Renal cell carcinoma classification: Difference between revisions

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Latest revision as of 16:38, 9 October 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Renal cell carcinoma may be classified according to histologic appearance of the tumor into 6 subtypes: conventional (clear cell), papillary, chromophobe, oncocytoma, collecting duct, and unclassified.

Classification

The following table classifies renal cell carcinoma according to histologic appearance and differentiates sporadic from hereditary forms of renal cell carcinoma. Clear type (also called Conventional type) renal cell carcinoma is considered the most common type of renal carcinoma. The most common classification of renal cell carcinoma is based on the histopathological appearance of the tumor. There are currently six subtypes of renal cell carcinoma, most common of which are the conventional (also called clear cell) renal carcinoma, accounting for approximately 75% of all cases.^[1] Renal cell carcinoma may also be clinically classified based on the staging of the tumor, as shown below.

Histologic Appearance

The following table summarizes the incidence of various histological types of renal tumors:

**Heidelberg Classification Renal Cell Carcinoma According to Histological Appearance (1997)^[1]^[2]**
Histologic Appearance	Incidence (%)
Conventional (Clear Cell)	75
Papillary	12
Chromophobe	4
Oncocytoma	4
Collecting Duct	< 1
Unclassified	3 - 5

^{Adapted from Cohen HT, McGovern FJ. Renal-cell carcinoma.N Engl J Med. 2005; 353:2477-90}

More than 70% of renal cell carcinomas are clear cell carcinomas. Papillary carcinomas are the second most common renal cell carcinomas. The least common types of renal cell carcinomas are collecting-duct renal cell carcinomas, accounting for less than 1% of all cases.^[1]

References

↑ ^1.0 ^1.1 ^1.2 Cohen HT, McGovern FJ (2005). "Renal-cell carcinoma". N Engl J Med. 353 (23): 2477–90. doi:10.1056/NEJMra043172. PMID 16339096.
↑ Kovacs G, Akhtar M, Beckwith BJ, Bugert P, Cooper CS, Delahunt B; et al. (1997). "The Heidelberg classification of renal cell tumours". J Pathol. 183 (2): 131–3. doi:10.1002/(SICI)1096-9896(199710)183:2<131::AID-PATH931>3.0.CO;2-G. PMID 9390023.

Template:WH Template:WS

[pmid16339096-1] 1.0 ^1.1 ^1.2 Cohen HT, McGovern FJ (2005). "Renal-cell carcinoma". N Engl J Med. 353 (23): 2477–90. doi:10.1056/NEJMra043172. PMID 16339096.

[pmid9390023-2] Kovacs G, Akhtar M, Beckwith BJ, Bugert P, Cooper CS, Delahunt B; et al. (1997). "The Heidelberg classification of renal cell tumours". J Pathol. 183 (2): 131–3. doi:10.1002/(SICI)1096-9896(199710)183:2<131::AID-PATH931>3.0.CO;2-G. PMID 9390023.

[1]

[2]

