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Voxel-based whole-lesion enhancement parameters: a study of its clinical value in differentiating clear cell renal cell carcinoma from renal oncocytoma. Abdom Radiol (NY) 2017; 42:552-560. [PMID: 27595574 DOI: 10.1007/s00261-016-0891-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study was to compare whole-lesion (WL) enhancement parameters to single region of interest (ROI)-based enhancement in discriminating clear cell renal cell carcinoma (ccRCC) from renal oncocytoma. MATERIALS AND METHODS In this IRB-approved retrospective study, the surgical database was queried to derive a cohort of 94 postnephrectomy patients with ccRCC or oncocytoma (68 ccRCC, 26 oncocytoma), who underwent preoperative multiphase contrast-enhanced computed tomography (CECT) between June 2009 and August 2013. CT acquisitions were transferred to a three-dimensional workstation, and WL ROIs were manually segmented. WL enhancement and histogram distribution parameters skewness, kurtosis, standard deviation (SD), and interquartile range (IQR) were calculated. WL enhancement parameters were compared to single ROI-based enhancement using receiver operating characteristic (ROC) analysis. RESULTS Oncocytoma had significantly higher WL enhancement than ccRCC in nephrographic (mean, p = 0.02; median, p = 0.03) and excretory phases (mean, p = 0.03; median p < 0.01). ccRCC had significantly higher kurtosis than oncocytoma in corticomedullary (p = 0.03) and excretory phases (p < 0.01), and significantly higher SD and IQR than oncocytoma in all postcontrast phases: corticomedullary (SD, p = 0.02; IQR, p < 0.01), nephrographic (SD, p = 0.01; IQR, p = 0.03), and excretory (SD, p < 0.01; IQR, p < 0.01). When compared to single ROI-based enhancement, WL enhancement alone did not demonstrate a statistical advantage in discriminating between ccRCC and oncocytoma (area under ROC curve of 0.78 and 0.72 respectively), but when combined with histogram distribution parameters (area under ROC curve of 0.86), it did demonstrate a slight improvement. CONCLUSION Our study suggests that voxel-based WL enhancement parameters provide only a slight improvement over single ROI-based enhancement techniques in differentiating between ccRCC and renal oncocytoma.
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Thierry S, Kammerer-Jacquet SF, Dugay F, Berquet G, Couapel JP, Alimi Q, Bensalah K, Rioux-Leclercq N. [Oncocytoma with a thrombus into the renal vein: A case report]. Prog Urol 2016; 27:1-2. [PMID: 27889176 DOI: 10.1016/j.purol.2016.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 10/16/2016] [Accepted: 10/21/2016] [Indexed: 11/17/2022]
Affiliation(s)
- S Thierry
- Service d'anatomie et cytologie pathologiques, université de Rennes 1, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France.
| | - S F Kammerer-Jacquet
- Service d'anatomie et cytologie pathologiques, université de Rennes 1, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France
| | - F Dugay
- Service de cytogénétique et biologie cellulaire, université de Rennes 1, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France
| | - G Berquet
- Service d'urologie, université de Rennes 1, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France
| | - J P Couapel
- Service d'urologie, université de Rennes 1, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France
| | - Q Alimi
- Service d'urologie, université de Rennes 1, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France
| | - K Bensalah
- Service d'urologie, université de Rennes 1, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France
| | - N Rioux-Leclercq
- Service d'anatomie et cytologie pathologiques, université de Rennes 1, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France
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Renal oncocytoma with vascular invasion: a series of 22 cases. Hum Pathol 2016; 58:1-6. [PMID: 27498062 DOI: 10.1016/j.humpath.2016.07.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/11/2016] [Accepted: 07/20/2016] [Indexed: 11/20/2022]
Abstract
Renal oncocytomas are benign neoplasms that are often excised, as clinically they cannot be distinguished with certainty from renal cell carcinoma. One of the least common findings in oncocytomas is vascular invasion, and their behavior is not well characterized with only reports of isolated examples and smaller case series. Whether vascular invasion is acceptable for the diagnosis of oncocytoma still remains controversial, even amongst genitourinary pathologists with expertise in renal tumor pathology. Of 1474 cases of renal oncocytoma identified at 3 large medical centers, 22 (1.5%) had vascular invasion. Patients included 12 men and 10 women with an average age at diagnosis of 67.5 years (range, 48-91 years). Thirteen cases showed large vessel invasion, and the remainder involved medium or small vessels. Tumor was grossly visible in the renal vein in 2 cases. Clinical data were available on 16 of the 22 cases with an average follow-up time of 29.9 months (range, 7.5-94.5 months). Of the cases with clinical follow-up, all but one individual was alive. All living individuals were free of recurrence or metastatic disease at the time of last follow-up. Our cohort showed no metastasis or recurrence and overall survival of 94.7% at 2.5 years following diagnosis, supporting the finding that vascular invasion does not alter the favorable prognosis of oncocytoma. The presence of vascular invasion should not lead to any uncertainty about the diagnosis in an otherwise typical oncocytoma.
