Renal Cell Carcinomas: Radiologic and Pathologic Correlations

腎細胞癌: 画像所見と病理所見の対比

7. Oct. 2008.　　　Elective Student L. B.

Renal Cell Carcinoma• Malignant Neoplasms• Case I: Clear Cell RCC• Case II: Papillary RCC• Case III: Chromophobe RCC

• Benign Neoplasm• Oncocytoma

Clear Cell RCC1) Definition:• Malignant neoplasm composed of cells with clear or

eosinophilic cytoplasm within a delicate vascular network

2) Epidemiology/ Incidence:• Most common type of RCCs (65-80%)

3) Somatic Genetics:• Associated with Von-Hippel-Lindau (VHL) disease

4) Histopathology/ Characteristics:

• Pseudocapsule• Typically golden yellow (rich lipid content:

cholesterol, neutral lipids and phospholipids)• Common: cysts, necrosis, haemorrhage and

calcification• Uncommon: diffuse infiltration

Case I: Clear Cell RCC

• Male in his 50’s

• Haematuria, Proteinuria for three years,but symptom-free

• July.2007. to the urologist: Health screening

• July.2007. Urocytology: Class II

• Aug.2007. Laparoscopic right nephrectomy

Macroscopy: Clear Cell RCC

Microscopy: Clear Cell RCC

Microscopy: Clear Cell RCC

CT of the abdomen

precontrast dynamic parenchymal phasedynamic early phase

CT of the abdomen

dynamic early phase, MPR image

Papillary RCC1) Definition:• Malignant renal parenchymal tumor with a

papillary or tubulopapillary architecture

2) Epidemiology/ Incidence: • Comprise approximately 10% of RCCs

3) Somatic Genetics:• Trisomy or tetrasomy 7, trisomy 17 and loss of

chromosome Y

4) Histopathology/ Characteristics:• Frequently contains areas of haemorrhage, necrosis

and cystic degeneration• More common: bilateral and multifocal, calcified

concretions, relative hypovascularity• Thick capsule

• Type I: Basophilic – composed of small cuboidal cells with uniform nuclei

covering thin papillae

• Type II: Eosinophilic – consist of large eosinophilic cells with pleomorphic nuclei:

haemorrhage and necrosis

Case II: Papillary RCC• Male in his 50’s• March 2007. US- Health screening, tumor in

left kidney• Apr.2007. Solid tumor (φ3cm) on US • May.2007. CT (φ3.5 cm enhancing tumor,

RCC was suspected)• May.2007. MRI• July.2007. Left partial nephrectomy

Macroscopy: Papillary RCC

Microscopy: Papillary RCC

Microscopy: Papillary RCC

MRI of the abdomen

DWI b800

DWI b50

T2WI

MRI of the abdomen

dynamic early phase dynamic parenchymal phase

MRI of the abdomen

in phase out of phase

Chromophobe RCC1) Definition:• Renal carcinoma characterized by large pale cells

with prominent cell membranes

2) Epidemiology/ Incidence:• 4-11% of RCCs• Shows a mean age of incidence in the 6th decade• M:F = 1:1

3) Somatic Genetics:• Associated with Birt-Hogg-Dube Syndrome

4) Histopathology/ Characteristics:

• Well circumscribed, tan-brown tumors with a mildly lobulated surface

• Solid growth pattern, sometimes glandular, with focal calcifications

• No central necrosis • Arise from the intercalated cells of the renal cortex

Case III: Chromophobe RCC

• Female in her 60’s• Nov.2007. Microhaematuria, US of the

abdomen • Nov.2007. Dynamic CT of kidneys φ3.5 cm:

RCC on the right• Dec.2007. Laparoscopic right nephrectomy

(suspected cT1aN0M0)

Macroscopy: Chromophobe RCC

Microscopy : Chromophobe RCC

Colloidal iron stain

Microscopy : Chromophobe RCC

CT of the abdomen

precontrast

dynamic delayed phase

dynamic early phase

CT of the abdomen

dynamic early phase

Oncocytoma1) Definition:• Benign renal epithelial, well circumscribed,

encapsulated neoplasm composed of large cells with mitochondria-rich eosinophilic cytoplasm, thought to arise from the intercalated cells

2) Epidemiology/ Incidence:• Account for 3-7% of renal tumors• Peak incidence in the 7th decade of life• M:F = 2:1 • Most occur sporadically3) Somatic Genetics:• Associated with Birt-Hogg-Dube Syndrome

4) Histopathology/ Characteristics:• Typically spheric and well-defined masses• May be multicentric, bilateral or metachronous in a

minority of cases• Mahagony-brown in up to 54% of cases• Central scar: stellate central area of fibrosis or

hyalinized connective tissue with compressed blood vessels

• The presence of a pseudocapsule is non specific and can be seen in up to 60% of RCCs as well

Papillary RCC

Chromophobe RCC

Oncocytoma

Tan - brown

Mahagony - brown

Vascularity

3 – 7%

Pseudo - capsule65 – 80% hyper

Thick - capsule hypo

intermediatePseudo - capsule

intermediatePseudo - capsule

Clear Cell RCC

10%

4 – 11%

Capsule

Golden - yellow

Beige

Incidence Color

Key facts of RCC

Papillary RCC

Chromophobe RCC

Oncocytoma no

yes

MRI

no Low SI on T2WI and GRE

no

no

Key facts of RCC

Clear Cell RCC

Solid

Microscopic fatCalcification

yes

yes

yes

Central scar

Low SI onout of phase

References• John N. Eble, Guido Sauter, Jonathan I. Epstein, Isabell a. Sesterhenn:

Pathology and Genetics of Tumors of the Urinary System and Male Genital Organs: 23-43, 2004

• Federle, Jeffrey, Desser, Anne, Eraso: Diagnostic Imaging – ABDOMEN: Part III-3-84-86, Part III-3-96-98, 2005

• Ivan Pedrosa, Maryellen R. Sun, Matthew Spencer, Elizabeth M. Genega, Aria F. Olumi, William C. Dewolf, Neil M. Rofsky: MR Imaging of Renal Masses: Correlation with Findings at Surgery and Pathologic Analysis: RadioGraphics, 985 – 1003, Volume 28, 2008