H2599/2000 Renal Cell Carcinoma RCC

• differentiating towards the renal tubular epithelium (adenocarcinoma)
• adult or elderly
• M:F ratio varing from 2:1 to 3:1
• distinguished from clear cell sarcoma in childhood
• rare familiar cases: von Hippel-Lindau disease

Peculiarities:

• occasional regression
• 'recipient' of a metastatic tumour
• para-neoplastic endocrine syndromes
• high tendency for vascular invasion
• can metastasize to unusual sites
• late appearance of metastasis

classical triad in only 9%

• hematuria
• flank pain
• abdominal mass (many cases present late as large tumours)

Grossly

• well circumscribed
• apparently extrarenal mass
• solid bright yellowish
• variegated appearance
• some cases are entirely cystic

Tumour cells

• two types: clear cell and granular
• 'vegetable cell' - contains glycogen and fat but no mucin
• graded based on nuclear features
• other histological variants
• ? significance of granuloma in this patient

Tumour cells, special techniques

• various epithelial markers AND vimentin
• various enzymes
• various proteins and hormones (like proximal tubular cells)
• abnormalities of chromosome 3

Prognostic factors:

• Distant metastasis occurs in 1/3 cases
• Tumour size: 3< or >12 cm
• Invasion of renal vein in high grade cases
• DNA ploidy correlate with nuclear grading
• Flow cytometry: S-phase fraction
• p53 overexpression associated with metastatic disease

Staging
 

Stage	Description	5-year survival
Stage I	Confined to the kidney.	60-80%
Stage II	Extension to perirenal fat but within Gerota's fascia	40-70%
Stage III	Renal vein or vena caval involvement, or regional lymph node metastases	10-40%
Stage IV	Extension to adjacent organs other than adrenal, or distant metastases	<5%