | last2 = Novara | first2 = G. | last3 = Antonelli | first3 = A. | last4 = Artibani | first4 = W. | last5 = Bertini | first5 = R. | last6 = Carini | first6 = M. | last7 = Carmignani | first7 = G. | last8 = Ciciliato | first8 = S. | last9 = Cunico | first9 = SC. | title = Prognostic role of tumour multifocality in renal cell carcinoma. | journal = BJU Int | volume = 110 | issue = 11 Pt B | pages = E443-8 | month = Dec | year = 2012 | doi = 10.1111/j.1464-410X.2012.11121.x | PMID = 22502873 }}</ref> it is the renal tumour that is most commonly multifocal.
 ==Microscopic==
 Features:<ref name=Ref_PBoD1017-8>{{Ref PBoD|1017-8}}</ref>
 *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'''.
-**Most sensitive and specific feature of PRCC.<ref>{{cite journal |author=Granter SR, Perez-Atayde AR, Renshaw AA |title=Cytologic analysis of papillary renal cell carcinoma |journal=Cancer |volume=84 |issue=5 |pages=303?8 |year=1998 |month=October |pmid=9801205 |doi= |url=http://dx.doi.org/10.1002/(SICI)1097-0142(19981025)84:5<303::AID-CNCR6>3.0.CO;2-7}}</ref>
+**Most sensitive and specific feature of PaRCC.<ref>{{cite journal |author=Granter SR, Perez-Atayde AR, Renshaw AA |title=Cytologic analysis of papillary renal cell carcinoma |journal=Cancer |volume=84 |issue=5 |pages=303?8 |year=1998 |month=October |pmid=9801205 |doi= |url=http://dx.doi.org/10.1002/(SICI)1097-0142(19981025)84:5<303::AID-CNCR6>3.0.CO;2-7}}</ref>
 *Highly vascular.
 Size criterion:
-*Papillary lesions '''''must''''' be >0.5 cm to be called ''carcinoma''; smaller lesions (<=0.5 cm) are called ''[[renal papillary adenoma|papillary adenoma]]s''.<ref name=Ref_GUP288>{{Ref GUP|288}}</ref>
+*Papillary lesions with low [[ISUP nucleolar grade|ISUP grade]] '''''must''''' be >1.5 cm to be called ''carcinoma''; smaller lesions (<=1.5 cm) with low ISUP grade are called ''[[renal papillary adenoma|papillary adenoma]]s''.<ref name=pmid26935559>{{Cite journal  | last1 = Moch | first1 = H. | last2 = Cubilla | first2 = AL. | last3 = Humphrey | first3 = PA. | last4 = Reuter | first4 = VE. | last5 = Ulbright | first5 = TM. | title = The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part A: Renal, Penile, and Testicular Tumours. | journal = Eur Urol | volume =  | issue =  | pages =  | month = Feb | year = 2016 | doi = 10.1016/j.eururo.2016.02.029 | PMID = 26935559 }}</ref><ref name=Ref_GUP288>{{Ref GUP|288}}</ref> †
 Mnemonic ''HIP'':  '''h'''ighly vascular, '''i'''nterstitial foam cells, '''p'''apillae.
+Note:
+*† The [[diagnostic size cut-off]] in the 2004 [[WHO]] GU (blue) book was 0.5 cm.<ref name=pmid26935559/><ref>{{Ref WHOGU|28}}</ref>
 DDx:
 *[[Clear cell RCC]].
-**Papillary: +histiocytes, +intracellular hemosiderin, [[CK7]]+.
+**Papillary: histiocytes, intracellular hemosiderin, [[CK7]] +ve.
-*[[Clear cell papillary renal cell carcinoma]].
+*[[Clear cell papillary renal cell carcinoma]] - apical nuclei, usu. no true papillae.
-*[[Metanephric adenoma]] - esp. solid PRCC type 1.
