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Pathology - Renal cell carcinoma
Definition: A malignant epithelial tumor originating in the kidney.
Epidemiology • Represents approximately 2% of all cancers globally. • Prevalent in developed nations, with an average incidence of approximately 10 per 100,000 in males and 3 per 100,000 in females.
Aetiology • Identified risk factors encompass smoking, hypertension, obesity, environmental toxins, and prolonged dialysis. Certain genetic disorders, such as von Hippel-Lindau and tuberous sclerosis, are linked to renal cell carcinoma (RCC). Genetics Clear cell renal cell carcinomas exhibit deletions on chromosome 3p. Papillary RCCs exhibit trisomy of chromosomes 7 and 17, together with the deletion of chromosomal Y in males. Chromophobe RCCs exhibit significant chromosomal deletions.
Presentation • Approximately fifty percent of all cases manifest as painless hematuria. • The majority of the remaining cases are detected incidentally by imaging. A minor percentage exhibits metastatic illness.
Macroscopy The tumors are typically located in the renal cortex. • The clear cell types exhibit heterogeneity, characterized by golden yellow regions. • Papillary tumors may exhibit friability. • Chromophobe tumors are often solid and brown-hued. Histopathology transparent cell RCC (70%) consists of cells exhibiting transparent or eosinophilic cytoplasm arranged within a fine vascular framework. • Papillary RCC (15%) exhibits a papillary or tubulopapillary development pattern and measures greater than 5 mm in size. Chromophobe RCC (5%) consists of layers of big cells characterized by well-defined cell boundaries. The tumor's vasculature is characterized by thick walls. The remaining components consist of a combination of uncommon subtypes, including collecting duct carcinoma and mucinous tubular and spindle cell carcinoma.
Prognosis • The overall five-year survival rate is around 60%. • Stage and grade are the primary prognostic determinants. • The prevalent grading system utilized is the four-tiered Fuhrman system, which assesses nuclear size, shape, chromatin structure, and nucleolar prominence. Grade 1 exhibits the most favorable outlook, while grade 4 demonstrates the least favorable.
TNM 7 pathological staging of renal cell carcinomas
Primary tumour (T)
pT1a: tumour d 4cm, limited to the kidney.
pT1b: tumour > 4cm, but d 7cm, limited to the kidney.
pT2a: tumour > 7cm, but d 10cm, limited to the kidney.
pT2b: tumour > 10cm, limited to the kidney.
pT3a: tumour extends into perinephric fat or renal veins.
pT3b: tumour extends into the vena cava below the diaphragm.
pT3c: tumour extends into the vena cava above the diaphragm.
pT4: tumour directly invades the adrenal gland or beyond the Gerota fascia.
Regional lymph nodes (N)
pN0: no regional lymph node metastasis.
pN1: metastasis in regional lymph node
Definition: A malignant epithelial tumor originating in the kidney.
Epidemiology • Represents approximately 2% of all cancers globally. • Prevalent in developed nations, with an average incidence of approximately 10 per 100,000 in males and 3 per 100,000 in females.
Aetiology • Identified risk factors encompass smoking, hypertension, obesity, environmental toxins, and prolonged dialysis. Certain genetic disorders, such as von Hippel-Lindau and tuberous sclerosis, are linked to renal cell carcinoma (RCC). Genetics Clear cell renal cell carcinomas exhibit deletions on chromosome 3p. Papillary RCCs exhibit trisomy of chromosomes 7 and 17, together with the deletion of chromosomal Y in males. Chromophobe RCCs exhibit significant chromosomal deletions.
Presentation • Approximately fifty percent of all cases manifest as painless hematuria. • The majority of the remaining cases are detected incidentally by imaging. A minor percentage exhibits metastatic illness.
Macroscopy The tumors are typically located in the renal cortex. • The clear cell types exhibit heterogeneity, characterized by golden yellow regions. • Papillary tumors may exhibit friability. • Chromophobe tumors are often solid and brown-hued. Histopathology transparent cell RCC (70%) consists of cells exhibiting transparent or eosinophilic cytoplasm arranged within a fine vascular framework. • Papillary RCC (15%) exhibits a papillary or tubulopapillary development pattern and measures greater than 5 mm in size. Chromophobe RCC (5%) consists of layers of big cells characterized by well-defined cell boundaries. The tumor's vasculature is characterized by thick walls. The remaining components consist of a combination of uncommon subtypes, including collecting duct carcinoma and mucinous tubular and spindle cell carcinoma.
Prognosis • The overall five-year survival rate is around 60%. • Stage and grade are the primary prognostic determinants. • The prevalent grading system utilized is the four-tiered Fuhrman system, which assesses nuclear size, shape, chromatin structure, and nucleolar prominence. Grade 1 exhibits the most favorable outlook, while grade 4 demonstrates the least favorable.
TNM 7 pathological staging of renal cell carcinomas
Primary tumour (T)
pT1a: tumour d 4cm, limited to the kidney.
pT1b: tumour > 4cm, but d 7cm, limited to the kidney.
pT2a: tumour > 7cm, but d 10cm, limited to the kidney.
pT2b: tumour > 10cm, limited to the kidney.
pT3a: tumour extends into perinephric fat or renal veins.
pT3b: tumour extends into the vena cava below the diaphragm.
pT3c: tumour extends into the vena cava above the diaphragm.
pT4: tumour directly invades the adrenal gland or beyond the Gerota fascia.
Regional lymph nodes (N)
pN0: no regional lymph node metastasis.
pN1: metastasis in regional lymph node
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