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Ackerman Atlas(chaptr24)

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Kindney Neoplastic

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Figure 24.1 Various Gross Appearances of Wilms Tumor. A and B, Variegated appearance. C, More homogeneous and nodular. D, Extensive areas of infarct-like necrosis

Figure 24.2 Microscopic Appearance of Wilms Tumor. A, Low-power microscopic view showing a combination of blastema, stroma, epithelial tubular formations, and immature glomeruli. B, High-power view showing blastema, stroma, and immature tubular formations

Figure 24.3 Mucinous epithelium in Wilms tumor

Figure 24.4 Anaplastic ("Unfavorable Histology") Wilms Tumor. A, Marked pleomorphism with giant hyperchromatic nuclei and atypical mitoses. B, Strong nuclear immunoreactivity for p53

Figure 24.5 Nephrogenic rests. Perilobar (A) and intralobar (B) types

Figure 24.6 Congenital Mesoblastic Nephroma. Gross appearance of the well-circumscribed character of this tumor and its white fibrous cut surface are well illustrated

 

Figure 24.7 Congenital Mesoblastic Nephroma, Classic Type. Microscopic appearance showing a monotonous proliferation of spindle cells with bland nuclei, resembling fibromatosis

Figure 24.8 Congenital Mesoblastic Nephroma, Cellular Type, Accompanied by Mitotic Activity. An entrapped glomerulus is present in a corner. Some of these tumors behave in an aggressive fashion

Figure 24.9 Gross Appearance of Clear Cell Sarcoma of Kidney. The tumor is well circumscribed and whitish, and it bulges on the cut surface

Figure 24.10 Clear cell sarcoma of kidney, prototypical appearance

 Figure 24.11 Clear cell sarcoma of kidney, trabecular pattern of growth

Figure 24.12 Clear Cell Sarcoma of Kidney. A, Myxoid pattern. B, Sclerotic pattern

Figure 24.13 Rhabdoid Tumor of Kidney. Syncytial sheets of highly atypical cells, often with admixed inflammation

Figure 24.14 Rhabdoid Tumor of Kidney. The nuclear grade is high. An eosinophilic amorphous ("hyaline") material fills the scanty cytoplasm and pushes the nucleus aside

Figure 24.15 Gross appearance of pediatric cystic nephroma involving most of the kidney

Figure 24.16 Low-power microscopic appearance of pediatric cystic nephroma showing multiple cysts lined by flattened epithelium and separated by a cellular spindle cell stroma

Figure 24.17 Pediatric Cystic Nephroma. The epithelial lining of the cyst has a hobnail quality and the stroma is loose and hypocellular

Figure 24.18 Pediatric Cystic Nephroma. The stroma shows subtle cellularity adjacent to the epithelium, which is more atrophic

Figure 24.19 Gross appearance of Ewing sarcoma, primary in the kidney

Figure 24.20 Metanephric Adenoma. The lesion is extremely cellular with a small tubular pattern

 

Figure 24.21 Papillary pattern of growth of metanephric adenoma

Figure 24.22 Gross Appearance of Metanephric Adenofibroma. The tumor is solid and vaguely nodular

Figure 24.23 Renal Cell Carcinoma Developing in the Adult Form of Polycystic Kidney Disease. The tumor was multicentric

Figure 24.24 Gross Appearances of Renal Cell Carcinoma. Both tumors are relatively well circumscribed and variegated, with a combination of cystic, solid, and hemorrhagic areas. The tumor shown in A has a bright yellow color, whereas that portrayed in B has extensive areas of hemorrhage

Figure 24.25 Renal cell carcinoma with multilocular gross appearance

Figure 24.26 Renal cell carcinoma, clear cell type

Figure 24.27 Renal cell carcinoma, clear cell type, with rhabdoid differentiation

Figure 24.28 Renal Cell Carcinoma, Papillary Type 1. A, Typical thick fibrous capsule with papillary tumor filling a cystic space. B, Single cuboidal layer of cytologically bland cells

Figure 24.29 Renal cell carcinoma, papillary type 1, with solid growth

Figure 24.30 Renal cell carcinoma, papillary type 1, with so-called squamo-alveolar pattern

Figure 24.31 Renal cell carcinoma, papillary type 2

 Figure 24.32 Multilocular cystic renal neoplasm of low malignant potential

Figure 24.33 Gross Appearance of Renal Chromophobe Cell Car- cinoma. The tumor is well circumscribed and has a light brown color

Figure 24.34 Chromophobe renal cell carcinoma, classic type, with thick cell membranes

Figure 24.35 Chromophobe renal cell carcinoma, eosinophilic type, with prominent perinuclear halos.

