Renal neoplasms overview

 

History of classification of carcinomas:

Granular cell carcinoma is no longer considered a specific entity.

 

renal cell carcinoma

Second series AFIP fascicle

clear cell carcinoma

granular cell carcinoma

Current classification

melanocytic clear cell neoplasm

conventional carcinoma

eosinophilic variant of conventional carcinoma

chromophobe renal cell carcinoma

renal oncocytoma

papillary renal cell carcinoma

colecting duct carcinoma

epithelioid angiomyolipoma

renal carcinoid

renal cell carcinoma, unclassified

 

Current classification:

 

 

disease-specific survival

progression-free survival

  

frequency

metastases

5-year

10-year

5-year

10-year

b
e
n
i
g
n

renal cortical adenoma

 

 

 

renal oncocytoma

6.7% (27/405)7

0.4% (2/~450)7*

100%

100%

100%

100%

metanephric adenoma

1/4057

 0/~1007*

 

 

m
a
l
i
g
n
a
n
t

conventional clear cell carcinoma

63% (255/405)7

37%7*, 27.4%7

76%7

70%7

70%7

64%7

papillary renal cell carcinoma

15-20%7*, 18.5% (75/405)7

6-26%7*, 12%7

82-90% of ~4027*, 86%7

82%7

88%7

83%7

chromophobe renal cell carcinoma

5-7%7*, 5.9% (24/405)7

7.1% of 3197*, 4.2%7

100%7

90%7

78-92%7*, 94%7

94%7

collecting duct carcinoma

rare

~50 of ~1007*

33% at 2 years7*

 

 

Mucinous tubular and spindle cell carcinoma

rare

unusual

no recorded deaths

    

renal cell carcinoma, unclassified

5.7% (23/405)7

70%7

24%7

12%7

18%7

18%7

RCC combined

 

25.5%7

77%7

73%7

72%7

66%7
 

There has been a case report of renal type clear cell carcinoma occurring as a primary tumour in the prostate8.

 

Histology

 

architecture

cytoplasm

nuclei

  

oncocytoma

nested, tubulocystic or mixed

uniform eosinophilic, finely granular. clear cells in regions of scarring

round, uniform chromatin, +/- nucleoli

metanephric adenoma

small tightly packed tubules, psammoma bodies, papillary structures resembling glomeruli

inconspicuous

round, uniform chromatin

conventional clear cell carcinoma

solid, alveolar , tubular, tubulocystic, pseudopapillary due to loss of cohesion, (focally papillary), fibrovascular framework, racemose vasculature

clear or eosinophilic

 

papillary renal cell carcinoma

frequently multifocal, very well circumscribed, may have fibrous capsule, papillary or tubulopapillary

eosinophilic to amphiphilic, focally clear. foam cells, necrosis and haemosiderin frequent

 

chromophobe renal cell carcinoma

alveolar, nested, solid, inconspicuous vasculature

two cell types, eosinophilic and clear, in varying proportions. clear cells have flocculent (soap-bubble) cytoplasm. May have peripheral eosinophilia with perinuclear clearing (plant cell appearance)

frequent binucleation, course chromatin, wrinkled nuclear membranes, koilocytoid atypia

collecting duct carcinoma

centred on pelvicalyceal system. tubulopapillary or tubulocystic, desmoplasia, inflammation, mucin production

eosinophilic to clear, some hobnail cells

high grade

Mucinous tubular and spindle cell carcinoma

biphasic cubloidal and spindle cell tumour with a mucinous stroma

renal cell carcinoma, unclassified

does not correspond to any of the above.
 

 

Sarcomatoid change may arise in all malignant cell types. To identify a tumour as a sarcomatoid renal cell carcinoma, there must either be an epithelial element or the spindle cells must be positive for either cytokeratins or EMA. Granular renal cell carcinoma is no longer a distinct subtype in this classification.

 

 

conventional clear cell carcinoma

chromophobe renal cell carcinoma

oncocytoma

micropapillary renal cell carcinoma

 

macropapillary renal cell carcinoma

nephrogenic adenoma

  

AE1/3

variable

 

 

 

 

positive

Cam5.2

positive

 

 

 

 

positive

34bE12

negative

 

 

 

 

variable

CK7

negative (3/1528)

positive (11/1528)

variable (1/1028)

usually positive (13/1528)

usually negative

positive

CK19

 

 

 

positive

usually positive

 

CK20

 

 

 

 

 

positive

CEA

 

 

 

 

 

negative

EMA

 

positive

 

 

 

positive

dolichos biflorus agglutinin

 

 

 

usually positive

usually negative

 

CD10

positive (58/6218, 41/4619)

negative (0/1918)

variable (3/918)

positive (13/1418)

 

CD117

negative

positive

positive

 

