Renal Cell Carcinoma Associated with End Stage Renal Disease
Definition
- Two types of distinctive renal cell carcinomas associated with end stage renal disease
Diagnostic Criteria
- Classical types of renal cell tumors can occur with end stage renal disease (ESRD)
- Clear cell, papillary, chromophobe carcinomas
- Collecting duct, tubulocystic, translocation carcinomas
- Oncocytoma, angiomyolipoma also reported
- More common are two distinctive patterns:
- Aquired cystic disease associated renal cell carcinoma
- Surrounded by pseudocapsule with frequent dystrophic calcification
- Frequently can be seen to arise in and fill a cyst
- Solid or acinar patterns, may be micro or macrocystic
- Papillary foci may be present
- Abundant to voluminous granular eosinophilic cytoplasm, occasionally focally clear
- Microcribriform appearance due to frequent intracytoplasmic and intercellular microlumens
- Large nuclei with prominent nucleoli, Fuhrman grade 3
- Frequent oxalate crystals and calcifications
- Occurs only in patients with ESRD with cystic disease
- Clear cell tubulopapillary renal cell carcinoma of end stage kidneys
- Predominantly tubulopapillary pattern
- Frequently cystic
- Clear cytoplasm
- Cytologically low grade, Fuhrman 1 or 2
- Frequently apically polarized nuclei
- Separated from base by clear cytoplasm
- Reminiscent of early secretory endometrium
- Separated from base by clear cytoplasm
- Primarily occurs in ESRD but rarely same tumor appears sporadically (Aydin)
- Incidence of carcinoma in ESRD is elevated 100x compared to general population
- Especially elevated with aquired cystic disease
- Also elevated in familial polycystic disease
- Less frequently seen in ESRD in the absence of cystic disease, but does happen
- Especially elevated with aquired cystic disease
John P Higgins MD
Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342
Last update: 6/2/15
