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Kidney tumor - adult malignancies

Adult renal cell carcinoma

Acquired cystic disease associated renal cell carcinoma


Reviewers: Sean Williamson, M.D. (see Reviewers page)
Revised: 8 June 2012, last major update June 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Unique morphology of renal cell carcinoma arising in kidneys with acquired cystic disease due to end stage renal disease (ESRD), characterized by papillary, solid, eosinophilic and clear cell-like areas with tumoral calcium oxalate crystals (Am J Surg Pathol 2006;30:141)

Epidemiology
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● Acquired cystic disease occurs in 35% of long-term dialysis patients; of these, 6% develop carcinoma

Clear cell papillary renal cell carcinoma:
● (Either cystic or non-cystic) is the other “unique” tumor in ESRD (although may occur in otherwise normal kidneys)
● Other tumors in ESRD have features similar to sporadic cases

Clinical description
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● May have sarcomatoid features, nodal or distant metastases and cause death (Am J Surg Pathol 2006;30:141)

Case reports
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● Clear cell and papillary subtypes with abundant calcium oxalate crystals (Arch Pathol Lab Med 2003;127:E89)
● Sarcomatoid change (Histol Histopathol 2008;23:1327)

Gross description
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● Dominant mass in 36% of kidneys, often multifocal, usually 3 cm or less

Micro description
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● Microcystic architecture, abundant eosinophilic cytoplasm with grade 3 nuclei, intratumoral oxalate crystals (Am J Surg Pathol 2005;29:443)

Micro images
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Various images


Calcium oxalate crystals

Cytology description
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● Moderately cellular, papillary clusters of polygonal to columnar cells with abundant eosinophilic granular cytoplasm, round and central nuclei, finely granular chromatin, prominent central Fuhrman grade 3 nucleoli (Diagn Cytopathol 2008;36:344)

Positive stains
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● CD10, AE1-AE3 (Mod Pathol 2006;19:780)

Negative stains
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● EMA, CK7, 34betaE12

Differential diagnosis
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Xanthogranulomatous pyelonephritis: rare to occur in acquired cystic disease of kidney (Nephrology (Carlton) 2003;8:101)

End of Kidney tumor - adult malignancies > Adult renal cell carcinoma > Acquired cystic disease associated renal cell carcinoma


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