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Adeniran AJ, Shuch B, Humphrey PA. Sarcomatoid and Rhabdoid Renal Cell Carcinoma: Clinical, Pathologic, and Molecular Genetic Features. Am J Surg Pathol 2024; 48:e65-e88. [PMID: 38736105 DOI: 10.1097/pas.0000000000002233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Renal cell carcinoma (RCC) with sarcomatoid and rhabdoid morphologies has an aggressive biological behavior and a typically poor prognosis. The current 2022 WHO classification of renal tumors does not include them as distinct histologic entities but rather as transformational changes that may arise in a background of various distinct histologic types of RCC. The sarcomatoid component shows malignant spindle cells that may grow as intersecting fascicles, which is reminiscent of pleomorphic undifferentiated sarcoma. The rhabdoid cells are epithelioid cells with eccentrically located vesicular nuclei with prominent nucleoli and large intracytoplasmic eosinophilic inclusions. Studies have shown that RCCs with sarcomatoid and rhabdoid differentiation have distinctive molecular features. Sarcomatoid RCC harbors shared genomic alterations in carcinomatous and rhabdoid components, but also enrichment of specific genomic alterations in the sarcomatoid element, suggesting molecular pathways for development of sarcomatoid growth from a common clonal ancestor. Rhabdoid differentiation also arises through clonal evolution although less is known of specific genomic alterations in rhabdoid cells. Historically, treatment has lacked efficacy, although recently immunotherapy with PD-1/PD-L1/CTLA-4 inhibitors has produced significant clinical responses. Reporting of sarcomatoid and rhabdoid features in renal cell carcinoma is required by the College of American Pathologists and the International Collaboration on Cancer Reporting. This manuscript reviews the clinical, pathologic, and molecular features of sarcomatoid RCC and rhabdoid RCC with emphasis on the morphologic features of these tumors, significance of diagnostic recognition, the molecular mechanisms of tumorigenesis and differentiation along sarcomatoid and rhabdoid lines, and advances in treatment, particularly immunotherapy.
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Affiliation(s)
| | - Brian Shuch
- Department of Urology, University of California Los Angeles, Los Angeles, CA
| | - Peter A Humphrey
- Department of Pathology, Yale University School of Medicine, New Haven, CT
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Zhang H, Majeed NK, Sharifi R, Guzman G. A Case of Sarcomatoid Renal Cell Carcinoma With Osseous Metaplasia and Papillary Renal Cell Carcinoma Metastasis. CLINICAL PATHOLOGY 2019; 12:2632010X19848005. [PMID: 31206101 PMCID: PMC6537066 DOI: 10.1177/2632010x19848005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 04/05/2019] [Indexed: 11/18/2022]
Abstract
Sarcomatoid renal cell carcinoma is an uncommon and aggressive renal tumor with rapid disease progression. A median survival time is only 4-9 months after diagnosis. Osteogenic differentiation is a rare feature of the tumor. Here, we present a case of renal cell carcinoma with sarcomatoid feature and osteoid differentiation, and papillary renal cell carcinoma metastasis in a 58 year-old African-American male. This is the first reported renal cell carcinoma case with the combination of sarcomatoid feature, osteoid differentiation, and papillary renal cell carcinoma metastasis.
