Difference between revisions of "Clear cell renal cell carcinoma"

From patholines.org
Jump to navigation Jump to search
(Templated)
(→‎Grading: Grade)
Line 16: Line 16:
 
===Grading===
 
===Grading===
 
CCRCCs are graded by the ISUP/WHO as follows:<ref>{{cite web|title=What is the ISUP/WHO grading system for renal cell carcinoma (RCC)?|url=https://www.medscape.com/answers/1612022-189804/what-is-the-isupwho-grading-system-for-renal-cell-carcinoma-rcc|website=Medscape|author=YiFen Zhang}} Updated: Jul 02, 2019</ref><ref name="Moch2016">{{cite journal|last1=Moch|first1=H.|title=WHO-ISUP-Graduierungssystem für Nierenkarzinome|journal=Der Pathologe|volume=37|issue=4|year=2016|pages=355–360|issn=0172-8113|doi=10.1007/s00292-016-0171-y}}</ref>
 
CCRCCs are graded by the ISUP/WHO as follows:<ref>{{cite web|title=What is the ISUP/WHO grading system for renal cell carcinoma (RCC)?|url=https://www.medscape.com/answers/1612022-189804/what-is-the-isupwho-grading-system-for-renal-cell-carcinoma-rcc|website=Medscape|author=YiFen Zhang}} Updated: Jul 02, 2019</ref><ref name="Moch2016">{{cite journal|last1=Moch|first1=H.|title=WHO-ISUP-Graduierungssystem für Nierenkarzinome|journal=Der Pathologe|volume=37|issue=4|year=2016|pages=355–360|issn=0172-8113|doi=10.1007/s00292-016-0171-y}}</ref>
*'''Grade 1''': Inconspicuous and basophilic nucleoli at ×400 magnification
 
 
<gallery mode=packed heights=200>
 
<gallery mode=packed heights=200>
 +
File:Histopathology of clear cell renal cell carcinoma, grade 1, high magnification.jpg|'''Grade 1''': Inconspicuous and basophilic nucleoli at ×400 magnification
 
File:Grade 2 clear cell renal cell carcinoma.jpg|'''Grade 2''':Clearly visible and eosinophilic nucleoli at ×400 magnification
 
File:Grade 2 clear cell renal cell carcinoma.jpg|'''Grade 2''':Clearly visible and eosinophilic nucleoli at ×400 magnification
 
File:Histopathology of grade 3 clear cell renal cell carcinoma, annotated nucleolus.jpg|'''Grade 3''': Clearly visible nucleoli (arrow) at ×100 magnification
 
File:Histopathology of grade 3 clear cell renal cell carcinoma, annotated nucleolus.jpg|'''Grade 3''': Clearly visible nucleoli (arrow) at ×100 magnification

Revision as of 17:13, 29 September 2021

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

Gross processing

As per: Kidney with tumor

Microscopic examination

Clear cell renal cell carcinoma.

CCRCC typically shows cells in nests or solid pattern, and a delicate branching fibrovascular network.[1]

Differential diagnosis: Kidney with tumor
If unsure, useful immunohistochemistry markers that are positive in CCRCC are vimentin, EMA, keratin, CD10, Pax2, RCC, CAIX (circumferential membranous).[1]

Grading

CCRCCs are graded by the ISUP/WHO as follows:[2][3]

  • 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:
  • Clear cell renal cell carcinoma, 3.2 cm in greatest dimension, ISUP/WHO grade 3.
  • 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

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. 1.0 1.1 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. 

Image sources