Chromophobe renal cell carcinoma with osteosarcoma-like differentiation

Chromophobe renal cell carcinoma with sarcomatoid and heterologous osteosarcoma-like differentiation: a case report and literature review

Chromophobe renal cell carcinoma (CRCC) is a subtype of renal cell carcinoma (RCC) with a favorable prognosis. Sarcomatoid differentiation in RCC is assumed to be the outcome of the parent tumor's dedifferentiation and associated with poorer prognosis. Sarcomatoid differentiation can be detected in CRCC as well as other subtypes, but the occurrence of divergent osteosarcoma-like components in sarcomatoid CRCC is extremely unusual. Only six cases have been previously reported in the literature, we reviewed them and presented the seventh case in a 71-year-old male who had a left kidney heterogeneous mass. The resected tumor showed a sarcoma-like spindle cell area with an adjacent osteosarcoma area producing lacy bone material and bony trabeculae in a hard area mixed with a typical CRCC. In conclusion, sarcomatoid CRCC with osteosarcomatous differentiation is a very rare tumor and should be kept in mind especially when dealing with small or frozen sections biopsies.

Clinicopathologic and Immunohistochemical Characterization of Sarcomatoid Chromophobe Renal Cell Carcinoma: An Analysis of 22 Cases

Sarcomatoid differentiation in chromophobe renal cell carcinoma (ChRCC) is a rare finding and a significant predictor of worse outcomes. When the sarcomatoid component overgrows the conventional component or is the only component on a biopsy, the differential diagnoses encompass a variety of entities. Therefore, we reviewed 22 sarcomatoid ChRCCs and characterized the immunophenotype. Given that renal carcinomas with sarcomatoid features may benefit from immune checkpoint inhibitor-based therapy we also assessed the programmed death-ligand 1 (PD-L1) (28-8) expression. DOG1, CD117, cytokeratin 7, and PAX8 were negative in 100%, 88%, 63%, and 44% of the sarcomatoid components, respectively. GATA3 was expressed in 31% of the conventional components and in 50% of the sarcomatoid components. One conventional and 3 sarcomatoid components expressed PD-L1. Sarcomatoid ChRCCs have a high propensity for metastases and cancer progression. Distant metastatic disease was seen in 73% of the cases and median survival in this cohort was <1 year. The sarcomatoid portion had increased expression of PD-L1 and frequent loss of expression of multiple immunohistochemical markers associated with ChRCC. Half of the sarcomatoid ChRCC exhibited GATA3 expression, 3 of which did not express PAX8.

Sarcomatoid Chromophobe Renal Cell Carcinoma: A Case Report and Review of the Literature

Patient: Female, 63

Final Diagnosis: Sarcomatoid chromophobe renal cell carcinoma

Symptoms: Painless gross hematuria

Medication: —

Clinical Procedure: —

Specialty: Renal Surgery

Chromophobe renal cell carcinoma with sarcomatoid differentiation containing various heterologous components

Renal cell carcinoma (RCC) occasionally has sarcomatoid differentiation and rarely contains heterologous components. We report a case of chromophobe RCC with sarcomatoid differentiation that had various heterologous components including a unique lipomatous area. The patient was an 83-year-old woman with a palpable mass in the left lower abdomen. Grossly, the tumor was 14 cm in diameter and had yellowish-to-whitish color with focal necrosis and hemorrhage. Histologically, the tumor was composed of an eosinophilic subtype of chromophobe RCC with sarcomatoid differentiation including mainly chondrosarcoma, some osteosarcoma and a lipomatous area. The heterologous components of sarcomatoid RCC are usually osteosarcoma or chondrosarcoma, and sarcomatoid RCC with multiple heterologous components is extremely rare.

Papillary Renal Cell Carcinoma With Osteosarcomatous Heterologous Differentiation: A Case Report With Molecular Genetic Analysis and Review of the Literature

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.

