Abstract
Renal cell carcinoma (RCC), which arises from the renal tubular epithelial cells, accounts for more than 90% of primary renal tumors in adults. This article reviews the current literature on RCC, including the new histologic subtypes that were included in the latest World Health Organization classification. It also reviews the conventional histopathologic prognostic parameters, potential prognostic biomarkers, and molecular profiling of RCC. Evolving understanding of genetics, coupled with morphologic and immunophenotypic characteristics, should enable more precise categorization of RCCs for diagnosis and clinical behavior and, hence, better stratification of patients for the most beneficial treatment.
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References and Recommended Reading
Eble JN, Sauter G, Epstein JI, Sesterhenn IA: Pathology and Genetics, Tumors of the Urinary System and Male Genital Organs. Lyon: IAPC Press; 2004:9–88.
Suzigan S, López-Beltrán A, Montironi R, et al.: Multilocular cystic renal cell carcinoma: a report of 45 cases of a kidney tumor of low malignant potential. Am J Clin Pathol 2006, 125:217–222.
Antonelli A, Portesi E, Cozzoli A, et al.: The collecting duct carcinoma of the kidney: a cytogenetical study. Eur Urol 2003, 43:680–685.
Karakiewicz PI, Trinh QD, Rioux-Leclercq N, et al.: Collecting duct renal cell carcinoma: a matched analysis of 41 cases. Eur Urol 2007, 52:1140–1145.
Tokuda N, Naito S, Matsuzaki O, et al.: Collecting duct (Bellini duct) renal cell carcinoma: a nationwide survey in Japan. J Urol 2006, 176:40–43; discussion 43.
Watanabe IC, Billis A, Guimarães MS, et al.: Renal medullary carcinoma: report of seven cases from Brazil. Mod Pathol 2007, 20:914–920.
Bell MD: Response to paclitaxel, gemictabine, and cisplatin in renal medullary carcinoma. Pediatr Blood Cancer 2006, 47:228.
Strouse JJ, Spevak M, Mack AK, et al.: Significant responses to platinum-based chemotherapy in renal medullary carcinoma. Pediatr Blood Cancer 2005, 44:407–411.
Ferlicot S, Alorry Y, Compérat E, et al.: Mucinous tubular and spindle cell carcinoma: a report of 15 cases and a review of the literature. Virchows Arch 2005, 447:978–983.
Kuroda N, Toi M, Hiroi M, et al.: Review of mucinous tubular and spindle-cell carcinoma of the kidney with a focus on clinical and pathobiological aspects. Histol Histopathol 2005, 20:221–224.
Fine SW, Argani P, DeMarzo AM, et al.: Expanding the histologic spectrum of mucinous tubular and spindle cell carcinoma of the kidney. Am J Surg Pathol 2006, 30:1554–1560.
Paner GP, Srigley JR, Radhakrishnan A, et al.: Immunohistochemical analysis of mucinous tubular and spindle cell carcinoma and papillary renal cell carcinoma of the kidney: significant immunophenotypic overlap warrants diagnostic caution. Am J Surg Pathol 2006, 30:13–19.
Brandal P, Lie AK, Bassarova A, et al.: Genomic aberrations in mucinous tubular and spindle cell renal cell carcinomas. Mod Pathol 2006, 19:186–194.
Cossu-Rocca P, Eble JN, Delahunt B, et al.: Renal mucinous tubular and spindle carcinoma lacks the gains of chromosomes 7 and 17 and losses of chromosome Y that are prevalent in papillary renal cell carcinoma. Mod Pathol 2006, 19:488–493.
Argani P, Ladanyi M: Translocation carcinomas of the kidney. Clin Lab Med 2005, 25:363–378.
Argani P, Antonescu CR, Illei PB, et al.: Primary renal neoplasms with the ASPL-TFE3 gene fusion of alveolar soft part sarcoma: a distinctive tumor entity previously included among renal cell carcinomas of children and adolescents. Am J Pathol 2001, 159:179–192.
Argani P, Olgac S, Tickoo SK, et al.: Xp11 translocation renal cell carcinoma in adults: expanded clinical, pathologic, and genetic spectrum. Am J Surg Pathol 2007, 31:1149–1160.
Meyer PN, Clark JI, Flanigan RC, Picken MM: Xp11.2 translocation renal cell carcinoma with very aggressive course in five adults. Am J Clin Pathol 2007, 128:70–79.
Merino MJ, Torres-Cabala C, Pinto P, Linehan WM: The morphologic spectrum of kidney tumors in hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome. Am J Surg Pathol 2007, 31:1578–1585.