+*[[Metanephric adenoma]] (esp. solid PaRCC type 1) - no histiocytes, WT-1 +ve.
-*[[Collecting duct carcinoma]] - esp. PRCC type 2.
+*[[Collecting duct carcinoma]] - esp. PaRCC type 2.
-*[[Renal papillary adenoma]].
+*[[Urothelial carcinoma]].
+*[[Renal papillary adenoma]] - doesn't fulfill size criterion for PaRCC.
+*[[Acquired cystic disease-associated renal cell carcinoma]].
+*[[Renal mucinous tubular and spindle cell carcinoma]].
+*[[Hereditary leiomyomatosis and renal cell carcinoma syndrome-associated renal cell carcinoma]] - for ''type 2 PaRCC''; CK7 -ve, prominent eosinophilic nucleoli.
+*[[ALK translocation renal cell carcinoma]].
+*[[Mixed epithelial and stromal tumour]].<ref name=pmid31862520>{{cite journal |authors=Rogala J, Kojima F, Alaghehbandan R, Agaimy A, Martinek P, Ondic O, Ulamec M, Sperga M, Michalova K, Pivovarcikova K, Pitra T, Hora M, Ferak I, Marečková J, Michal M, Hes O |title=Papillary renal cell carcinoma with prominent spindle cell stroma - tumor mimicking mixed epithelial and stromal tumor of the kidney: Clinicopathologic, morphologic, immunohistochemical and molecular genetic analysis of 6 cases |journal=Ann Diagn Pathol |volume=44 |issue= |pages=151441 |date=February 2020 |pmid=31862520 |doi=10.1016/j.anndiagpath.2019.151441 |url=}}</ref>
+*[[Papillary renal neoplasm with reverse polarity]] (PRNRP) - nuclei at luminal aspect of cell (rather than closer to the basement membrane).<ref name=pmid31135486>{{cite journal |authors=Al-Obaidy KI, Eble JN, Cheng L, Williamson SR, Sakr WA, Gupta N, Idrees MT, Grignon DJ |title=Papillary Renal Neoplasm With Reverse Polarity: A Morphologic, Immunohistochemical, and Molecular Study |journal=Am J Surg Pathol |volume=43 |issue=8 |pages=1099–1111 |date=August 2019 |pmid=31135486 |doi=10.1097/PAS.0000000000001288 |url=}}</ref>
+**May be considered a subtype of papillary renal cell carcinoma (rather than a distinct entity).
+*[[Xp11 translocation renal cell carcinoma]].
 ===Images===
@@ Line 63: / Line 86: @@
 Image:Papillary_renal_cell_carcinoma_high_mag.jpg| PaRCC - high mag. (WC/Nephron)
 Image:Papillary_renal_cell_carcinoma_very_high_mag.jpg| PaRCC - very high mag. (WC/Nephron)
+</gallery>
+<gallery>
+Image: Papillary renal cell carcinoma - 2 -- intermed mag.jpg | PaRCC - intermed. mag. (WC)
+Image: Papillary renal cell carcinoma - 2 -- high mag.jpg | PaRCC - high mag. (WC)
+Image: Papillary renal cell carcinoma - 2 -- very high mag.jpg | PaRCC - very high mag. (WC)
+</gallery>
+<gallery>
+Image: Papillary renal cell carcinoma -- high mag.jpg | PaRCC - high mag. (WC/Nephron)
+Image: Papillary renal cell carcinoma -- very high mag.jpg | PaRCC - very high mag. (WC/Nephron)
 </gallery>
 ===Histological subtyping===
-Generally accepted subtypes:<ref name=Ref_GUP289>{{Ref GUP|289}}</ref><ref>{{Cite journal  | last1 = Delahunt | first1 = B. | last2 = Eble | first2 = JN. | title = Papillary renal cell carcinoma: a clinicopathologic and immunohistochemical study of 105 tumors. | journal = Mod Pathol | volume = 10 | issue = 6 | pages = 537-44 | month = Jun | year = 1997 | doi =  | PMID = 9195569 }}</ref>
+Historically, PaRCC was subtyped:<ref name=Ref_GUP289>{{Ref GUP|289}}</ref><ref>{{Cite journal  | last1 = Delahunt | first1 = B. | last2 = Eble | first2 = JN. | title = Papillary renal cell carcinoma: a clinicopathologic and immunohistochemical study of 105 tumors. | journal = Mod Pathol | volume = 10 | issue = 6 | pages = 537-44 | month = Jun | year = 1997 | doi =  | PMID = 9195569 }}</ref>
 *''Type 1'' - single layer of cells on basement membrane - '''most important'''.