Morphological, immunohistochemical, and chromosomal analysis of multicystic chromophobe renal cell carcinoma, an architecturally unusual challenging variant

Chromophobe renal cell carcinoma (ChRCC) is typically composed of large leaf-like cells and smaller eosinophilic cells arranged in a solid-alveolar pattern. Eosinophilic, adenomatoid/pigmented, or neuroendocrine variants have also been described. We collected 10 cases of ChRCC with a distinct multicystic pattern out of 733 ChRCCs from our registry, and subsequently analyzed these by morphology, immunohistochemistry, and array comparative genomic hybridization. Of the 10 patients, 6 were males with an age range of 50-89 years (mean 68, median 69). Tumor size ranged between 1.2 and 20 cm (mean 5.32, median 3). Clinical follow-up was available for seven patients, ranging 1-19 years (mean 7.2, median 2.5). No aggressive behavior was documented. We observed two growth patterns, which were similar in all tumors: (1) variable-sized cysts, resembling multilocular cystic neoplasm of low malignant potential and (2) compressed cystic and tubular pattern with slit-like spaces. Raisinoid nuclei were consistently present while necrosis was absent in all cases. Half of the cases showed eosinophilic/oncocytic cytology, deposits of pigment (lipochrome) and microcalcifications. The other half was composed of pale or mixed cell populations. Immunostains for epithelial membrane antigen (EMA), CK7, OSCAR, CD117, parvalbumin, MIA, and Pax 8 were positive in all tumors while negative for vimentin, TFE3, CANH 9, HMB45, cathepsin K, and AMACR. Ki67 immunostain was positive in up to 1 % of neoplastic cells. Molecular genetic examination revealed multiple chromosomal losses in two fifths analyzable tumors, while three cases showed no chromosomal numerical aberrations. ChRCC are rarely arranged in a prominent multicystic pattern, which is probably an extreme form of the microcystic adenomatoid pigmented variant of ChRCC. The spectrum of tumors entering the differential diagnosis of ChRCC is quite different from that of conventional ChRCC. The immunophenotype of ChRCC is identical with that of conventional ChRCC. Chromosomal numerical aberration pattern was variable; no chromosomal numerical aberrations were found in three cases. All the cases in this series have shown an indolent and non-aggressive behavior.

Immunohistochemical analysis of cytochrome C oxidase facilitates differentiation between oncocytoma and chromophobe renal cell carcinoma

In this study, immunohistochemical staining pattern of cytochrome c oxidase subunit 1 (CCO1) was investigated in the differentiation of renal oncocytoma (RO) from eosinophilic (EoC) and classic chromophobe renal cell carcinoma (ChRCC). A feature found in ChRCC/EoC but not in RO is the predominance of a perinuclear halo when stained for CCO1. In a cohort of 103 mixed cases including 44 RO, 37 classic ChRCC and 22 EoC, the diagnosis based on this immunohistochemical feature alone was consistent with the previous routine diagnosis in 95.7%. We reached 100% specificity and 81.4% sensitivity of this pattern in ChRCC. Specificity for RO was 93.2% and sensitivity correspondingly 95.5%. We propose a novel and easily interpretable immunohistochemical method for the discrimination of benign RO from certain subtypes of malignant ChRCC. Because of strong similarity in morphology of the 2 entities the diagnosis often cannot be made based on standard histopathology alone. The study describes for the first time the formation of a perinuclear halo in CCO1 immunohistochemistry as a highly specific marker for the diagnosis of ChRCC. We think this method can be a strong amendment for routine diagnostics in renal cell carcinoma.

