This tumor board discusses a 28-year-old male patient who underwent a left radical nephrectomy for a large left renal mass. Gross and microscopic examination of the specimen revealed a 10x9 cm clear cell renal cell carcinoma, Fuhrman Grade II, invading the renal capsule. Surgical margins and perinephric fat were free of tumor. Based on these findings, the tumor was staged as pT2N0.

1. TUMOR BOARD
18.07.2017

2. Patient details
• Mr. S, 28/M
• MRD No: 17/227994
• Biopsy No: 1630/17
• Nature of specimen - Left radical nephrectomy
• CECT – 14 x 8 cm mass in the left kidney occupying
the upper and mid pole area
• Clinical diagnosis - left renal mass - ?Renal cell
carcinoma

5. Gross examination
• Received left radical nephrectomy specimen with
attached perinephric pad of fat measuring 15.5x12x7
cms
• External surface is bosselated and congested
• Cut section shows renal parenchyma totally distorted
by a tumor measuring 10x9 cms
• Tumor shows a variegated appearance
• Attached renal vein measuring 3 cms
• Renal artery measuring 3.5 cms
• Ureter measuring 2.5 cm

6. Gross examination
• Tumor is infiltrating the capsule.
• A part of renal parenchyma is compressed at the
periphery measuring 4x2 cms
• No lymph nodes identified in the perinephric pad of
fat

15. Microscopy
• Sections studied from renal arterial, ureteric and
renal venous margins are free of tumor
• Section studied from tumor composed of cells
arranged in solid sheets and nests.
• Individual tumor cells are clear, vacuolated
cytoplasm with vesicular nucleus and prominent
nucleoli.
• At few places, granular eosinophilic cytoplasm is also
seen

16. Microscopy
• Occasional bizarre looking cells are seen
• Surrounding areas show fibrosis and desmoplastic
stroma infiltrated by lymphocytes
• Few areas show hemorrhage and necrosis
• Tumor shows capsular invasion
• Focal areas show osseous metaplasia
• Adjacent renal parenchyma shows dilated tubules
and focal glomerulosclerosis
• Sections from perinephric fat is free of tumor

17. Impression
• Clear cell variant of Renal cell carcinoma - Left kidney
• According to Fuhrman Nuclear Grading, Grade II with
capsular invasion
• Renal arterial, ureteric and renal venous margins are
free of tumor
• Perinephric pad of fat is free of tumor
• Staging - pT2N0

18. Fuhrman Nuclear Grading of Renal Cell
Carcinoma
• Grade 1 Small, round and uniform nuclei. No evident
nucleoli
• Grade 2 Nuclei with irregular outlines. Inconspicuous
nucleoli
• Grade 3 Irregular nuclei with identifiable nucleoli at
100× magnification
• Grade 4 Large, hyperchromatic, pleomorphic nuclei.
Single or multiple nucleoli

19. Tumor, Node, Metastasis (TNM) Staging Scheme for Renal Cell Carcinoma
PRIMARY TUMOR (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
T1 Tumor ≤7 cm in greatest dimension, limited to the kidney
T1a Tumor ≤4 cm in greatest dimension, limited to the kidney
T1b Tumor >4 cm but not >7 cm in greatest dimension, limited to the kidney
T2 Tumor >7 cm in greatest dimension, limited to the kidney
T3 Tumor extends into major veins or invades adrenal gland or perinephric tissues but not
beyond Gerota's fascia
T3a Tumor directly invades adrenal gland or perirenal and/or renal sinus fat but not beyond
Gerota's fascia
T3b Tumor grossly extends into the renal vein or its segmental (muscle-containing) branches, or
vena cava below the diaphragm
T3c Tumor grossly extends into vena cava above the diaphragm or invades the wall of the vena
cava
T4 Tumor invades beyond Gerota's fascia
REGIONAL LYMPH NODES (N)*
NX Regional lymph nodes cannot be assessed
N0 No regional lymph nodes metastases
N1 Metastases in a single regional lymph node
N2 Metastasis in more than one regional lymph node
*Laterality does not affect the N classification
DISTANT METASTASIS (M)
MX Distant metastasis cannot be assessed
M0 No distant metastasis

20. • Thank you