NEOPLASMS of the KIDNEY

NEOPLASMS of the KIDNEY

RENAL CELL NEOPLASMS
MIXED EPITHELIAL AND STROMAL
NEOPLASMS
MISCCELANEOUS TUMORS
UROTHELIAL NEOPLASMS
PEDIATRIC RENAL NEOPLASMS

Classification of Epithelial Kidney Tumors

(WHO 2004 & AFIP 4th Ed)
Benign tumors
Papillary adenoma
Metanephric adenoma
Metanephric adenofibroma
Oncocytoma

Classification of Epithelial Kidney Tumors

(WHO 2004 & AFIP 4th Ed)
Malignat tumors (renal cell carcinoma)
Clear cell renal cell carcinoma
Multilocular cystic renal cell carcinoma
Papillary renal cell carcinoma
Chromophobe cell carcinoma
Collecting duct carcinoma
Medullary carcinoma
Mucinous tubular and spindle cell carcinoma
X:1 Translocation carcinoma
Carcinoma associated with neuroblastoma
Unclassified carcinoma

Classification of Mixed and Mesenchymal Kidney Tumors(Adults)

(WHO 2004 modified, Grignon 2006)
Mixed epithelial and mesenchymal tumors
Cystic nephroma
Mixed epithelial and stromal tumors
Synovial sarcoma
Mesenchymal tumors (benign)
Angiomyolipoma
Leiomyoma
Hemangioma
Juxtaglomerular cell tumor
Renomedullary interstitial cell tumor
Other benign
Mesenchymal tumors (malignant)
Epithelioid angiomyolipoma
Leimyosarcoma
Angiosarcoma
Solitary fibrous tumor
Other sarcomas

RENAL CELL NEOPLASMS

RENAL CELL CARCINOMAS are
tumors that arise from the renal tubular
epithelium
Before they were thought arise from
adrenal rests, termed hypernephroma
Accounting for more than 90% of all
malignancies arising in the kidney

CORTEX

MEDULLA

CLEAR CELL RENAL CELL

CARCINOMA
Definition:
- the most common variant epithelial tumors
- cells: clear or eosinophilic granular
cytoplasm
Location: renal cortex
Gender: M>F. 2:1
Age: adult, 6 to 7 decade
Clinical feature: hematuria

PATHOLOGY
GROSS
- solitary renal cortical mass
- well circumscribed
- golden yellow, necrosis and hemorrhage
MICROSCOPIC
- nests and sheets of clear cells
- delicate vascular network
- pseudopapillary, tubular, trabecular,
microcystic, sarcomatoid

IMMUNOHISTOCHEMICAL
Cam 5.2, AE1-AE3,EMA, RCC, Vimentin
and CD10 positive
Keratin 34E12 negative
S-100 or CEA rarely positive

FUHRMANS nuclear grading

Tumors are graded from grade 1 4,
according to NUCLEAR size and shape,
and NUCLEOLAR prominence
Grading is most useful in clear cell and the
other subtype of RCC

FUHRMAN GRADE 1/4

FUHRMAN GRADE 4/4

AJCC-TNM Staging of Renal Cell Carcinoma (2002)

Primary Tumor (T)
TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

T1a

Confined to Kidney, 4.0 cm.

T1b

Confined to Kidney, > 4.0 cm and 7.0 cm

T2

Confined to Kidney, > 7.0 cm

T3a

Tumor invades the perinephric fat or the adrenal gland

but not beyond Gerotas fascia

T3b

Tumor grossly extends into the renal vein(s) or vena cava

below the diaphragm

T3c

Tumor grossly extends into the renal vein(s) or vena cava

above the diaphragm

T4

Tumor invades beyond Gerotas fascia

Regional Lymph Nodes(N); Distant Metastases (M); Staging

WILMS Tumor
(Nephroblastoma)

Definition
Wilms' tumor is a rare kidney cancer that
primarily affects children.
Also known as nephroblastoma, it's the
most common malignant tumor of the
kidneys in children.
The peak time of Wilms' tumor occurrence
is around ages 3 to 4, and it occurs only
rarely after age 6.

CLINICAL features
A malignant embryonal neoplasm derived
from nephrogenic blastemal cells
Most of these tumors are found before
metastazise
1 in 8000 children
Abdominal mass, pain, hematuria,
hypertension
Associated with dysmorphic syndromes

Fate of NEPHROGENIC REST

Remain unchanged in size and
composition
Maturation, sclerosis and disappearance
Hyperplastic NRs, proliferation of all
susceptible cells. Absence of pseudocapsule at the interface between hyperplastic NRs and renal parenchyma
Neoplastic induction, to represent a
clonal event originating in single cells of a
rest

PATHOLOGY
GROSS
- well-circumscribed
- encapsulated
- gray-tan, lobulated cut surface
MICROSCOPIC
- three patterns:1)blastemal, 2)epithelial,
3) stromal

IMMUNOHISTOCHEMICAL

Vimentin positive
WT1 positive: blastemal and epithelial
WT1 negative: epithelial and stromal
P53 over expression

UROTHELIAL NEOPLASM
(TRANSITIONAL CELL TUMORS

UROTHELIAL NEOPLASM
(TRANSITIONAL CELL TUMORS)
90% of bladder tumors are classified as
urothelial carcinoma, also referred to as
transitional cell carcinoma (TCC)
are believed to originate from transformation of the normal urothelium
urothelial dysplasia > carcinoma in situ >
invasive carcinoma

Bladder: Urothelial carcinomas

Classification
Histologic types:
urothelial carcinoma of the bladder
squamous cell carcinoma
adenocarcinoma (2%), rare
poorly differenciated carcinoma/small cell
carcinoma, exceptional

UROTHELIAL NEOPLASM
(TRANSITIONAL CELL TUMORS)
Carcinoma cell squamosa 5% in USA,
70-80% in Middle East
M3/F1
Occurs mainly in the 6th-8th decades
Risk factor: cigarette smoking, and
occupational exposure (aniline, benzydine
and naphtylamine
20-30 yrs latency after exposure

PATHOLOGY
Grading and staging
Graded by the degree of cellular atypia
(papilloma, G1->G3) WHO 1973
Staged - WHO 2004
- papilloma
- papillary tumor of low malignant potential
(PTLMP)
- papillary urothelial carcinomas low grade
- papillary urothelial carcinomas high grade.

Papilloma

Inverted papilloma

Inverted papilloma

Inverted papilloma

SUPERFICIAL BLADDER CANCER

Clinically
Non invasive papillary Ca

Muscle invasive bladder cancer

PATHOLOGICAL STAGING

STAGING OF TRANSITIONAL CELL

CARCINOMA OF THE RENAL PELVIS
pTIS Carcinoma in situ
pTa Non-invasive papillary tumors
pT1 Invasion of lamina propria (no muscle)
pT2 Superficial muscularis propria
pT3 Deep muscularis propria or pelvic fat
pT4 Adjacent structures (including kidney)