Chromophobe renal cell carcinoma with neuroendocrine and neuroendocrine-like features. Morphologic, immunohistochemical, ultrastructural, and array comparative genomic hybridization analysis of 18 cases and review of the literature

Chromophobe renal cell carcinoma (CRCC) with neuroendocrine differentiation (CRCCND) has only recently been described. Eighteen cases of CRCC with morphologic features suggestive of neuroendocrine differentiation were selected from among 624 CRCCs in our registry. The tissues were fixed in neutral formalin, embedded in paraffin, cut into 4- to 5-μm-thick sections, and stained with hematoxylin and eosin. As CRCC with neuroendocrine features, tumors with following morphology were suggested: (1) trabecular/palisading/ribbon-like, gyriform, insular, glandular, and solid pattern; (2) uniform polygonal cells formed in small islets; and (3) cribriform pattern in combination with palisading. Selected cases were further analyzed using immunohistochemistry, electron microscopy, array comparative genomic hybridization, and fluorescence in situ hybridization. Cases were classified as CRCCND or CRCC with neuroendocrine-like features (CRCCND-L) based on the immunohistochemical expression of neuroendocrine markers: CRCCND, 4 cases, age range 49 to 79 years, size ranged from 2.2 to 22 cm, and CRCCND-L, 14 cases, age range 34 to 74 years, size range 3.8 to 16.5 cm. Follow-up information was available for 11 of 18 patients aged 0.5 to 12 years. Two of 4 CRCCNDs showed aggressive clinical course with metastatic spreading. Chromophobe renal cell carcinomas with neuroendocrine differentiation were focally positive for CD56 (4/4), synaptophysin (4/4), chromogranin A (1/4), and neuron-specific enolase (3/4). All 14 CRCCND-Ls were mostly negative or very weakly focally positive for some of the aforementioned markers. All 18 tumors were positive for cytokeratin 7 and CD117. Ultrastructural analysis showed poorly preserved neuroendocrine granules only in 2 of 4 analyzed CRCCNDs. Losses of chromosomes 1, 2, 6, and 10 were found in all analyzable CRCCNDs, whereas multiple losses (chromosomes 1, 2, 6, 10, 13, 17, and 21) and gains (chromosomes 4, 11, 12, 14, 15, 16, 19, and 20) were found in CRCCND-L.

Chromophobe Renal Cell Carcinoma With Heterologous (Liposarcomatous) Differentiation

A 44-year-old woman presented with right flank mass of 6 months duration. A right side renal tumor was diagnosed, and a radical nephrectomy was performed. Histopathological examination showed chromophobe renal cell carcinoma (CRCC) with sarcomatoid transformation. The sarcomatous component contained large pleomorphic lipoblasts. The CRCC was positive for Hale’s colloidal iron stain, whereas the sarcomatous component was negative. Based on histopathological and immunohistochemical findings, a diagnosis of sarcomatoid CRCC with heterologous liposarcomatous differentiation was made. To the authors’ knowledge, this is the second reported case of a sarcomatoid CRCC where the sarcomatous component displayed features of liposarcoma. The case has been reported for its rarity.

Sarcomatoid chromophobe renal cell carcinoma with heterologous sarcomatoid elements. A case report and review of the literature

Chromophobe renal cell carcinoma (CRCC) is a distinct subtype of renal cell carcinoma (RCC) that is well known for its relatively good prognosis. Sarcomatoid transformation in this tumor, although rare, has been well documented in the literature and, as in other types of RCC, carries an ominous prognosis for the patient. The finding of heterologous elements in the sarcomatoid component of CRCC is an extraordinary event, which has been reported in only 2 previous cases. Here, we present the third such case, occurring in the left kidney of a previously healthy 63-year-old woman. The nephrectomy specimen showed CRCC with extensive sarcomatoid changes displaying heterologous elements in the form of chondrosarcomatous and osteosarcomatous differentiation. As in other sarcomatoid RCCs, this tumor behaves aggressively, with frequent distant metastases. It is important to recognize the sarcomatoid component in these tumors because of its consequential adverse prognosis for the patient.

