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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