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Abstract
The SMARCB1/INI1 gene was first discovered in the mid-1990s, and since then it has been revealed that loss of function mutations in this gene result in aggressive rhabdoid tumors. Recently, the term "rhabdoid tumor" has become synonymous with decreased SMARCB1/INI1 expression. When genetic aberrations in the SMARCB1/INI1 gene occur, the result can cause complete loss of expression, decreased expression, and mosaic expression. Although SMARCB1/INI1-deficient tumors are predominantly sarcomas, this is a diverse group of tumors with mixed phenotypes, which can often make the diagnosis challenging. Prognosis for these aggressive tumors is often poor. Moreover, refractory and relapsing progressive disease is common. As a result, accurate and timely diagnosis is imperative. Despite the SMARCB1/INI1 gene itself and its implications in tumorigenesis being discovered over two decades ago, there is a paucity of rhabdoid tumor cases reported in the literature that detail SMARCB1/INI1 expression. Much work remains if we hope to provide additional therapeutic strategies for patients with aggressive SMARCB1/INI1-deficient tumors.
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Affiliation(s)
- Nathaniel A Parker
- University of Kansas School of Medicine, 1010 N Kansas St, Wichita, KS, 67214, USA
| | - Ammar Al-Obaidi
- University of Kansas School of Medicine, 1010 N Kansas St, Wichita, KS, 67214, USA
| | - Jeremy M Deutsch
- Cancer Center of Kansas, 818 N. Emporia #403, Wichita, KS, 67214, USA
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2
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Goel R, Panaiyadiyan S, Nayak B, Singh P. Multimodal management of locally advanced rhabdoid tumour of the kidney in an adult. BMJ Case Rep 2021; 14:14/4/e236830. [PMID: 33846176 PMCID: PMC8048002 DOI: 10.1136/bcr-2020-236830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Malignant rhabdoid tumours of the kidney (MRTK) are rare paediatric tumours known for their aggressive nature and early metastasis. However, MRTK in adults are even more rare with only a few cases reported in the literature. Herein, we report a case of 65-year-old woman with rapidly progressive left renal mass requiring en-bloc radical nephrectomy, splenectomy and distal pancreatectomy. Histopathology revealed a malignant rhabdoid tumour with characteristic histological and immunohistochemical findings with negative margins. To the best of our knowledge, this is the first reported case of aggressive surgical management of locally advanced MRTK. Despite surgery with curative intent, the patient developed early recurrence and started on tyrosine kinase inhibitor. Unfortunately, the patient expired after 8 months of surgery due to disease progression.
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Affiliation(s)
- Ritesh Goel
- Department of Urology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sridhar Panaiyadiyan
- Department of Urology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Brusabhanu Nayak
- Department of Urology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences, New Delhi, Delhi, India
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3
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Han E, Kim J, Jung MJ, Chin S, Lee SW, Moon A. Malignant rhabdoid tumor of the kidney in an adult with loss of INI1 expression and mutation in the SMARCB1 gene. J Pathol Transl Med 2021; 55:145-153. [PMID: 33677955 PMCID: PMC7987524 DOI: 10.4132/jptm.2021.01.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/26/2021] [Indexed: 11/17/2022] Open
Abstract
A 57-year-old man with left flank pain was referred to our institute. Computed tomography scans revealed two enhancing masses in the left kidney. The clinical diagnosis was renal cell carcinoma (RCC). He underwent a radical nephrectomy with an adrenalectomy. Two well-circumscribed solid masses in the hilum and the lower pole (4.5 × 3.5 cm and 7.0 × 4.1 cm) were present. Poorly cohesive uniform round to polygonal epithelioid cells making solid sheets accounted for most of the tumor area. The initial diagnosis was RCC, undifferentiated with rhabdoid features. As the tumor showed loss of INI1 expression and a mutation in the SMARCB1 gene on chromosome 22, the revised diagnosis was a malignant rhabdoid tumor (MRT) of the kidney. To date, only a few cases of renal MRT in adults have been reported. To the best of our knowledge, this is the first report of MRT in the native kidney of an adult demonstrating a SMARCB1 gene mutation, a hallmark of MRT.
