Revision 8 for 'Renal cell carcinoma on a background of autosomal dominant polycystic kidney disease'

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Renal cell carcinoma on a background of autosomal dominant polycystic kidney disease

MACROSCOPIC DESCRIPTION: "Left partial nephrectomy": A 68g specimen, comprising loose fatty tissue 85x35x10mm, and a partial nephrectomy, 45x60x40mm. The entire surface (capsule and cut margin) is inked black. Sections show a cystic lesion, containing hemorrhagic material, with wall thickness 1-15mm. Sections through the thick wall of the cyst show a mottled gelatinous grey/yellow/pale pink cut face. Normal renal parenchyma is not clearly identified. The lesion meets the inked dissection margin. The lesion is present at the capsule surface, which is smooth and does not appear to be involved by tumor. Sections through loose fatty tissue are unremarkable. Photographs taken. BLOCK DESIGNATION: A-D - thick wall cyst E - thin wall of cyst. P5. (CH) MICROSCOPIC DESCRIPTION: The solid areas within the cyst wall show a Sections taken from the thin area of the cyst show tumor with similar features although much thinner. Again there is a thin fibrous pseudocapsule. The features suggest the tumor size to be 50mm but with prominent central cystic necrosis. Focal dystrophic calcification is noted. Renal carcinoma synoptic report. Site: Left. Size: 50mm Type and morphology: Type 1 papillary carcinoma with papillary and tubular features. The cells show a minimum amount of eosinophilic cytoplasm whilst others show clear cytoplasm. There are focal areas showing foamy macrophages. The tumor has a pushing margin and a pseudocapsule <1mm extending over the surface which in one area is incomplete but the tumor remains pushing. Mitotic figures are present but infrequent. There are focal areas of hemorrhage and necrosis. Grade (Fuhrman): 2 Capsular penetration: Absent but < 1mm. Vascular invasion: Absent. Non involved kidney: None present for assessment. DIAGNOSIS: Left partial nephrectomy: Type 1 papillary carcinoma, sized 50mm, Fuhrman grade 2, with marked cystic central necrotic change.

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