 

renal cell carcinoma marker

53/6218, 59/7026, 34/3732

negative (0/1918, 5/1126)

negative (0/1526)

positive (13/1418, 52/5426, 7/732)

 

hKIM-1

positive (15/2121, 54/7324 )

negative (1/1721, 0/5424 )

negative (4/4124 )

positive (4/521, 28/3024)

 

b defensin-1

negative (3/2330)

positive (8/830)

positive (8/830)

positive (7/730)

 

parvalbumin

negative (5/2330)

positive (8/830)

positive (8/830)

contradictory (5/1730)

 

vimentin

usually positive (13/1528, 19/2330)

negative (1/1528, 0/830)

negative (1/1028, 0/830)

positive (15/1528, 6/730)

negative

KSP-cadherin

variable (10/3317)

positive (31/3617)

positive (31/4117)

negative (0/1517)

 

  

MIB-1

often > 2%

< 2%

< 2%

 

 

 

  

RON

variable

positive

positive

 

 

 

  

Glutathione s-transferase alpha

166/20220

1/5220

5/4020

11/5420

 

  

Vinculin

negative (0/5422)

5/522

1/122

variable (5/1222)

 

  

MN/CA9

positive (40/4023)

0/223

0/223

3/323

 

  

SPARC

25/3627

0/327

 

0/227

 

  

S100

56/8125

1/1625

13/1525

10/3325

 

  

P504S

13/5229, 48/7031

0/1829, 2/731

3/2029, 2/831

41/4129, 15/1531

 

  

colloidal iron

negative

positive

variable

 

 

 

  

anti-mitochondrial antibody

diffuse in eosinophilic variant

peripheral, 6/2412

peripheral, 5/612

 

 

 

  
 

In one study, on multivariate analysis MOC31, BerEP4, RCC Ma and CD10 were independently informative in discriminating between various renal neoplasms14:

 

reference 14

indicative of:

sensitivity

specificity

  

BerEP4-/CD10+

clear cell RCC

59%

93%

RCC Ma+/BerEP4+

papillary carcinoma

51%

89%

MOC31+

chromophobe carcinoma

82%

96%
       

Prognosis

Sarcomatoid change in any subtype is associated with a poor prognosis10.

 

References

1 Ono, Y., Ito, T., Tsujino, S., Aizawa, S. and Suzuki, M. [A study of papillary renal cell carcinoma. Clinicopathological, immunohistochemical features and its typing]. Nippon Hinyokika Gakkai Zasshi 1997;88:587-95.

2 Delahunt, B. and Eble, J.N. Papillary renal cell carcinoma: a clinicopathologic and immunohistochemical study of 105 tumors. Mod Pathol 1997;10:537-44.

3 Renshaw, A.A., Zhang, H., Corless, C.L., Fletcher, J.A. and Pins, M.R. Solid variants of papillary (chromophil) renal cell carcinoma: clinicopathologic and genetic features. Am J Surg Pathol 1997;21:1203-9.

4 Leroy, X., Moukassa, D., Copin, M.C., Saint, F., Mazeman, E. and Gosselin, B. Utility of cytokeratin 7 for distinguishing chromophobe renal cell carcinoma from renal oncocytoma. Eur Urol 2000;37:484-7.

5 Avery, A.K., Beckstead, J., Renshaw, A.A. and Corless, C.L. Use of antibodies to RCC and CD10 in the differential diagnosis of renal neoplasms. Am J Surg Pathol 2000;24:203-10.

6 Young, A.N., de Oliveira Salles, P.G., Lim, S.D., Cohen, C., Petros, J.A., Marshall, F.F., Neish, A.S. and Amin, M.B. Beta defensin-1, parvalbumin, and vimentin: a panel of diagnostic immunohistochemical markers for renal tumors derived from gene expression profiling studies using cDNA microarrays. Am J Surg Pathol 2003;27:199-205.

7 Amin, M. B., Tamboli, P., Javidan, J., Stricker, H., de-Peralta Venturina, M., Deshpande, A., Menon, M. Prognostic impact of histologic subtyping of adult renal epithelial neoplasms: an experience of 405 cases. Am J Surg Pathol 2002;26:281-291. 1* indicates figure is from a review of the literature.

8 Singh, H., Flores-Sandoval, N. and Abrams, J. Renal-type clear cell carcinoma occurring in the prostate. Am J Surg Pathol 2003;27:407-10.

9 Mathers, M.E., Pollock, A.M., Marsh, C. and O'Donnell, M. Cytokeratin 7: a useful adjunct in the diagnosis of chromophobe renal cell carcinoma. Histopathology 2002;40:563-7.

10 Renshaw, A. A. (2002). "Subclassification of renal cell neoplasms: an update for the practising pathologist." Histopathology 41(4): 283-300.

