Papillary Renal Cell Carcinoma: Radio -logic-Pathologic Cor?relation and Spectrum of Disease

Raghunandan Vikram, MBBS, MRCP, FRCR , Chaan S. Ng, MD Pheroze Tamboli, MD, Nizar M. Tannir, MD , Eric Jonasch, MD , Surena F. Matin, MD , Christopher G. Wood, MD , Carl M. Sandler, MD

Papillary renal cell carcinoma (pRCC) is the second most common type/of renal cell carcinoma (RCC). pRCC has unique imaging and clinical features that may allow differentiation from clear cell RCC (cRCC). There have been significant advances in our knowledge of the natural history and treatment of pRCC, with data suggesting that it may be best to manage pRCC differently from the other subtypes of RCC. At contrast material-enhanced computed tomography, pRCC enhances less than does cRCC in all phases of contrast-enhanced im­aging. The difference in the degree of enhancement between pRCC and cRCC is due to differences in their intratumoral vascularity. In general, if a heterogeneous mass enhances to a degree similar to that manifested by the renal cortex, it is likely to be a cRCC. A mass that enhances to a lesser degree is likely to be a non-clear cell RCC. It is common for metastatic lesions from pRCC to show enhance­ment characteristics similar to those of the primary tumor and be hypovascular.