Elsevier

Human Pathology

Volume 32, Issue 6, June 2001, Pages 590-595
Human Pathology

Original Contributions
Morphologic typing of papillary renal cell carcinoma: Comparison of growth kinetics and patient survival in 66 cases*

https://doi.org/10.1053/hupa.2001.24984Get rights and content

Abstract

Whereas papillary renal cell carcinoma is now established as a subtype of renal cell neoplasia, division of these tumors into 2 distinctive morphotypes has been proposed. Type 1 tumors have cells with scanty pale cytoplasm arranged in a single layer on the basement membrane of papillary cores. In these tumors, psammoma bodies and foamy macrophages are frequently seen, and the tumors frequently express cytokeratin 7. Type 2 tumor cells have pseudostratified nuclei and usually have voluminous eosinophilic cytoplasm. Recent studies have supported this subclassification of papillary renal cell carcinoma by demonstrating differing genotypes for type 1 and 2 tumors. To further study the subclassification of papillary renal carcinoma, we compared clinical features, nuclear grade, stage, tumor growth kinetics, and survival in a series of 50 type 1 and 16 type 2 papillary renal cell carcinomas. Comparison of patient age at presentation, sex, and primary tumor size shows no significant difference between the 2 tumor types. Type 1 tumors were of significantly lower Fuhrman grade (P =.0001) and higher Robson stage (P =.009) than type 2 tumors. There was no significant difference when tumors were staged according to the TNM classification. Assessment of tumor growth kinetics showed significantly different mean silver-staining nucleolar organizer region (AgNOR) scores and Ki-67 indices (AgNOR type 1, 3.83, type 2, 7.24, P =.0001; Ki-67 type 1, 3.17%, type 2, 6.01%, P =.0002). Multivariate analysis showed tumor type (P =.03), presence of metastases (P =.04), AgNOR score (P =.001), and Ki-67 index (P =.03) to be independently associated with survival. These results provide evidence of the clinical utility of dividing papillary renal cell carcinomas into 2 types according to histologic characteristics. HUM PATHOL 32:590-595. Copyright © 2001 by W.B. Saunders Company

Section snippets

Materials and methods

Sixty-eight cases of papillary renal cell carcinoma were identified from a population-based case-control study of renal cell carcinoma in New South Wales13 and from the files of Wellington Hospital. The blocks were reviewed, sections were cut from the blocks, and the histology was reviewed independently by 2 pathologists (B.D. and J.N.E.). The tumors were classified as type 1 papillary renal cell carcinoma and type 2 papillary renal cell carcinoma according to previously reported criteria.11

Results

There were 54 men and 14 women in the series with age at presentation ranging from 26 to 86 (mean, 63.0) years. The review of tumor histology showed 52 cases to be type 1 and 16 to be type 2. There were 43 men and 9 women with type 1 tumors and 11 men and 5 women with type 2 tumors. Patient age at presentation ranged from 26 to 86 (mean, 62.3) years for type 1 tumors and 34 to 83 (mean, 65.3) years for type 2 tumors. There was no significant difference in sex distribution (Fisher exact P =.29)

Discussion

Early series that compared the histopathology and clinical features of papillary renal cell carcinoma and other types of renal cell carcinoma (predominantly clear cell renal cell carcinoma) showed that papillary renal cell carcinoma was associated with a more favorable prognosis.2 It was subsequently noted that a higher proportion of papillary renal cell carcinomas were organ-localized at the time of diagnosis and that low-stage tumors had a higher 5-year survival rate than clear cell renal

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    *

    Address correspondence and reprint requests to Brett Delahunt, MD, FRCPA, Department of Pathology and Molecular Medicine, Wellington School of Medicine, PO Box 7343, Wellington South, New Zealand.

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