Papillary renal cell carcinoma

Papillary renal cell carcinoma (pRCC) is one of the subtypes of renal cell carcinoma.

This subtype may account 13-20% of all renal cell cancer. There is slightly increased male predilection.

As with other types of renal cell cancer, most are asymptomatic and incidentally discovered.

There are two subtypes described according to morphology 7:

  • type I
    • have papillae covered by a single layer of cuboidal or low columnar cells with scanty cytoplasm and low-grade nuclei
    • carry a better prognosis than type II tumours
  • type II:
    • are of a higher nuclear grade and contain more than one layer of cells with abundant eosinophilic cytoplasm
    • although mostly unilateral, this subtype is considered the most common to result in bilateral renal cell cancers 1

While it has been described to have a tendency to present at a lower stage, it still has a distinct potential for progression and aggressive behaviour 4.

Associations

Although there is no absolute rule, in general, papillary renal cancers at diagnosis tends to have a smaller mean diameter and be at a lower stage. The imaging features of type 1 and type 2 tumours may overlap.

CT

On CT, many papillary renal cell cancers do not enhance, indicating that assessment of enhancement alone as being insufficient for differentiation from hyper-attenuating cysts 8. Contrast enhancement, in general, tends to be less intense.

Smaller lesions tend to be homogeneous is attenuation with larger tumours tending to be heterogeneous.

MRI
  • T1: hypointense
  • T2: hypointense
  • T1 C+ (Gd): contrast enhancement tends to be less intense than in the more common clear cell RCC variant
  • DWI: restricted diffusion may be useful for differentiating from a hemorrhagic cyst
  • frequently shows a pseudo capsule
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Article information

rID: 32353
System: Urogenital
Synonyms or Alternate Spellings:
  • Papillary renal cell cancer
  • Papillary renal cell carcinoma (pRCC)
  • Chromophil renal cell carcinoma
  • Chromophil renal cell carcinomas
  • Papillary renal cell carcinomas
  • Papillary renal cell cancers

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    Case 1: type II
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