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Affiliation(s)
- Hui Zhang
- Department of pathology, University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
| | - Nasma K Majeed
- Department of pathology, University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
| | - Roohollah Sharifi
- Department of surgery, University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
| | - Grace Guzman
- Department of pathology, University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
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3
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Aird JJ, Nic An Riogh AU, Fleming S, Hislop RG, Sweeney P, Mayer N. Papillary Renal Cell Carcinoma With Osteosarcomatous Heterologous Differentiation: A Case Report With Molecular Genetic Analysis and Review of the Literature. Int J Surg Pathol 2017; 25:745-750. [PMID: 28669254 DOI: 10.1177/1066896917716772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sarcomatoid differentiation can occur in all subtypes of renal cell carcinoma (RCC). In rare cases, heterologous differentiation has been described. We present a case of heterologous osteosarcomatous differentiation in association with sarcomatoid papillary RCC including an analysis of chromosomal copy number alteration. This is the first case to identify heterologous differentiation in association with papillary RCC. The patient was a 70-year-old man who had a mass in the right kidney. Speckled calcification was seen on computed tomography scan. Histological assessment demonstrated papillary RCC merging with areas of sarcomatoid change and malignant bone formation simulating osteosarcoma. Cytogenetic evaluation demonstrated additional copies of chromosome 7 in both epithelial and osteosarcomatous components. A literature review identified 33 previous cases of heterologous differentiation in association with RCC. Of the 14 cases that reported an epithelial subtype, 13 cases were reported to be chromophobe RCC and 1 case was reported to be clear cell RCC.
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Affiliation(s)
| | | | | | | | | | - Nick Mayer
- 1 Cork University Hospital, Wilton, Cork, Ireland
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4
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Wei S, Al-Saleem T. The Pathology and Molecular Genetics of Sarcomatoid Renal Cell Carcinoma: A Mini-Review. J Kidney Cancer VHL 2017; 4:19-23. [PMID: 28725540 PMCID: PMC5515895 DOI: 10.15586/jkcvhl.2017.70] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 05/03/2017] [Indexed: 02/04/2023] Open
Abstract
Sarcomatoid renal cell carcinoma is a highly aggressive tumor. It is not a distinct histologic entity as it can be found in any subtypes of renal cell carcinoma. Recent molecular and genetic evidence suggest that sarcomatoid component is transformed from a common progenitor of the associated renal cell carcinoma, and the TP53 gene plays a pivotal role in this process. The presence of sarcomatoid carcinoma indicates poor prognosis, which also correlates with the amount of the sarcomatoid component. Therefore, the presence and quantity of sarcomatoid component should be reflected in pathology reports. However, pathology reporting seems to vary among laboratories prompting the need for a unified reporting system. We propose a pathology reporting system similar to that of transformed follicular lymphoma that is consistent with the molecular pathogenesis to ensure uniform reporting.
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Affiliation(s)
- Shuanzeng Wei
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Tahseen Al-Saleem
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Gulbahar MY, Arslan HH, Gacar A, Karayigit MO, Nisbet O, Albayrak H, Kabak YB. Sarcomatoid renal cell carcinoma with scant epithelial components in an Angora cat. N Z Vet J 2013; 61:362-6. [PMID: 23600482 DOI: 10.1080/00480169.2013.781895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
CASE HISTORY A 6-year-old, neutered, female Angora cat presented with a history of lethargy and anorexia for 2 months and a clinically palpable and gradually enlarging, solid mass in the abdominal cavity extending from the last costal arch to the pelvic cavity. CLINICAL FINDINGS Examination of the cat revealed jaundice, dehydration and hypothermia. Haematological manifestations included lymphopenia and substantial decrease in haematocrit value. Biochemical analysis of the blood revealed hypoglycaemia, three-fold elevated blood urea nitrogen values, increased level of serum aspartate aminotransferase and increased total bilirubin while the creatinine level was normal. Ultrasonographic examination of the abdomen showed a disrupted and large hypoechoic area around the left kidney. The cat was anaesthetised and the left kidney was removed, but the cat died following surgery. PATHOLOGICAL FINDINGS On post-mortem examination, the left kidney was markedly enlarged and both the cortical and medullary parenchyma were replaced by confluent, multilobulated, pale tan-white, firm nodular masses protruding above the capsular surface. Metastasis was not observed. Cytological examination revealed a population of spindle-shaped cells of variable size, with abundant coarse chromatin and occasionally prominent nucleoli. Initial sections of the kidney were indicative of undifferentiated sarcoma confirmed by immunohistochemistry revealing vimentin-positive and cytokeratin-negative results in all tumour tissues. Additional sections showed very small amounts of both cytokeratin-positive and vimentin-positive areas. DIAGNOSIS Sarcomatoid renal cell carcinoma (SRCC) with scant epithelial components originating from left kidney. CLINICAL RELEVANCE Clinical and pathological features were similar to those of human SRCC, even though there was no evidence of metastases. Immunohistochemistry for vimentin and cytokeratin may be useful for definitive diagnosis of renal cell carcinoma with sarcomatoid differentiation, although staining of sections from several different parts of the tumour may be necessary. When a primary renal tumour is presented, SRCC should be considered as this diagnosis may influence treatment protocols and the clinical outcome.