11 Morgan B et al. Immunohistochemical subtyping of renal cortical tumours. J Pathol July 2004, abstract 21.

12 Abrahams, N. A., G. T. Maclennan, et al. (2004). "Chromophobe renal cell carcinoma: a comparative study of histological, immunohistochemical and ultrastructural features using high throughput tissue microarray." Histopathology 45(6): 593-602.

13 Martignoni, G., M. Pea, et al. (2001). "Parvalbumin is constantly expressed in chromophobe renal carcinoma." Mod Pathol 14(8): 760-7.

14 Pan CC, Chen PC,Ho DM. The diagnostic utility of MOC31, BerEP4, RCC marker and CD10 in the classification of renal cell carcinoma and renal oncocytoma: an immunohistochemical analysis of 328 cases. Histopathology 2004; 45:452-9

15 Mathers ME, Pollock AM, Marsh C, et al. Cytokeratin 7: a useful adjunct in the diagnosis of chromophobe renal cell carcinoma. Histopathology 2002; 40:563-7

16 Wang HY,Mills SE. KIT and RCC are useful in distinguishing chromophobe renal cell carcinoma from the granular variant of clear cell renal cell carcinoma. Am J Surg Pathol 2005; 29:640-6

17 Adley BP, Gupta A, Lin F, et al. Expression of kidney-specific cadherin in chromophobe renal cell carcinoma and renal oncocytoma. Am J Clin Pathol 2006; 126:79-85

18 Avery AK, Beckstead J, Renshaw AA, et al. Use of antibodies to RCC and CD10 in the differential diagnosis of renal neoplasms. Am J Surg Pathol 2000; 24:203-10

19 Chu P,Arber DA. Paraffin-section detection of CD10 in 505 nonhematopoietic neoplasms. Frequent expression in renal cell carcinoma and endometrial stromal sarcoma. Am J Clin Pathol 2000; 113:374-82.

20 Chuang ST, Chu P, Sugimura J, et al. Overexpression of glutathione s-transferase alpha in clear cell renal cell carcinoma. Am J Clin Pathol 2005; 123:421-9

21 Han WK, Alinani A, Wu CL, et al. Human kidney injury molecule-1 is a tissue and urinary tumor marker of renal cell carcinoma. J Am Soc Nephrol 2005; 16:1126-34 FULL TEXT

22 Kuroda N, Naruse K, Miyazaki E, et al. Vinculin: its possible use as a marker of normal collecting ducts and renal neoplasms with collecting duct system phenotype. Mod Pathol 2000; 13:1109-14

23 Liao SY, Aurelio ON, Jan K, et al. Identification of the MN/CA9 protein as a reliable diagnostic biomarker of clear cell carcinoma of the kidney. Cancer Res 1997; 57:2827-31 FULL TEXT

24 Lin F, Zhang PL, Yang XJ, et al. Human kidney injury molecule-1 (hKIM-1): a useful immunohistochemical marker for diagnosing renal cell carcinoma and ovarian clear cell carcinoma. Am J Surg Pathol 2007; 31:371-81

25 Lin F, Yang W, Betten M, et al. Expression of S-100 protein in renal cell neoplasms. Hum Pathol 2006; 37:462-70

26 McGregor DK, Khurana KK, Cao C, et al. Diagnosing primary and metastatic renal cell carcinoma: the use of the monoclonal antibody 'Renal Cell Carcinoma Marker'. Am J Surg Pathol 2001; 25:1485-92.

27 Sakai N, Baba M, Nagasima Y, et al. SPARC expression in primary human renal cell carcinoma: upregulation of SPARC in sarcomatoid renal carcinoma. Hum Pathol 2001; 32:1064-70.

28 Skinnider BF, Folpe AL, Hennigar RA, et al. Distribution of cytokeratins and vimentin in adult renal neoplasms and normal renal tissue: potential utility of a cytokeratin antibody panel in the differential diagnosis of renal tumors. Am J Surg Pathol 2005; 29:747-54

29 Tretiakova MS, Sahoo S, Takahashi M, et al. Expression of alpha-methylacyl-CoA racemase in papillary renal cell carcinoma. Am J Surg Pathol 2004; 28:69-76

30 Young AN, de Oliveira Salles PG, Lim SD, et al. Beta defensin-1, parvalbumin, and vimentin: a panel of diagnostic immunohistochemical markers for renal tumors derived from gene expression profiling studies using cDNA microarrays. Am J Surg Pathol 2003; 27:199-205

31 Lin F, Brown RE, Shen T, et al. Immunohistochemical detection of P504S in primary and metastatic renal cell carcinomas. Appl Immunohistochem Mol Morphol 2004; 12:153-9

32 Yoshida SO,Imam A Monoclonal antibody to a proximal nephrogenic renal antigen: immunohistochemical analysis of formalin-fixed, paraffin-embedded human renal cell carcinomas. Cancer Res 1989; 49:1802-9

This page last revised 17.5.2008.

©SMUHT/PW Bishop