Figure 526

The staging of renal adenocarcinoma. Renal cell cancer can be staged using one of two systems in common use. The TNM (tumor, node, metastasis) system has the advantage of being more specific but the disadvantage of being cumbersome; a modification of the Robson staging system (as illustrated here) is more practical and more widely used in the United States. In this system, stage I represents cancer that is confined to the kidney capsule; stage II indicates invasion through the renal capsule, but not beyond Gerota's fascia; stage III reflects involvement of regional lymph nodes and the ipsilateral renal vein or the vena cava; and stage IV indicates the presence of distant metastases [57].

With regard to pathologic assessment, previously renal carcinomas were classified according to cell type and growth pattern. The former included clear cell, spindle cell, and oncocytic carcinoma, while the latter included acinar, papillary, and sarcomatoid varieties. Recently, this classification has undergone a transformation to reflect more accurately the morphologic, histochemical, and molecular basis of differing types of adenocarcinoma [58]. Based on these studies, five distinct types of carcinoma have been identified: clear cell, chromophilic, chromophobic, oncocytic, and collecting duct. Each of these types has a unique growth pattern, cell of origin, and cytogenetic characteristics [59,60]. (From Brenner and Rector [56].)

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