Morphologic typing of papillary renal cell carcinoma: comparison of growth kinetics and patient survival in 66 cases

Hum Pathol. 2001 Jun;32(6):590-5. doi: 10.1053/hupa.2001.24984.


Whereas papillary renal cell carcinoma is now established as a subtype of renal cell neoplasia, division of these tumors into 2 distinctive morphotypes has been proposed. Type 1 tumors have cells with scanty pale cytoplasm arranged in a single layer on the basement membrane of papillary cores. In these tumors, psammoma bodies and foamy macrophages are frequently seen, and the tumors frequently express cytokeratin 7. Type 2 tumor cells have pseudostratified nuclei and usually have voluminous eosinophilic cytoplasm. Recent studies have supported this subclassification of papillary renal cell carcinoma by demonstrating differing genotypes for type 1 and 2 tumors. To further study the subclassification of papillary renal carcinoma, we compared clinical features, nuclear grade, stage, tumor growth kinetics, and survival in a series of 50 type 1 and 16 type 2 papillary renal cell carcinomas. Comparison of patient age at presentation, sex, and primary tumor size shows no significant difference between the 2 tumor types. Type 1 tumors were of significantly lower Fuhrman grade (P =.0001) and higher Robson stage (P =.009) than type 2 tumors. There was no significant difference when tumors were staged according to the TNM classification. Assessment of tumor growth kinetics showed significantly different mean silver-staining nucleolar organizer region (AgNOR) scores and Ki-67 indices (AgNOR type 1, 3.83, type 2, 7.24, P =.0001; Ki-67 type 1, 3.17%, type 2, 6.01%, P =.0002). Multivariate analysis showed tumor type (P =.03), presence of metastases (P =.04), AgNOR score (P =.001), and Ki-67 index (P =.03) to be independently associated with survival. These results provide evidence of the clinical utility of dividing papillary renal cell carcinomas into 2 types according to histologic characteristics.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Papillary / classification
  • Carcinoma, Papillary / mortality
  • Carcinoma, Papillary / pathology*
  • Carcinoma, Renal Cell / classification
  • Carcinoma, Renal Cell / mortality
  • Carcinoma, Renal Cell / pathology*
  • Cell Division*
  • Cell Nucleus / pathology
  • Cytoplasm / pathology
  • Female
  • Humans
  • Keratin-7
  • Keratins / analysis
  • Ki-67 Antigen / analysis
  • Kidney Neoplasms / classification
  • Kidney Neoplasms / mortality
  • Kidney Neoplasms / pathology*
  • Kinetics
  • Macrophages / pathology
  • Male
  • Middle Aged
  • Neoplasm Metastasis
  • Neoplasm Staging
  • Nucleolus Organizer Region / pathology
  • Silver Staining
  • Survival Rate*


  • KRT7 protein, human
  • Keratin-7
  • Ki-67 Antigen
  • Keratins