Papillary renal cell carcinoma

Last revised by Ammar Ashraf on 30 Jun 2023

Citation, DOI, disclosures and article data

Citation:

Weerakkody Y, Ashraf A, Niknejad M, et al. Papillary renal cell carcinoma. Reference article, Radiopaedia.org (Accessed on 16 Apr 2024) https://doi.org/10.53347/rID-32353

DOI:

https://doi.org/10.53347/rID-32353

Permalink:

https://radiopaedia.org/articles/32353

rID:

32353

Article created:

23 Nov 2014, Yuranga Weerakkody ◉

Disclosures:

At the time the article was created Yuranga Weerakkody had no recorded disclosures.

View Yuranga Weerakkody's current disclosures

Last revised:

30 Jun 2023, Ammar Ashraf ◉

Disclosures:

At the time the article was last revised Ammar Ashraf had no financial relationships to ineligible companies to disclose.

View Ammar Ashraf's current disclosures

Revisions:

20 times, by 10 contributors - see full revision history and disclosures

Systems:

Urogenital

Tags:

kidney, renal cell carcinoma

Synonyms:

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

Papillary renal cell carcinomas (pRCC) are the second most common histological subtype of renal cell carcinoma (RCC).

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 tumors
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 behavior ⁴.

Radiographic features

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

Ultrasound

Generally tends to be hypoechoic on ultrasound⁹.

CT

Smaller lesions tend to be homogeneous in attenuation with larger tumors tending to be heterogeneous.

These tumors are characteristically less vascularized than the more common clear cell subtype, showing overall hypoenhancement compared to the adjacent normal renal cortex, particularly seen in the corticomedullary phase.

When not enhancing at all, it can be difficult to differentiate from hyper-attenuating cysts ⁸.

MRI

The tumors generally present with a pseudo-capsule.

T1: hypointense
T2: hypointense
T1 C+ (Gd): contrast enhancement tends to be less intense than in the more common clear cell RCC subtype
DWI: restricted diffusion may be useful for differentiating from a hemorrhagic cyst

References

1. Vikram R, Ng CS, Tamboli P et-al. Papillary renal cell carcinoma: radiologic-pathologic correlation and spectrum of disease. Radiographics. 2009;29 (3): 741-54. doi:10.1148/rg.293085190 - Pubmed citation
2. Ronnen EA, Kondagunta GV, Ishill N et-al. Treatment outcome for metastatic papillary renal cell carcinoma patients. Cancer. 2006;107 (11): 2617-21. doi:10.1002/cncr.22340 - Pubmed citation
3. Delahunt B, Eble JN, McCredie MR et-al. Morphologic typing of papillary renal cell carcinoma: comparison of growth kinetics and patient survival in 66 cases. Hum. Pathol. 2001;32 (6): 590-5. doi:10.1053/hupa.2001.24984 - Pubmed citation
4. Amin MB, Corless CL, Renshaw AA et-al. Papillary (chromophil) renal cell carcinoma: histomorphologic characteristics and evaluation of conventional pathologic prognostic parameters in 62 cases. Am. J. Surg. Pathol. 1997;21 (6): 621-35. Pubmed citation
5. Ng CS, Wood CG, Silverman PM et-al. Renal cell carcinoma: diagnosis, staging, and surveillance. AJR Am J Roentgenol. 2008;191 (4): 1220-32. AJR Am J Roentgenol (full text) - doi:10.2214/AJR.07.3568 - Pubmed citation
6. Herts BR, Coll DM, Novick AC et-al. Enhancement characteristics of papillary renal neoplasms revealed on triphasic helical CT of the kidneys. AJR Am J Roentgenol. 2002;178 (2): 367-72. doi:10.2214/ajr.178.2.1780367 - Pubmed citation
7. Delahunt B, Eble JN, McCredie MR et-al. Morphologic typing of papillary renal cell carcinoma: comparison of growth kinetics and patient survival in 66 cases. Hum. Pathol. 2001;32 (6): 590-5. doi:10.1053/hupa.2001.24984 - Pubmed citation
8. Egbert ND, Caoili EM, Cohan RH et-al. Differentiation of papillary renal cell carcinoma subtypes on CT and MRI. AJR Am J Roentgenol. 2013;201 (2): 347-55. doi:10.2214/AJR.12.9451 - Pubmed citation
9. Tsuda K, Kinouchi T, Tanikawa G et-al. Imaging characteristics of papillary renal cell carcinoma by computed tomography scan and magnetic resonance imaging. Int. J. Urol. 2005;12 (9): 795-800. doi:10.1111/j.1442-2042.2005.01126.x - Pubmed citation
9. Blei CL, Hartman DS, Friedman AC, Davis CJ. Papillary renal cell carcinoma: ultrasonic/pathologic correlation. Journal of clinical ultrasound : JCU. 10 (9): 429-34. Pubmed
10. Sidhar K, McGahan JP, Early HM, Corwin M, Fananapazir G, Gerscovich EO. Renal Cell Carcinomas: Sonographic Appearance Depending on Size and Histologic Type. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. 35 (2): 311-20. doi:10.7863/ultra.15.03051 - Pubmed
11. Karami S, Yanik E, Moore L et al. Risk of Renal Cell Carcinoma Among Kidney Transplant Recipients in the United States. Am J Transplant. 2016;16(12):3479-89. doi:10.1111/ajt.13862 - Pubmed

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