What is the pattern of tumor spread for sarcomatoid renal cell carcinoma (SRCC) and rhabdoid renal cell carcinoma (RRCC)?

Updated: Mar 11, 2019
  • Author: Ronald J Cohen, MB, BCh, PhD, FRCPA, FFPATH; Chief Editor: Liang Cheng, MD  more...
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Answer

As both sarcomatoid renal cell carcinoma (SRCC) and rhabdoid renal cell carcinoma (RRCC) can arise from various histological types of RCC, the location of tumor origin varies according to the underlying RCC subtype. Most RCCs are believed to arise within the renal cortex, with the epithelial cells of origin proposed to be from the proximal convoluted tubule for clear cell renal cell carcinoma (CCRCC), from the proximal straight tubule for papillary RCC, and from the intercalated cells of the cortical collecting duct for chromophobe RCC. Collecting duct (Bellini duct) carcinoma arises within the renal medulla, from the principal cells of the medullary collecting duct. [24, 25, 26]

Extension into the renal sinus is the most common pathway of spread for most histologic types of RCC because the sinus is not separated from the cortical columns of Bertin by connective tissue. [27] Because only 13-22% of SRCCs have regional lymph node involvement, but 45-66% have distant metastasis at presentation, [3, 4, 7] most of these tumors likely invade the vasculature of the renal sinus fat, as observed for CCRCC. [28, 29]

Although 37% of RRCCs have lymph node metastases and 22% have distant metastases at presentation, [8, 9, 10, 11] the small number of these tumors studied to date does not allow any conclusions to be drawn on their pattern of spread.


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