77-year-old male with bladder cancer and right renal tumor. Right radical nephrectomy is performed.
Micro: Sections through the large central tumor show invasive transitional cell carcinoma with extensive desmoplastic stromal reaction and areas of tumor necrosis. The tumor cells are hyperchromatic with high N/C ratio, smudged chromatin, and pink cytoplasm. Scattered giant tumor cells and frequent mitotic figures are identified. Perineural tumor invasion is focally observed. The tumor invades through the renal capsule and surrounding perirenal adipose tissue. The Gerota's fascia is not involved by the tumor. Two hilar lymph nodes are replaced by metastatic transitional cell carcinoma. The metastatic tumor cells share the similar morphology as the primary tumor. Lymphovascular tumor invasion is noted. The renal vein resection margin and the ureteral resection margin are focally involved by the invasive transitional cell carcinoma. Two hilar lymph nodes replaced by metastatic transitional cell carcinoma (2/2). H & E stain.
- Case Overview
- Diagnosis
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Middle-aged man with metastatic lung lesions and a large kidney mass.
Procedure: Radical nephrectomy.
Gross: see photos.
Micro: see photos (10X to 40X) H&E stain
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Hi...
Radiofrequency ablation is increasingly recognized as a treatment for uterine fibroids, but almost 20 years since he started in oncology with liver tumors. Logic suggested that it may also work in renal cell carcinoma, the most common type of kidney tumor.
Thanks.
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The gross photo is also cited in the paper of Faceless kidney (http://radiopaedia.org/articles/faceless-kidney) in Radiopaedia.org.
The gross photos are used in Radiopaedia.org (http://Radiopaedia.org/), It can be found in the case titled Transitional cell carcinoma of the renal pelvis - gross pathology
I think it should be noted that besides classic transitional cell histology it has squamous and micropapillary variants admixture
Great case! Excellent summary for teaching.
the tumor is T4N2M1, stage IV.
thank you for sharing a good case
TUMOR SUMMARY:
1. Procedure - Right radical nephrectomy.
2. Tumor site - Central portion of the kidney, mainly involving the renal pelvis and calyces.
3. Tumor size - 7 x 6 x 4 cm.
4. Gross extent of tumor - Tumor invades the perirenal adipose tissue, but not beyond the Gerota's fascia.
5. Histologic type - Transitional cell carcinoma.
6. Histologic grade - G2, moderately differentiated.
7. Microscopic extent of tumor - Tumor invades through the renal capsule to the perirenal
adipose tissue, and about 0.4 cm. away from the Gerota's fascia.
8. Margins - Positive (mainly in renal vein).
9. Blood/lymphatic invasion - Positive.
10. Adrenal gland - Not identified.
11. Regional lymph nodes - Positive (2/2).
12. Non-tumor renal tissue - Patchy mild interstitial chronic inflammation.
13. AJCC pathologic stage - T3,N2, MX, Stage IV.