Kidney tumor
Adult renal cell carcinoma
Urothelial carcinoma of renal pelvis - high grade variant

Author: Sean R. Williamson, M.D.

Revised: 24 August 2018, last major update June 2012

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: "Urothelial carcinoma of renal pelvis" "high grade"

Related Topic: Urothelial carcinoma of renal pelvis
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Page views in 2019 to date: 45
Cite this page: Williamson, S.R. High grade variant. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/kidneytumorurothelialhighgrade.html. Accessed May 21st, 2019.
Epidemiology
  • 70% male, mean age 70 years (range 28 - 92 years)
Clinical features
  • Associated with phenacetin nephropathy (25%), Thorotrast radiologic dye, cyclophosphamide, horseshoe kidney, hereditary nonpolyposis colorectal cancer syndrome
  • Patients present with hematuria due to fragmentation within renal pelvis
  • 40 - 50% have preexisting or coexisting bladder urothelial tumors
  • 5 year survival of 10% due to invasion of wall of pelvis and calyces; 50% if complete surgical resection
Prognostic factors
  • Extrarenal invasion, coexisting bladder tumor
Case reports
Treatment
  • Standard therapy is nephroureterectomy including bladder cuff since multicentric and often implants within bladder
  • Renal preserving surgery may also be effective (J Endourol 2009;23:341)
Gross description
  • Soft, grayish red masses with smooth glistening surfaces
Gross images

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Papillary tumor masses

Microscopic (histologic) description
  • Resembles other urothelial carcinomas
  • Carcinoma in situ may be present in nonadjacent areas
  • Often extends along collecting tubules (resembling CIS of cervix extending into cervical clefts) but are not adenocarcinomas
  • Vascular invasion in 35%
  • Rarely is sarcomatoid, resembles giant cell tumor of bone or has rhabdoid features (Hum Pathol 2006;37:168)
  • Analgesic abuse is associated with thickening of small stromal vessels
Microscopic (histologic) images

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Invasive

Cytology description
Positive stains
Negative stains
Molecular / cytogenetics description
  • 31% have microsatellite instability (Mod Pathol 2002;15:790)
  • Complex aberrations include -9, -17p, +8q, -13q, -18q, +17q
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