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Affiliation(s)
- M Y Gulbahar
- a Department of Pathology, Faculty of Veterinary Medicine , Ondokuz Mayis University , Kurupelit , Samsun , Turkey
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Shuch B, Bratslavsky G, Linehan WM, Srinivasan R. Sarcomatoid renal cell carcinoma: a comprehensive review of the biology and current treatment strategies. Oncologist 2012; 17:46-54. [PMID: 22234634 DOI: 10.1634/theoncologist.2011-0227] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Recent advancements in the molecular characterization of renal cell carcinoma altered the classification system and now kidney cancer is divided into several distinct histologic subtypes. Although once a separate histologic category, sarcomatoid renal cell carcinoma is no longer considered a separate tumor type because it can occur with all histologic subtypes. Limited research on tumors with sarcomatoid change has led to minimal progress in the understanding and treatment of these tumors. Because the sarcomatoid variant of renal cell carcinoma can account for approximately one in six cases of advanced kidney cancer, we hope to familiarize clinicians with these tumors by describing the historic background, histologic features, molecular characterization, diagnosis, prognosis, treatment strategies, and active clinical trials of this aggressive type of tumor.
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Affiliation(s)
- Brian Shuch
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive MSC 1107, Building 10, CRC, Room 1-5940, Bethesda, Maryland 20892-1107, USA
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Shuch B, Said J, LaRochelle JC, Zhou Y, Li G, Klatte T, Pouliot F, Kabbinavar FF, Belldegrun AS, Pantuck AJ. Histologic evaluation of metastases in renal cell carcinoma with sarcomatoid transformation and its implications for systemic therapy. Cancer 2010; 116:616-24. [PMID: 19998348 DOI: 10.1002/cncr.24768] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Sarcomatoid features in renal cell carcinoma may represent an aggressive subclone arising from the primary tumor. The patterns of metastases for these tumors were evaluated to determine if sarcomatoid features were retained at metastasis and whether the percentage of sarcomatoid features in the primary tumor influenced spread. METHODS All patients with sarcomatoid features found at nephrectomy with synchronous or metachronous resection of metastases were evaluated. The histology, grade, and percentage of sarcomatoid features in the primary and metastatic site were recorded. The association between percentage of sarcomatoid features, grade, histology, and pattern of metastases was evaluated. RESULTS Thirty-two patients were identified with sarcomatoid features and resected metastases. Fifty-two metastatic sites were evaluated. A single histologic appearance (sarcomatoid or carcinomatoid) was present in 50 of 52 sites (96%). Thirty sites (58%) demonstrated only a sarcomatoid pattern, whereas 20 (38%) contained only a carcinoma pattern. Histology and carcinoma grade did not influence metastatic pattern; however, greater percentage of sarcomatoid features was associated with the presence of distant sarcomatoid histology. A cutoff of 30% sarcomatoid features in the primary tumor was useful in predicting systemic sarcomatoid histology. CONCLUSIONS Sarcomatoid elements are frequently observed in the metastases of primary tumors with sarcomatoid features, and these metastases generally contain a solitary pattern supporting the subclone hypothesis. However, both components can metastasize in the same patient. The percentage of sarcomatoid features influences the pattern of spread, and patients with >30% sarcomatoid features in the primary tumor frequently have distant sarcomatoid histology. This cutpoint may be helpful for inclusion criteria for future clinical trials.