Cohen D, Zhou M: Molecular genetics of familial renal cell carcinoma syndromes. Clin Lab Med 2005, 25:259–277.
Schmidt L, Duh FM, Chen F, et al.: Germline and somatic mutations in the tyrosine kinase domain of the MET proto-oncogene in papillary renal carcinomas. Nat Genet 1997, 16:68–73.
Launonen V, Vierimaa O, Kiuru M, et al.: Inherited susceptibility to uterine leiomyomas and renal cell cancer. Proc Natl Acad Sci U S A 2001, 98:3387–3392.
Murakami T, Sano F, Huang Y, et al.: Identification and characterization of Birt-Hogg-Dube associated renal carcinoma. J Pathol 2007, 211:524–531.
Greene FL, Page DL, Fleming ID, et al.: AJCC Cancer Staging Handbook, 6th edn. New York: Springer; 2002.
Leibovich BC, Cheville JC, Lohse CM, et al.: A scoring algorithm to predict survival for patients with metastatic clear cell renal cell carcinoma: a stratification tool for prospective clinical trials. J Urol 2005, 174:1759–1763; discussion 1763.
Patard JJ, Leray E, Rioux-Leclercq N, et al.: Prognostic value of histologic subtypes in renal cell carcinoma: a multicenter experience. J Clin Oncol 2005, 23:2763–2771.
Sorbellini M, Kattan MW, Synder ME, et al.: A postoperative prognostic nomogram predicting recurrence for patients with conventional clear cell renal cell carcinoma. J Urol 2005, 173:48–51.
Frank I, Blute ML, Leibovich BC, et al.: Independent validation of the 2002 American Joint Committee on cancer primary tumor classification for renal cell carcinoma using a large, single institution cohort. J Urol 2005, 173:1889–1892.
Hafez KS, Fergany AF, Novick AC: Nephron sparing surgery for localized renal cell carcinoma: impact of tumor size on patient survival, tumor recurrence and TNM staging. J Urol 1999, 162:1930–1933.
Ficarra V, Guillè F, Schips L, et al.: Proposal for revision of the TNM classification system for renal cell carcinoma. Cancer 2005, 104:2116–21123.
Leibovich BC, Blute ML, Cheville JC, et al.: Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy. J Urol 2004, 171:1066–1070.
Patard JJ, Shvarts O, Lam JS, et al.: Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol 2004, 171(Pt 1):2181–2185; quiz 2435.
Elmore JM, Kadesky KT, Koeneman KS, Sagalowsky AI: Reassessment of the 1997 TNM classification system for renal cell carcinoma. Cancer 2003, 98:2329–2334.
Klatte T, Pattard JJ, Goel RH, et al.: Prognostic impact of tumor size on pT2 renal cell carcinoma: an international multicenter experience. J Urol 2007, 178:35–40; discussion 40.
Gilbert SM, Murphy AM, Katz AE, et al.: Reevaluation of TNM staging of renal cortical tumors: recurrence and survival for T1N0M0 and T3aN0M0 tumors are equivalent. Urology 2006, 68:287–291.
Gofrit ON, Shapiro A, Pizov G, et al.: Does stage T3a renal cell carcinoma embrace a homogeneous group of patients? J Urol 2007, 177:1682–1686.
Jeong IG, Jeong CW, Hong SK, et al.: Prognostic implication of capsular invasion without perinephric fat infiltration in localized renal cell carcinoma. Urology 2006, 67:709–712.
Klatte T, Chung J, Leppert JT, et al.: Prognostic relevance of capsular involvement and collecting system invasion in stage I and II renal cell carcinoma. BJU Int 2007, 99:821–824.
Thomas DH, Verghese A, Kynaston HG, Griffiths DH: Analysis of the prognostic implications of different tumour margin types in renal cell carcinoma. Histopathology 2003, 43:374–380.
Thompson RH, Leibovich BC, Cheville JC, et al.: Is renal sinus fat invasion the same as perinephric fat invasion for pT3a renal cell carcinoma? J Urol 2005, 174(Pt 1):1218–1221.
Margulis V, Tamboli P, Matin SF, et al.: Location of extrarenal tumor extension does not impact survival of patients with pT3a renal cell carcinoma. J Urol 2007, 178:1878–1882.
Bonsib SM: The renal sinus is the principal invasive pathway: a prospective study of 100 renal cell carcinomas. Am J Surg Pathol 2004, 28:1594–1600.
Bonsib SM: T2 clear cell renal cell carcinoma is a rare entity: a study of 120 clear cell renal cell carcinomas. J Urol 2005, 174(Pt 1):1199–1202; discussion 1202.
