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Sakr M, Badran M, Hassan SA, Elsaqa M, Elwany MA, Deeb NMFE, Sharafeldeen M. Detection of two synchronous histologically different renal cell carcinoma subtypes in the same kidney: a case report and review of the literature. J Med Case Rep 2024; 18:250. [PMID: 38760853 PMCID: PMC11102143 DOI: 10.1186/s13256-024-04527-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/27/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION Renal cell carcinoma (RCC) is the dominant primary renal malignant neoplasm, encompassing a significant portion of renal tumors. The presence of synchronous yet histologically distinct ipsilateral RCCs, however, is an exceptionally uncommon phenomenon that is rather under-described in the literature regarding etiology, diagnosis, management, and later outcomes during follow-up. CASE PRESENTATION We aim to present the 9th case of a combination chromophobe RCC (ChRCC) and clear cell RCC (ccRCC) in literature, according to our knowledge, for a 69-year-old North African, Caucasian female patient who, after complaining of loin pain and hematuria, was found to have two right renal masses with preoperative computed tomography (CT) and underwent right radical nephrectomy. Pathological examination later revealed the two renal masses to be of different histologic subtypes. CONCLUSION The coexistence of dissimilar RCC subtypes can contribute to diverse prognostic implications. Further research should focus on enhancing the complex, yet highly crucial, preoperative detection and pathological examination to differentiate multiple renal lesions. Planning optimal operative techniques (radical or partial nephrectomy), selecting suitable adjuvant regimens, and reporting long-term follow-up outcomes of patients in whom synchronous yet different RCC subtypes were detected are of utmost importance.
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Affiliation(s)
- Mohamed Sakr
- Faculty of Medicine, Alexandria University, Champollion Street, Alexandria, Egypt
| | - Merhan Badran
- Faculty of Medicine, Alexandria University, Champollion Street, Alexandria, Egypt.
| | - Sarah Ahmed Hassan
- Faculty of Medicine, Alexandria University, Champollion Street, Alexandria, Egypt
| | - Mohamed Elsaqa
- Faculty of Medicine, Alexandria University, Champollion Street, Alexandria, Egypt
| | - Mohamed Anwar Elwany
- Faculty of Medicine, Alexandria University, Champollion Street, Alexandria, Egypt
| | - Nevine M F El Deeb
- Faculty of Medicine, Alexandria University, Champollion Street, Alexandria, Egypt
| | - Mohamed Sharafeldeen
- Faculty of Medicine, Alexandria University, Champollion Street, Alexandria, Egypt
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Belle Mbou V, Sanglier F, Pestre-Munier J, Descazeaud A, Labrousse F. Renal collision tumours: three additional case reports. BMC Urol 2022; 22:113. [PMID: 35870918 PMCID: PMC9308929 DOI: 10.1186/s12894-022-01063-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Multiple kidney tumours are frequently seen in hereditary syndromes and familial diseases. Renal collision tumours (RCT) are characterized by the simultaneous existence of different and unrelated tumour types within the same location in the kidney, forming a single, heterogenous lesion. RCT are uncommon histological entities with distinctive features. The most frequent subtypes include clear cell renal cell carcinoma (CCRCC), papillary renal cell carcinoma (PRCC), chromophobe renal cell carcinoma (CRCC), and collecting duct carcinoma (CDC). Case presentation Here, we report three sporadic cases of RCT successfully treated by nephrectomy and confirmed by histological analysis. The first case was of a 64-year-old man diagnosed with RCT composed of a stage 2 nucleolar grade 3 CCRCC and a stage 1a nucleolar grade 2 type 1 PRCC. The second case was of a 68-year-old woman diagnosed with a combined nucleolar grade 2 type 1 PRCC and an angiomyolipoma (non-assessed stage), while the third case was of a 59-year-old woman diagnosed with a combined stage 1a nucleolar grade 3 CCRCC and a stage 1b CDC. Conclusions Due to the rarity of RCT, there are no standard guidelines for their management. Hence, the prognosis is considered to be associated with the most aggressive component, possibly the tumour with the highest nucleolar grade and stage. The histogenesis of RCT remains debated, and increase in knowledge regarding this can help enable the development of targeted therapies for advanced or metastatic tumours.
