Clear-cell and papillary carcinoma of the kidney: an analysis of chromosome 3, 7, and 17 abnormalities by microsatellite amplification, cytogenetics, and fluorescence in situ hybridization

Assessing Genomic Copy Number Alterations as Best Practice for Renal Cell Neoplasia: An Evidence-Based Review from the Cancer Genomics Consortium Workgroup

Renal cell neoplasia are heterogeneous with diverse histology, genetic alterations, and clinical behavior that are diagnosed mostly on morphologic features. The Renal Cell Neoplasia Workgroup of the Cancer Genomics Consortium systematically evaluated peer-reviewed literature on genomic studies of renal cell carcinoma (RCC), including clear cell RCC, papillary RCC, chromophobe RCC, and the translocation RCC involving TFE3, TFEB and MITF rearrangements, as well as benign oncocytoma, which together comprise about 95% of all renal cell neoplasia. The Workgroup curated recurrent copy number alterations (CNAs), copy-neutral loss-of-heterozygosity (cnLOH), rearrangements, and mutations, found in each subtype and assigned clinical relevance according to established criteria. In clear cell RCC, loss of 3p has a disease-initiating role and most likely also in progression with mutations detected in VHL and other genes mapped to this arm, and loss of 9p and/or 14q has well-substantiated prognostic utility. Gain of chromosomes 7 and 17 are hallmark CNAs of papillary RCC, but patterns of other CNAs as detected by chromosomal microarray analysis (CMA) afford sub-classification into Type 1 and 2 with prognostic value, and for further sub-stratification of Type 2. Inherent chromosome loss in chromophobe RCC as detected by CMA is useful for distinguishing the eosinophilic variant from benign oncocytoma which in contrast exhibits few CNAs or rearranged CCND1, but share mitochondrial DNA mutations. In morphologically atypical RCCs, rearrangement of TFE3 and TFEB should be considered in the differential diagnosis, portending an aggressive RCC subtype. Overall, this evidence-based review provides a validated role for assessment of CNAs in renal cell neoplasia in the clinical setting to assist in renal cell neoplasm diagnosis and sub-classification within subtypes that is integral to the management of patients, from small incidentally found renal masses to larger surgically resected specimens, and simultaneously identify the presence of key alterations portending outcome in malignant RCC subtypes.

Practical Molecular Testing in a Clinical Genitourinary Service

CONTEXT.—

Molecular testing is increasingly playing a key role in the diagnosis, prognosis, and treatment of neoplasms of the genitourinary system.

OBJECTIVE.—

To provide a general overview of the clinically relevant molecular tests available for neoplasms of the genitourinary tract.

DATA SOURCES.—

Relevant medical literature indexed on PubMed.

CONCLUSIONS.—

Understanding of the molecular oncology of genitourinary neoplasms is rapidly advancing, and the pathologist must be aware of the practical implications of molecular testing. While many genomic abnormalities are not yet clinically relevant, there is an increasing library of ancillary tests that may guide diagnosis, prognosis, and/or treatment of many neoplasms. Recurrent genomic abnormalities have been identified in many types of renal cell carcinoma, and some types of renal cell carcinoma are specifically defined by the molecular abnormality. Two major routes of developing urothelial carcinoma have been molecularly described. Recurrent translocations involving ETS family genes are found in approximately half of prostate cancer cases. Testicular germ cell tumors typically harbor i(12p). Penile neoplasms are often high-risk human papillomavirus-driven cancers. Nonetheless, even as genitourinary neoplasms are increasingly better understood at the molecular level, further research with eventual clinical validation is needed for optimal diagnosis, prognosis, and treatment of aggressive malignancies in the genitourinary tract.

Mitochondrial ribosomal protein S18-2 evokes chromosomal instability and transforms primary rat skin fibroblasts

We have shown earlier that overexpression of the human mitochondrial ribosomal protein MRPS18-2 (S18-2) led to immortalization of primary rat embryonic fibroblasts. The derived cells expressed the embryonic stem cell markers, and cellular pathways that control cell proliferation, oxidative phosphorylation, cellular respiration, and other redox reactions were activated in the immortalized cells.Here we report that, upon overexpression of S18-2 protein, primary rat skin fibroblasts underwent cell transformation. Cells passed more than 300 population doublings, and two out of three tested clones gave rise to tumors in experimental animals. Transformed cells showed anchorage-independent growth and loss of contact inhibition; they expressed epithelial markers, such as E-cadherin and β-catenin. Transformed cells showed increased telomerase activity, disturbance of the cell cycle, and chromosomal instability. Taken together, our data suggest that S18-2 is a newly identified oncoprotein that may be involved in cancerogenesis.