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Affiliation(s)
- Eunkyung Han
- Department of Pathology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jiyoon Kim
- Department of Pathology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Min Jung Jung
- Department of Pathology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Susie Chin
- Department of Pathology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sang Wook Lee
- Department of Urology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ahrim Moon
- Department of Pathology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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4
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Okumura Y, Adachi Y, Shirahase T, Nagashima Y, Tanaka Y, Taki Y, Watanabe J, Uegaki M, Sakatani T, Ikehara S. Malignant rhabdoid tumour in an adult kidney: A case report. Mol Clin Oncol 2019; 11:55-58. [PMID: 31289678 DOI: 10.3892/mco.2019.1848] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 03/20/2019] [Indexed: 12/19/2022] Open
Abstract
Malignant rhabdoid tumours (MRTs) in the kidney are rare paediatric tumours that are extremely rare in adults. We herein report the case of an adult patient with a renal MRT. A 79-year-old Japanese woman was found to have a tumour sized 63×48 mm in the left kidney, in addition to multiple metastatic bone and lymph node lesions. The needle biopsy specimen obtained from the patient's kidney revealed tumour cells with rhabdoid characteristics: The cells appeared large, round or polygonal, with eccentrically located nuclei and prominent nucleoli. Immunohistochemically, the tumour cells were positive for vimentin, epithelial membrane antigen, CAM 5.2, and p53, and negative for INI1, cytokeratin (CK)7, CK20, α-methylacyl-CoA racemase, S100, CD45, renal cell carcinoma marker, anaplastic lymphoma kinase, α-smooth muscle actin, desmin, MyoD, myogenin, human melanoma black 45 and melan A. Therefore, the tumour was diagnosed as an MRT located in the kidney. Although the patient was treated with axitinib, a tyrosine kinase inhibitor, the renal tumour and its metastatic lesions continued to progress, and the number of metastatic lesions increased. The patient succumbed to the disease 5 months after the first hospital visit. The disease progression was rapid, with a poor prognosis, consistently with previous reports that of MRTs in the adult kidney.
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Affiliation(s)
- Yoshinaga Okumura
- Department of Urology, Toyooka Hospital, Toyooka, Hyogo 668-8501, Japan
| | - Yasushi Adachi
- Department of Diagnostic Pathology, Toyooka Hospital, Toyooka, Hyogo 668-8501, Japan
| | | | - Yoji Nagashima
- Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Yukichi Tanaka
- Clinical Research Institute and Department of Pathology, Kanagawa Children's Medical Center, Yokohama, Kanagawa 232-8555, Japan
| | - Yoji Taki
- Department of Urology, Toyooka Hospital, Toyooka, Hyogo 668-8501, Japan
| | - Jun Watanabe
- Department of Urology, Toyooka Hospital, Toyooka, Hyogo 668-8501, Japan
| | - Masayuki Uegaki
- Department of Urology, Toyooka Hospital, Toyooka, Hyogo 668-8501, Japan
| | - Toru Sakatani
- Department of Urology, Toyooka Hospital, Toyooka, Hyogo 668-8501, Japan
| | - Susumu Ikehara
- Professor Emeritus, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
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5
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Perrino CM, Hucthagowder V, Evenson M, Kulkarni S, Humphrey PA. Genetic alterations in renal cell carcinoma with rhabdoid differentiation. Hum Pathol 2015; 46:9-16. [DOI: 10.1016/j.humpath.2014.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 09/02/2014] [Accepted: 09/04/2014] [Indexed: 12/15/2022]
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Podduturi V, Campa-Thompson MM, Zhou XJ, Guileyardo JM. Malignant rhabdoid tumor of the kidney arising in an adult patient. Proc (Bayl Univ Med Cent) 2014; 27:239-41. [PMID: 24982576 DOI: 10.1080/08998280.2014.11929125] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Malignant rhabdoid tumors (MRT) of the kidney are rare in children and even less common in adults, with only six previously reported adult cases. We present the case of a 60-year-old man with an MRT arising in the left kidney with extensive pulmonary micrometastases and thromboembolism resulting in thrombotic pulmonary microangiopathy (pulmonary tumor embolism syndrome). MRT is an extremely aggressive neoplasm with a short survival time.