@@ Line 3: / Line 3: @@
 {{CMG}}
 ==Overview==
+Renal cell carcinoma may be classified according to [[histologic]] appearance of the tumor into 6 subtypes: conventional (clear cell), [[papillary]], [[chromophobe]], [[oncocytoma]], [[collecting duct]], and unclassified.
 ==Classification==
-===Sporadic vs. Hereditary===
+The following table classifies renal cell carcinoma according to histologic appearance and differentiates sporadic from hereditary forms of renal cell carcinoma. Clear type (also called Conventional type) renal cell carcinoma is considered the most common type of renal carcinoma.
-The following tables classify renal cell carcinoma according to histologic appearance and differentiates sporadic from hereditary forms of renal cell carcinoma.
+The most common classification of renal cell carcinoma is based on the [[histopathological]] appearance of the [[tumor]]. There are currently six subtypes of renal cell carcinoma, most common of which are the conventional (also called clear cell) renal carcinoma, accounting for approximately 75% of all cases.<ref name="pmid16339096">{{cite journal| author=Cohen HT, McGovern FJ| title=Renal-cell carcinoma. |journal=N Engl J Med | year= 2005 | volume= 353 | issue= 23 | pages= 2477-90 | pmid=16339096 |doi=10.1056/NEJMra043172 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16339096  }} </ref> Renal cell carcinoma may also be clinically classified based on the staging of the tumor, as shown below.
-====Sporadic Forms====
-{| border="1" style="border-collapse:collapse; text-align:left;" cellpadding="5" align="center"
-|+ '''''Sporadic Forms of Renal Cell Carcinoma<ref name="pmid16339096">{{cite journal| author=Cohen HT, McGovern FJ| title=Renal-cell carcinoma. | journal=N Engl J Med | year= 2005 | volume= 353 | issue= 23 | pages= 2477-90 | pmid=16339096 | doi=10.1056/NEJMra043172 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16339096  }} </ref>'''''
-| bgcolor="#d9ff54"|'''Histologic Appearance''' || bgcolor="#d9ff54"|'''Incidence'''||bgcolor="#d9ff54"|'''Gene'''||bgcolor="#d9ff54"|'''Frequency'''
-|-
-| bgcolor="#ececec"|'''Conventional''' || 75 || VHL|| 60 %
-|-
-| bgcolor="#ececec"|'''Papillary''' || 12|| MET <br> TFE3|| 13 %<br> < 1 %
-|-
-| bgcolor="#ececec"|'''Chromophobe''' || 4  ||  ||
-|-
-| bgcolor="#ececec"|'''Oncocytoma''' || 4 ||  ||
-|-
-|bgcolor="#ececec"|'''Collecting Duct''' || < 1 ||  ||
-|-
-|bgcolor="#ececec"|'''Unclassified''' || 3 - 5 ||  ||
-|}
-<sup><center>Adapted from Cohen HT, McGovern FJ. Renal-cell carcinoma.''N Engl J Med''. 2005; 353:2477-90</center></sup>
-====Hereditary Forms====
-{| border="1" style="border-collapse:collapse; text-align:left;" cellpadding="5" align="center"
-|+ '''''Hereditary Forms of Renal Cell Carcinoma<ref name="pmid16339096">{{cite journal|author=Cohen HT, McGovern FJ| title=Renal-cell carcinoma. | journal=N Engl J Med |year= 2005 | volume= 353 | issue= 23 | pages= 2477-90 | pmid=16339096 |doi=10.1056/NEJMra043172 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16339096  }}</ref>'''''
-| bgcolor="#d9ff54"|'''Syndrome''' || bgcolor="#d9ff54"|'''Associated Gene'''||bgcolor="#d9ff54"|'''Common Histological Appearance'''
+===Histologic Appearance===
+The following table summarizes the incidence of various histological types of renal tumors:
+{| style="border-collapse:collapse; text-align:left;" align="center" cellpadding="5" border="1"
+|+'''''Heidelberg Classification Renal Cell Carcinoma According to Histological Appearance (1997)<ref name="pmid16339096">{{cite journal| author=Cohen HT, McGovern FJ| title=Renal-cell carcinoma. | journal=N Engl J Med | year= 2005 | volume= 353 | issue= 23 | pages= 2477-90 | pmid=16339096 | doi=10.1056/NEJMra043172 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16339096  }} </ref><ref name="pmid9390023">{{cite journal| author=Kovacs G, Akhtar M, Beckwith BJ, Bugert P, Cooper CS, Delahunt B et al.| title=The Heidelberg classification of renal cell tumours. | journal=J Pathol | year= 1997 | volume= 183 | issue= 2 | pages= 131-3 | pmid=9390023 | doi=10.1002/(SICI)1096-9896(199710)183:2<131::AID-PATH931>3.0.CO;2-G | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9390023  }} </ref>'''''
+| style="background:#4479BA; color: #FFFFFF;" align="center" |'''Histologic Appearance'''|| style="background:#4479BA; color: #FFFFFF;" align="center" |'''Incidence (%)'''
 |-
-| bgcolor="#ececec"|'''VHL Disease''' || VHL || Conventional
+| bgcolor="#D5D5D5" |'''Conventional (Clear Cell)'''|| 75
 |-
-| bgcolor="#ececec"|'''FCRC''' || Chromosome 3p translocation || Conventional
+| bgcolor="#D5D5D5" |'''Papillary'''|| 12
 |-
-| bgcolor="#ececec"|'''Hereditary Paraganglioma''' || SDHB || Conventional
+| bgcolor="#D5D5D5" |'''Chromophobe'''|| 4
 |-
-| bgcolor="#ececec"|'''HPRC''' || MET || Papillary