MiT Family Translocation-Associated Renal Cell Carcinoma: A Contemporary Update With Emphasis on Morphologic, Immunophenotypic, and Molecular Mimics

Translocation-associated renal cell carcinoma (t-RCC) is a relatively uncommon subtype of renal cell carcinoma characterized by recurrent gene rearrangements involving the TFE3 or TFEB loci. TFE3 and TFEB are members of the microphthalmia transcription factor (MiT) family, which regulates differentiation in melanocytes and osteoclasts, and MiT family gene fusions activate unique molecular programs that can be detected immunohistochemically. Although the overall clinical behavior of t-RCC is variable, emerging molecular data suggest the possibility of targeted approaches to advanced disease. Thus, distinguishing t-RCC from its morphologic, immunophenotypic, and molecular mimics may have important clinical implications. The differential diagnosis for t-RCC includes a variety of common renal neoplasms, particularly those demonstrating clear cell and papillary features; in addition, because of immunophenotypic overlap and/or shared molecular abnormalities (ie, TFE3 gene rearrangement), a distinctive set of nonepithelial renal tumors may also warrant consideration. Directed ancillary testing is an essential aspect to the workup of t-RCC cases and may include a panel of immunohistochemical stains, such as PAX8, pancytokeratins, epithelial membrane antigen, carbonic anhydrase IX, HMB-45, and Melan-A. Dual-color, break-apart fluorescent in situ hybridization for TFE3 or TFEB gene rearrangement may be helpful in diagnostically challenging cases or when molecular confirmation is needed.

Relationships between Chromosome 7 Gain, MET Gene Copy Number Increase and MET Protein Overexpression in Chinese Papillary Renal Cell Carcinoma Patients

To investigate the relationships between Chromosome 7 gain, mesenchymal-epithelial transition factor (MET) gene copy number increase and MET protein overexpression in Chinese patients with papillary renal cell carcinoma (PRCC), immunohistochemistry (IHC), immunofluorescence (IF) and fluorescence in situ hybridization (FISH) were performed on 98 formalin-fixed, paraffin-embedded (FFPE) PRCC samples. Correlations between MET gene copy number increase, Chromosome 7 gain and MET protein overexpression were analyzed statistically. A highly significant correlation was observed between the percentage of tumor cells with MET gene copy number ≥3 and CEP7 copy number ≥3 (R² = 0.90, p<0.001) across two subtypes of PRCC. In addition, the percentage of tumor cells with MET gene copy number ≥3 was found to increase along with increases in MET IHC score. This correlation was further confirmed in those PRCC tumor cells with average MET gene copy number >5 using combined IF and FISH methodology. Overall, this study provides evidence that Chromosome 7 gain drives MET gene copy number increase in PRCC tumors, and appears to subsequently lead to an increase in MET protein overexpression in these tumor cells. This supports MET activation as a potential therapeutic target in sporadic PRCC.

Genetic and Chromosomal Aberrations and Their Clinical Significance in Renal Neoplasms

The most common form of malignant renal neoplasms is renal cell carcinoma (RCC), which is classified into several different subtypes based on the histomorphological features. However, overlaps in these characteristics may present difficulties in the accurate diagnosis of these subtypes, which have different clinical outcomes. Genomic and molecular studies have revealed unique genetic aberrations in each subtype. Knowledge of these genetic changes in hereditary and sporadic renal neoplasms has given an insight into the various proteins and signalling pathways involved in tumour formation and progression. In this review, the genetic aberrations characteristic to each renal neoplasm subtype are evaluated along with the associated protein products and affected pathways. The potential applications of these genetic aberrations and proteins as diagnostic tools, prognostic markers, or therapeutic targets are also assessed.

