Difference between revisions of "Unclassified renal cell carcinoma"

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#redirect [[Kidney_tumours#Unclassified_renal_cell_carcinoma]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Unclassified_renal_cell_carcinoma_-_thyroid-like_and_clear_cell-like_--_low_mag.jpg
| Width      =
| Caption    = Unclassified renal cell carcinoma with thyroid-like and clear cell-like areas. [[H&E stain]].
| Synonyms  =
| Micro      = One of the following: (1) a combination of other RCC histologic types, (2) "non-identifiable" pattern/unrecognizable cell type (3) pure [[sarcomatoid RCC]] without an identifiable (epithelioid) RCC subtype
| Subtypes  =
| LMDDx      = [[clear cell renal cell carcinoma]], [[collecting duct carcinoma]], undifferentiated carcinoma extending into kidney, [[kidney metastasis]], retroperitoneal [[sarcoma]], newly described renal tumour or emerging entity - see ''[[Vancouver classification]]'', [[collision tumour]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      = kidney mass
| Grossing  = [[partial nephrectomy grossing]], [[total nephrectomy for tumour grossing]]
| Staging    = [[kidney cancer staging]]
| Site      = [[kidney]] - see ''[[kidney tumours]]''
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = poor
| Other      =
| ClinDDx    = other renal tumours
| Tx        = excision if feasible
}}
'''Unclassified renal cell carcinoma''', abbreviated '''URCC''', is a [[malignant]] epithelial tumour arising from the [[kidney]] parenchyma, i.e. a [[renal cell carcinoma]], that cannot be further classified.


