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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 and chromophobe renal cell carcinoma (RCC), and collecting duct carcinoma.

A small proportion of rare kidney cancer entities are defined on a molecular basis, e.g. the microphthalmia transcription factor (MiT) family translocation RCC and succinate dehydrogenase-deficient RCC.

A 2018 study from Carlo et al showed a high prevalence of cancer-associated germline mutations in advanced kidney cancers (especially in non-clear cell RCC: 11.7% RCC-associated gene mutations).

Pathological tumour stage has a strong prognostic impact.

In the past, various grading systems (e.g. Thoenes or Fuhrmann) have been used for RCC staging. Today, the World Health Organization/International Society of Urological Pathology (WHO/ISUP) four-tiered system should be applied.

Tumour grade is defined mainly on the basis of nucleolar prominence.

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 kidney 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 renal neoplasm of low malignant potential 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 RCC?
  2. What is the best predictor of prognosis in RCC?
  3. Which carcinoma has the best prognosis?
Editors and Contributors Tumours of the Urinary System

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