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Affiliation(s)
- Sean R Williamson
- Henry Ford Health System, Detroit, MI, USA
- Wayne State University School of Medicine, Detroit, MI, USA
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55
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56
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The 2012 ISUP Vancouver and 2016 WHO classification of adult renal tumors: changes for common renal tumors. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.mpdhp.2016.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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57
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58
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Renal oncocytosis: a clinicopathological and cytogenetic study of 42 tumours occurring in 11 patients. Pathology 2016; 48:41-6. [DOI: 10.1016/j.pathol.2015.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 07/28/2015] [Accepted: 08/06/2015] [Indexed: 02/05/2023]
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59
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Arias-Stella JA, Williamson SR. Updates in Benign Lesions of the Genitourinary Tract. Surg Pathol Clin 2015; 8:755-87. [PMID: 26612226 DOI: 10.1016/j.path.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The genitourinary tract is a common site for new cancer diagnosis, particularly for men. Therefore, cancer-containing specimens are very common in surgical pathology practice. However, many benign neoplasms and nonneoplastic, reactive, and inflammatory processes in the genitourinary tract may mimic or cause differential diagnostic challenges with malignancies. Emerging clinicopathologic, immunohistochemical, and molecular characteristics have shed light on the pathogenesis and differential diagnosis of these lesions. This review addresses differential diagnostic challenges related to benign genitourinary tract lesions in the kidney, urinary bladder, prostate, and testis, with emphasis on recent advances in knowledge and areas most common in diagnostic practice.
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Affiliation(s)
- Javier A Arias-Stella
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Sean R Williamson
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI, USA.
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Lang M, Vocke CD, Merino MJ, Schmidt LS, Linehan WM. Mitochondrial DNA mutations distinguish bilateral multifocal renal oncocytomas from familial Birt-Hogg-Dubé tumors. Mod Pathol 2015; 28:1458-69. [PMID: 26428318 PMCID: PMC4628590 DOI: 10.1038/modpathol.2015.101] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 04/10/2015] [Accepted: 07/08/2015] [Indexed: 01/06/2023]
Abstract
Oncocytomas are mostly benign tumors characterized by accumulation of defective mitochondria, and in sporadic cases, are associated with disruptive mitochondrial DNA (mtDNA) mutations. However, the role mtDNA mutations have in renal tumors of Birt-Hogg-Dubé (BHD) patients and other renal oncocytomas with an apparent genetic component has not been investigated to date. Here we characterize the mitochondrial genome in different renal tumors and investigate the possibility of employing mtDNA sequencing analyses of biopsy specimens to aid in the differential diagnosis of oncocytomas. The entire mitochondrial genome was sequenced in 25 samples of bilateral and multifocal (BMF) renal oncocytomas, 30 renal tumors from BHD patients and 36 non-oncocytic renal tumors of different histologies as well as in biopsy samples of kidney tumors. mtDNA sequencing in BMF oncocytomas revealed that all tumors carry disruptive mutations, which impair the assembly of the NADH-ubiquinone oxidoreductase. Multiple tumors from a given BMF oncocytoma patient mainly harbor the same somatic mutation and the kidneys of these patients display diffuse oncocytosis. In contrast, renal oncocytomas of patients with BHD syndrome and renal tumors with different histologies do not show disruptive mtDNA mutations. Moreover, we demonstrate that it is feasible to amplify and sequence the entire mtDNA in biopsy specimens, and that these sequences are representative of the tumor DNA. These results show that pathogenic mtDNA mutations affecting complex I of the respiratory chain are strongly correlated with the oncocytoma phenotype in non-BHD-related renal tumors and that mtDNA sequences from biopsies are predictive of the tumor genotype. This work supports a role for mtDNA mutations in respiratory chain complexes as diagnostic markers for renal oncocytomas.
