I- Kidney tumors’adult :
the renal parenchyma cancers represent 5 % cancers of the’adult. Their frequency peak s’observe between 50 and 70 years with a male predominance (2/1).
Some causative factors are demonstrated : smoking, Von Hippie Lindau disease that associates (Kidney Cancer + hemangioblastoma cerebellum or retina +/- phéochromocytome +/- cysts of the pancreas and kidney), The tuberous sclerosis, The long-term chronic hemodialysis patients with multicystic acquired disease of the kidneys have a higher risk of developing kidney tumors
II- Anatomical pathology study :
The pathologist has a crucial role in tumor pathology kidney, it allows to be a definitive diagnosis, by classifying the tumor according to the classification of’WHO, editing 2016, but also d’establish a TNM staging which will allow a prognostic evaluation but also dictate the therapeutic management.
A- benign tumors :
1- papillary adenoma : 7 at 22% autopsies, fortuitous discovery and n’have no clinical impact.
it s’acts of’a small papillary tumor, well defined but unencapsulated, cortical seat, of diameter < 1,5 cm.
Microscopy : the papillae are coated by a single layer of cubo-cylindrical cells which do not show d’atypies.
2- metanephric adenoma : less of 100 published cases. Average age would 40 years with a likely female
Macroscopie : rounded tumor, very limited, average height < 5cm.
Microscopy : Tubes, bays, buds and mass of identical cells together.
3- Oncocytome : benign tumor of the renal cortex, represented 5 to7% of kidney tumors. L’average age is 62 years with male predominance.
Macroscopie : Tm very limited but possible invasion kidney fat, brown or mahogany yellow chamois with a central fibrous scar. The alterations are rare and kystisations.
4- Angiomyolipome : C’is the most common benign kidney tumor. Occurs sporadically or as part of’tuberous sclerosis of bourneville where the’angiomyolipoma is often multiple and bilateral.
Macroscopie : Tumor unencapsulated, +/* voluminous, l’peri-renal and / or extra-renal extension is possible
Microscopy : Triple adipose quota, muscular and vascular in varying proportions
5- epithelial and stromal tumor mixed : More common in women, l’average age is 45 years
Macroscopie : tm rounded, very limited, white with cysts.
Microscopy : large cysts or micro cysts sometimes with papillary proliferations. cystic nephroma adult and pediatric are included in this chapter in the new WHO classification 2016
6- cysts : Simple cysts urineux, diagnosed by ultrasound and CT, mainly occurring in the elderly.
B- malignancies :
1- Clear cell carcinoma of the kidney : the most common kidney carcinomas (70 at 80%), l’mean age of onset is 60 years, touch 2 times more d’men than women. Maybe sporadic or familial occurring in patients with the von Hippel Lindau disease.
Macroscopie : often voluminous, color yellow variegated, rouge, two à l’alternating fleshy tumor areas, areas of’hemorrhage and necrosis.
Microscopy : tumor n’is not papillary, it forms solid epithelial mass, or tubes or honeycomb structures. The cells are often clear (rich in fat and glycogen), sometimes eosinophils.
NB : Carcinoma renal clear cell and gene VHL (maladie de von Hippel Lindau) is a variant of this clear cell carcinoma, often cystic, multiple and bilateral
2- cystic multilocular clear cell carcinoma :
Macroscopie : c’is a multilocular cyst
Microscopy : the cyst shell and septa are lined with’a cubic epithelium with small, clear cells with a regular nucleus.
These lesions are considered grade I Führman, d’excellent prognosis, c’is for this reason that the’WHO 2016 l’renamed : Multicystic neoplasm of low malignant potential
3- papillary carcinoma : Represented 10 -15 % kidney cancer. There are sporadic and familial forms. Frequency, l’age and gender : Same as the clear cell carcinoma.
Tm usually multiple and bilateral as clear cell carcinoma survival better than clear cell carcinoma: 80 at 90% at 5 years.
Macroscopie : well-defined lesion of the cortex.
Microscopy : the tumor has the same morphology as the’papillary adenoma except that the tumor is larger. are frequently found calcifications (psammomes) and foamy macrophages.
4- Carcinome chromophobe : 5 at 10 % kidney cancer’adult.
Macroscopie : single tumor, well circumscribed, has a chamois appearance
Microscopy : a variant consists of clear cells, and a variant consisting of d cells’allure oncocytaire. In both variants, the nuclei of the cells vary in size, the jagged edges and hyper chromatic and they are often surrounded by a clear halo.
The tumor has a compact or cellular architecture. it n’there are no taste buds.
Histochimie : the tumor cells are stained bright blue by iron colloidal (coloring Haie).
The chromophobe carcinoma prognosis is good. No Fuhrman grade should be done anymore according to the’WHO 2016
5- Collecting duct carcinoma : or Bellini carcinoma tubes (<1%)
Macroscopie : the tumor grows in the medulla of kidney
Microscopy : c’is a papillary adenocarcinoma where cyto-nuclear atypia are abundant and mitoses numerous.
Evolution : aggressive tumor, poor prognosis
III- Tumors of infantile kidney :
- infantile fibromatosis (tumor Bolande)
- Fibrosarcome child (tumor cell Bolande)
- Tumeur rhabdoïde
- Clear cell sarcoma
- PNET (Peripheral neuroectodermal tumor )
IV- prognostic factors :
* Stadium (TNM) is the most important prognostic factor.
TNM classification 2009
T – primary tumor
→ TX Primary tumor can not be assessed
→ T0 No evidence of primary tumor
→ T1 Tumor limited to the kidney s 7 cm long axis
– T1A Tumor limited to the kidney s 4 cm long axis
– T1b Tumor limited to the kidney " 4 cm but s; 7 cm long axis
→ T2 Tumor limited to the kidney " 7 cm long axis
– T2a Tumor limited to the kidney > 7 cm but s 10 cm long axis
– T2b Tumor limited to the kidney > 10 cm
→ T3 Tumor interesting major veins or invades perirenal fat or renal sinus but without reaching the fascia Gerota
– T3a Tumor invades the renal vein or its segmental branches of division, renal sinus fat or perirenal but not reaching the adrenal and not exceeding the fascia Gerota.
– T3b Tumor invading the vena cava in the form of’a sub-diaphragmatic thrombus.
– T3c Tumor invading the lining of your inferior vena cava or thrombi’extending above the diaphragm
→ T4 Tumor extending beyond Gerota fascia, including the invasion of adjacent the ipsilateral adrenal.
N – Invasion of regional lymph nodes
→ NX the adenomegalies can not be assessed
→ N0 No lymph node metastasis
→ N1 Single lymph node metastasis
→ N2 More than 1 lymph node metastasis
M – Distant metastasis
→ MX Distant metastasis can not be assessed
→ M0 No distant metastasis
→ M1 Distant metastasis
Grouping of TNM stage
→ In Stade : T1 N0 M0
→ Stade II : T2 N0 M0
→ Stade III : T3 and T1 N0 M0, T2, T3N1 M0
→ Stage IV : T4 N0, N1 M0. all T N2 M0 and M1 all T N
the grade Nuclear is an independent prognostic factor in cancer grading most used is that Fuhrman.
Pr Hamdouche S course – Faculty of Constantine