PATHOHISTOLOGICAL CHARACTERISTICS OF CLEAR CELL AND PAPILLARY RENAL CELL CARCINOMA IN PATIENTS IN THE DEPARTMENT OF PATHOLOGY UNIVERSITY HOSPITAL SPLIT BETWEEN 2002 – 2011

Cilj istraživanja: Od ukupnog broja zloćudnih tumora u odraslih osoba, prosječno 3% otpada na karcinom bubrega. Napredak u razumijevanju temeljne morfologije, imunohistokemije, citogenetike i molekularne patologije doveo je do ekspanzije različitih podtipova karcinoma pri čemu 70-80% karcinoma bubrega čini svijetlostanični karcinom bubrega, 10-15% otpada na papilarni karcinom bubrega, a ostali su rjeđi histološki podtipovi. Cilj ovog istraživanja je odrediti demografske i patohistološke karakteristike svijetlostaničnog i papilarnog karcinoma bubrega Ispitanici i metode: Retrospektivno istraživanje obuhvatilo je arhivski materijal 376 pacijenta dobiven nakon radikalne ili parcijalne nefrektomije te histološki potvrđene dijagnoze karcinoma bubrega u Kliničkom zavodu za patologiju, sudsku medicinu i citologiju KBC-a Split u vremenskom razdoblju od 01. 01. 2002. do 31.12. 2011. godine. Podciljevi studije su analizirati demografske i patohistološke karakteristike bolesnika, te analizirati prognostički značajne patohistološke čimbenike svijetlostaničnog i papilarnog karcinoma bubrega (veličina karcinoma, prisutnost nekroze, prisutnost vaskularne invazije i proširenost karcinoma) s obzirom na niski i visoki nuklearni gradus. Rezultati: Od ukupnog broja karcinoma u studiji (n=376) dijagnosticirana su 334 svijetlostanična karcinoma i 42 papilarna karcinoma bubrega. Analiza godišnje raspodjele oboljelih pokazuje porast broja dijagnosticiranih za oba histološka tipa karcinoma. Muškarci su češće obolijevali od žena i to u omjeru 2,4:1 za svijetlostanični karcinom i 3,6:1 za papilarni karcinom. Prosječna dob oboljelih je 63 godine za svijetlostanični karcinom i 64 godine za papilarni karcinom. Analiza prognostičkih čimbenika s obzirom na nuklearni gradus karcinoma pokazala je da su karcinomi niskog gradusa prosječno manje veličine od karcinoma visokog gradusa. Svijetlostanični i papilarni tip 1 karcinomi visokog nuklearnog gradusa pokazuju veći postotak prisutne nekroze nego karcinomi niskog gradusa, dok papilarni karcinom tip 2 pokazuje prisutnost nekroze u visokom postotku neovisno o gradusu. Invazija u perirenalno tkivo i limfovaskularna invazija izraženije su u slučaju svijetlostaničnih i papilarnih tip 1 karcinoma visokog nuklearnog gradusa. Papilarni karcinom tip 2 nema prisutnu limfovaskularnu invaziju. Zaključci: Brojna istraživanja usmjerena su na otkrivanje novih prognostičkih čimbenika, ali i na što precizniju klasifikaciju već znanih patohistoloških i kliničkih čimbenika važnih za prognozu karcinoma bubrega. Prema rezultatima istraživanja ističe se potreba za što preciznijom klasifikacijom nuklearnog gradusa karcinoma bubrega kao važnog prediktivnog čimbenika.Objectives and background: Renal cell carcinoma (RCC) accounts for approximately 3% of adult malignancies. Advances in understanding of basic morphology, immunohistochemistry, cytogenetics and molecular pathology have led to more precise classification. About 70-80% of kidney cancers are clear cell RCC, 10-15% are papillary carcinoma and the remainder are rare malignancies. Patients and Methods: From January 2002 until December 2011 case records of 376 patients who underwent partial or complete nephrectomy with confirmed diagnosis of renal cell carcinoma were retrospectively reviewed. Data were collected from archives of the Department of Pathology, University Hospital Split. Objectives of the study are to analyze the demographic and pathological characteristics of patients, and to analyze the prognostic significant histopathological factors of clear cell and papillary RCC (cancer size, presence of necrosis, the presence of vascular invasion and the degree of invasion of cancer) due to the low and high nuclear grade. Results: Of the total number of cancers in the study (n=376) there were 334 clear cell RCC and 42 papillary RCC. Analysis of the annual distribution of patients showed an increase in the number of diagnosed for both histological types of carcinoma.The majority of patients were males, with a ratio of approximately 2,4:1 for clear cell RCC and 3,6:1 for papillary RCC. The average age of patients with clear cell RCC was 63 years old, and for papillary RCC 64 year old. The analysis of prognostic factors with consideration to the nuclear grade of cancers showed that low grade carcinomas has lower average size than high grade carcinomas. Clear cell and papillary type 1 carcinoma of high nuclear grade shows a higher rate of the present necrosis than low grade carcinoma. Papillary carcinoma type 2 shows the presence of necrosis in a high percentage, regardless of the nuclear grade. Invasion of the perirenal tissue and vascular invasion, are more pronounced in the case of clear cell and papillary type 1 carcinoma of high nuclear grade than the lower grade. Papillary carcinoma type 2 shows no lymphovascular invasion. Conclusions: Numerous studies have focused on the discovery of new prognostic factors, but also on a more accurate classification already known histopathological and clinical factors important for the prognosis of kidney cancer. The research shows the need for more precise classification of nuclear grade of renal cell carcinoma as an important predictive factor