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Affiliation(s)
- Varsha Podduturi
- Department of Pathology, Baylor University Medical Center at Dallas (Podduturi, Campa-Thompson, Zhou, Guileyardo); and Renal Path Diagnostics, Pathologists Bio-Medical Laboratories, Lewisville, Texas (Zhou)
| | - Molly M Campa-Thompson
- Department of Pathology, Baylor University Medical Center at Dallas (Podduturi, Campa-Thompson, Zhou, Guileyardo); and Renal Path Diagnostics, Pathologists Bio-Medical Laboratories, Lewisville, Texas (Zhou)
| | - Xin J Zhou
- Department of Pathology, Baylor University Medical Center at Dallas (Podduturi, Campa-Thompson, Zhou, Guileyardo); and Renal Path Diagnostics, Pathologists Bio-Medical Laboratories, Lewisville, Texas (Zhou)
| | - Joseph M Guileyardo
- Department of Pathology, Baylor University Medical Center at Dallas (Podduturi, Campa-Thompson, Zhou, Guileyardo); and Renal Path Diagnostics, Pathologists Bio-Medical Laboratories, Lewisville, Texas (Zhou)
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7
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Zhao G, Na R, Yang Y, Han R. Pure malignant rhabdoid tumor of the left kidney in an adult: A case report and review of the literature. Oncol Lett 2013; 5:1481-1484. [PMID: 23761028 PMCID: PMC3678854 DOI: 10.3892/ol.2013.1207] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 02/07/2013] [Indexed: 12/13/2022] Open
Abstract
Malignant rhabdoid tumors of the kidney (MRTKs) are extremely rare. Pure MRTKs in adult patients are particularly rare and have not been previously reported in China. Due to the non-specific clinical symptoms, it is difficult but also essential to be able to give a definite diagnosis. The present study reports a case of pure adult malignant rhabdoid tumor in a patient’s left kidney with characteristic clinicopathological features. Considering the fact that the characteristic findings are often not observed in clinical symptom and imaging studies, the histological features, immunohistochemical staining and cytogenetic studies may aid in confirming the diagnosis of pure MRTKs. Although pure adult MRTKs remain extremely uncommon, it is necessary to consider this possibility when such types of renal tumors are encountered.
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Affiliation(s)
- Guangning Zhao
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211
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8
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The challenging diagnosis of the rhabdoid carcinoma of the pelvis: a case report with literature review. Appl Immunohistochem Mol Morphol 2012; 20:177-83. [PMID: 22553822 DOI: 10.1097/pai.0b013e318230ac42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Rhabdoid tumor is an uncommon neoplasia characterized by a monotonous population of large, noncohesive cells with vesicular nuclei and large nucleoli. The misleading name was originally suggested because of the striking morphologic resemblance to other skeletal muscle tumors, but neither ultrastructural nor immunohistochemical features support a myogenic origin for this tumor. The rhabdoid tumors of the kidney in pediatric age are characterized by mutation or deletion of 22q11. In adults, tumors with rhabdoid features are uncommon neoplasia reported in different anatomic sites, but their histogenesis is still unclear. We focused on the literature data regarding the rhabdoid features in pelvic and renal tumors, and we describe a carcinoma involving the pelvis and the kidney with exclusive rhabdoid features, which make the anatomical allocation of the tumor difficult. The tumor did not exhibit any similarities to conventional histologic types of renal cell cancer, not even of the sarcomatous type. Tumor cells showed a strong positivity for epithelial markers (AE1/AE3 and CK 8) and for vimentin, whereas they were negative for skeletal and smooth muscle markers. The nuclei of the tumor cells demonstrated a INI1-positive immunohistochemical stain, indicating the lack of mutation or deletion of the 22q11 chromosome. The appropriate diagnosis is that of an extrarenal high-grade rhabdoid carcinoma originating from the urothelium of the renal pelvis. The decision as to whether the tumor arose primarily in the renal parenchyma or in the renal pelvis could be of therapeutic importance. Appropriate immunohistochemical markers can help in the difficult differential diagnosis.
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9
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Kapoor A, Tutino R, Kanaroglou A, Hotte SJ. Treatment of adult rhabdoid renal cell carcinoma with sorafenib. Can Urol Assoc J 2011; 2:631-4. [PMID: 19066685 DOI: 10.5489/cuaj.983] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Renal cell carcinoma (RCC) with rhabdoid features is an uncommon and highly aggressive malignancy. We report a case of adult clear-cell RCC with extensive rhabdoid features treated with the tyrosine kinase inhibitor sorafenib. A review of the literature summarizes important aspects of this malignancy. We discuss clinical and histological findings as well as the patient's response to sorafenib therapy.