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Affiliation(s)
- Brian Shuch
- Department of Urology, David Geffen School of Medicine at University of California-Los Angles, Los Angeles, California 90095-1738, USA
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Gómez García I, Burgos Revilla FJ, Sanz Mayayo E, Rodríguez Patrón R, Conde Someso S, Cosio Piqueras MG, García Ortells D, Fernández Fernández E, Escudero Barrilero A. [Sarcomatoid carcinoma of the kidney. Report of a new case and review of the bibliography]. Actas Urol Esp 2003; 27:649-53. [PMID: 14587243 DOI: 10.1016/s0210-4806(03)72990-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report a new case of sarcomatoid renal cell carcinoma, in a male of 67 years old, with locoregional recidive four months after first surgery, with two episodes of retroperitoneal hemorrhage after second surgery. The objective of this work is to contribute a new case and of doing one revision.
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9
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Figueirêdo SDS, Argollo RS, Costa MAB, Ribeiro FADS, Nóbrega BBD, Pinto SA, Lôbo LVB, Rebolças MAM, Teixeira KISS. Carcinoma renal sarcomatóide: achados de imagem e anatomopatológicos. A propósito de um caso. Radiol Bras 2003. [DOI: 10.1590/s0100-39842003000400011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O carcinoma renal sarcomatóide é uma neoplasia agressiva cujas características clínicas e radiológicas são similares às do carcinoma de células renais convencionais (células claras). O tumor é composto por camadas de células fusiformes malignas com aspectos imuno-histoquímicos e ultra-estruturais de células epiteliais e estromais, também podendo conter áreas mixóides de células gigantes osteoclasto-símile, células pleomórficas rabdomioblasto-símile, bem como outros componentes sarcomatóides raros. Os autores relatam um caso de carcinoma renal sarcomatóide em paciente do sexo masculino, com 54 anos de idade, apresentando a clássica tríade clínica do carcinoma de células renais. Ressaltam, também, as características macroscópicas e microscópicas típicas da lesão, e discutem os achados dos métodos de imagem e seu diagnóstico diferencial com sarcomas renais verdadeiros.
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10
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Daneshmand S, Chandrasoma S, Lum C. Sarcomatoid renal cell carcinoma with massive osteosarcomatous differentiation: an unusual image in clinical urology. Urology 2003; 61:1031-2. [PMID: 12736033 DOI: 10.1016/s0090-4295(03)00017-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Siamak Daneshmand
- Department of Urology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
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11
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Itoh T, Chikai K, Ota S, Nakagawa T, Takiyama A, Mouri G, Shinohara N, Yamashita T, Suzuki S, Koyanagi T, Nagashima K. Chromophobe renal cell carcinoma with osteosarcoma-like differentiation. Am J Surg Pathol 2002; 26:1358-62. [PMID: 12360051 DOI: 10.1097/00000478-200210000-00013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sarcomatoid differentiation in renal cell carcinoma is thought to be the result of the dedifferentiation of the parent tumor, and it can be found in the chromophobe renal cell carcinoma just as other subtypes. We report a case of chromophobe renal cell carcinoma, which showed osteosarcoma-like differentiation. This is the first known case ever to be clearly identified as such. The patient was a 74-year-old man, and the CT scan revealed a huge retroperitoneal mass, which protruded from the lower half of the kidney and directly invaded the colon. Intraabdominal dissemination and metastases to the liver and lungs were also found. The resected tumor histologically showed sarcoma-like spindle cell proliferation and partly produced massive osteoid, which simulated the osteosarcoma. In addition, a typical histology of chromophobe renal cell carcinoma was found in part of the tumor. Immunohistochemically, spindle cells were reactive for epithelial membrane antigen, cytokeratin, and vimentin. The cell nests that were labeled by epithelial membrane antigen and cytokeratin were also found in the osteosarcoma-like area. We think that these phenomena were the result of "dedifferentiation" and metaplasia of the chromophobe renal cell carcinoma.
