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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.


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


● 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

● 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

● 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

● Mean 4 cm, 28% multifocal

Gross images

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

● 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

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

Papillary urothelial carcinoma

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

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