Papillary renal cell carcinoma: Difference between revisions

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==Microscopic examination==
==Microscopic examination==
Papillary renal cell carcinoma has mainly the two following types:
Papillary renal cell carcinoma has the following main characteristics:
{| class="wikitable"
<gallery mode=packed heights=210>
! Renal carcinoma subtype !! Characteristic morphology<ref name="SirohiSmith2018">Unless otherwise specified, reference in table is: {{cite journal|last1=Sirohi|first1=Deepika|last2=Smith|first2=Steven C.|last3=Agarwal|first3=Neeraj|last4=Maughan|first4=Benjamin L.|title=Unclassified renal cell carcinoma: diagnostic difficulties and treatment modalities|journal=Research and Reports in Urology|volume=Volume 10|year=2018|pages=205–217|issn=2253-2447|doi=10.2147/RRU.S154932}}</ref> !! Positive immunohistochemistry<ref name="SirohiSmith2018"/> !! Image
File:Histopathology of papillary renal cell carcinoma type 1.jpg|Papillary architecture, small-to-medium-sized cells, foamy macrophages in fibrovascular cores.<ref name="SirohiSmith2018">{{cite journal|last1=Sirohi|first1=Deepika|last2=Smith|first2=Steven C.|last3=Agarwal|first3=Neeraj|last4=Maughan|first4=Benjamin L.|title=Unclassified renal cell carcinoma: diagnostic difficulties and treatment modalities|journal=Research and Reports in Urology|volume=Volume 10|year=2018|pages=205–217|issn=2253-2447|doi=10.2147/RRU.S154932}}</ref>
|-
File:Histopathology of papillary renal cell carcinoma type 1, grade 2, with variable density.jpg|This case being more compact at right.
! [[Papillary renal cell carcinoma]], type 1
File:Histopathology of papillary renal cell carcinoma type 2.jpg|It may lack foamy macrophages and have pseudostratified nuclei.<ref name="SirohiSmith2018"/><ref group=note>Papillary renal cell carcinoma lacking foamy macrophages and having pseudostratified nuclei was previously classified as type 2, but this is no longer recommended.<br>- {{cite journal| author=Lobo J, Ohashi R, Amin MB, Berney DM, Compérat EM, Cree IA | display-authors=etal| title=WHO 2022 landscape of papillary and chromophobe renal cell carcinoma. | journal=Histopathology | year= 2022 | volume= 81 | issue= 4 | pages= 426-438 | pmid=35596618 | doi=10.1111/his.14700 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35596618  }} </ref>
| Papillary architecture, small-to-medium-sized cells, foamy macrophages in fibrovascular cores. || Vimentin, keratins, CK7, AMACR, RCC || [[File:Histopathology of papillary renal cell carcinoma type 1.jpg|190px]]
</gallery>
|-
 
! [[Papillary renal cell carcinoma]], type 2
Even if the histology favors the diagnosis, it is generally appropriate to perform confirmatory '''[[immunohistochemistry]]''':
| Papillary architecture, medium to large cell, pseudostratified nuclei. || Variable || [[File:Histopathology of papillary renal cell carcinoma type 2.jpg|190px]]
*PAX-2 (typically positive), TTF-1 and thyroglobulin (typically negative) to confirm renal rather than a metastatic [[papillary thyroid carcinoma]].
|}
*CK-7 and P504S/AMACR (both typically positive) to confirm the histologic type versus [[clear cell papillary]] and [[clear cell renal cell carcinoma]].


===Grading===
===Grading===
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*'''Grade 3''': Clearly visible nucleoli (arrow) at ×100 magnification.
*'''Grade 3''': Clearly visible nucleoli (arrow) at ×100 magnification.
*'''Grade 4''': Extreme pleomorphism or rhabdoid and/or sarcomatoid morphology.
*'''Grade 4''': Extreme pleomorphism or rhabdoid and/or sarcomatoid morphology.
<noinclude>
===Staging===
{{Renal tumor staging}}</noinclude>


==Microscopy report==
==Microscopy report==
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*Papillary renal cell carcinoma, 3.2 cm in greatest dimension, ISUP/WHO grade 2.
*Papillary renal cell carcinoma, 3.2 cm in greatest dimension, ISUP/WHO grade 2.
*Surgical margins are negative for carcinoma.
*Surgical margins are negative for carcinoma.
|}
{{Renal cell carcinoma - synoptic report}}
{{Renal cell carcinoma - synoptic report}}
|}
 
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