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Affiliation(s)
- Tomoo Itoh
- Department of Surgical Pathology, Hokkaido University Hospital, Hokkaido, Japan.
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12
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Chao D, Zisman A, Freedland SJ, Pantuck AJ, Said JW, Belldegrun AS. Sarcomatoid renal cell carcinoma. Urol Oncol 2001. [DOI: 10.1016/s1078-1439(01)00125-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Koga F, Kawano K, Honda M, Sumi S, Horimi H, Kondo S, Yoshida K. Sarcomatoid renal cell carcinoma with scant carcinomatous components. Int J Urol 2000; 7:58-60; discussion 61. [PMID: 10710249 DOI: 10.1046/j.1442-2042.2000.00134.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 30-year-old male underwent radical nephrectomy for a right renal tumor 15 cm in diameter. On microscopic examination of initial 17 sections, the tumor consisted of pleomorphic giant cells and spindle neoplastic cells. There was no carcinomatous component. Immunohistochemically, the neoplastic cells were negative for keratin and epithelial membrane antigen but positive for vimentin. The giant cells were also scatteringly, weakly positive for myoglobin. At that time a diagnosis of rhabdomyosarcoma of the kidney was made. However, further microscopic examination of another eight sections revealed small areas of clear cell-type renal cell carcinoma (RCC) which transited to sarcomatous components and led to a diagnosis of sarcomatoid RCC. The patient underwent three cycles of adjuvant chemotherapy. He has been free of the disease for 14 months after nephrectomy.
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Affiliation(s)
- F Koga
- Department of Urology, Dokkyo University School of Medicine, Tochigi, Japan.
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14
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Delahunt B. Sarcomatoid renal carcinoma: the final common dedifferentiation pathway of renal epithelial malignancies. Pathology 1999; 31:185-90. [PMID: 10503259 DOI: 10.1080/003130299104945] [Citation(s) in RCA: 119] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Sarcomatoid renal carcinoma (SRC) is an aggressive neoplasm with an age and gender distribution similar to that of conventional (clear cell) renal cell carcinoma (RCC). Genetic and morphologic evidence indicates that the tumor results from de-differentiation of renal epithelial malignancy and associations with RCC, papillary renal carcinoma, chromophobe renal carcinoma and collecting duct carcinoma have been reported. The tumor is composed of sheets of malignant spindle cells that have immunohistochemical and ultrastructural features of both stromal and epithelial cells, and may contain myxoid areas containing osteoclast-like giant cells or pleomorphic sarcomatoid spindle cells resembling rhabdomyoblasts. Rare cases of osteogenic SRC have been described. The tumor shows marked proliferative activity in growth kinetic studies and is usually associated with a poor patient survival that is best predicted by staging.
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Affiliation(s)
- B Delahunt
- Department of Pathology, Wellington School of Medicine, University of Otago, New Zealand.
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15
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Aigner T, Neureiter D, Völker U, Belke J, Kirchner T. Epithelial-mesenchymal transdifferentiation and extracellular matrix gene expression in pleomorphic adenomas of the parotid salivary gland. J Pathol 1998; 186:178-85. [PMID: 9924434 DOI: 10.1002/(sici)1096-9896(1998100)186:2<178::aid-path161>3.0.co;2-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Mesenchymal and epithelial cell differentiation are assumed to be dichotomic primary events in embryonic development. In this study, pleomorphic adenomas of the parotid gland were analysed as a model which shows morphological features of both epithelial and mesenchymal tissue types. Using matrix gene expression profiles as a supplementary criterion for the identification of cellular phenotypes, areas with unequivocal epithelial and mesenchymal differentiation could be demonstrated. Many areas displayed a transitional phenotype with cells showing both epithelial and mesenchymal features. The data provide evidence that epithelial-mesenchymal transitions represent the basic principle of the tisuse heterogeneity in pleomorphic adenomas. Thus, pleomorphic adenomas demonstrate the potential of adult (neoplastic) epithelial cells to transdifferentiate into mesenchymal cells in vivo.