-** Usually low grade nuclear features, i.e. low Fuhrman grade.
+** Usually low grade nuclear features, i.e. low [[ISUP nucleolar grade]].
 ** Other characteristics:
 *** Clear cytoplasm.
@@ Line 74: / Line 106: @@
 *** Cells smaller.
 *''Type 2'' - pseudostratification of cells - '''most important'''.
-** Usually high grade nuclear features, i.e. high Fuhrman grade.
+** Usually high grade nuclear features, i.e. high [[ISUP nucleolar grade]].
 ** Other characteristics:
 *** Eosinophilic cytoplasm.
 *** Foamy macrophages - uncommon.
 *** Cells larger.
+The WHO GU Blue Book 5th Ed. recommends against subtyping.
 Another subtype:
 *''Oncocytic'' - oncocytic cytoplasm.
-**Extremely rare ~ largest series is 12 cases.<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>
+**Extremely rare ~ a few dozen reported.<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><ref name=pmid16730306>{{Cite journal  | last1 = Hes | first1 = O. | last2 = Brunelli | first2 = M. | last3 = Michal | first3 = M. | last4 = Cossu Rocca | first4 = P. | last5 = Hora | first5 = M. | last6 = Chilosi | first6 = M. | last7 = Mina | first7 = M. | last8 = Boudova | first8 = L. | last9 = Menestrina | first9 = F. | title = Oncocytic papillary renal cell carcinoma: a clinicopathologic, immunohistochemical, ultrastructural, and interphase cytogenetic study of 12 cases. | journal = Ann Diagn Pathol | volume = 10 | issue = 3 | pages = 133-9 | month = Jun | year = 2006 | doi = 10.1016/j.anndiagpath.2005.12.002 | PMID = 16730306 }}</ref>
+***One "large" series was 14 cases.<ref name=pmid27931799>{{Cite journal  | last1 = Han | first1 = G. | last2 = Yu | first2 = W. | last3 = Chu | first3 = J. | last4 = Liu | first4 = Y. | last5 = Jiang | first5 = Y. | last6 = Li | first6 = Y. | last7 = Zhang | first7 = W. | title = Oncocytic papillary renal cell carcinoma: A clinicopathological and genetic analysis and indolent clinical course in 14 cases. | journal = Pathol Res Pract | volume = 213 | issue = 1 | pages = 1-6 | month = Jan | year = 2017 | doi = 10.1016/j.prp.2016.04.009 | PMID = 27931799 }}</ref>
 ==IHC==
 Features:<ref name=Ref_GUP289>{{Ref GUP|289}}</ref>
-*AMACR +ve.<ref>ALS Feb 9, 2009.</ref>
+*AMACR +ve.
 *HMWCK (34betaE12) +ve.
 *Panker (AE1/AE3) +ve.
 *CK7 +ve ~90% of type 1, 20% of type 2.
+*CD10 +ve.<ref>[http://surgpathcriteria.stanford.edu/kidney/papillary-renal-cell-carcinoma/differential-diagnosis.html http://surgpathcriteria.stanford.edu/kidney/papillary-renal-cell-carcinoma/differential-diagnosis.html]. Accessed on: 6 May 2014.</ref>
-More reading:
+Others:
-*[http://www.e-immunohistochemistry.info/web/Papillary_renal_cell_carcinoma.htm PaRCC (e-immunohistochemistry.info)].
