Renal cell carcinoma
Presentation
Flank pain
Patient Data
Age: 55
From the case:
Renal cell carcinoma
Pathology
Left kidney - coronal section
Gross pathology
There is a multi-nodular, yellow/grey, variably congested tumour, 120 mm in maximum dimension, in the upper to mid pole of the kindey. The tumour shows predominantly expansile growth but also shows invasion into sinus fat and prominent renal vein involvement.
The photo shows a left kidney bisected in the coronal plane.
From the case:
Renal cell carcinoma
Pathology
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100x H&E
Clear cell RCC - nucleolar and Fuhrman grade 2
Histological sections confirmed clear cell renal cell carcinoma (RCC) with tumour cells containing abundant, predominantly cleared cytoplasm. Clear cell RCC is graded according to presence/size of nuceoli (nucleolar grading) +/- nuclear morphology (Fuhrman grading), with a final grade based on the highest grade area.
Case Discussion
This is a nice example of clear cell renal cell carcinoma that demonstrates several aspects of the tumour;
- Classical yellow/golden macroscopic appearance.
- Propensity to grow into the renal vein, sometimes extending into the inferior ven cava and right ventricle.
- Cells classically have clear cytoplasm; this is actually a processing artifact secondary to removal of the cytoplasmic lipid during processing.
- Often has marked variation in tumour cell morphology and grade across the tumour; this is attributed to 'clones' of tumour cells arising out the initial tumour clone.
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