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Affiliation(s)
- T Aigner
- Institute of Pathology, University of Erlanger-Nürnberg, Germany
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16
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Akhtar M, Tulbah A, Kardar AH, Ali MA. Sarcomatoid renal cell carcinoma: the chromophobe connection. Am J Surg Pathol 1997; 21:1188-95. [PMID: 9331291 DOI: 10.1097/00000478-199710000-00009] [Citation(s) in RCA: 104] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Eleven cases of sarcomatoid renal cell carcinoma were studied to determine the relative frequency of various subtypes of renal cell carcinoma that may be associated with sarcomatoid transformation. The epithelial components in these tumors were subcategorized according to established histologic criteria into chromophobe carcinoma (n = 6 cases), clear cell carcinoma (n = 3), papillary carcinoma (n = 1), and indeterminate (n = 1). In nine cases, material was available for immunohistochemical and DNA ploidy studies. The sarcomatoid component in all cases showed positivity for epithelial membrane antigen cytokeratin, indicating an epithelial derivation of these cells. Staining for mesenchymal markers was mostly negative, except for vimentin, which reacted strongly in all cases. DNA ploidy studies using flow cytometry and cell image analysis provided very similar results. Five of five chromophobe sarcomatoid carcinomas showed hypodiploid cell lines in the epithelial areas, whereas the sarcomatoid components mostly showed aneuploid peaks. In the remaining cases, DNA ploidy pattern was more variable. These findings indicate that chromophobe carcinoma may be the most frequent epithelial component associated with sarcomatoid renal cell carcinoma.
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Affiliation(s)
- M Akhtar
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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17
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Balercia G, Bhan AK, Dickersin GR. Sarcomatoid carcinoma: an ultrastructural study with light microscopic and immunohistochemical correlation of 10 cases from various anatomic sites. Ultrastruct Pathol 1995; 19:249-63. [PMID: 7571082 DOI: 10.3109/01913129509064228] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The histogenesis of sarcomatoid carcinoma has been an intriguing topic for pathologists for many years, and considerable evidence has accumulated in the fields of tissue culture, electron microscopy, and immunohistochemistry to support the concept that the sarcomatous cells derive by way of "divergent differentiation" (metaplasia) from the carcinomatous elements. We have studied a group of 10 cases of these tumors from various organs, using detailed ultrastructural analysis as well as light microscopic and immunohistochemical correlation. We found that there is an ultrastructural spectrum of differentiation from epithelial to mesenchymal type features and that the malignant spindle cells may be purely epithelial (3 cases), purely mesenchymal (3 cases), or a mixture of both (4 cases). Furthermore, individual cells may show biphasia, having desmosomes and tonofibrils as well as well developed rough endoplasmic reticulum and filaments with dense bodies. Electron microscopic and immunohistochemical results do not always correlate, illustrating the prudence of using several keratin antibodies, including wide-spectrum ones, and of performing electron microscopic examination on these tumors.
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Affiliation(s)
- G Balercia
- Department of Anatomy, University of Verona, Italy
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18
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Hassan MO, Gogate PA, Hampel N. Malignant mesenchymoma of the prostate: immunohistochemical and ultrastructural observations. Ultrastruct Pathol 1994; 18:449-56. [PMID: 7941044 DOI: 10.3109/01913129409023217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A case of malignant mesenchymoma of the prostate is reported. Immunohistochemical and ultrastructural examination revealed malignant chondro-osteoblastic and rhabdomyoblastic features. A separate incidental prostatic adenocarcinoma was also seen. These lesions should be differentiated from carcinosarcoma in which adenocarcinoma is intermingled with malignant mesenchymal components.