+*GATA3 +ve - oncocytic variant of PaRCC; negative in other PaRCC subtypes.<ref name=pmid28984673>{{cite journal |authors=Saleeb RM, Brimo F, Farag M, Rompré-Brodeur A, Rotondo F, Beharry V, Wala S, Plant P, Downes MR, Pace K, Evans A, Bjarnason G, Bartlett JMS, Yousef GM |title=Toward Biological Subtyping of Papillary Renal Cell Carcinoma With Clinical Implications Through Histologic, Immunohistochemical, and Molecular Analysis |journal=Am J Surg Pathol |volume=41 |issue=12 |pages=1618–1629 |date=December 2017 |pmid=28984673 |doi=10.1097/PAS.0000000000000962 |url=}}</ref>
 Type 1 versus Type 2:<ref name=pmid9234615>{{Cite journal  | last1 = Ono | first1 = Y. | last2 = Ito | first2 = T. | last3 = Tsujino | first3 = S. | last4 = Aizawa | first4 = S. | last5 = Suzuki | first5 = M. | title = [A study of papillary renal cell carcinoma. Clinicopathological, immunohistochemical features and its typing]. | journal = Nihon Hinyokika Gakkai Zasshi | volume = 88 | issue = 6 | pages = 587-95 | month = Jun | year = 1997 | doi =  | PMID = 9234615 }}</ref>
@@ Line 117: / Line 153: @@
 ==Sign out==
+<pre>
+Kidney Tumour, Left, Partial Nephrectomy:
+- PAPILLARY RENAL CELL CARCINOMA.
+-- Surgical margins NEGATIVE.
+-- ISUP nucleolar (Fuhrman) Grade 3.
+-- TNM stage: pT1a pNx.
+-- Please see tumour summary.
+</pre>
+===Block letters===
+<pre>
+KIDNEY, RIGHT, RADICAL NEPHRECTOMY:
+- PAPILLARY RENAL CELL CARCINOMA, WHO/ISUP NUCLEOLAR GRADE 3, pT2a(2), pNx.
+-- SURGICAL MARGINS NEGATIVE.
+-- PLEASE SEE TUMOUR SUMMARY.
+- RENAL PAPILLARY ADENOMAS.
+</pre>
+====Micro====
+The sections show a tumour in the kidney with fibrovascular cores (papillae) that focally contain macrophages. Psammoma bodies are present. Siderophages are present.
+The papillae predominantly have a single layer of tumour cells and the cytoplasm of the tumour cells is predominantly clear.
+Nucleoli are visible focally with the 10x objective (ISUP nucleolar grade 3).
+A second tumour with the same morphology is present and measures 8 millimetres.
+Multiple small lesions, like the largest tumour, less than 1.5 cm are present.
+===Oncocytic variant===
 <pre>
 KIDNEY, RIGHT, NEPHRECTOMY:
 - PAPILLARY RENAL CELL CARCINOMA, ONCOCYTIC -- SEE COMMENT;
-- FUHRMANN GRADE 2;
+- WHO/ISUP GRADE 2;
 - SURGICAL MARGINS NEGATIVE;
 - PLEASE SEE TUMOUR SUMMARY.
@@ Line 135: / Line 201: @@
 ==See also==
 *[[Kidney tumours]].
+*[[Acquired cystic disease-associated renal cell carcinoma]].
 ==References==
@@ Line 141: / Line 208: @@
 [[Category:Kidney tumours]]
 [[Category:Diagnosis]]
+[[Category:Papillary tumour]]

Difference between revisions of "Papillary renal cell carcinoma"

Papillary renal cell carcinoma (view source)

Revision as of 00:02, 20 March 2024

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