Difference between revisions of "Kidney tumours"

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Kidney tumours (view source)

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Selected common tumours of the kidney:<ref>{{Ref GUP|281-304}}</ref><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>
Selected common tumours of the kidney:<ref>{{Ref GUP|281-304}}</ref><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>
{| class="wikitable"
{| class="wikitable"
|
|
|Gross
|Architecture
|Nuclear atypia
|Cytoplasm
|Other
|IHC
|Main DDx
|Key features
|-
|'''Clear cell RCC'''
|'''Clear cell RCC'''
| golden yellow, <br>solid
| nests, sheets
| low-high<br>typically medium-high
| clear
| delicate vessels,<br>necrosis common
| CK7-, EMA+
| chromophobe<br>classic variant
| clear cells, vascular
|-
|'''Papillary RCC<br>type 1'''
|'''Papillary RCC<br>type 1'''
| friable
| papillary, simple
| low-medium
| eosinophilic
| histiocytes<br> in fibrovascular cores, >0.5 cm
| AMACR+, EMA+, CK7+
| PaRCC type 2, mets
| papillae, histiocytes<br>simple epithelium
|-
|'''Papillary RCC<br>type 2'''  
|'''Papillary RCC<br>type 2'''  
| friable
| papillary,<br>pseudostratified
| medium-high
| eosinophilic
| histiocytes<br> in fibrovascular cores, >0.5 cm
| AMACR+, E-cadherin+, CK7-
| PaRCC type 1, mets
| papillae, histiocytes,<br>stratified
|-
|'''Chromophobe RCC<br>classic variant'''
|'''Chromophobe RCC<br>classic variant'''
| '''Chromophobe RCC<br>eosinophilic variant'''
| light brown
| '''Oncocytoma'''
| nests, sheets
| low-high
| cobwebs / <br>clear
| perinuclear clearing, thick vessels
| CD117+, CK7+ (membrane)
| clear cell RCC
| perinuc. clearing,<br>wispy cytoplasm
|-
|-
|Gross
|'''Chromophobe RCC<br>eosinophilic variant'''
| Golden yellow, solid
| light brown
| friable
| nests, sheets
| friable
| low-high
| light brown
| eosinophilic /<br>cobwebs
| light brown
| perinuclear clearing, <br>thick vessels
| mahogany/brown, +/-central scar
| CD117+, CK7+ (membrane)
| oncocytoma
| perinuc. clearing,<br>wispy eosinophilic<br>cytoplasm
|-
|-
|Architecture
|'''Oncocytoma'''
| nests, sheets
| mahogany / <br>brown, <br>+/-central scar
| papillary, simple
| papillary,<br>pseudostratified
| nests, sheets
| nests, sheets
| nests, sheets
| nests, sheets
|-
|Nuclear atypia
| low-high<br>typically medium-high
| low-medium
| medium-high
| low-high
| low-high
| low-medium, round nuclei
| low-medium, round nuclei
|-
| eosinophilic/<br>granular & <br>abundant
|Cytoplasm
| clear
| eosinophilic
| eosinophilic
| cobwebs/clear
| eosinophilic/cobwebs
| eosinophilic/<br>granular & abundant
|-
|Other
| delicate vessels,<br>necrosis common
| histiocytes<br> in fibrovascular cores, >0.5 cm
| histiocytes<br> in fibrovascular cores, >0.5 cm
| perinuclear clearing, thick vessels
| perinuclear clearing, thick vessels
| in loose fibrous/hyaline stroma
| in loose fibrous/hyaline stroma
| Vimentin-, EMA+
| chromophobe<br>eosinophilic variant
|eosinophilic, granular cytoplasm
|-
|-
|IHC
|CK7-, EMA+
|AMACR+, EMA+, CK7+
|AMACR+, E-cadherin+, CK7-
|CD117+, CK7+ (membrane)
|CD117+, CK7+ (membrane)
|Vimentin-, EMA+
|-
|Main DDx
|chromophobe<br>classic variant
|PaRCC type 2, mets
|PaRCC type 1, mets
|clear cell RCC
|oncocytoma
|chromophobe<br>eosinophilic variant
|-
|Key features ||clear cells, vascular || papillae, histiocytes<br>simple epithelium ||papillae, histiocytes,<br>stratified ||perinuc. clearing,<br>wispy cytoplasm ||perinuc. clearing,<br>wispy eosinophilic<br>cytoplasm ||eosinophilic, granular cytoplasm
|}
|}
Notes:
Notes:
*Cell shape: all have epithelioid morphology.
*Cell shape: all have epithelioid morphology.


===Oncocytoma vs. Chromophobe RCC===
Histomorphologic features useful to distinguish ChRCC and oncocytoma:<ref name=pmid9844591>{{Cite journal  | last1 = Tickoo | first1 = SK. | last2 = Amin | first2 = MB. | title = Discriminant nuclear features of renal oncocytoma and chromophobe renal cell carcinoma. Analysis of their potential utility in the differential diagnosis. | journal = Am J Clin Pathol | volume = 110 | issue = 6 | pages = 782-7 | month = Dec | year = 1998 | doi =  | PMID = 9844591 }}
Histomorphologic features useful to distinguish ChRCC and oncocytoma:<ref name=pmid9844591>{{Cite journal  | last1 = Tickoo | first1 = SK. | last2 = Amin | first2 = MB. | title = Discriminant nuclear features of renal oncocytoma and chromophobe renal cell carcinoma. Analysis of their potential utility in the differential diagnosis. | journal = Am J Clin Pathol | volume = 110 | issue = 6 | pages = 782-7 | month = Dec | year = 1998 | doi =  | PMID = 9844591 }}
</ref>
</ref>
{| class="wikitable"
{| class="wikitable"
|
|
| ChRCC
| '''ChRCC (eosinophilic<br> variant)'''
| Oncocytoma
| '''Oncocytoma'''
|-
|-
| Nuclear morphology
| Nuclear morphology
| "raisinoid"/wrinkled  
| "raisinoid"/wrinkled  
| round with small nucleolus, little size variation
| round with small nucleolus, <br>little size variation
|-
|-
| Multinucleation
| Multinucleation
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| Architecture
| Architecture
| solid, crowded nests
| solid, crowded nests
| spaced nests / archipelago-like, solid
| spaced nests / <br>archipelago-like, solid
|-
|-
| Cytoplasm
| Cytoplasm
Michael
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