Current and proposed molecular diagnostics in a genitourinary service line laboratory at a tertiary clinical institution

The idea that detailed knowledge of molecular oncogenesis will drive diagnostic, prognostic, and therapeutic clinical decision making in an increasingly multidisciplinary practice of oncologic care has been anticipated for many years. With the recent rapid advancement in our understanding of the molecular underpinnings of genitourinary malignancies, this concept is now starting to take shape in the fields of prostate, kidney, bladder, testicular, and penile cancer. Such breakthroughs necessitate the development of robust clinical-grade assays that can be quickly made available for patients to facilitate diagnosis in challenging cases, risk-stratify patients for subsequent clinical management, select the appropriate targeted therapy from among increasingly diverse and numerous options, and enroll patients in advanced clinical trials. This rapid translation of basic and clinical cancer research requires a streamlined, multidisciplinary approach to clinical assay development, termed here the molecular diagnostics service line laboratory. In this review, we summarize the current state and explore the future of molecular diagnostics in genitourinary oncology to conceptualize a genitourinary service line laboratory at a tertiary clinical institution.

Recurrent chromosomal gains and heterogeneous driver mutations characterise papillary renal cancer evolution

Papillary renal cell carcinoma (pRCC) is an important subtype of kidney cancer with a problematic pathological classification and highly variable clinical behaviour. Here we sequence the genomes or exomes of 31 pRCCs, and in four tumours, multi-region sequencing is undertaken. We identify BAP1, SETD2, ARID2 and Nrf2 pathway genes (KEAP1, NHE2L2 and CUL3) as probable drivers, together with at least eight other possible drivers. However, only ~10% of tumours harbour detectable pathogenic changes in any one driver gene, and where present, the mutations are often predicted to be present within cancer sub-clones. We specifically detect parallel evolution of multiple SETD2 mutations within different sub-regions of the same tumour. By contrast, large copy number gains of chromosomes 7, 12, 16 and 17 are usually early, monoclonal changes in pRCC evolution. The predominance of large copy number variants as the major drivers for pRCC highlights an unusual mode of tumorigenesis that may challenge precision medicine approaches.

Genetic profiles in renal tumors

Renal cell carcinoma in adult comprises a heterogeneous group of tumors with variable clinical outcomes, which ranges from indolent to aggressively malignant. The application of molecular genetics techniques to the study of renal neoplasms has resulted in improved classification of these entities and better understanding of biological mechanisms responsible for tumor development and progression. In the present article we review the molecular genetic profiles of different renal cell tumors and discuss their relevance to the carcinogenesis mechanisms and to the clinical diagnosis of renal cell carcinoma. Understanding of the molecular genetics of renal tumors is beneficial in making accurate diagnoses, assessing prognoses, and selecting appropriate and targeted therapeutic options.

Diffuse minute clear cell proliferation in kidney: case report and review of literature

To our knowledge, diffuse involvement of renal parenchyma by multiple minute foci of clear cell proliferations has not been previously reported. We report such a case, found incidentally, in an 86-year-old woman who had undergone right ureteronephrectomy for pyeloureteral urothelial carcinoma. Macroscopy of the kidney showed numerous yellow dot-like cortical nodules less than 0.3 cm. Histologic examination of the kidney and nodules revealed innumerable foci of minute clear cell proliferations in a background of chronic pyelonephritis. The benign or malignant nature of those clear cell microtumors was investigated by immunohistochemistry and fluorescent in situ hybridization analysis of chromosome 3p.

Renal mucinous tubular and spindle carcinoma lacks the gains of chromosomes 7 and 17 and losses of chromosome Y that are prevalent in papillary renal cell carcinoma

Mucinous tubular and spindle cell carcinoma of the kidney is an uncommon, distinctive neoplasm characterized by the proliferation of cuboidal and spindle cells arranged in tubular or sheet-like arrays, typically with a mucinous or myxoid background. The most important differential diagnostic consideration of mucinous tubular and spindle cell carcinoma is papillary renal cell carcinoma, type 1, with sarcomatoid transformation. The aim of our study is to investigate the pattern of possible gains or losses of chromosomes 7, 17 and Y in 10 mucinous tubular and spindle cell carcinomas with interphase fluorescence in situ hybridization (FISH). Four-micron sections were obtained from paraffin blocks representative of the tumors and including adjacent non-neoplastic renal parenchyma from 10 patients. The patients' ages ranged from 20 to 80 years (mean: 62 years); eight were female, while two were male. FISH analysis was performed with centromeric probes for chromosomes 7, 17 and Y. One hundred fifty to 200 nuclei from each case were scored for hybridization signals and non-neoplastic parenchyma served as control tissue. We found that renal mucinous tubular and spindle carcinoma lacks the gains of chromosomes 7 and 17 and losses of chromosome Y that are typical of papillary renal cell carcinoma. FISH analysis with centromeric probes for these chromosomes is potentially helpful in differentiating mucinous tubular and spindle cell carcinomas from papillary renal cell carcinomas.