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Affiliation(s)
- Martin Lang
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892
| | - Cathy D. Vocke
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892
| | - Maria J. Merino
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892
| | - Laura S. Schmidt
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892
- Basic Science Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD 21702
| | - W. Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892
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Abstract
Tumours of the distal nephron are uncommon but can create diagnostic difficulties. They may be divided into three groups-tumours of intercalated cell phenotype, those of principal cell phenotype and others with an unconfirmed distal nephron origin. Oncocytomas, chromophobe carcinoma and hybrid oncocytoma chromophobe carcinoma, all show features of intercalated cells and the distinction amongst these is one of the most common areas of diagnostic dilemma. Collecting duct carcinoma and renal medullary carcinoma are the most aggressive forms of renal cancer but recent evidence suggests they may respond to targeted therapy so their recognition becomes crucial to the management of these patients. There remains debate over the precise phenotype of both tubulocystic carcinoma and mucinous tubular and spindle cell carcinoma.
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Affiliation(s)
- Stewart Fleming
- Department of Cellular and Molecular Pathology, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, UK.
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Kryvenko ON, Jorda M, Argani P, Epstein JI. Diagnostic approach to eosinophilic renal neoplasms. Arch Pathol Lab Med 2014; 138:1531-41. [PMID: 25357116 PMCID: PMC4352320 DOI: 10.5858/arpa.2013-0653-ra] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Eosinophilic renal neoplasms include a spectrum of solid and papillary tumors ranging from indolent benign oncocytoma to highly aggressive malignancies. Recognition of the correct nature of the tumor, especially in biopsy specimens, is paramount for patient management. OBJECTIVE To review the diagnostic approach to eosinophilic renal neoplasms with light microscopy and ancillary techniques. DATA SOURCES Review of the published literature and personal experience. CONCLUSIONS The following tumors are in the differential diagnosis of oncocytic renal cell neoplasm: oncocytoma, chromophobe renal cell carcinoma (RCC), hybrid tumor, tubulocystic carcinoma, papillary RCC, clear cell RCC with predominant eosinophilic cell morphology, follicular thyroid-like RCC, hereditary leiomyomatosis-associated RCC, acquired cystic disease-associated RCC, rhabdoid RCC, microphthalmia transcription factor translocation RCC, epithelioid angiomyolipoma, and unclassified RCC. In low-grade nonpapillary eosinophilic neoplasms, distinction between oncocytoma and low-grade RCC mostly rests on histomorphology; however, cytokeratin 7 immunostain may be helpful. In high-grade nonpapillary lesions, there is more of a role for ancillary techniques, including immunohistochemistry for cytokeratin 7, CA9, CD10, racemase, HMB45, and Melan-A. In papillary eosinophilic neoplasms, it is important to distinguish sporadic type 2 papillary RCC from microphthalmia transcription factor translocation and hereditary leiomyomatosis-associated RCC. Histologic and cytologic features along with immunohistochemistry and fluorescence in situ hybridization tests for TFE3 (Xp11.2) and TFEB [t(6;11)] are reliable confirmatory tests. Eosinophilic epithelial neoplasms with architecture, cytology, and/or immunoprofile not qualifying for either of the established types of RCC should be classified as unclassified eosinophilic RCC and arbitrarily assigned a grade (low or high).
