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Renal cell carcinoma: histological classification and correlation with imaging findings.

Muglia VF, Prando A - Radiol Bras (2015 May-Jun)

Bottom Line: The histological classification of RCCs is of utmost importance, considering the significant prognostic and therapeutic implications of its histological subtypes.The present study is aimed at reviewing the main clinical and imaging findings of histological RCC subtypes.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Postdoctoral Scholar, Associate Professor at Centro de Ciências das Imagens e Física Médica (CCIFM) - Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil.

ABSTRACT
Renal cell carcinoma (RCC) is the seventh most common histological type of cancer in the Western world and has shown a sustained increase in its prevalence. The histological classification of RCCs is of utmost importance, considering the significant prognostic and therapeutic implications of its histological subtypes. Imaging methods play an outstanding role in the diagnosis, staging and follow-up of RCC. Clear cell, papillary and chromophobe are the most common histological subtypes of RCC, and their preoperative radiological characterization, either followed or not by confirmatory percutaneous biopsy, may be particularly useful in cases of poor surgical condition, metastatic disease, central mass in a solitary kidney, and in patients eligible for molecular targeted therapy. New strategies recently developed for treating renal cancer, such as cryo and radiofrequency ablation, molecularly targeted therapy and active surveillance also require appropriate preoperative characterization of renal masses. Less common histological types, although sharing nonspecific imaging features, may be suspected on the basis of clinical and epidemiological data. The present study is aimed at reviewing the main clinical and imaging findings of histological RCC subtypes.

No MeSH data available.


Related in: MedlinePlus

Clear cell RCC variant. CT, pre-contrast (A), corticomedullary(B) and nephrographic (C) phases. Note the expansileheterogeneous lesion with internal cystic components and peripheral solid areaswith mean density = 83 HU at the pre-contrast phase, with intense contrast uptake,from 162 HU at the corticomedullary phase to 109 HU at the nephrographicphase.
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f02: Clear cell RCC variant. CT, pre-contrast (A), corticomedullary(B) and nephrographic (C) phases. Note the expansileheterogeneous lesion with internal cystic components and peripheral solid areaswith mean density = 83 HU at the pre-contrast phase, with intense contrast uptake,from 162 HU at the corticomedullary phase to 109 HU at the nephrographicphase.

Mentions: This is the most common variant, representing between 70% and 75% of all RCCs(3,7). Most clear cell carcinomas (95%) are sporadic, and the remaining 5%are associated with hereditary syndromes (von Hippel-Lindau disease, tuberoussclerosis). Clear cell RCC originates from the proximal convoluted tubules epithelium(renal cortex) e presents a predominantly expansile growth pattern. Macroscopically, itis a solid, yellowish lesion with variable degrees of internal necrosis, hemorrhage andcystic degeneration. Such findings are most frequently observed in large-volume,fast-growing tumors. Tumor calcifications may also be found. Histologically, suchlesions present clear cells because of their lipid- and glycogen-rich cytoplasmiccontent(4). Frequently, suchtumors also present cell with eosinophil granular cytoplasm. The imaging findings arecompatible with such histopathological features, identifying hypervascularized andheterogeneous lesions due to necrosis, hemorrhage, cysts and calcifications. Necrosis ismore common in larger lesions, generally with dimensions > 4 cm. The rate ofoccurrence and degree of necrosis have also been associated with high-grade tumorhistology(15,16). At computed tomography (CT), such tumors usuallypresent with intense contrast uptake in the corticomedullary phase (120-140 HU) andtypical washout in the nephrographic phase (90-100 HU) (Figure 2).


Renal cell carcinoma: histological classification and correlation with imaging findings.

Muglia VF, Prando A - Radiol Bras (2015 May-Jun)

Clear cell RCC variant. CT, pre-contrast (A), corticomedullary(B) and nephrographic (C) phases. Note the expansileheterogeneous lesion with internal cystic components and peripheral solid areaswith mean density = 83 HU at the pre-contrast phase, with intense contrast uptake,from 162 HU at the corticomedullary phase to 109 HU at the nephrographicphase.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492569&req=5

f02: Clear cell RCC variant. CT, pre-contrast (A), corticomedullary(B) and nephrographic (C) phases. Note the expansileheterogeneous lesion with internal cystic components and peripheral solid areaswith mean density = 83 HU at the pre-contrast phase, with intense contrast uptake,from 162 HU at the corticomedullary phase to 109 HU at the nephrographicphase.
Mentions: This is the most common variant, representing between 70% and 75% of all RCCs(3,7). Most clear cell carcinomas (95%) are sporadic, and the remaining 5%are associated with hereditary syndromes (von Hippel-Lindau disease, tuberoussclerosis). Clear cell RCC originates from the proximal convoluted tubules epithelium(renal cortex) e presents a predominantly expansile growth pattern. Macroscopically, itis a solid, yellowish lesion with variable degrees of internal necrosis, hemorrhage andcystic degeneration. Such findings are most frequently observed in large-volume,fast-growing tumors. Tumor calcifications may also be found. Histologically, suchlesions present clear cells because of their lipid- and glycogen-rich cytoplasmiccontent(4). Frequently, suchtumors also present cell with eosinophil granular cytoplasm. The imaging findings arecompatible with such histopathological features, identifying hypervascularized andheterogeneous lesions due to necrosis, hemorrhage, cysts and calcifications. Necrosis ismore common in larger lesions, generally with dimensions > 4 cm. The rate ofoccurrence and degree of necrosis have also been associated with high-grade tumorhistology(15,16). At computed tomography (CT), such tumors usuallypresent with intense contrast uptake in the corticomedullary phase (120-140 HU) andtypical washout in the nephrographic phase (90-100 HU) (Figure 2).

Bottom Line: The histological classification of RCCs is of utmost importance, considering the significant prognostic and therapeutic implications of its histological subtypes.The present study is aimed at reviewing the main clinical and imaging findings of histological RCC subtypes.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Postdoctoral Scholar, Associate Professor at Centro de Ciências das Imagens e Física Médica (CCIFM) - Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil.

ABSTRACT
Renal cell carcinoma (RCC) is the seventh most common histological type of cancer in the Western world and has shown a sustained increase in its prevalence. The histological classification of RCCs is of utmost importance, considering the significant prognostic and therapeutic implications of its histological subtypes. Imaging methods play an outstanding role in the diagnosis, staging and follow-up of RCC. Clear cell, papillary and chromophobe are the most common histological subtypes of RCC, and their preoperative radiological characterization, either followed or not by confirmatory percutaneous biopsy, may be particularly useful in cases of poor surgical condition, metastatic disease, central mass in a solitary kidney, and in patients eligible for molecular targeted therapy. New strategies recently developed for treating renal cancer, such as cryo and radiofrequency ablation, molecularly targeted therapy and active surveillance also require appropriate preoperative characterization of renal masses. Less common histological types, although sharing nonspecific imaging features, may be suspected on the basis of clinical and epidemiological data. The present study is aimed at reviewing the main clinical and imaging findings of histological RCC subtypes.

No MeSH data available.


Related in: MedlinePlus