Surgical pathology of cystic renal cell carcinomas: is there an overestimation of malignancy?

Paner, Gladell P.; Cimadamore, Alessia; Darrell, Caitlin M.; Tretiakova, Maria; Montironi, Rodolfo

doi:10.1016/j.mpdhp.2020.04.003

Cited by 4 publications

(5 citation statements)

References 49 publications

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“…108 In cases being considered for MCRNLMP, the presence of WHO/ISUP grade 3 nuclei or expansile nests with intervening vascular sinusoidal pattern warrants additional sampling as it may represent an extensively cystic CCRCC. 107,109 It is unclear if higher grade nuclei alone in the classic context of a multilocular low-grade lesion with only lesional cells lining cysts qualify for MCRNLMP and will influence its prognosis.…”

Section: Renal Epithelial Neoplasm Where Low World Health Organizatio...mentioning

confidence: 99%

Updates in Grading of Renal Cell Carcinomas Beyond Clear Cell Renal Cell Carcinoma and Papillary Renal Cell Carcinoma

Paner

Chumbalkar

Montironi

et al. 2022

Advances in Anatomic Pathology

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The World Health Organization (WHO) recommends grading of clear cell renal cell carcinoma (RCC) and papillary RCC using the WHO/International Society of Urological Pathology (ISUP) grade, which is primarily based on nuclear features. As the spectrum of RCC continues to evolve, with more recently described subtypes in the past decade, literature evidence on grading these subtypes is limited or not available for some tumor types. Herein, we outline a pragmatic approach to the topic of grading RCC, dividing the contemporarily described RCC subtypes into 7 categories based on the potential clinical applicability of grading as a useful prognostic parameter: (1) RCC subtypes that are reasonably validated and recommended for WHO/ISUP grading; (2) RCC subtypes where WHO/ISUP is not applicable; (3) RCC subtypes where WHO/ISUP grading is potentially clinically useful; (4) inherently aggressive RCC subtypes where histologic classification itself confers an aggressive biologic potential; (5) renal epithelial tumors where WHO/ISUP grading provides potentially misleading prognostic implication; (6) renal epithelial neoplasms where low WHO/ISUP grade features are a prerequisite for accurate histologic classification; and (7) renal epithelial neoplasms with no or limited data on grading or incomplete understanding of the biologic potential. Our aim in outlining this approach is 2-fold: (a) identify the gaps in understanding and application of grading in RCC subtypes so that researchers in the field may perform additional studies on the basis of which the important pathologic function of assignment of grade may be recommended to be performed as a meaningful exercise across a wider spectrum of RCC; and (b) to provide guidance in the interim to surgical pathologists in terms of providing clinically useful grading information in RCC based on currently available clinicopathologic information.

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Section: Renal Epithelial Neoplasm Where Low World Health Organizatio...mentioning

confidence: 99%

Updates in Grading of Renal Cell Carcinomas Beyond Clear Cell Renal Cell Carcinoma and Papillary Renal Cell Carcinoma

Paner

Chumbalkar

Montironi

et al. 2022

Advances in Anatomic Pathology

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“…U p to 15% of renal neoplasms are cystic and the majority of these tumors have indolent behavior. [1][2][3][4] By radiologic imaging, a renal tumor is considered cystic if it contains < 25% nonenhancing tissue. 5 The Bosniak classification, updated in 2019, is used to predict their likelihood for malignancy with management recommendations based on the extent of cystic features (Table 1).…”

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confidence: 99%

“…5,6 Using this classification, a significant proportion of resected cystic renal tumors (Bosniak IIF to IV) turned out to be histologically malignant [ie, renal cell carcinomas (RCCs)] although most of these RCCs have favorable behavior on follow-up. 4,[7][8][9][10] By pathologic examination, an older arbitrary cutoff of > 75% cystic has been used to define cystic RCC. 11 However, documentation of cystic change in RCCs has been inconsistent in pathology reports, and descriptors such as "purely," "predominantly," and "partially" cystic have been variably used.…”

mentioning

confidence: 99%

“…Up to 15% of renal neoplasms are cystic and the majority of these tumors have indolent behavior 1–4 . By radiologic imaging, a renal tumor is considered cystic if it contains <25% nonenhancing tissue 5 .…”

mentioning

confidence: 99%

“…The Bosniak classification, updated in 2019, is used to predict their likelihood for malignancy with management recommendations based on the extent of cystic features (Table 1). 5,6 Using this classification, a significant proportion of resected cystic renal tumors (Bosniak IIF to IV) turned out to be histologically malignant [ie, renal cell carcinomas (RCCs)] although most of these RCCs have favorable behavior on follow-up 4,7–10 . By pathologic examination, an older arbitrary cutoff of >75% cystic has been used to define cystic RCC 11 .…”

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Cystic Features in Renal Epithelial Neoplasms and Their Increasing Clinical and Pathologic Significance

Tretiakova,

Kwon,

Paner

2024

Advances in Anatomic Pathology

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Most cystic renal tumors after resection (Boniak IIF to IV cysts) have an indolent course despite the significantly higher proportion of malignant [ie, renal cell carcinoma (RCC)] diagnosis. Most cystic renal tumors have clear cell histology that include cystic clear cell RCC and multilocular cystic renal neoplasm of low malignant potential (MCNLMP). There is growing evidence to suggest that MCNLMP, cystic clear cell RCC, and noncystic clear cell RCC form a cystic-to-solid biological spectrum with MCNLMP representing the most indolent form and with cystic clear cell RCC behaving better than noncystic (solid) clear cell RCC. Extensively (>75%) cystic clear cell RCC also has an excellent outcome similar to MCNLMP stressing the need to reevaluate the histologic criteria that separate these 2 cystic clear cell tumors. Other tumors with clear cells that can be extensively cystic such as the recently reclassified noncancerous clear cell papillary renal tumor and the newly described MED15::TFE3 RCC also have indolent course and may mimic MCNLMP. Cystic features occur also in renal tumors with nonclear cell histology including tumors capable of metastasis such as acquired cystic disease-associated, tubulocystic, fumarate hydratase-deficient, and eosinophilic solid and cystic RCCs. Cystic imaging presentation of some renal tumors such as papillary RCC can be attributed in part to pseudocystic necrosis and hemorrhage. It is important to know that tubulocystic RCC may have a lower Bosniak class presentation that overlaps with benign renal cysts (Bosniak I to IIF) that are managed conservatively. This review highlights the cystic renal tumors with clear cell and nonclear cell morphologies including some novel RCC subtypes that may have cystic features. The presence of cystic features and their extent may aid in the classification and prognostication of renal neoplasms underscoring its increasing importance in the pathologic diagnosis and reporting of renal neoplasia.

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Renal Cell Tumors: Molecular Findings Reshaping Clinico-pathological Practice

Tretiakova

2020

Archives of Medical Research

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Surgical pathology of cystic renal cell carcinomas: is there an overestimation of malignancy?

Cited by 4 publications

References 49 publications

Updates in Grading of Renal Cell Carcinomas Beyond Clear Cell Renal Cell Carcinoma and Papillary Renal Cell Carcinoma

Updates in Grading of Renal Cell Carcinomas Beyond Clear Cell Renal Cell Carcinoma and Papillary Renal Cell Carcinoma

Cystic Features in Renal Epithelial Neoplasms and Their Increasing Clinical and Pathologic Significance

Renal Cell Tumors: Molecular Findings Reshaping Clinico-pathological Practice

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