renal cell carcinoma for students
DESCRIPTION
Causes, pathogenesis, Morphology, stages and prognosisTRANSCRIPT
Renal Cell Carcinoma
Lecturer 53
Tumors of the Kidney
Adenocarcinoma of the Kidney
Hypernephroma
HYPERNEPHROMA- RCC• Because of their gross yellow color and the
resemblance of the tumor cells to clear cells of the adrenal cortex, they were at one time
called Hypernephroma.
Renal Adenocarcinoma
• It is now clear that all these tumors arise from tubular epithelium and are therefore
RENAL ADENOCARCINOMAS.
Epidemiology• Male predominance (1.6:1.0 M:F)• Highest incidence between age 60-80-Median age of diagnosis is 66 years-Median age of death 70 years• Highest incidence in Scandinavia and North
America, lowest in Africa
Risk Factors
Causes/ Risk Factors
• There is also an increased incidence in
patients with chronic renal failure and acquired cystic disease and in
tuberous sclerosis.
RCC•Most renal cancer is
sporadic, but unusual forms of
autosomal dominant familial cancers occur, usually in
younger individuals.
Classification of RCCThe major types of RCC are as follows:• 1. Clear cell carcinoma -70-80%, 95%
Sporadic• 2. Papillary carcinoma- 10-15%• 3. Chromophobe renal carcinoma- 5%• 4. Collecting duct (Bellini duct) carcinoma-
1% 0r less
Pathogenesis of VHL• Von Hippel-Lindau protein, product of VHL gene,
is a tumor suppressor • VHL inhibits hypoxia-inducible genes involved in
angiogenesis such as VEGF, TGF-a, GLUT-1• VHL destabilizes and promotes ubiquination of
HIF-a (hypoxia-inducible factor) • Loss of VHL results in tumor angiogenesis, tumor-
cell proliferation, epithelial cell proliferationGlucose transporter 1Ubiquination: a small polypeptide, found in most eukaryotic cells, that combines with other proteins to
make them susceptible to degradation
Morphology•Renal cell carcinomas may
arise in any portion of the kidney, but more commonly affects the
poles.
RCC Morphology• One of the striking
characteristics of renal cell carcinoma is its tendency to invade the renal vein and grow as a solid column of cells within this vessel.
Clear cell Carcinomas
Morphology- Papillary Carcinomas
• Papillary carcinomas are the most common type of renal cancer in patients who develop dialysis-associated cystic disease.
Microscopy- Papillary Carcinoma
• Papillary carcinoma is composed of cuboidal or low columnar cells arranged in papillary formations.
• Interstitial foam cells are common in the papillary cores.
• Psammoma bodies may be present. • The stroma is usually scanty but highly
vascularized.
Chromophobe renal carcinoma• Chromophobe renal carcinoma is made up of
pale eosinophilic cells, often with a
perinuclear halo, arranged in
solid sheets with a concentration of
the largest cells around blood vessels.
Collecting duct carcinoma
• Collecting duct carcinoma is a rare variant showing irregular channels lined by highly atypical epithelium with a hobnail pattern.
RCC•Sarcomatoid changes
arise infrequently in all types of renal cell carcinoma and are a decidedly
ominous feature.
Renal cell carcinoma. Typical cross-section of yellowish, spherical neoplasm in one pole of the kidney. Note the tumor in the dilated thrombosed renal vein.
Paraneoplastic Syndromes
1. Polycythemia, 2. Hypercalcemia,3. Hypertension,4. Hepatic dysfunction, 5. Feminization or masculinization, 6. Cushing syndrome, 7. Eosinophilia, 8. Leukemoid reactions, and9. Amyloidosis.
RCC
Clinical Presentation• Most asymptomatic • Hematuria present 40% of patients• Classic triad: flank pain, hematuria, palpable
abdominal mass occur in 9% of patients• 45% present with localized disease, • 25% with locally advanced disease,• 30% with metastatic disease
Treatment•Nephrectomy has been the
treatment of choice, but
•Partial nephrectomy to preserve renal function is being done with increasing frequency and similar outcome.