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Affiliation(s)
- M O Hassan
- Pathology and Laboratory Medicine Service, Veterans Affairs Medical Center, Cleveland, Ohio
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19
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Saw KC, Ball RY, Khan NH, Pilling JR, Eardley I, Ashken MH. Renal cell carcinoma with osteosarcomatous differentiation simulating staghorn calculus: a case report and literature review. J Urol 1994; 151:1607-9. [PMID: 8189574 DOI: 10.1016/s0022-5347(17)35315-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We report a case of renal cell carcinoma that showed extensive osteosarcomatous differentiation and simulated a staghorn calculus clinically and radiologically. The literature on osteosarcomatous differentiation in renal cell carcinoma is reviewed.
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Affiliation(s)
- K C Saw
- Department of Urology, Norfolk and Norwich Hospital, Norwich, United Kingdom
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20
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Vogelzang NJ, Fremgen AM, Guinan PD, Chmiel JS, Sylvester JL, Sener SF. Primary renal sarcoma in adults. A natural history and management study by the American Cancer Society, Illinois Division. Cancer 1993; 71:804-10. [PMID: 8381704 DOI: 10.1002/1097-0142(19930201)71:3<804::aid-cncr2820710324>3.0.co;2-a] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Primary renal sarcomas in adults are rare and unusual neoplasms. This study was performed to better define the natural history and current management of these sarcomas in a typical medical setting in the United States. METHODS The hospital records of 4018 adult patients with renal neoplasms treated in the state of Illinois from 1975 to 1985 were examined by American Cancer Society professional volunteers. RESULTS A primary renal sarcoma occurred in 34 patients (0.8% incidence). Eleven adult patients had Wilms tumor, 21 had primary renal sarcoma (47% leiomyosarcoma), and 2 were not found to have sarcoma on review. The median age of the patients with Wilms tumor was 30 years, whereas that of the patients with non-Wilms sarcoma was 65 years. Four of the patients with Wilms tumor (36%) are long-term survivors and all received adjuvant chemotherapy after radical nephrectomy. Six of the patients with non-Wilms sarcoma (29%) are long-term survivors after radical nephrectomy alone. CONCLUSIONS Primary renal sarcomas, when treated with radical nephrectomy and, in the case of Wilms tumor, adjuvant chemotherapy, appear to be curable in 29-36% of cases. Histologic review of patients younger than 40 years of age with renal neoplasia is recommended.
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Affiliation(s)
- N J Vogelzang
- Section of Hematology/Oncology and Urology, University of Chicago, Illinois 60637-1470
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21
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Morikawa Y, Tohya K, Kusuyama Y, Masui M, Wakasugi C. Sarcomatoid renal cell carcinoma. An immunohistochemical and ultrastructural study. Int Urol Nephrol 1993; 25:51-8. [PMID: 8514474 DOI: 10.1007/bf02552254] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A case of sarcomatoid renal cell carcinoma is reported with light, immunohistochemical and electron microscopic findings. The tumour consisted of typical clear cells of renal cell carcinoma and spindle cells compatible with malignant fibrous histiocytoma (MFH). Although an epithelial membrane antigen was demonstrated in the clear cells, this was not detected in the MFH-like spindle cells. In contrast, the spindle cells expressed vimentin that was not identified in the clear cells. Electron microscopy reveal epithelial features in the spindle cells. Comparisons were made with previous sarcomatoid renal cell carcinoma in the literature. Thus, ultrastructural study was vital in diagnosis of sarcomatoid renal cell carcinoma.