Dedifferentiated chromophobe renal cell carcinoma with massive osteosarcoma-like divergent differentiation: a singular entity in the spectrum of retroperitoneal calcifying tumors

Sarcomatoid change in renal cell carcinoma is the result of the dedifferentiation of the "parent" tumor into a high-grade malignancy characterized by sarcoma-like features and associated with an accelerated clinical course and poorer prognosis. Any of the renal cell carcinoma subtypes can undergo sarcomatoid dedifferentiation, with the chromophobe variant being the most prone. The present report describes the case of a woman affected by a classic chromophobe renal cell carcinoma that developed dedifferentiation accompanied by a very rare osteosarcoma-like divergent differentiation, which constituted about 90% of the entire retroperitoneal mass. In addition to presenting the relevant imaging, histopathological, and immunohistochemical findings, this article briefly discusses the main differential diagnosis of retroperitoneal ossifying/ calcifying masses, which could give rise to diagnostic problems either in small biopsies or at imaging.

Squamous differentiation in a sarcomatoid chromophobe renal cell carcinoma: an unusual case report with review of the literature

We describe an extremely rare occurrence of a squamous differentiation in a sarcomatoid chromophobe renal cell carcinoma in a 45-year-old woman with nodal and lung metastasis at presentation. The tumor on histology showed all 3 components intimately admixed with each other, which to the best of our knowledge is the first such case to be reported in the literature. The renal pelvis was smooth walled and uninvolved. Kidney-specific cadherin was positive in the chromophobe renal cell carcinoma areas and negative in the sarcomatoid and squamous areas.

Claudin-7 and claudin-8: immunohistochemical markers for the differential diagnosis of chromophobe renal cell carcinoma and renal oncocytoma

Claudin-7 and claudin-8 code for tight junction proteins expressed in distal nephron epithelium. In a recent oligonucleotide microarray study, we identified claudin-7 and claudin-8 as candidate markers to distinguish chromophobe renal cell carcinoma from other renal tumors, including oncocytoma. Distinction of these lesions can be difficult by light microscopy but is clinically important because chromophobe renal cell carcinoma has malignant biological potential, whereas renal oncocytoma is benign. Claudin-7 and claudin-8 expression was studied by immunohistochemistry in 11 chromophobe renal cell carcinomas and 17 oncocytomas using formalin-fixed paraffin-embedded tissue sections of tumor with adjacent nonneoplastic kidney. Steam antigen retrieval was performed before immunohistochemistry. Specificity was verified by negative control reactions without primary antibody and appropriate membranous staining patterns in positive control tissues (colon carcinoma and adjacent nonneoplastic kidney). Claudin-7 protein was expressed in a membranous pattern in 10 of 11 chromophobe renal cell carcinomas and 4 of 17 oncocytomas (P < .01). Claudin-8 was expressed in multiple patterns: In oncocytoma, 11 of 17 cases showed cytoplasmic, 4 of 17 membranous, and 2 of 17 negative reactions. In chromophobe renal cell carcinoma, 0 of 11 cases showed cytoplasmic, 3 of 11 membranous, and 8 of 11 negative reactions (P < .01). The immunohistochemical pattern of membranous claudin-7 and negative claudin-8 was seen in 7 of 11 chromophobe renal cell carcinomas and 1 of 17 oncocytomas (63% sensitivity, 84% specificity, 88% positive predictive value for chromophobe renal cell carcinoma). Negative claudin-7 and cytoplasmic claudin-8 were observed in 10 of 17 oncocytomas and 0 of 11 chromophobe renal cell carcinomas (59% sensitivity, 100% specificity and positive predictive value for oncocytoma). The distal nephron proteins claudin-7 and claudin-8 have potential use as immunohistochemical biomarkers in the differential diagnosis of chromophobe renal cell carcinoma and oncocytoma. Expression of claudin-7 and claudin-8 may reflect the relationship of chromophobe renal cell carcinoma and oncocytoma to intercalated cells of the cortical collecting duct. It may be necessary to identify additional biomarkers to include with claudin-7 and claudin-8 in a larger immunohistochemical panel to improve diagnostic sensitivity and specificity.