Ficarra V, Novara G, Iafrate M, et al.: Proposal for reclassification of the TNM staging system in patients with locally advanced (pT3-4) renal cell carcinoma according to the cancer-related outcome. Eur Urol 2007, 51:722–729; discussion 729–731.
Thompson RH, Leibovich BC, Cheville JC, et al.: Should direct ipsilateral adrenal invasion from renal cell carcinoma be classified as pT3a? J Urol 2005, 173:918–921.
Klatte T, Pantuck AJ, Riggs SB, et al.: Prognostic factors for renal cell carcinoma with tumor thrombus extension. J Urol 2007, 178(Pt 1):1189–1195; discussion 1195.
Moinzadeh A, Libertino JA: Prognostic significance of tumor thrombus level in patients with renal cell carcinoma and venous tumor thrombus extension. Is all T3b the same? J Urol 2004, 171(Pt 1):598–601.
Haferkamp A, Bastian PJ, Jakobi H, et al.: Renal cell carcinoma with tumor thrombus extension into the vena cava: prospective long-term followup. J Urol 2007, 177:1703–1708.
Thompson RH, Cheville JC, Lohse CM, et al.: Reclassification of patients with pT3 and pT4 renal cell carcinoma improves prognostic accuracy. Cancer 2005, 104:53–60.
Terrone C, Cracco C, Porpiglia F, et al.: Reassessing the current TNM lymph node staging for renal cell carcinoma. Eur Urol 2006, 49:324–331.
Cheville JC, Lohse CM, Zincke H, et al.: Comparisons of outcome and prognostic features among histologic subtypes of renal cell carcinoma. Am J Surg Pathol 2003, 27:612–624.
Upton MP, Parker RA, Youmans A, et al.: Histologic predictors of renal cell carcinoma response to interleukin-2-based therapy. J Immunother (1197) 2005, 28:488–495.
Novara G, Martignoni G, Artibani W, Ficarra V: Grading systems in renal cell carcinoma. J Urol 2007, 177:430–436.
Rioux-Leclercq N, Karakiewcz PI, Trinh QD, et al.: Prognostic ability of simplified nuclear grading of renal cell carcinoma. Cancer 2007, 109:868–874.
Lang H, Lindner V, de Fromont M, et al.: Multicenter determination of optimal interobserver agreement using the Fuhrman grading system for renal cell carcinoma: Assessment of 241 patients with > 15-year follow-up. Cancer 2005, 103:625–629.
Sika-Paotonu D, Bethwaite PB, McCredie MR, et al.: Nucleolar grade but not Fuhrman grade is applicable to papillary renal cell carcinoma. Am J Surg Pathol 2006, 30:1091–1096.
Delahunt B, Sika-Paotonu D, Bethwaite PB, et al.: Fuhrman grading is not appropriate for chromophobe renal cell carcinoma. Am J Surg Pathol 2007, 31:957–960.
de Peralta-Venturina M, Moch H, Amin M, et al.: Sarcomatoid differentiation in renal cell carcinoma: a study of 101 cases. Am J Surg Pathol 2001, 25:275–284.
Cheville JC, Lohse CM, Zincke H, et al.: Sarcomatoid renal cell carcinoma: an examination of underlying histologic subtype and an analysis of associations with patient outcome. Am J Surg Pathol 2004, 28:435–441.
Gökden N, Nappi O, Swanson PE, et al.: Renal cell carcinoma with rhabdoid features. Am J Surg Pathol 2000, 24:1329–1338.
Leroy X, Zini L, Buob D, et al.: Renal cell carcinoma with rhabdoid features: an aggressive neoplasm with overexpression of p53. Arch Pathol Lab Med 2007, 131:102–106.
Lam JS, Shvarts O, Said JW, et al.: Clinicopathologic and molecular correlations of necrosis in the primary tumor of patients with renal cell carcinoma. Cancer 2005, 103:2517–2525.
Lee SE, Byun SS, Oh JK, et al.: Significance of macroscopic tumor necrosis as a prognostic indicator for renal cell carcinoma. J Urol 2006, 176(Pt 1):1332–1337; discussion 1337–1338.
Frank I, Blute ML, Cheville JC, et al.: An outcome prediction model for patients with clear cell renal cell carcinoma treated with radical nephrectomy based on tumor stage, size, grade and necrosis: the SSIGN score. J Urol 2002, 168:2395–2400.
Uzzo RG, Cherullo EE, Myles J, Novick AC: Renal cell carcinoma invading the urinary collecting system: implications for staging. J Urol 2002, 167:2392–2396.
Palapattu GS, Pantuck AJ, Dorey F, et al.: Collecting system invasion in renal cell carcinoma: impact on prognosis and future staging strategies. J Urol 2003, 170:768–772; discussion 772.
