Tumours of the Kidney

Chapter 1 - Anatomy of the GU Tract and Histology of GU Tumours

>95% of kidney cancers have a characteristic morphology that can be classified as: clear cell, papillary, chromophobe renal cell carcinoma, and carcinoma of the collecting ducts of Bellini.

Patient outcome varies between histological kidney cancer subtypes and is dependent on the treatment given.

Only a few kidney cancers have an unusual morphology and have been categorised as rare kidney cancer entities, e.g. mucinous tubular and spindle cell carcinoma.

Primary tumour category has a strong prognostic impact.

Histological tumour grade (mostly performed according to Thoenes or Fuhrman) is more subjective and has less prognostic influence.

Criteria for a high (unfavourable) grade generally include a large nucleus size, polymorphy of the nuclei, presence of prominent nucleoli, and mitoses.

Tumours of the Kidney Figure 3

Courtesy http://alf3.urz.unibas.ch/pathopic/intro.htm

5%-7% of kidney tumours are benign. Oncocytoma is the most frequent benign tumour. The tumour is well circumscribed, mahogany brown with a central scar.

Angiomyolipomas represent 1% of kidney tumours. They consist of varying proportions of mature fat, thick-walled blood vessels, and smooth muscle.

Multilocular cystic carcinoma is in principle a malignant tumour but is entirely composed of cysts, with very few cancer cells. Metastases have not been reported.

Revision Questions

  1. What are the main subtypes of renal cell carcinoma?
  2. What is the best predictor of prognosis in renal cell carcinoma?
  3. Which carcinoma has the best prognosis?

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Last update: 18 September 2015