Simultaneous chromophobe renal cell carcinoma and squamous renal cell carcinoma

Chromophobe renal cell carcinoma (CHRC) is a neoplasm of the kidney with clinicopathologic peculiarities that seems to be of better prognosis than conventional renal cell carcinoma. Classical and eosinophilic types are the two histological variants recorded. Also, it has been described in association with carcinoma of collecting ducts, conventional renal cell carcinoma and sarcomatoid renal cell carcinoma. Squamous renal carcinoma is a very rare neoplasm with a malignant course. We describe a case of simultaneous chromophobe renal cell carcinoma with squamous cell carcinoma, finding which, to the best of our knowledge, has not previously been reported.

Chromosomal gains in the sarcomatoid transformation of chromophobe renal cell carcinoma

The hallmark of chromophobe renal cell carcinoma is multiple chromosomal losses from among chromosomes 1, 2, 6, 10 and 17. Chromophobe renal cell carcinoma with distant metastases or sarcomatoid transformation are uncommon and little is known about their chromosomal abnormalities. We collected six sarcomatoid chromophobe renal cell carcinomas and three primary chromophobe renal cell carcinomas with distant metastases. A cytogenetic analysis by fluorescent in situ hybridization on paraffin-embedded tissue was performed using centromeric probes for chromosomes 1, 2, 6, 10 and 17. We found more than one signal in four of six (66%) sarcomatoid chromophobe renal cell carcinomas, in both sarcomatoid and adjacent epithelial components. Both primary chromophobe renal cell carcinomas and matched metastases showed single signals for all chromosomes studied in two cases and no abnormalities in the remaining case. We concluded that: (1) both epithelial and sarcomatoid components of sarcomatoid chromophobe renal cell carcinoma show different genetic abnormalities from those characteristic of chromophobe renal cell carcinoma; (2) sarcomatoid chromophobe renal cell carcinomas frequently have multiple gains (polysomy) of chromosomes 1, 2, 6, 10 and 17; (3) distant metastases show the same genetic patterns, usually chromosomal losses (monosomy), found in the primary tumors.

Sarcomatoid Renal Cell Carcinoma With Divergent Sarcomatoid Growth Patterns: A Case Report and Review of the Literature

A 71-year-old woman who presented with left abdominal pain was found to have a noncalcified renal mass with a perisplenic extension on imaging studies. Histologically, the tumor showed predominantly malignant spindle cells with extensive osteoid and chondroid matrix production. Various growth patterns resembling rhabdomyosarcoma, malignant fibrous histiocytoma, and fibrosarcoma were also observed. Immunohistochemistry showed positive staining of the neoplastic cells for cytokeratin and focally positive staining for CD10 and CD117 (c-Kit). Electron microscopic examination revealed a poorly differentiated neoplasm with both mesenchymal and epithelial features. The tumor was diagnosed as a sarcomatoid renal cell carcinoma with overgrowth of the sarcomatoid component (World Health Organization: renal cell carcinoma, unclassified). To our knowledge, sarcomatoid renal cell carcinoma with such a broad morphologic phenotype in a single case has not been documented. Furthermore, the CD117 expression in a sarcomatoid renal cell carcinoma that was observed in this case merits further investigation.

Chromophobe renal cell carcinoma showing oncocytoma-like hyalinized and edematous stroma: A case report and review of the literature

A case of chromophobe renal cell carcinoma (CRCC) with abundant hyalinized and edematous stroma mimicking oncocytoma is presented. This stromal architecture in the current case has not been reported on CRCC to our knowledge. A further interesting finding is entrapped non-neoplastic tubules in the hyalinized and edematous stroma composing the tumor. These histological features, such as abundant hyalinized and edematous stroma containing non-neoplastic tubules, may be analogous to oncocytoma. We reported a unique case of CRCC and studied with light microscopy and immunohistochemistry.

[Sarcomatoid carcinoma of the kidney. Report of a new case and review of the bibliography]

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.