acroscopic The left kidney and attached fatty tissue weighed 1240g. On section, much of the kidney tissue is largely replaced by a cystic cream tumour. The tumour shows large areas of necrosis. A wire spiral is inserted in the thrombosed renal artery. Microscopic The sections show large areas of clear cell renal cell carcinoma with smaller foci of granular cell change in the renal cell carcinoma. There are large areas of necrosis present. Some vessels show foam like material related to a previous embolisation procedure. CCA pic comments: Fuhrman nuclear grading system correlated well with survival in patients with renal cell carcinoma. Grade 1 tumors have round, uniform nuclei with inconspicuous or absent nucleoli. fuhrman pic Gross: Usually a solitary, unilateral tumor arising from the cortex and gravitating towards a pole of the kidney. Yellow (due to fat and glycogen in the “clear” cells). The kidney may be cystic, with tumor cells in the cyst walls. The tumor can extend outside the kidney. 2. Histo: CCC consists of nests of neoplastic cells (clear cytoplasm and central nucleus). The cytoplasm is clear due to washed out fat vacuoles and glycogen. Vascular connective tissue between the nests bleeds easily. 3. How: Associated with loss of section of chromosome 3 in 98% of cases, which leads to loss of VHL gene. 4. Clinical: It’s often sporadic and associated with hereditary symptoms. The tumor often grows into the renal vein and IVC, which can cause tumor emboli to travel to the heart. CCA of the kidney Comments: This partial nephrectomy specimen shows the typical yellow-orange gross appearance commonly seen in renal cell carcinoma. However, on gross features alone, its distinction from angiomyolipoma and xanthogranulomatous pyelonephritis may be impossible. (Photo courtesy of: Dr. Kyle Molberg, UT Southwestern Med. Ctr, Dallas) return to Clear Cell Renal Cell Carcinoma cca gross 2 Tn
large renal cell carcinoma shows cyst formation and foci of hemorrhage and necrosis. return to Clear Cell Renal Cell Carcinoma gross 2 uclear contours are more irregular than Grade 1; nuclei are about 15 microns in diameter. Nucleoli may be visible at high magnification. fuhrman grade 2 uclear contours are even more irregular. Nuclear diameters can approach 20 microns. Nucleoli are readily seen. fuhrman grade 3