A 60-year-old man presented with abdominal fullness and weight loss. Imaging showed an 11cm right renal mass invading the renal vein. He underwent right nephrectomy. The diagnosis was clear cell renal cell carcinoma (RCC), the most common type. Grossly, RCCs are variegated masses that distort the kidney. Microscopically, they show nests of cells with clear cytoplasm. Prognosis depends on stage - 5-year survival is over 90% for stage I but only 10% for stage IV with distant metastasis.

1. RENAL CELL CARCINOMA
AJM

2. A 60 yr old man presents with a feeling of
fullness in his abdomen and 5kg weight loss
over the past 6 months. Physical examination in
entirely normal. Lab studies show Hb is 8.2g/dl,
haematocrit is 24% and MCV is 70, Urine
analysis shows haematuria(+++), but no protein,
glucose or leucocytes. An abdominal CT scan
shows a 11cm mass at the upper pole of the
right Kidney. Right nephrectomy was performed
and upon gross examination renal vein is seen
distended by the tumor

4. 1. What is your diagnosis?
2. What are the Clinical manifestations of
the disease?.
3. What are the gross and microscopic
features?.
4. What is the prognosis .

5. WHAT IS THE DIAGNOSIS?
Renal Cell Carcinoma(RCC). The diagnosis was
based on the
– Age of the patient
– Chronic nature of his complaints
– Massive haematuria
– The detection of the mass on Abdominal CT
examination
– Invasion of the renal vein*
– Significant weight loss*

6. • Classification of renal cell carcinoma is
based on cytogenetic, genetic and
histological features.
• The major types of tumors are
1. CLEAR CELL CARCINOMA
2. PAPILLARY CARCINOMA
3. CHROMOPHOBE RENAL CARCINOMA
4. COLLECTING DUCT CARCINOMA

7. CLEAR CELL CARCINOMA
• Most common
• Loss of sequences on short arm of chromosome
3 (3p12 to 3p26).
• This region harbors the VHL gene(3p25.3), which
acts as a tumor suppressor gene in familial and
sporadic forms.
• It codes for pVHL which plays a role in
ubiquination of proteins, and hence protein
degradation.

8. • HIF-1 is an important target of pVHL, when it is
mutated high levels of HIF-1 are maintained.
• Insulin like growth factor another target of
pVHL is also upregulated.

9. WHAT ARE THE GROSS AND
MORPHOLOGICAL FEATURES?

10. MORPHOLOGY:
1. Arise from proximal tubular
epithelium.
2. Solitary unilateral lesions.
3. Well defined margins and confined
to the renal capsule
4. Spherical masses
5. Variegated areas that distorts the
renal outline.
6. Large areas of *ischemic, *opaque,
gray-white necrosis, *foci of
haemorrhagic discolouration and
*areas of softening.

11. MICROSCOPY:
1.Nests cells are seen. Nonpapillary pattern is
seen
2.Cells are rounded or polygonal shape
3.Abundant clear or granular
cytoplasm(vacuolated).
4.Tumors have delicate branching fibro vascular
septae
5.Well differentiated ,but some show marked
nuclear atypia.

13. PAPILLARY CARCINOMA
• Papillary growth pattern
• Occurs in both familial and sporadic forms.
• Unlike clear cell carcinomas, papillary
carcinomas are multifocal in origin.

14. MORPHOLOGY:
1. They are thought to arise
from the DCT’s,
2. Multifocal and B/L.
3. They are typically
haemorrhagic and cystic,
especially when large.
4. Fungate through the
walls of the collecting
tubules to enter the
ureter.
5. Invade the renal veins.

17. WHAT ARE THE CLINICAL
FEATURES?
* In 10% of cases a triad of
1. COSTOVERTEBRAL PAIN
2. A PALPABLE MASS
3. HAEMTURIA
are seen.
• The are generalised symptoms of fever
malaise, weakness and weight loss.

18. • More than 10 cm in diameter when it is
clinically detected.
• RCC gives several false localising symptoms.
• RCC can give rise to several paraneoplastic
entities.
• Metastasize widely before giving rise to any
local symptoms or signs.

19. The common sites of metastasis are
Lungs > Bones > LN’s > Liver > Adrenals > Brain

20. STAGING AND PROGNOSIS
• Stage I: <7cms – Confined to the kidney.
• Stage II: >=7cms – Conifined to the kidney.
• Stage III: Tumors extend through the renal
capsule but are confined to Gerotas fascia
(IIIa).
• Stage IV: Invaded adjacent organs(excluding
kidney) or multile LN’s or distant metastasis

21. • The 5-year survival rate varies by stage:
– >90%- Stage I
– 85% - Stage II
– 60% - Stage III
– 10% - Stage IV