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Affiliation(s)
- Y Morikawa
- Department of Pathology, Wakayama Medical School, Japan
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22
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Bird DJ, Semple JP, Seiler MW. Sarcomatoid renal cell carcinoma metastatic to the heart: report of a case. Ultrastruct Pathol 1991; 15:361-6. [PMID: 1755100 DOI: 10.3109/01913129109016245] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
An unusual case of metastatic sarcomatoid renal cell carcinoma is presented. Fifteen months after nephrectomy for a typical clear cell carcinoma, a 63-year-old man presented with bilateral pleural effusions, cardiomegaly, and tamponade. A pericardial biopsy showed an anaplastic spindle cell tumor that was strongly keratin positive and showed desmosomes ultrastructurally. The patient died shortly thereafter, and the autopsy revealed massive tumor infiltration of the heart, pulmonary and adrenal metastases, and tumor nodules at the incision site of his nephrectomy. The differential diagnosis of sarcomatoid renal cell carcinoma is discussed.
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Affiliation(s)
- D J Bird
- Department of Veterans Affairs Medical Center, West Roxbury, Massachusetts 02132
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23
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Sugarman I, Birch P, Carter M. Osteogenic differentiation in a sarcomatoid renal carcinoma. BRITISH JOURNAL OF UROLOGY 1990; 66:663-4. [PMID: 2265346 DOI: 10.1111/j.1464-410x.1990.tb07210.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- I Sugarman
- Department of Urology, St Mary's Hospital, Portsmouth
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24
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Abstract
The ultrastructural and immunohistochemical features of 19 hepatoblastomas were examined to evaluate the phenotypic expressivity of this solid embryonic neoplasm of childhood. Electron microscopy confirmed the embryonal and fetal characteristics of the neoplastic hepatocytes, but in addition, cells with features intermediate between these two cell types were identified. Dense bundles of collagen corresponding to the osteoid-like material by light microscopy surrounded nests of cells; the cells within this matrix stained for epithelial membrane antigen and vimentin and focally for cytokeratin, and they showed ultrastructural features of epithelial cells. The two cases of small cell hepatoblastoma reacted positively for vimentin and cytokeratin; the remaining 17 cases were immunoreactive for cytokeratin and alpha-fetoprotein, and some also for alpha 1-antitrypsin, ferritin, and vimentin. A histogenetic scheme based on our findings is proposed to explain the divergent morphologic features of this neoplasm.
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Affiliation(s)
- P Abenoza
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School and Hospital, Minneapolis
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25
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Abstract
The clinical, light and ultrastructural features of three renal neoplasms demonstrating a sarcomatous appearance on light microscopic examination are reported. At the time of radical nephrectomy, all three tumors displayed aggressive features with capsular invasion and either metastases or invasion of adjacent organs. Ultrastructural examination revealed epithelial features in a pure spindle cell tumor and in a malignant fibrous histiocytoma-like tumor (sarcomatoid renal carcinoma) and smooth muscle differentiation (leiomyosarcoma) in a lesion showing features of malignant fibrous histiocytoma. All three patients died from 1 to 9 months after nephrectomy. Renal tumors with a sarcomatous histologic appearance are aggressive neoplasms that cannot be classified accurately solely by employing light microscopic criteria.
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26
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Abstract
Forty-two cases of sarcomatoid renal cell carcinoma were reviewed clinicopathologically. Twenty-four patients were men, and 18 women; average age was 56.2 years (range, 30-81 years). Eight, 9, 13, and 12 cases were Stages I, II, III, and IV, respectively. Three morphologic patterns of sarcomatoid components were identified: malignant fibrous histiocytomatous (26 cases), fibrosarcomatous (6 cases), and unclassified sarcomatoid (10 cases). Mitotic count, degree of pleomorphism, cellularity, and amount of tumor matrix in the sarcomatoid areas, and similar morphologic parameters in the carcinomatous component all failed to correlate with prognosis, as did tumor size and renal vein involvement by tumor. Clinicopathologic stage was a most significant prognostic factor, with a survival of 49.7 months for Stage I and 6.8 months for combined Stages II, III, and IV. Tumor necrosis in the sarcomatoid area and proportion of sarcomatoid components were also poor prognostic factors. When these factors were compared to the stage, necrosis was an independent variable, however, proportion of sarcomatoid components was a poor prognostic indicator only for Stages I and II.
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