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MESH Headings
- Adenoma, Oxyphilic/diagnosis
- Adenoma, Oxyphilic/pathology
- Angiomyolipoma/diagnosis
- Angiomyolipoma/pathology
- Basic Helix-Loop-Helix Leucine Zipper Transcription Factors/genetics
- Carcinoma, Renal Cell/diagnosis
- Carcinoma, Renal Cell/genetics
- Carcinoma, Renal Cell/pathology
- Chromosomes, Human, X/genetics
- Eosinophilia/pathology
- Female
- Humans
- Kidney Diseases, Cystic/complications
- Kidney Diseases, Cystic/pathology
- Kidney Neoplasms/diagnosis
- Kidney Neoplasms/etiology
- Kidney Neoplasms/genetics
- Kidney Neoplasms/pathology
- Leiomyomatosis/diagnosis
- Leiomyomatosis/pathology
- Male
- Microphthalmia-Associated Transcription Factor/genetics
- Neoplastic Syndromes, Hereditary
- Skin Neoplasms/diagnosis
- Skin Neoplasms/pathology
- Translocation, Genetic
- Uterine Neoplasms/diagnosis
- Uterine Neoplasms/pathology
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Affiliation(s)
- Oleksandr N Kryvenko
- From the Departments of Pathology (Drs Kryvenko and Jorda) and Urology (Drs Kryvenko and Jorda), University of Miami Miller School of Medicine, Miami, Florida; and the Departments of Pathology (Drs Argani and Epstein), Oncology (Drs Argani and Epstein), and Urology (Dr Epstein), The Johns Hopkins Medical Institutions, Baltimore, Maryland
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63
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Compérat E. [Rare renal tumors. Case no 7. "Atypical" oncocytoma: how many atypia can we accept?]. Ann Pathol 2014; 34:160-3. [PMID: 24703032 DOI: 10.1016/j.annpat.2014.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 02/08/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Eva Compérat
- Service d'anatomie et cytologie pathologiques 1, université Pierre-et-Marie-Curie Paris VI, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
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Ng KL, Rajandram R, Morais C, Yap NY, Samaratunga H, Gobe GC, Wood ST. Differentiation of oncocytoma from chromophobe renal cell carcinoma (RCC): can novel molecular biomarkers help solve an old problem? J Clin Pathol 2013; 67:97-104. [PMID: 24170213 DOI: 10.1136/jclinpath-2013-201895] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Standard treatment of renal neoplasms remains surgical resection, and nephrectomy for localised renal cell carcinoma (RCC) still has the best chance of cure with excellent long-term results. For smaller renal masses, especially stage T1a tumours less than 4 cm, nephron-sparing surgery is often employed. However, small incidentally detected renal masses pose an important diagnostic dilemma as a proportion of them may be benign and could be managed conservatively. Renal oncocytoma is one such lesion that may pose little risk to a patient if managed with routine surveillance rather than surgery. Additionally, lower-risk RCC, such as small chromophobe RCC, may be managed in a similar way, although with more caution than the renal oncocytomas (RO). The ability to differentiate ROs from chromophobe RCCs, and from other RCCs with a greater chance of metastasis, would guide the physician and patient towards the most appropriate management, whether nephron-sparing surgical resection or conservative surveillance. Consistent accurate diagnosis of ROs is likely to remain elusive until modern molecular biomarkers are identified and applied routinely. This review focuses on the differentiation of renal oncocytomas and chromophobe RCCs. It summarises the history, epidemiology and clinical presentation of the renal neoplasms, explains the diagnostic dilemma, and describes the value, or not, of current molecular markers that are in development to assist in diagnosis of the renal neoplasms.
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Affiliation(s)
- Keng Lim Ng
- Centre for Kidney Disease Research, School of Medicine, The University of Queensland, Translational Research Institute, , Brisbane, Australia
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65
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Ginzburg S, Uzzo R, Al-Saleem T, Dulaimi E, Walton J, Corcoran A, Plimack E, Mehrazin R, Tomaszewski J, Viterbo R, Chen DYT, Greenberg R, Smaldone M, Kutikov A. Coexisting hybrid malignancy in a solitary sporadic solid benign renal mass: implications for treating patients following renal biopsy. J Urol 2013; 191:296-300. [PMID: 23899990 DOI: 10.1016/j.juro.2013.07.059] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2013] [Indexed: 01/20/2023]
Abstract
PURPOSE Concern regarding coexisting malignant pathology in benign renal tumors deters renal biopsy and questions its validity. We examined the rates of coexisting malignant and high grade pathology in resected benign solid solitary renal tumors. MATERIALS AND METHODS Using our prospectively maintained database we identified 1,829 patients with a solitary solid renal tumor who underwent surgical resection between 1994 and 2012. Lesions containing elements of renal oncocytoma, angiomyolipoma or another benign pathology formed the basis for this analysis. Patients with an oncocytic malignancy without classic oncocytoma and those with known hereditary syndromes were excluded from study. RESULTS We identified 147 patients with pathologically proven elements of renal oncocytoma (96), angiomyolipoma (44) or another solid benign pathology (7). Median tumor size was 3.0 cm (IQR 2.2-4.5). As quantified by the R.E.N.A.L. (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior and location relative to polar lines) nephrometry score, tumor anatomical complexity was low in 28% of cases, moderate in 56% and high in 16%. Only 4 patients (2.7%) were documented as having hybrid malignant pathology, all involving chromophobe renal cell carcinoma in the setting of renal oncocytoma. At a median followup of 44 months (IQR 33-55) no patient with a hybrid tumor experienced regional or metastatic progression. CONCLUSIONS In our cohort of patients with a solitary, sporadic, solid benign renal mass fewer than 3% of tumors showed coexisting hybrid malignancy. Importantly, no patient harbored coexisting high grade pathology. These data suggest that uncertainty regarding hybrid malignant pathology coexisting with benign pathological components should not deter renal biopsy, especially in the elderly and comorbid populations.
