Renal Pathology Outline

• Introductory stuff
• Glomerular diseases
• Tubular and interstitial diseases
• Diseases involving blood vessels
• Cystic diseases
• Tumors
– Renal cell carcinoma
– Bladder carcinoma
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Renal Cell Carcinoma

Renal cell carcinoma accounts for 3 % of all

malignancies.Most of these cancers arise
from the proximal renal tubular epithelium
Risk factors include: smoking, hypertension,
cadmium exposure, and obesity.
The classification of the three most common
types of tumors is based upon genetic
predisposition.

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RCC con’t
• The three most common types of RCC :
1. Clear cell carcinoma
2. Papillary renal cell carcinoma
3. Chromophobe renal carcinoma

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RCC
Clear cell carcinoma
-This is the most common type ( 70-80%)
-As the name suggests, it is made up of cells
with clear or granular cytoplasm
-There may be an association with von Hippel
Lindau (VHL) disease
-VHL is an autosomal dominant disease that is
characterized by cerebellar or retinal
hemangioblastomas
- Presents as bilateral multiple cysts

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RCC
Clear cell carcinoma
-VHL gene (tumor suppressor gene) is present on
chromosome 3 (3p25) and an individual inherits the
germ line mutation.
-Somatic “hit” or somatic mutation causes the loss of the
second allele. This leads to clear cell mutation, by
uncontrolled tumor growth and angiogenesis
-The tumor invades the renal vein, as it enlarges and
extends through the kidney to reach other parts of the
body- IVC penetration and invade the heart
-they can metastasize to lungs (most frequent) and bone
(causes lytic lesions)

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RCC

• Papillary Renal Cell Carcinoma

- They make up 10-15 % of all renal cancers
- These tumors are multifocal and bilateral
with a papillary growth pattern
-Associated with the MET- proto-oncogene,
which is located on chromosome 7 (7q31)
- Grossly, they appear as a yellow mass, but to
a lesser degree than clear cell carcinoma (due
to lower lipid content)

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RCC
• Chromophobe Renal Carcinoma
- These tumors represent 5 % of all renal cell
carcinomas
-They are made up of intercalated cells of the
collecting duct.
-Grossly, the tumor appears tan brown.
Microscopically, nuclei are surrounded by clear
cytoplasm
- Missing chromosomes ( chromosomes 1,2 6, 10,
13, 17, and 21)=> hypodiploidy

-This tumor has a good prognosis

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This photograph shows the cut
surface of a kidney

There is a large renal cell

carcinoma in the upper pole with
bright yellow areas, areas of
hemorrhage, and tan and white
areas

They appear as spherical masses

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RCC (clear cell carcinoma)-
M/E

The malignant cells have

abundant clear or empty
appearing cytoplasm

The tumor may appear

vacuolated or solid

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RCC

Clinical findings:
-triad of :
painless hematuria, palpable abdominal mass,
and dull flank pain
-fever
-polycythemia-erythropoiesis
-paraneoplastic syndrome:
hypertension, hypercalcemia, Cushing
syndrome

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Renal cell carcinoma
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Renal cell carcinoma