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Difference between revisions of "Kidney tumours"
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===Tabular comparison=== | ===Tabular comparison=== | ||
Selected common tumours of the kidney:<ref>GUP | 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 | 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 | *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 | *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 | 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 | 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 | 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 | 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 | 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 | *CK7 +ve cell membrane.<ref name=Ref_GUP293>{{Ref GUP|293}}</ref> | ||
DDx: | DDx: | ||
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===Microscopy=== | ===Microscopy=== | ||
Features:<ref>GUP | 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 | *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 | *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 | *Melanocytic markers +ve<ref name=Ref_GUP324>{{Ref GUP|324}}</ref> (e.g. HMB-45 +ve). | ||
*Epithelial markers -ve.<ref>GUP | *Epithelial markers -ve.<ref name=Ref_GUP324>{{Ref GUP|324}}</ref> | ||
*SMA +ve. | *SMA +ve. | ||
*CD117 +/-. | *CD117 +/-. | ||