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Eble JN, Sauter G., Epstein JI, Sesterhenn IA - iarc

Eble JN, Sauter G., Epstein JI, Sesterhenn IA - iarc

Eble JN, Sauter G., Epstein JI, Sesterhenn IA - iarc

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A<br />

Fig. 1.26 Type 1 Papillary renal cell carcinoma. A Type 1 PRCC with foamy macrophages in papillary cores. B Type 1 PRCC showing a compact tubulopapillary pattern.<br />

B<br />

A<br />

B<br />

Fig. 1.27 A Papillary carcinoma, type 2. Large cells with eosinophilic cytoplasm in type 2 papillary RCC. B Type 2 Papillary renal cell carcinoma. Tumour cells show<br />

nuclear pseudostratification and eosinophilic cytoplasm.<br />

Fig. 1.28 Papillary carcinoma. Chromosome 17 trisomy,<br />

typical for papillary RCC. FISH technique.<br />

Somatic genetics<br />

Trisomy or tetrasomy 7, trisomy 17 and<br />

loss of chromosome Y are the commonest<br />

karyotypic changes in PRCC {1373}.<br />

High resolution studies have shown interstitial<br />

3p loss of heterozygosity in some<br />

PRCC {1789,2723}. Trisomy of 12, 16<br />

and 20 is also found in PRCC and may<br />

be related to tumour progression<br />

{618,1373}, while loss of heterozygosity<br />

at 9p13 is associated with shorter survival<br />

{2340}. Comparative genomic<br />

hybridization studies show more gains of<br />

chromosomes 7p and 17p in type 1<br />

PRCC when compared to type 2 tumours<br />

{1219}, while more recently, differing patterns<br />

of allelic imbalance at 17q and 9p<br />

have been noted {2291}.<br />

Prognosis and predictive factors<br />

In series of PRCC containing both type<br />

1 and 2 tumours, five year survivals for<br />

all stages range from 49% to 84%<br />

{584,1612}, with tumour grade {76,<br />

675,1428,1753}, stage at presentation<br />

{76,1753} and the presence of sarcomatoid<br />

dedifferentiation {76,1753}<br />

being correlated with outcome.<br />

Additionally the presence of extensive<br />

tumour necrosis and numerous foamy<br />

macrophages has been associated<br />

with a more favourable prognosis {76,<br />

1612}, while on multivariate modelling<br />

only tumour stage retained a significant<br />

correlation with survival {76}.<br />

While grade 1 tubulopapillary tumours<br />

between 0.5 and 2 cm are strictly<br />

defined as carcinomas, many pathologists<br />

prefer to report them as "papillary<br />

epithelial neoplasm of low malignant<br />

potential" for practical reasons.<br />

Up to 70% of PRCC are intrarenal at<br />

diagnosis {76,1428,1612,1860} and<br />

type 1 tumours are usually of lower<br />

stage and grade than type 2 tumours<br />

{76,585,587,1753}. Longer survivals<br />

have been demonstrated for type 1<br />

when compared with type 2 PRCC on<br />

both univariate {1753} and multivariate<br />

analysis that included both tumour<br />

stage and grade {587}.<br />

28 Tumours of the kidney

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