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Renal cell carcinoma | Associations | Imaging | Morphologic characteristics | Behavior | Incidence |
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Clear cell | Patients >50 years Von Hippel–Lindau tuberous sclerosis | Hypervascular Heterogeneous (hemorrhage, necrosis, or cysts) Originates from the renal cortex | Cells with clear cytoplasm, prominent nucleoli, and extensive intricate branching vasculature, arranged in a nested architectural pattern. | Aggressive | 75% |
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Papillary cell | Patients >50 years Hereditary papillary RCC End-stage renal | Hypovascular Homogeneous More common to be bilateral or multifocal | Neoplastic cells arranged in discrete papillary fronds with fibrovascular cores and can also be in a papillary-trabecular or papillary-solid architectural pattern. | Aggressive | 10–15% |
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Chromophobe | Patients >50 years Birt–Hogg–Dube syndrome | Hypovascular spoke-wheel contrast enhancement Indistinguishable from oncocytomas | Smaller eosinophilic and larger pale neoplastic cells with wrinkled nuclei and perinuclear halos arranged in a predominantly solid architectural pattern. | Favorable, low mortality | 5–11% |
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Collecting duct | Male-to-female ratio: 2 : 1 Patients: fourth and fifth decades | Heterogeneous (necrosis, hemorrhage, and calcification) infiltrative growth Originates from the medullary center | High-grade neoplastic cells with variable architectural patterns ranging from cribriform, papillary, solid, and tubular. Prominent stromal desmoplasia. | Very aggressive, 1/3 metastatic on diagnosis | 1% |
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Renal medullary | Associated with sickle cell trait Male-to-female ratio: 2 : 1 Mean age: 22 years | Hypovascular Heterogeneous (hemorrhage and necrosis) Liver and lung metastasis | High-grade eosinophilic, neoplastic cells in varying architectural patterns. Cribriform pattern is the most common. Prominent desmoplastic stroma. | Very aggressive Mean survival: 15 weeks | 1% |
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Multiloculated cystic | Mean age: 50 years Predominate in women with male-to-female ratio 1 : 4 | Largely cystic lesions, <25% solid | Multiple cysts with thin septa, lined by clear cells. | Indolent, favorable prognosis | Less than 1% |
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Tubulocystic | Patients >50 years Male-to-female ratio: 7 : 1 | Predominately cystic lesion with thin septa | Purely tubular and cystic growth pattern. Cysts lined by a single layer of neoplastic cells with hobnail appearance. | Largely indolent, rare reports of metastatic disease | Rare (less than 100 cases reported) |
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