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Affiliation(s)
- Anil Kapoor
- Division of Urology, Department of Surgery, McMaster University, Hamilton, Ont., and the
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10
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Sato Y, Iizuka J, Imai K, Sawada Y, Komatsu T, Yago R, Kondo T, Ishida H, Tanabe K. [Case report of rhabdoid tumor of the kidney occurring in own kidney following kidney transplantation from the living relative]. Nihon Hinyokika Gakkai Zasshi 2010; 101:683-688. [PMID: 20715500 DOI: 10.5980/jpnjurol.101.683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The patient was a 30-year-old man who had undergone living-donor kidney transplantation for renal failure caused by IgA nephropathy at age 29. On post-transplantation day 83, he visited our department with a chief complaint of asymptomatic hematuria. CT performed on post-transplantation day 95 revealed a tumor (size, 4 cm) in the right native kidney that had not been observed at the time of transplantation. CT performed on post-transplantation day 153 showed that the tumor had enlarged to 6 cm, while retrograde pyelogram performed on post-transplantation day 171 was negative for renal pelvic tumor. On post-transplantation day 193, radical right nephrectomy was performed. The tumor had directly invaded the diaphragm and the lower surface of the liver, and was histopathologically diagnosed as rhabdoid tumor of the kidney. As the pathological tissue was extremely malignant, hepatic posterior segmentectomy, right adrenalectomy, and lymph node dissection were further performed for metastases on post-transplantation day 200. On the 23rd day after radical right nephrectomy (post-transplantation day 216), the patient developed dyspnea. Chest CT showed pleural effusion, hemothorax in right lung and metastases in both lungs. The patient's general status gradually worsened thereafter, and he died on the 53rd day after radical right nephrectomy (post-transplantation day 246). Rhabdoid tumor of the kidney is a rare renal tumor that affects children, and only four adult cases have been reported to date. We report our experience with this rare case.
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Affiliation(s)
- Yasuyuki Sato
- Department of Urology, Tokyo Women's Medical University
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11
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Lou E, Goodwin J, Howell DN, Hicks J, Caram LB. A G-CSF-secreting adrenal carcinoma with rhabdoid-like differentiation causing leukocytosis. Nat Rev Urol 2010; 6:392-7. [PMID: 19578356 DOI: 10.1038/nrurol.2009.101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND A 57-year-old African American man presented to a tertiary care center with a 6-month history of fatigue and worsening abdominal pain. He had lost 9.1 kg in weight in the 3 months leading up to presentation, and described subjective fevers and night sweats for 1 month with a nonproductive cough and blurred vision for several weeks before presentation. He had chronic renal insufficiency, sleep apnea, hypertension, and peripheral vascular disease. INVESTIGATIONS Physical examination, complete blood count, peripheral blood smear, leukocyte alkaline phosphatase score, bone marrow biopsy, CT of the chest, abdomen, and pelvis, MRI of the abdomen and pelvis, measurement of plasma and urine metanephrines, 24 h urine testing for cortisol and 17-ketosteroids, measurement of serum granulocyte colony-stimulating factor (G-CSF) level, histopathologic examination and immunohistochemical staining of resected tumor. DIAGNOSIS G-CSF-secreting adrenal carcinoma with rhabdoid-like differentiation. MANAGEMENT En bloc surgical resection of kidney, suprarenal mass and spleen was performed, followed by initiation of mitotane chemotherapy 3 months later.
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Affiliation(s)
- Emil Lou
- Department of Internal Medicine, Division of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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12
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Bourdeaut F, Fréneaux P, Thuille B, Bergeron C, Laurence V, Brugières L, Vérité C, Michon J, Delattre O, Orbach D. Extra-renal non-cerebral rhabdoid tumours. Pediatr Blood Cancer 2008; 51:363-8. [PMID: 18506766 DOI: 10.1002/pbc.21632] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rhabdoid tumours (RTs) are aggressive malignancies of childhood, mainly occurring in the kidney and brain. We describe a national multi-centre retrospective analysis of extra-renal non-cranial RTs (ERRTs). PROCEDURE Diagnosis relied on central histological review and/or on hSNF5/INI1 defect, evidenced by immunohistochemistry or molecular screening. Clinical data were obtained from physicians. RESULTS Twenty six patients fulfilled the inclusion criteria. Median age at diagnosis was 28 months [0-366], including late childhood and young adults cases. Surgery, either initial or secondary, was complete in three. All but three patients received chemotherapy, with variable regimens. Additional radiotherapy was used in six patients. Median time to recurrence or progression was 5 months [0-44], and one patient remained free of disease at 7 years. CONCLUSIONS ERRTs share the same chemosensitivity, early recurrence, and poor prognosis as renal and cerebral RTs. No chemotherapy regimen demonstrates a superior response.