==General==
*Uncommon.
*A [[WHO]] classification ''diagnosis of exclusion''.
*Worse prognosis than [[clear cell renal cell carcinoma]].<ref name=pmid17822461>{{Cite journal  | last1 = Karakiewicz | first1 = PI. | last2 = Hutterer | first2 = GC. | last3 = Trinh | first3 = QD. | last4 = Pantuck | first4 = AJ. | last5 = Klatte | first5 = T. | last6 = Lam | first6 = JS. | last7 = Guille | first7 = F. | last8 = de La Taille | first8 = A. | last9 = Novara | first9 = G. | title = Unclassified renal cell carcinoma: an analysis of 85 cases. | journal = BJU Int | volume = 100 | issue = 4 | pages = 802-8 | month = Oct | year = 2007 | doi = 10.1111/j.1464-410X.2007.07148.x | PMID = 17822461 }}</ref>
*High variation in the prevalence (when comparing institutions); this suggests a lack of uniformity in the diagnosis of this subtype.<ref name=pmid17822461/>
==Gross==
*Mass lesion arising from the kidney - solid and/or cystic.
**Confined to kidney or predominantly within the kidney.
==Microscopic==
Features:
*Malignant tumour that is one of the following:<ref name=Ref_WMSP293>{{Ref WMSP|293}}</ref><ref name=pmid22404824>{{Cite journal  | last1 = Lopez-Beltran | first1 = A. | last2 = Kirkali | first2 = Z. | last3 = Montironi | first3 = R. | last4 = Blanca | first4 = A. | last5 = Algaba | first5 = F. | last6 = Scarpelli | first6 = M. | last7 = Yorukoglu | first7 = K. | last8 = Hartmann | first8 = A. | last9 = Cheng | first9 = L. | title = Unclassified renal cell carcinoma: a report of 56 cases. | journal = BJU Int | volume = 110 | issue = 6 | pages = 786-93 | month = Sep | year = 2012 | doi = 10.1111/j.1464-410X.2012.10934.x | PMID = 22404824 }}</ref>
*#A combination of other RCC histologic types (~35% of cases of URCC).
*#Has a "non-identifiable" pattern/unrecognizable cell type (~60% of cases of URCC).
*#Pure [[sarcomatoid RCC]] without an identifiable (epithelioid) RCC subtype (~5% of cases of URCC).<ref name=pmid22404824/>
DDx:
*[[Clear cell renal cell carcinoma]].
*[[Collecting duct carcinoma]].
*Undifferentiated carcinoma.
*[[Kidney metastasis]] - typically metastatic carcinoma.
*Retroperitoneal [[sarcoma]], e.g. [[pleomorphic undifferentiated sarcoma]].
*Newly described renal tumour or emerging entity - see ''[[Vancouver classification]]''.
*[[Collision tumour]], e.g. [[urothelial carcinoma]] and identifiable [[renal cell carcinoma]].
===Images===
====Case 1====
<gallery>
Image: Unclassified renal cell carcinoma - thyroid-like with myomatous stroma -- low mag.jpg | URCC - low mag.
Image: Unclassified renal cell carcinoma - thyroid-like -- intermed mag.jpg | URCC - intermed. mag.
Image: Unclassified renal cell carcinoma - thyroid-like -- high mag.jpg | URCC - high mag.
Image: Unclassified renal cell carcinoma - thyroid-like and clear cell-like -- low mag.jpg | URCC - low mag.
Image: Unclassified renal cell carcinoma - thyroid-like and clear cell-like -- intermed mag.jpg | URCC - intermed. mag.
Image: Unclassified renal cell carcinoma - thyroid-like and clear cell-like - alt -- intermed mag.jpg | URCC - intermed. mag.
Image: Unclassified renal cell carcinoma - mixed clear cell and thyroid-like  -- low mag.jpg | URCC - low mag.
Image: Unclassified renal cell carcinoma - mixed clear cell and thyroid-like -- intermed mag.jpg | URCC - intermed. mag.
Image: Unclassified renal cell carcinoma - mixed clear cell and thyroid-like -- high mag.jpg | URCC - high mag.
</gallery>
====Case 2====
<gallery>
Image: Unclassified renal cell carcinoma in BHD -- low mag.jpg | URCC in [[BHD]] - low mag.
Image: Unclassified renal cell carcinoma in BHD -- intermed mag.jpg | URCC in [[BHD]] - intermed. mag.
Image: Unclassified renal cell carcinoma in BHD -- high mag.jpg | URCC in BHD - high mag.
Image: Unclassified renal cell carcinoma in BHD -- very high mag.jpg | URCC in BHD - very high mag.
Image: Unclassified renal cell carcinoma in BHD - b -- intermed mag.jpg | URCC in BHD - intermed. mag.
Image: Unclassified renal cell carcinoma in BHD - b -- high mag.jpg | URCC in BHD - high mag.
Image: Unclassified renal cell carcinoma in BHD - b -- very high mag.jpg | URCC in BHD - very high mag.
</gallery>
==IHC==
*Pankeratin +ve.
*[[PAX8]] +ve.
*Vimentin +ve/-ve.
*p63 -ve.<ref>{{Cite journal  | last1 = Carvalho | first1 = JC. | last2 = Thomas | first2 = DG. | last3 = McHugh | first3 = JB. | last4 = Shah | first4 = RB. | last5 = Kunju | first5 = LP. | title = p63, CK7, PAX8 and INI-1: an optimal immunohistochemical panel to distinguish poorly differentiated urothelial cell carcinoma from high-grade tumours of the renal collecting system. | journal = Histopathology | volume = 60 | issue = 4 | pages = 597-608 | month = Mar | year = 2012 | doi = 10.1111/j.1365-2559.2011.04093.x | PMID = 22260386 }}</ref>
**Usually +ve in [[UCC]].
==See also==
*[[Kidney tumours]].
==References==
{{Reflist|2}}
[[Category:Kidney tumours]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]