Figure 24.36 Chromophobe renal cell carcinoma, microcystic pattern

Figure 24.37 Clear cell-papillary renal cell carcinoma with predominant papillary architecture. The linear nuclear alignment and sub-nuclear cytoplasm are also evident

Figure 24.38 Clear cell-papillary renal cell carcinoma with mixed branching tubules and more solid clear cell pattern

Figure 24.39 MiT Family Translocation Renal Cell Carcinoma. Rare cases may mimic clear cell-papillary or multilocular cystic renal neoplasm

Figure 24.40 MIT Family Translocation Renal Cell Carcinoma, TFE3 Type, With Psammoma Bodies. A, Papillary pattern. B, Nested pattern mimicking clear cell RCC

Figure 24.41 MiT family translocation renal cell carcinoma, TFEB type, with classic biphasic pattern

 

Figure 24.42 Collecting duct carcinoma

Figure 24.43 Fumarate hydratase-deficient renal cell carcinoma with prototypical peri-nucleolar halos

Figure 24.44 Fumarate hydratase-deficient renal cell carcinoma with infiltrating glandular pattern

Figure 24.45 Fumarate hydratase-deficient renal cell carcinoma with mixed tubulocystic and solid pattern

Figure 24.46 Fumarate hydratase-deficient renal cell carcinoma with deceptive "low-grade" appearance

Figure 24.47 Renal Medullary Carcinoma. A, Admixture of glands, single cells, and cords. B, Rhabdoid features

Figure 24.48 Tubulocystic Carcinoma. A, Prototypical low-power architecture. B, Lining cells are eosinophilic and atypical

Figure 24.49 Mucinous, Tubular, and Spindle Cell Carcinoma. A, Classic tubular architecture with interspersed mucin. B, Spindled morphology with bland cytologic features

Figure 24.50 Acquired cystic kidney disease-associated renal cell carcinoma

Figure 24.51 SDH-deficient renal cell carcinoma

Figure 24.52 SDH-deficient renal cell carcinoma with nuclear pleomor- phism and mitotic activity, clinically malignant

Figure 24.53 SDH-Deficient Renal Cell Carcinoma (SDHB Immu- nostain). Cytoplasmic loss in neoplastic cells, but retained in endothelial cells

Figure 24.54 Eosinophilic, solid, and cystic (ESC) renal cell carcinoma, low-power magnification

Figure 24.55 Eosinophilic, Solid, and Cystic (ESC) Renal Cell Carcinoma. A, Eosinophilic cells lining septa have a hobnail appearance. B, Nuclei are large with variable nucleoli and coarse cytoplasmic stippling

 Figure 24.56 Renal cell carcinoma with (angio)leiomyomatous stroma

Figure 24.57 Clear cell renal cell carcinoma with definitive macroscopic invasion of renal sinus (pT3)

Figure 24.58 Gross Appearance of Oncocytoma of Kidney. The tumor is characteristically well circumscribed, mahogany brown, and has a central fibrous scar

Figure 24.59 Typical nesting and cystic pattern of renal oncocytoma

Figure 24.60 Renal Oncocytoma. Nuclei are round and monomorphic

 

Figure 24.61 Perinuclear halos, binucleation, and "koilocytotic atypia" are features of a prototypical chromophobe renal cell carcinoma

Figure 24.62 Oncocytic Renal Neoplasms With Features Not Pro- totypical for Either Oncocytoma or Chromophobe. A, This tumor has more variability in nuclear size with multiple nucleoli, but nuclei remain relatively round with no perinuclear clearing. B, This case has very prominent and consistent macronucleoli. Other foci showed solid growth. Such tumors have significant variability in diagnosis, even among experts

Figure 24.63 So-called renal oncocytosis. Many similar nodules were scattered throughout the kidney

Figure 24.64 "Atrophic Kidney-Like Tumor." A, Cystically dilated follicles of various sizes are typical, with admixed smaller tubules. B, Follicles are lined by a flattened epithelium, and psammoma bodies and amorphous calcifications are present

Figure 24.65 A and B, Gross appearances of angiomyolipoma of kidney. Both tumors are variegated, with a predominance of yellow areas, admixed with hemorrhagic foci

Figure 24.66 Typical Renal Angiomyolipoma. The tumor is composed of lipid-rich and myoid-like cells with admixed blood vessels

Figure 24.67 Intimate relationship of the eosinophilic neoplastic cells of angiomyolipoma with a large vessel. This is an important diagnostic clue

Figure 24.68 Epithelioid angiomyolipoma of the kidney showing marked pleomorphism of the tumor cells. This tumor recurred locally and later metastasized to lung

Figure 24.69 Renal angiomyolipoma showing a predominant myoid appearance

Figure 24.70 Microscopic Appearance of Juxtaglomerular Cell Tumor. The lesion has a distinct vascular background

Figure 24.71 Secretory Granules of Juxtaglomerular Cell Tumor as Seen Ultrastructurally. Some of them are diamond shaped, identical to those seen in normal juxtaglomerular cells. This case has been reported by Conn et al.848 (Courtesy of Dr. M.R. Abell, Ann Arbor, MI.)

 Figure 24.72 Mixed epithelial and stromal tumor with classic ovarian-like stroma

Figure 24.73 Mixed epithelial and stromal tumor with crowded and various shaped glands

Figure 24.74 Anastomosing hemangioma in the renal hilum

Figure 24.75 Massive renal involvement by malakoplakia

Figure 24.76 Gross Appearances of Urothelial Carcinoma of Renal Pelvis. A and B, The tumor protrudes into the pelvic cavity and has a granular surface. C, The tumor coats the pelvis and calyces

Figure 24.77 Benign fibroepithelial polyp emerging from lower calyx of the left kidney in a 61-year-old woman. The tumor caused hematuria, and total nephrectomy was performed