Sarcomatoid differentiation may be seen in many types of renal carcinomas
(de Peralta-Venturina; Cheville)
It no longer refers to a type of carcinoma
It is considered an adverse prognostic factor
Prognosis may be worse than simple grade 4 carcinoma
Defined as a spindle cell component measuring at least one low power (40x) field with either
Adjacent carcinoma, or
Evidence of epithelial differentiation in the spindle cells
Spindle cells usually show moderate to marked atypia
Frequent patterns include fibrosarcoma, malignant fibrous histiocytoma, rhabdomyosarcoma
Occasional cases have low grade atypia in spindle component
No clinical significance to type of differentation or degree of atypia
May arise in setting of many types of carcinoma
Clear cell RCC (reported 5-8% incidence of sarcomatoid foci, in our experience it is less frequent)
Papillary RCC (2-3% incidence)
Chromophobe RCC (9% incidence)
Collecting duct carcinoma (39% incidence)
Bibliography (for Grading)
Murphy WM, Grignon DJ, Perlman EJ. Tumors of the Kidney, Bladder and Related Urinary Structures, Atlas of Tumor Pathology, AFIP Fourth Series, Fascicle 1, 2004
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Lohse CM, Blute ML, Zincke H, Weaver AL, Cheville JC. Comparison of standardized and nonstandardized nuclear grade of renal cell carcinoma to predict outcome among 2,042 patients. Am J Clin Pathol. 2002 Dec;118(6):877-86.
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