Renal dataset

Question 1

Relevant clinical info on request form

Answer 1

Side -  left or right
Type of procedure (radical vs partial)
Access (open vs lap)
Adrenal included?
Pre-op treatment = ?embolisation

Question 2

Opening

Answer 2

Ink fat margin
mildine longitudinal incision along the long axis
additional perpendicular incision PRN for fixation
Examine renal vein
If partial open perpendicular to the parenchymal margin

Question 3

Renal hilar anatomy

Answer 3

Renal vein lies ANTERIOR to Renal artery

Renal pelvis POSTERIOR to both

Question 4

Nephrectomy macro

Answer 4

Weight
3D measurement
length of ureter
Open ureter (after sampling)
Open vein
Examine hilar fat for LN
Size of adrenal gland
Slice transversely then comment on tumour location and size
Comment on where the tumour arises from
If multiple, measure the 5 largest
Measure distance to fat margin and comment on perinephric fat invasion

Question 5

Blocks

Answer 5

Ureteric resection margin
Vascular resection margin
Renal vein thrombus if present
Renal sinus interface
Tumour blocks = 1block/cm, any different area, necrosis with tumour, interface with fat/invasion, minimum distance to the surgical margin, tumour with normal tissue
Invasion to adrenal
Renal pelvis
Normal tissue
Adrenal gland
All LNs

Question 6

partial nephrectomy macro

Answer 6

3D measurementrs
Ink surgical margin
Distance to surgical margin

Question 7

Tumour type

Answer 7

RCC (90%) - Clear vs Papillary vs Chromophobe
Benign oncocytoma
Collecting duct carcinoma

Papillary RCC - Type 1 & type 2
Type 1 - CK7 +ve, MET pathway alteration, better prognosis
Type 2 - NRF2 ARE pathway
Clear cell papillary RCC
Succinate dehydrogenase deficient RCC
Tubulocystic RCC
Acquired cystic disease associated RCC
HLRCC = FH gene - fumarate hydratase

Question 8

Familial RCC

Answer 8

Von Hippel Lindau
Hereditary papillary RCC
Hereditary Leiomyomatosis and RCC
Birt Hogg Dube syndrome
Tuberous sclerosis
Succinate dehydrogenase deficient RCC

Question 9

Grading RCC

Answer 9

1 to 4
1 nucleoli absent or inconspicuous and basophilic at 400x
2 nucleoli absent or inconspicuous at 100x
3 nucleoli conspicuous and eosinophilic at 100x
4 pleomorphic/sarcomatoid/Rhabdoid

Question 10

Prognostic factor

Answer 10

Necrosis
Grade 4 - Sarcomatoid/rhabdoid
Perinephric fat invasion pT3a
Gerota's fascia invasion pT4
Renal sinus invasion 
Renal vein invasion
Involvement of IVC - pT3c
LVSI
Invasion of pelvicalyceal system
Adrenal involvement
LN involvement - ?extracapsular spread, regional = hilar, aortic, caval
Margin status

Question 11

Immunohistochemistry

Answer 11

PAX8 +ve
CD10 +ve
TTF1, CDX2, ER, PSA -ve
Clear cell = CAIX (“cup like”), AMACR -ve
Papillary = CK7, AMACR +ve
Epithelioid angiomyolipoma = HMB45 and MelanA
Urothelial = p63, GATA3 +ve

Question 12

Molecular test for Target therapy

Answer 12

VHL
BAP1
PBRM1
SETD2
KDM5C

Question 13

Staging

Answer 13

pT1a - <4cm
pT1b - <7cm
pT2a - <10cm
pT2b - >10cm but in kidney
pT3a - local extends renal veisn, pelvis, sinus, fat NOT beyond Gerota's
pT3b - IVC below diaphragm
pT3c - IVC above diaphragm/ invades wall of IVC
pT4 - beyond Gerota's fascia