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Clear cell variant of renal cell acrcinoma

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Renal cell carcinoma - Clear cell variant

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Clear cell variant of renal cell acrcinoma

  1. 1. TUMOR BOARD 18.07.2017
  2. 2. Patient details • Mr. S, 28/M • MRD No: 17/227994 • Biopsy No: 1630/17 • Nature of specimen - Left radical nephrectomy • CECT – 14 x 8 cm mass in the left kidney occupying the upper and mid pole area • Clinical diagnosis - left renal mass - ?Renal cell carcinoma
  3. 3. Gross examination • Received left radical nephrectomy specimen with attached perinephric pad of fat measuring 15.5x12x7 cms • External surface is bosselated and congested • Cut section shows renal parenchyma totally distorted by a tumor measuring 10x9 cms • Tumor shows a variegated appearance • Attached renal vein measuring 3 cms • Renal artery measuring 3.5 cms • Ureter measuring 2.5 cm
  4. 4. Gross examination • Tumor is infiltrating the capsule. • A part of renal parenchyma is compressed at the periphery measuring 4x2 cms • No lymph nodes identified in the perinephric pad of fat
  5. 5. Microscopy • Sections studied from renal arterial, ureteric and renal venous margins are free of tumor • Section studied from tumor composed of cells arranged in solid sheets and nests. • Individual tumor cells are clear, vacuolated cytoplasm with vesicular nucleus and prominent nucleoli. • At few places, granular eosinophilic cytoplasm is also seen
  6. 6. Microscopy • Occasional bizarre looking cells are seen • Surrounding areas show fibrosis and desmoplastic stroma infiltrated by lymphocytes • Few areas show hemorrhage and necrosis • Tumor shows capsular invasion • Focal areas show osseous metaplasia • Adjacent renal parenchyma shows dilated tubules and focal glomerulosclerosis • Sections from perinephric fat is free of tumor
  7. 7. Impression • Clear cell variant of Renal cell carcinoma - Left kidney • According to Fuhrman Nuclear Grading, Grade II with capsular invasion • Renal arterial, ureteric and renal venous margins are free of tumor • Perinephric pad of fat is free of tumor • Staging - pT2N0
  8. 8. Fuhrman Nuclear Grading of Renal Cell Carcinoma • Grade 1 Small, round and uniform nuclei. No evident nucleoli • Grade 2 Nuclei with irregular outlines. Inconspicuous nucleoli • Grade 3 Irregular nuclei with identifiable nucleoli at 100× magnification • Grade 4 Large, hyperchromatic, pleomorphic nuclei. Single or multiple nucleoli
  9. 9. Tumor, Node, Metastasis (TNM) Staging Scheme for Renal Cell Carcinoma PRIMARY TUMOR (T) TX Primary tumor cannot be assessed T0 No evidence of primary tumor T1 Tumor ≤7 cm in greatest dimension, limited to the kidney T1a Tumor ≤4 cm in greatest dimension, limited to the kidney T1b Tumor >4 cm but not >7 cm in greatest dimension, limited to the kidney T2 Tumor >7 cm in greatest dimension, limited to the kidney T3 Tumor extends into major veins or invades adrenal gland or perinephric tissues but not beyond Gerota's fascia T3a Tumor directly invades adrenal gland or perirenal and/or renal sinus fat but not beyond Gerota's fascia T3b Tumor grossly extends into the renal vein or its segmental (muscle-containing) branches, or vena cava below the diaphragm T3c Tumor grossly extends into vena cava above the diaphragm or invades the wall of the vena cava T4 Tumor invades beyond Gerota's fascia REGIONAL LYMPH NODES (N)* NX Regional lymph nodes cannot be assessed N0 No regional lymph nodes metastases N1 Metastases in a single regional lymph node N2 Metastasis in more than one regional lymph node *Laterality does not affect the N classification DISTANT METASTASIS (M) MX Distant metastasis cannot be assessed M0 No distant metastasis
  10. 10. • Thank you

Editor's Notes

  • gerota s fascia, adrenal
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