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Published on: January 22, 2013
Papillary Renal Cell Carcinomas Demonstrating Micropapillary Features: An Investigation Into the Diagnostic and
Beatriz Caraballo1, Maha Abdulla1, Sunder Sham2
1Pathology and Laboratory Medicine, Lenox Hill Hospital, New York City, USA.
Aims:
Papillary renal cell carcinoma (PRCC) with micropapillary carcinoma (MC) has been rarely described. We conducted a retrospective descriptive evaluation of the association of MC with PRCC and the possible prognostic implications.
Methods:
A database search was made at the University of Southern California (USC) and Lenox Hill Hospital (LHH; New York City) in June 2016-June 2019 of PRCC cases with MC. Diagnosis of MC was made using routine histology, based on the presence of small clusters of cells without a vascular core. Features evaluated included: percent of MC, gross appearance, PRCC typing, nuclear grade, lymphovascular invasion, and lymph node metastasis.
Results:
848 RCC cases (690 from USC and 157 from LHH); 70 cases PRCC (54 from USC, 16 from LHH) of these cases, 13 had an MC, 12 were from radical nephrectomy, and 12 cases were male. Mean age was 68.3 years; seven were located in the right kidney. Average tumor size was 8.6 cm. MC ranged from 10% to 80% (average 37.5%), nine cases were PRCC type 2 and four type 1. Nuclear grade: three cases (grade 2), nine cases (grade 3), and one case (grade 4); 11 out of 13 tumors presented with extrarenal extension; nine cases that had lymph nodes submitted had metastatic carcinoma.
Conclusions:
The presence of a micropapillary component in PRCC was found to be 18.5%, and it was predominantly associated with high pathologic stage and lymph node metastases. The clinical course of these tumors seems similar to MC in other tissues/organ systems. We advocate reporting this pattern when identified.
Insights
The micropapillary component in papillary renal cell carcinoma (PRCC) is associated with advanced disease. This finding suggests PRCC with micropapillary carcinoma (MC) warrants careful reporting due to its aggressive nature.
Area of Science:
- Urology
- Oncology
- Pathology
Background:
- Papillary renal cell carcinoma (PRCC) is a subtype of kidney cancer.
- The micropapillary carcinoma (MC) pattern is rarely described in PRCC.
- Understanding MC in PRCC is crucial for accurate diagnosis and prognosis.
Purpose of the Study:
- To evaluate the association of the micropapillary carcinoma (MC) pattern with papillary renal cell carcinoma (PRCC).
- To investigate the prognostic implications of MC in PRCC.
- To describe the clinicopathologic features of PRCC with an MC component.
Main Methods:
- Retrospective analysis of 848 renal cell carcinoma (RCC) cases from two institutions.
- Identification of PRCC cases with a micropapillary carcinoma (MC) component using routine histology.
- Evaluation of features including MC percentage, PRCC typing, nuclear grade, and lymph node metastasis.
Main Results:
- 13 out of 70 PRCC cases exhibited an MC component (18.5%).
- MC in PRCC was associated with high nuclear grade (grade 3-4), extrarenal extension, and lymph node metastasis.
- Tumor size averaged 8.6 cm, with MC comprising an average of 37.5%.
Conclusions:
- The presence of a micropapillary component in PRCC is linked to high pathologic stage and lymph node metastases.
- The clinical behavior of PRCC with MC appears similar to MC in other organs.
- Reporting the micropapillary pattern in PRCC is recommended for clinical management.