Terrone C, Cracco C, Guercio S, et al.: Prognostic value of the involvement of the urinary collecting system in renal cell carcinoma. Eur Urol 2004, 46:472–476.
Antunes AA, Srougi M, Dall’Oglio MF, et al.: Microvascular invasion is an independent prognostic factor in patients with prostate cancer treated with radical prostatectomy. Int Braz J Urol 2006, 32:668–675; discussion 675–677.
Madbouly K, Al-Qahtani SM, Ghazwani Y, et al.: Microvascular tumor invasion: prognostic significance in low-stage renal cell carcinoma. Urology 2007, 69:670–674.
Castilla EA, Liou LS, Abrahams NA, et al.: Prognostic importance of resection margin width after nephron-sparing surgery for renal cell carcinoma. Urology 2002, 60:993–997.
Sutherland SE, Resnick MI, Maclennan GT, Goldman HB: Does the size of the surgical margin in partial nephrectomy for renal cell cancer really matter? J Urol 2002, 167:61–64.
Timsit MO, Bazin JP, Thiounn N, et al.: Prospective study of safety margins in partial nephrectomy: intraoperative assessment and contribution of frozen section analysis. Urology 2006, 67:923–926.
Jiang Z: Prognostic biomarkers in renal cell carcinoma. Exp Rev Mol Diagn 2007, 7:293–307.
Bui MH, Seligson D, Han KR, et al.: Carbonic anhydrase IX is an independent predictor of survival in advanced renal clear cell carcinoma: implications for prognosis and therapy. Clin Cancer Res 2003, 9:802–811.
Atkins M, Regan M, McDermott D, et al.: Carbonic anhydrase IX expression predicts outcome of interleukin 2 therapy for renal cancer. Clin Cancer Res 2005, 11:3714–3721.
Leibovich BC, Sheinin Y, Lohse CM, et al.: Carbonic anhydrase IX is not an independent predictor of outcome for patients with clear cell renal cell carcinoma. J Clin Oncol 2007, 25:4757–4764.
Flies DB, Chen L: The new B7s: playing a pivotal role in tumor immunity. J Immunother (1997) 2007, 30:251–260.
Thompson RH, Kuntz SM, Leibovich BC, et al.: Tumor B7-H1 is associated with poor prognosis in renal cell carcinoma patients with long-term follow-up. Cancer Res 2006, 66:3381–3385.
Krambeck AE, Thompson RH, Dong H, et al.: B7-H4 expression in renal cell carcinoma and tumor vasculature: associations with cancer progression and survival. Proc Natl Acad Sci U S A 2006, 103:10391–10396.
Jiang Z, Chu PG, Woda BA, et al.: Analysis of RNA-binding protein IMP3 to predict metastasis and prognosis of renal-cell carcinoma: a retrospective study. Lancet Oncol 2006, 7:556–564.
Yin-Goen Q, Dale J, Yang WL, et al.: Advances in molecular classification of renal neoplasms. Histol Histopathol 2006, 21:325–339.
Yang XJ, Hutchinson PL, Johson CH, et al.: Classification of renal neoplasms based on molecular signatures. J Urol 2006, 175:2302–2306.
Furge KA, Lucas KA, Takahashi M, et al.: Robust classification of renal cell carcinoma based on gene expression data and predicted cytogenetic profiles. Cancer Res 2004, 64:4117–4121.
Takahashi M, Rhodes DR, Furge KA, et al.: Gene expression profiling of clear cell renal cell carcinoma: gene identification and prognostic classification. Proc Natl Acad Sci U S A 2001, 98:9754–9759.
Vasselli JR, Shih JH, Iyengar SR, et al.: Predicting survival in patients with metastatic kidney cancer by gene-expression profiling in the primary tumor. Proc Natl Acad Sci U S A 2003, 100:6958–6963.
Furge KA, Tan MH, Dykema K, et al.: Identification of deregulated oncogenic pathways in renal cell carcinoma: an integrated oncogenomic approach based on gene expression profiling. Oncogene 2007, 26:1346–1350.
Chen YT, Fukuhara T, Tanaka M, et al.: Messenger RNA expression ratios among four genes predict subtypes of renal cell carcinoma and distinguish oncocytoma from carcinoma. Clin Cancer Res 2005, 11:58–66.
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Aydin, H., Zhou, M. The changing face of renal cell carcinoma pathology. Curr Oncol Rep 10, 235–244 (2008). https://doi.org/10.1007/s11912-008-0036-5
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DOI: https://doi.org/10.1007/s11912-008-0036-5