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	positive	variable	usually positive	usually negative	positive
CK19				positive	usually positive
CK20						positive
CEA						negative
EMA		positive				positive
dolichos biflorus agglutinin				usually positive	usually negative
CD10	positive	usually negative	variable	positive
CD117	negative	positive	positive
renal cell carcinoma marker	positive	negative	negative	positive
b defensin-1	negative	positive	positive	positive
parvalbumin	negative	positive	positive	contradictory
vimentin	usually positive	negative	negative	positive		negative
MIB-1	often > 2%	< 2%	< 2%
RON	variable	positive	positive
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

This page last revised 17.7.2005.

©SMUHT/PW Bishop