Molecular analysis of a familial case of renal cell cancer and a t(3;6)(q12;q15)

We identified a novel familial case of clear-cell renal cancer and a t(3;6)(q12;q15). Subsequent cytogenetic and molecular analyses showed the presence of several abnormalities within tumour samples obtained from different patients. Loss of the der(3) chromosome was noted in some, but not all, of the samples. A concomitant VHL gene mutation was found in one of the samples. In addition, cytogenetic and molecular evidence for heterogeneity was obtained through analysis of several biopsy samples from one of the tumours. Based on these results and those reported in the literature, we conclude that loss of der(3) and subsequent VHL gene mutation may represent critical steps in the development of renal cell cancers in persons carrying the chromosome 3 translocation. Moreover, preliminary data suggest that other (epi)genetic changes may be related to tumour initiation.

Frequent gain of the p40/p51/p63 gene locus in primary head and neck squamous cell carcinoma

We have identified a new human p53 homologue, p40 (p51/p63). This gene was mapped to the distal arm of 3q and was found to be essential for normal epithelial development. We used microsatellite and FISH analyses to search for genetic alterations of p40 in primary HNSCC. A more precise localization of p40 was completed using 6 known markers on 3q and a newly isolated microsatellite marker within the p40 gene. We also determined the genomic organization of the p40 gene using human YAC and BAC clones. Microsatellite analysis revealed that 14 of 26 (54%) primary HNSCC had allelic imbalance in at least 1 of the 7 microsatellite loci. However, FISH analysis with a p40 probe showed that a majority of HNSCC had an increased copy number of the locus regardless of allelic status. Thus, overrepresentation of the p40 locus may play an important role in the development of HNSCC.

Inclusion of new microsatellite repeats in allelic loss analysis excludes retention of heterozygosity in the renal cell carcinoma critical region in 3p21

A variety of human cancers, including renal cell carcinoma (RCC), show frequent heterozygous deletion events in 3p21.3. An approximate 400-kb segment from within 3p21.3 is suspect of harboring a tumor suppressor gene, as it is homozygously deleted in three lung cancer cell lines and heterozygously deleted in virtually all lung tumors. Loss of heterozygosity (LOH) studies of this segment are hampered by the absence of highly informative markers. We have identified several new nucleotide repeats that map within this region, and have used these to complement our previous LOH studies in RCC. Our present analysis clearly shows that the common region of homozygous deletions in the lung cancer cell lines is always contained within the smallest region of overlap of heterozygous deletions in RCC.

Phylogenetic relationships of a class of hominoid-specific retro-elements (SINE-R) on human chromosomes 7 and 17

SINE-R elements are a class of retroposon derived from the human endogenous retrovirus HERV-K that has been active in hominoid evolution and may include some members that are Homo sapiens specific. Both SINE-R elements and the HERV-K class of element have potential relevance to recent genome change. Here we report on sequences in the SINE-R class that can be detected on human chromosomes 7 and 17 and compare them with sequences that we have previously reported on the X chromosome and in hominoid primates. The retroposons on chromosomes 7 and 17 showed a high degree of sequence homology (88-96%) with other human retroposons (SINE-R.C2, 11, 14, 19, and HS307/HS408). Phylogenetic analysis using the neighbour-joining method revealed that SINE-R-type retroposons on chromosomes 7 and 17 were inter-related with those of hominoid primates, suggesting that various sub-classes of these retroposons have been evolving independently during hominoid evolution. One element (17-11) on chromosome 17 shares one hundred per cent identity with a 7-11 element on chromosome 7 which suggests either recent transposition or a chromosomal translocation. Thus further investigation of the chromosomal locations of SINE-R elements that together with the HERV-K LTR sequence from which they are derived have the capacity to influence the function of neighbouring cellular genes may be expected to clarify the potential role of these elements in recent hominoid evolution.