+| bgcolor="#D5D5D5" |'''Oncocytoma'''|| 4
 |-
-| bgcolor="#ececec"|'''HLRCC''' || FH || Papillary
+| bgcolor="#D5D5D5" |'''Collecting Duct'''|| < 1
 |-
-|bgcolor="#ececec"|'''Birt-Hogg-Dube Syndrome''' || BHD || Chromophobe / Oncocytoma
+| bgcolor="#D5D5D5" |'''Unclassified'''|| 3 - 5
 |}
 <sup><center>Adapted from Cohen HT, McGovern FJ. Renal-cell carcinoma.''N Engl J Med''. 2005; 353:2477-90</center></sup>
-===Staging===
+More than 70% of renal cell carcinomas are clear cell carcinomas. Papillary carcinomas are the second most common renal cell carcinomas. The least common types of renal cell carcinomas are [[Collecting duct system|collecting-duct]] renal cell carcinomas, accounting for less than 1% of all cases.<ref name="pmid16339096">{{cite journal| author=Cohen HT, McGovern FJ| title=Renal-cell carcinoma. | journal=N Engl J Med | year= 2005 | volume= 353 | issue= 23 | pages= 2477-90 | pmid=16339096 | doi=10.1056/NEJMra043172 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16339096  }} </ref>
-Clear cell renal carcinomas can be classified according to staging or anatomic spread of the disease. Two commonly implemented systems are the Modified Robson's System (1969) and the TNM (Tumor - Nodes - Metastasis) System:
-====Robson's System====
-The Modified Robson's staging system has been proposed in 1969. It emphasizes the anatomic distribution of the tumor and proximity to important vasculature and lymph nodes with prognostic implications, reporting a 52% 5-year survival and a 66% 5-year survival in patients with localized tumor.<ref name="pmid5765875">{{cite journal| author=Robson CJ, Churchill BM, Anderson W| title=The results of radical nephrectomy for renal cell carcinoma. | journal=J Urol | year= 1969 | volume= 101 | issue= 3 | pages= 297-301 | pmid=5765875 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5765875  }} </ref>
-{| border="1" style="border-collapse:collapse; text-align:left;" cellpadding="5" align="center"
-|+ '''''Robson's Classification System of Renal Cell Carcinoma Staging<ref name="pmid5765875">{{cite journal| author=Robson CJ, Churchill BM, Anderson W| title=The results of radical nephrectomy for renal cell carcinoma. | journal=J Urol | year= 1969 | volume= 101 | issue= 3 | pages= 297-301 | pmid=5765875 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5765875  }} </ref>'''''
-| bgcolor="#d9ff54"|'''Stage''' || bgcolor="#d9ff54"|'''Definition
-|-
-| bgcolor="#ececec"|'''Stage I''' || Tumor confined within parenchyma
-|-
-| bgcolor="#ececec"|'''Stage II''' || Tumor involves perinephric fat, but still confined within Gerota's fascia
-|-
-| bgcolor="#ececec"|'''Stage III''' || A) Tumor involves main renal vein or vena cava  <br> B) Tumor involves regional lymph nodes  <br> C) Tumor involves both local vessels and lymph nodes
-|-
-| bgcolor="#ececec"|'''Stage IV''' || A) Tumor involves adjacent organs other than adrenal gland <br> B) Distant metastasis
-|}
-<sup><center>Adapted from Robson CJ, Churchill BM, Anderson W. The results of radical nephrectomy for renal cell carcinoma. ''J Urol''. 1969; 101(3):297-301.</center></sup>
-====TNM System====
-The TNM classification system for staging of clear cell renal carcinoma is commonly used.
-{| border="1" style="border-collapse:collapse; text-align:left;" cellpadding="5" align="center"
-|+ '''''TNM Classification System of Renal Cell Carcinoma Staging'''''
-| bgcolor="#d9ff54"|'''T.N.M''' || bgcolor="#d9ff54"|'''Stage|| bgcolor="#d9ff54"|'''Definition
-|-
-| bgcolor="#ececec"|'''Primary Tumor (T)''' || T0 <br> T1 <br> T2 <br> T3 <br> T3a <br> T3b <br> T4 || No evidence of primary tumor <br> Tumor 2.5 cm or less limited to kidney <br> Tumor more than 2.5 cm limited to kidney <br> Tumor extends into major veins or invades adrenal gland or perinephric tissues, but not beyond Gerota's fascia <br> Tumor invades adrenal gland or perinephric tissues, but not beyond Gerota's fascia <br> Tumor grossly extends into renal vein(s) or vena cava <br> Tumor grossly extends invades beyond Gerota's fascia
-|-
-| bgcolor="#ececec"|'''Regional Lymph Nodes (N)''' || N0 <br> N1 <br> N2 <br> N3 || No regional lymph nodes (LN) metastases <br> Metastasis in a single LN 2 cm or less <br> Metastasis in a single LN  greater than 2 cm, but less than 5 cm, or multiple LN none greater than 5 cm <br> Metastasis in LN greater than 5 cm
-|-
-| bgcolor="#ececec"|'''Distant Metastasis (M)''' || M0 <br> M1 || No distant metastasis <br> Distant metastasis
-|}
 ==References==
 {{reflist|2}}
 [[Category:Kidney diseases]]
 [[Category:Types of cancer]]
-[[Category:Oncology]]
 [[Category:Nephrology]]
 [[Category:Mature chapter]]
@@ Line 93: / Line 42: @@
 {{WH}}
 {{WS}}
+ [[Category:Up-To-Date]]
+[[Category:Oncology]]
+[[Category:Medicine]]
+[[Category:Nephrology]]
+[[Category:Surgery]]