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13
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Peng HQ, Stanek AE, Teichberg S, Shepard B, Kahn E. Malignant rhabdoid tumor of the kidney in an adult: a case report and review of the literature. Arch Pathol Lab Med 2003; 127:e371-3. [PMID: 12946214 DOI: 10.5858/2003-127-e371-mrtotk] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Malignant rhabdoid tumor of the kidney is an uncommon renal tumor in children. The tumor has aggressive behavior and a poor prognosis and is extremely rare in adults; only 3 cases of renal rhabdoid tumors have been reported in adults. We describe here the microscopic, immunohistochemical, and electron microscopic characteristics of another case in a 38-year-old woman. This case reinforces the importance of recognizing this entity in the adult population.
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Affiliation(s)
- Hong Qi Peng
- Department of Pathology, North Shore University Hospital, New York University School of Medicine, Manhasset 11030, USA
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14
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Winter P, Vahlensieck W, Miersch WD, Vogel J, Gokel JM, Hellerich U. Wilms' tumour in adults. Review of 10 cases. Int Urol Nephrol 2001; 28:469-75. [PMID: 9119630 DOI: 10.1007/bf02550952] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Nephroblastoma (Wilms' tumour) is very rarely found in adult patients. We report on 10 cases to demonstrate the diagnostic and therapeutic problems. In case of flank pain, large tumour mass, fast tumour growth and young age, the possibility of Wilms' tumour should be taken into consideration even in adult patients. The chances for a successful treatment by primary surgery with adjuvant therapy are favourable for the lower stages I and II. All our patients presenting with tumour stages I and II have survived and have been free of disease for 68 months now. One of the patients with stage III Wilms' tumour died 8 months postoperatively while the other one has been free of disease for 120 months now. In the advanced stage IV no patient survived. In cases of inoperable large tumours in adults, the possibility of primary chemotherapy should be considered under certain circumstances. Rapid tumour regression may confirm the diagnosis and will make feasible a salvage operation in some cases.
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Affiliation(s)
- P Winter
- Department of Urology, University of Bonn, Germany
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15
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Gökden N, Nappi O, Swanson PE, Pfeifer JD, Vollmer RT, Wick MR, Humphrey PA. Renal cell carcinoma with rhabdoid features. Am J Surg Pathol 2000; 24:1329-38. [PMID: 11023094 DOI: 10.1097/00000478-200010000-00002] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Neoplasms with rhabdoid features have been reported at many anatomic sites. In the kidney, rhabdoid tumors are typically found in children, whereas only rare examples have been reported in adults. Little is known of renal cell carcinomas (RCCs) that exhibit rhabdoid features. The objective of this study was to determine the incidence of RCC with rhabdoid attributes and characterize the histologic, immunophenotypic, and ultrastructural features by retrospective analysis of 480 consecutively identified cases of RCC in radical nephrectomy specimens. Immunohistochemical evaluation was performed in cases with rhabdoid foci using a panel of antibodies to pancytokeratin (pan-CK), CK7, CK20, epithelial membrane antigen (EMA), S-100 protein, desmin, vimentin, neuron-specific enolase (NSE), muscle-specific actin (MSA), smooth muscle actin (SMA), human melanoma, black-45 (HMB-45), and glial fibrillary acidic protein (GFAP). Electron microscopy was also performed in selected cases. The presence and extent of rhabdoid foci in relation to pathologic stage and grade were assessed. Twenty-three of 480 cases of RCC (4.7%) exhibited rhabdoid features. The 23 patients were all adults with a mean age of 61.8 years (age range, 33-84 yrs). Fifteen of the patients were men and eight were women. Histologically, the rhabdoid foci were typified by sheets and clusters of variably cohesive, large epithelioid cells with vesicular and often eccentric nuclei, prominent nucleoli, and large, paranuclear intracytoplasmic hyaline globules (inclusions). The presence of these rhabdoid features was related to high histologic Fuhrman grade of the nonrhabdoid carcinoma component, with an incidence of 0 of 84 grade I cases, eight of 300 grade 2 cases (2.6%), six of 70 grade 3 cases (8.9%), and nine of 26 grade 4 cases (34.6%; p = 3 x 10(-9)). The rhabdoid foci were all high grade. The presence of rhabdoid foci was also found in higher stage carcinomas. A total of 52% (12 of 23) of RCC cases with rhabdoid features exhibited extrarenal extension compared with 28% (24 of 92) of contemporary RCCs without rhabdoid features (p = 0.03). The size of the rhabdoid component ranged from 1 mm to more than 2 cm and comprised 1% to 50% of the renal mass. Immunoreactivity for vimentin (100%), NSE (79%), and panCK (56%) was present in the majority of cases. Substantial percentages of cases were immunopositive for EMA (47%) and S-100 protein (37%), with minimal to no immunohistochemical reactivity for CK7 (5%), SMA (5%), CK20 (0%), desmin (0%), MSA (0%), HMB-45 (0%), and GFAP (O%). A distinctive globular, paranuclear reaction pattern was found for the cytokeratin, EMA, and vimentin immunostains. Ultrastructurally, the rhabdoid cells had paranuclear intermediate filament aggregates or paranuclear condensation of organelles, often associated with peripheral vacuolization. Adult RCCs may harbor a rhabdoid component, and these neoplasms can be regarded as "composite" tumors. Rhabdoid elements are important to identify because of their high-grade nature, and association with high stage. Adult RCC with rhabdoid elements should be distinguished from pure rhabdoid tumors of kidney, in light of their clinicopathologic differences. Rhabdoid differentiation in adult renal cell carcinoma may represent clonal divergence and/ or evolution, and emergence of a particularly aggressive element.