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Affiliation(s)
- Serge Ginzburg
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University, Philadelphia, Pennsylvania
| | - Robert Uzzo
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University, Philadelphia, Pennsylvania
| | - Tahseen Al-Saleem
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University, Philadelphia, Pennsylvania
| | - Essel Dulaimi
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University, Philadelphia, Pennsylvania
| | - John Walton
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University, Philadelphia, Pennsylvania
| | - Anthony Corcoran
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University, Philadelphia, Pennsylvania
| | - Elizabeth Plimack
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University, Philadelphia, Pennsylvania
| | - Reza Mehrazin
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University, Philadelphia, Pennsylvania
| | - Jeffrey Tomaszewski
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University, Philadelphia, Pennsylvania
| | - Rosalia Viterbo
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University, Philadelphia, Pennsylvania
| | - David Y T Chen
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University, Philadelphia, Pennsylvania
| | - Richard Greenberg
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University, Philadelphia, Pennsylvania
| | - Marc Smaldone
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University, Philadelphia, Pennsylvania
| | - Alexander Kutikov
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University, Philadelphia, Pennsylvania.
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Xiao GQ, Ko HBM, Unger P. Telangiectatic oncocytoma: a previously undescribed variant of renal oncocytoma. Am J Clin Pathol 2013; 140:103-8. [PMID: 23765540 DOI: 10.1309/ajcp9hdxyb2wyyjx] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To identify, describe, and investigate the clinical, radiologic, and pathologic features of 8 cases of telangiectatic oncocytoma. METHODS Fifty-three consecutive renal oncocytomas were reviewed for the telangiectatic pathologic features that were subsequently correlated with the demographic, clinical, and radiographic findings. RESULTS Telangiectatic oncocytoma accounted for 15% of the 53 renal oncocytomas collected in the past 7 years in our institution. On radiology, almost all presented as an enhancing mass and were suspicious for or consistent with a renal malignant tumor. Grossly, the tumors ranged from 2.4 to 6.0 cm (mean, 3.5 cm) and macroscopically were hemorrhagic spongy or multicystic masses without a central stellate scar. Microscopically, they were characterized by variably sized blood-distended spaces (<0.1-mm to 2- to 3-mm blood lakes) lined by typical oncocytoma cells and without evidence of degenerative changes. CONCLUSIONS With its unique radiologic and pathologic presentations in comparison with classic renal oncocytoma, it is important to recognize this new variant of renal oncocytoma.
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Affiliation(s)
- Guang-Qian Xiao
- Department of Pathology, Mount Sinai School of Medicine, New York, NY
| | - Huai-Bin Mabel Ko
- Department of Pathology, Mount Sinai School of Medicine, New York, NY
| | - Pamela Unger
- Department of Pathology, Mount Sinai School of Medicine, New York, NY
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Poté N, Vieillefond A, Couturier J, Arrufat S, Metzger I, Delongchamps NB, Camparo P, Mège-Lechevallier F, Molinié V, Sibony M. Hybrid oncocytic/chromophobe renal cell tumours do not display genomic features of chromophobe renal cell carcinomas. Virchows Arch 2013; 462:633-8. [PMID: 23708994 DOI: 10.1007/s00428-013-1422-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 04/01/2013] [Accepted: 04/30/2013] [Indexed: 01/13/2023]
Abstract
Hybrid oncocytic/chromophobe tumours (HOCT) are renal tumours recently described displaying histological features of both renal oncocytoma (RO) and chromophobe renal cell carcinoma (ChRCC), raising the question of their precise signification in the RO/ChRCC group. This study aimed to describe clinicopathological features of so called HOCT and to characterise their genomic profile. Five hundred and eighty-three tumours belonging to the ChRCC/RO group were retrospectively reviewed. Twelve tumours that could not be classified as RO or CHRC were considered as HOCT. Hale staining and cytokeratin 7 (CK7) immunostaining were performed. Genomic profile was established by array comparative genomic hybridisation (array-CGH) on frozen samples. Mean age at diagnosis was 70 years (range 46-83). No recurrence was observed (median follow-up: 18 months; range 9-72). Tumour size ranged from 1 to 11 cm. HOCT showed an admixture of RO- and ChRCC-like areas and/or "hybrid" cells with overlapping cytonuclear and/or histochemical features. Hale staining was apical in 50 to 100 % of cells, and CK7 was expressed in 10 to 100 % of cells. Genomic profile was balanced in seven cases or showed a limited number of random imbalances in five cases, as observed in RO. In no instances were observed the characteristic chromosome losses of ChRCC. These results suggest that so called HOCT are not true hybrid tumours and rather could represent a morphological variant of RO. From a diagnostic perspective, an array-CGH analysis could be performed in ambiguous ChRCC/RO cases to formally exclude the diagnosis of ChRCC.