Latest revision as of 20:55, 5 May 2016

Unclassified renal cell carcinoma
Diagnosis in short

Unclassified renal cell carcinoma with thyroid-like and clear cell-like areas. H&E stain.
LM One of the following: (1) a combination of other RCC histologic types, (2) "non-identifiable" pattern/unrecognizable cell type (3) pure sarcomatoid RCC without an identifiable (epithelioid) RCC subtype
LM DDx clear cell renal cell carcinoma, collecting duct carcinoma, undifferentiated carcinoma extending into kidney, kidney metastasis, retroperitoneal sarcoma, newly described renal tumour or emerging entity - see Vancouver classification, collision tumour
Gross kidney mass
Grossing notes partial nephrectomy grossing, total nephrectomy for tumour grossing
Staging kidney cancer staging
Site kidney - see kidney tumours
Prevalence uncommon
Prognosis poor
Clin. DDx other renal tumours
Treatment excision if feasible

Unclassified renal cell carcinoma, abbreviated URCC, is a malignant epithelial tumour arising from the kidney parenchyma, i.e. a renal cell carcinoma, that cannot be further classified.

General

  • Uncommon.
  • A WHO classification diagnosis of exclusion.
  • Worse prognosis than clear cell renal cell carcinoma.[1]
  • High variation in the prevalence (when comparing institutions); this suggests a lack of uniformity in the diagnosis of this subtype.[1]

Gross

  • Mass lesion arising from the kidney - solid and/or cystic.
    • Confined to kidney or predominantly within the kidney.

Microscopic

Features:

  • Malignant tumour that is one of the following:[2][3]
    1. A combination of other RCC histologic types (~35% of cases of URCC).
    2. Has a "non-identifiable" pattern/unrecognizable cell type (~60% of cases of URCC).
    3. Pure sarcomatoid RCC without an identifiable (epithelioid) RCC subtype (~5% of cases of URCC).[3]

DDx:

Images

Case 1

  • URCC - low mag.

  • URCC - intermed. mag.

  • URCC - high mag.

  • URCC - low mag.

  • URCC - intermed. mag.

  • URCC - intermed. mag.

  • URCC - low mag.

  • URCC - intermed. mag.

  • URCC - high mag.

Case 2

  • URCC in BHD - low mag.

  • URCC in BHD - intermed. mag.

  • URCC in BHD - high mag.

  • URCC in BHD - very high mag.

  • URCC in BHD - intermed. mag.

  • URCC in BHD - high mag.

  • URCC in BHD - very high mag.

IHC

  • Pankeratin +ve.
  • PAX8 +ve.
  • Vimentin +ve/-ve.
  • p63 -ve.[4]
    • Usually +ve in UCC.

See also

References

  1. ↑ 1.0 1.1 Karakiewicz, PI.; Hutterer, GC.; Trinh, QD.; Pantuck, AJ.; Klatte, T.; Lam, JS.; Guille, F.; de La Taille, A. et al. (Oct 2007). "Unclassified renal cell carcinoma: an analysis of 85 cases.". BJU Int 100 (4): 802-8. doi:10.1111/j.1464-410X.2007.07148.x. PMID 17822461.
  2. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 293. ISBN 978-0781765275.
  3. ↑ 3.0 3.1 Lopez-Beltran, A.; Kirkali, Z.; Montironi, R.; Blanca, A.; Algaba, F.; Scarpelli, M.; Yorukoglu, K.; Hartmann, A. et al. (Sep 2012). "Unclassified renal cell carcinoma: a report of 56 cases.". BJU Int 110 (6): 786-93. doi:10.1111/j.1464-410X.2012.10934.x. PMID 22404824.
  4. ↑ Carvalho, JC.; Thomas, DG.; McHugh, JB.; Shah, RB.; Kunju, LP. (Mar 2012). "p63, CK7, PAX8 and INI-1: an optimal immunohistochemical panel to distinguish poorly differentiated urothelial cell carcinoma from high-grade tumours of the renal collecting system.". Histopathology 60 (4): 597-608. doi:10.1111/j.1365-2559.2011.04093.x. PMID 22260386.
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