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Kidney tumor - adult malignancies

Adult renal cell carcinoma

Urothelial carcinoma of renal pelvis


Reviewers: Sean Williamson, M.D. (see Reviewers page)
Revised: 2 July 2012, last major update June 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Formerly called transitional cell carcinoma
● Recommended to fix specimen prior to grossing for accurate staging (Am J Surg Pathol 2004;28:1545)

Epidemiology
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● Usually adults (7% of primary renal carcinomas, eMedicine), 64% men, mean age 67 years
● Recommended to stage renal caliceal tumors based on the extent of invasion relative to the corticomedullary junction (Hum Pathol 2007;38:1639)
● Inverted growth patterns are associated with microsatellite instability and hereditary nonpolyposis colorectal cancer syndrome (Hum Pathol 2003;34:222)

Poor prognostic factors
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● High pT classification and vascular invasion (Mod Pathol 2006;19:272)
● Also older patient age, high tumor grade, nodal metastases, sessile architecture (Cancer 2009;115:1224)
● High Ki-67 predicts development of bladder tumors (Urol Int 2008;81:306)

Case reports
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● 56 and 69 year old men with adjacent nodules resembling giant cell tumor of bone (Am J Surg Pathol 1984;8:139, Arch Pathol Lab Med 1997;121:162)
● 60 year old man with choriocarcinomatous features (Hum Pathol 2002;33:1234)
● 71 year old woman with nested variant (Pathol Res Pract 2009;205:508)

Gross description
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● Mean 4 cm, 28% multifocal

Gross images
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Papillary tumor of renal pelvis


Multiple masses


Large invasive tumor

Papillary tumor of renal pelvis

Tumor of the renal pelvis infiltrates the renal pelvic fat and the kidney #1; #2

Necrotic and infiltrative tumor

Micro description
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● May have osteoclast-like giant cells (Mod Pathol 2006;19:161), clear cell change or other unusual morphologic features (Mod Pathol 2006;19:494)
● May have sheets and nests of large epithelial cells with an abundant clear multivacuolated cytoplasm mimicking lipoblasts (Am J Surg Pathol 2007;31:770)

Micro images
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Papillary pattern


Various images


Lymphatic and vascular invasion


Clear cell change


Rhabdoid, signet-ring and plasmacytoid features


Pseudosarcomatous stroma


Invasion into collecting tubules

           

   
Osteoclast-like giant cells and mononuclear cells

Clear cell change

Vascular invasion

Perineural invasion

Forming glands with mucus #1; #2 - Alcian blue stains mucus

Diffuse infiltration into perirenal fat

Virtual slides
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Papillary urothelial carcinoma

End of Kidney tumor - adult malignancies > Adult renal cell carcinoma > Urothelial carcinoma of renal pelvis


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