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Affiliation(s)
- Nicolas Poté
- Department of Pathology, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France
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Brimo F, Epstein JI. Selected common diagnostic problems in urologic pathology: perspectives from a large consult service in genitourinary pathology. Arch Pathol Lab Med 2012; 136:360-71. [PMID: 22458899 DOI: 10.5858/arpa.2011-0187-ra] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Several common differential diagnoses are encountered in urologic pathology, frequently causing patient referrals for a second opinion. OBJECTIVES To review 3 common differential diagnoses encountered in a large consultation service in genitourinary pathology, including partial atrophy versus prostatic acinar adenocarcinoma, oncocytoma versus chromophobe renal cell carcinoma, and urothelial carcinoma in situ versus normal urothelium and reactive atypia. We will discuss the detailed, morphologically distinctive features and the usefulness of immunohistochemistry. DATA SOURCES Personal experience and review of the current literature. CONCLUSIONS Careful morphologic assessment and awareness of diagnostic pitfalls are fundamental in reaching a definitive diagnosis in most cases. Immunohistochemistry is useful but should be used only in conjunction with the morphologic impression.
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Affiliation(s)
- Fadi Brimo
- Departments of Pathology and Urology, McGill University Health Center, Montréal, Quebec, Canada
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69
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70
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Piccoli GB, Bonino LD, Campisi P, Vigotti FN, Ferraresi M, Fassio F, Brocheriou I, Porpiglia F, Restagno G. Chronic kidney disease, severe arterial and arteriolar sclerosis and kidney neoplasia: on the spectrum of kidney involvement in MELAS syndrome. BMC Nephrol 2012; 13:9. [PMID: 22353239 PMCID: PMC3306738 DOI: 10.1186/1471-2369-13-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 02/21/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND MELAS syndrome (MIM ID#540000), an acronym for Mitochondrial Encephalopathy, Lactic Acidosis and Stroke-like episodes, is a genetically heterogeneous mitochondrial disorder with protean manifestations and occasional kidney involvement. Interest in the latter is rising due to the identification of cases with predominant kidney involvement and to the hypothesis of a link between mitochondrial DNA and kidney neoplasia. CASE PRESENTATION We report the case of a 41-year-old male with full blown MELAS syndrome, with lactic acidosis and neurological impairment, affected by the "classic" 3243A > G mutation of mitochondrial DNA, with kidney cancer. After unilateral nephrectomy, he rapidly developed severe kidney functional impairment, with nephrotic proteinuria. Analysis of the kidney tissue at a distance from the two tumor lesions, sampled at the time of nephrectomy was performed in the context of normal blood pressure, recent onset of diabetes and before the appearance of proteinuria. The morphological examination revealed a widespread interstitial fibrosis with dense inflammatory infiltrate and tubular atrophy, mostly with thyroidization pattern. Vascular lesions were prominent: large vessels displayed marked intimal fibrosis and arterioles had hyaline deposits typical of hyaline arteriolosclerosis. These severe vascular lesions explained the different glomerular alterations including ischemic and obsolescent glomeruli, as is commonly observed in the so-called "benign" arteriolonephrosclerosis. Some rare glomeruli showed focal segmental glomerulosclerosis; as the patient subsequently developed nephrotic syndrome, these lesions suggest that silent ischemic changes may result in the development of focal segmental glomerulosclerosis secondary to nephron loss. CONCLUSIONS Nephron loss may trigger glomerular sclerosis, at least in some cases of MELAS-related nephropathy. Thus the incidence of kidney disease in the "survivors" of MELAS syndrome may increase as the support therapy of these patients improves.
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