Clear Cell Papillary RCC

Dr. Fintel,

In reference to Dr. Yagmour’s assessment of the case, he suggests that this could be the described entity of clear cell papillary renal carcinoma  (CCPRC) referenced here with attached commentary.  If that is the pathology that is being described here, the prognosis is really excellent as CCPRC is biologically a very indolent process that almost never metastasizes.   Please see the Hopkin’s series in the attached article for more information.  However, I will caution, in this case I question this as a diagnosis in that there was a 2.4cm paracaval LN with extracapsular extension describing a tumor which clearly is more biologically aggressive.  I would thus have the pathology reviewed by a higher volume center. I suppose we would have to follow the biology here in that it clearly is behaving more aggressively and thus prognostically would be a greater risk.  However, unfortunately all adjuvant therapy trials to date have failed to show any efficacy.  Thus, if there is an adjuvant clinical trial available, I would consider that for this patient.  The histology and biology are also important to understand in that I would also be more inclined to radiographically surveil him if more aggressive.