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Affiliation(s)
- N Gökden
- Lauren V. Ackerman Laboratory of Surgical Pathology, Barnes-Jewish Hospital and the Washington University School of Medicine, St. Louis, MO 63110, USA
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16
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Winter P, Vahlensieck W, Schoeneich G, Miersch WD, Vogel J. Nephroblastoma - Wilms’ tumour in adults. Review of 10 cases. Urologia 1997. [DOI: 10.1177/039156039706400113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nephroblastoma (Wilms’ tumour) is very rarely found in adult patients. We report on 10 cases to demonstrate the diagnostic and therapeutic problems. In the case of flank pain, large tumour mass, fast tumour growth and young age, the possibility of Wilms’ tumour should be taken into consideration even in adult patients. The chances for successful treatment by primary surgery with adjuvant therapy are favourable for the lower stages I and II. All our patients presenting with tumour stages I and II have survived and have been disease free for 68 months now. One of the patients with Wilms’ tumour stage III died 8 months postoperatively while another one has been disease-free for 120 months now. In the advanced stage IV, no patient survived. In cases of inoperable large tumours in adults, the possibility of primary chemotherapy should be considered under certain circumstances. Rapid tumour regression may confirm diagnosis and will enable salvage operation in some cases.
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Affiliation(s)
- P. Winter
- Department of Urology - University of Bonn
| | | | | | | | - J. Vogel
- Department of Pathology - University of Bonn
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17
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Abstract
Rhabdoid tumour of the kidney is an uncommon malignancy with a poor prognosis that usually occurs in childhood. Certain imaging features may help distinguish this lesion from the much more common Wilms' tumour. Extra-renal rhabdoid tumours appear to have no specific imaging characteristics.
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Affiliation(s)
- D J Roebuck
- Department of Radiology, Children's Hospital, Sydney, New South Wales, Australia
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18
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Ebbinghaus SW, Herrera G, Marshall ME. Rhabdoid tumor of the kidney in an adult: review of the literature and report of a case responding to interleukin-2. CANCER BIOTHERAPY 1995; 10:237-41. [PMID: 8547962 DOI: 10.1089/cbr.1995.10.237] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Rhabdoid tumor of the kidney is an uncommon and highly aggressive malignancy usually found in the pediatric age group. This tumor does not respond well to aggressive chemotherapy regimens and survival tends to be short. Only two cases of rhabdoid tumor of the kidney occurring in adults have been described previously. The third case of a rhabdoid tumor of the kidney in an adult is presented here. This clinical case report is unique not only because of the rare occurrence of this tumor in adulthood but because the patient described had an objective antitumor response to outpatient low dose interleukin-2. This single case report may have therapeutic implications for other patients with this tumor.
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Affiliation(s)
- S W Ebbinghaus
- Division of Hematology/Oncology, University of Alabama at Birmingham
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Jafri SZ, Freeman JL, Rosenberg BF, Cacciarelli A, Madrazo BL. Clinical and imaging features of rhabdoid tumor of the kidney. UROLOGIC RADIOLOGY 1991; 13:94-7. [PMID: 1897075 DOI: 10.1007/bf02924598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Rhabdoid tumor of the kidney (RTK) is a rare, highly malignant neoplasm of childhood. The clinical profile of this neoplasm differs from that of Wilms' tumor. We present two cases of RTK. In both our cases, large bulky masses with poorly defined margins and calcifications were demonstrated. The clinical and imaging findings are compared with other childhood renal neoplasms.
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Affiliation(s)
- S Z Jafri
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, MI 48073
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