Papillary renal cell carcinoma

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Author: Mikael Häggström [note 1]
Clear cell renal cell carcinoma (CCRCC):

Gross processing

As per: Kidney with tumor

Microscopic examination

Papillary renal cell carcinoma has mainly the two following types:

Renal carcinoma subtype Characteristic morphology[1] Positive immunohistochemistry[1] Image
Papillary renal cell carcinoma, type 1 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
Papillary renal cell carcinoma, type 2 Papillary architecture, medium to large cell, pseudostratified nuclei. Variable File:Histopathology of papillary renal cell carcinoma type 2.jpg

Grading

Papillary renal cell carcinomas are graded by the ISUP/WHO as follows:[2][3]

  • Grade 1: Inconspicuous and basophilic nucleoli at ×400 magnification
  • Grade 3: Clearly visible nucleoli (arrow) at ×100 magnification.
  • Grade 4: Extreme pleomorphism or rhabdoid and/or sarcomatoid morphology.

Microscopy report

There should preferably be a free text report and a synoptic report, the free text report including:

  • Diagnosis of clear cell renal cell carcinoma
  • Greatest dimension (from grossing)
  • ISUP/WHO grade
  • Radicality

Example:

Kidney, left, partial nephrectomy:
  • Papillary renal cell carcinoma, 3.2 cm in greatest dimension, ISUP/WHO grade 2.
  • Surgical margins are negative for carcinoma.

Synoptic report

The synoptic report should include:
Specimen:

  • Procedure: Total or partial nephrectomy
  • Laterality: Left or right

Tumor

  • Histologic type: Such as papillary renal cell carcinoma, type 1
  • Histologic grade
  • Tumor size: From gross description
  • Tumor focality: Unifocal or multifocal
  • Tumor extension: Such as tumor limited to kidney
  • Sarcomatoid features: Identified or not identified
  • Rhabdoid features: Identified or not identified
  • Tumor necrosis: Identified or not identified

Margins

  • Margin involvement: Involved by invasive carcinoma (and in which direction), or negative for malignancy
  • Margins type(s): Generally renal parenchymal margin if partial nephrectomy

Staging

  • Regional lymph nodes: Involved by invasive carcinoma (and how many), or "no lymph nodes submitted or found"
  • Pathologic stage classification (by pTNM, AJCC 8th Edition):
  • Primary tumor (pT)
  • Regional lymph nodes (pN): Such as pNX if no lymph nodes submitted or found

Any pathologic findings in non-neoplastic kidney


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  1. ↑ 1.0 1.1 Unless otherwise specified, reference in table is: Sirohi, Deepika; Smith, Steven C.; Agarwal, Neeraj; Maughan, Benjamin L. (2018). "Unclassified renal cell carcinoma: diagnostic difficulties and treatment modalities ". Research and Reports in Urology Volume 10: 205–217. doi:10.2147/RRU.S154932. ISSN 2253-2447. 
  2. ↑ YiFen Zhang. What is the ISUP/WHO grading system for renal cell carcinoma (RCC)?. Medscape. Updated: Jul 02, 2019
  3. ↑ Moch, H. (2016). "WHO-ISUP-Graduierungssystem für Nierenkarzinome ". Der Pathologe 37 (4): 355–360. doi:10.1007/s00292-016-0171-y. ISSN 0172-8113. 
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