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Dietlein F, Wang AB, Fagre C, Tang A, Besselink NJM, Cuppen E, Li C, Sunyaev SR, Neal JT, Van Allen EM. Genome-wide analysis of somatic noncoding mutation patterns in cancer. Science 2022; 376:eabg5601. [PMID: 35389777 PMCID: PMC9092060 DOI: 10.1126/science.abg5601] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
We established a genome-wide compendium of somatic mutation events in 3949 whole cancer genomes representing 19 tumor types. Protein-coding events captured well-established drivers. Noncoding events near tissue-specific genes, such as ALB in the liver or KLK3 in the prostate, characterized localized passenger mutation patterns and may reflect tumor-cell-of-origin imprinting. Noncoding events in regulatory promoter and enhancer regions frequently involved cancer-relevant genes such as BCL6, FGFR2, RAD51B, SMC6, TERT, and XBP1 and represent possible drivers. Unlike most noncoding regulatory events, XBP1 mutations primarily accumulated outside the gene's promoter, and we validated their effect on gene expression using CRISPR-interference screening and luciferase reporter assays. Broadly, our study provides a blueprint for capturing mutation events across the entire genome to guide advances in biological discovery, therapies, and diagnostics.
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Affiliation(s)
- Felix Dietlein
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.,Cancer Program, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA.,Corresponding author. (E.M.V.A.); (F.D.)
| | - Alex B. Wang
- Cancer Program, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA
| | - Christian Fagre
- Cancer Program, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA
| | - Anran Tang
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.,Cancer Program, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA
| | - Nicolle J. M. Besselink
- Center for Molecular Medicine and Oncode Institute, University Medical Center Utrecht, 3584 CX Utrecht, Netherlands
| | - Edwin Cuppen
- Center for Molecular Medicine and Oncode Institute, University Medical Center Utrecht, 3584 CX Utrecht, Netherlands.,Hartwig Medical Foundation, 1098 XH Amsterdam, Netherlands
| | - Chunliang Li
- Department of Tumor Cell Biology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Shamil R. Sunyaev
- Division of Genetics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA.,Department of Biomedical Informatics, Harvard Medical School, Boston, MA 02115, USA
| | - James T. Neal
- Cancer Program, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA
| | - Eliezer M. Van Allen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.,Cancer Program, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA.,Corresponding author. (E.M.V.A.); (F.D.)
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A Composite Renal Tumor with Dual Differentiation, Chromophobe and Collecting Duct Carcinoma. Case Rep Pathol 2018; 2018:2410920. [PMID: 30228921 PMCID: PMC6136464 DOI: 10.1155/2018/2410920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/08/2018] [Indexed: 11/17/2022] Open
Abstract
Chromophobe carcinoma constitutes a small subset of all renal carcinomas. Within this category, rare tumors with divergent differentiation have been recognized. Herein, we report a rare case of composite chromophobe and collecting duct carcinoma and describe its pathologic and clinical features.
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Arık D, Açıkalın MF, Can C. Papillary renal cell carcinoma and collecting duct carcinoma combination. A case report and review of synchronous renal cell carcinoma subtypes in the same kidney. Arch Med Sci 2015; 11:686-90. [PMID: 26170866 PMCID: PMC4495165 DOI: 10.5114/aoms.2015.52378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 02/12/2014] [Accepted: 02/18/2014] [Indexed: 11/18/2022] Open
Affiliation(s)
- Deniz Arık
- Department of Pathology, Faculty of Medicine, Eskisehir Osmangazi University, Eskişehir, Turkey
| | - Mustafa Fuat Açıkalın
- Department of Pathology, Faculty of Medicine, Eskisehir Osmangazi University, Eskişehir, Turkey
| | - Cavit Can
- Department of Urology, Faculty of Medicine, Eskisehir Osmangazi University, Eskişehir, Turkey
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Zhang Z, Min J, Yu D, Shi H, Xie D. Renal collision tumour of papillary cell carcinoma and chromophobe cell carcinoma with sarcomatoid transformation: A case report and review of the literature. Can Urol Assoc J 2014; 8:E536-9. [PMID: 25210558 PMCID: PMC4137020 DOI: 10.5489/cuaj.1811] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The simultaneous occurrence of different histological types of adjacent neoplasms in the same organ is called a collision tumour, and rarely occurs in the kidney. A 63-year-old female presented to the urology department with a 1-month history of a painless hematuria. The computed tomography scans of the abdomen revealed 2 heterogeneous incidental right renal masses. The patient underwent radical nephrectomy including lymphadenectomy without adjuvant therapy. Histopathological examination showed a type 2 renal collision tumour of the papillary renal cell carcinoma with eosinophilic cytoplasm and pseudostratified nuclei on papillary cores, and chromophobe renal cell carcinoma characterized by large polygonal cells with transparent reticulated cytoplasm and prominent cell membranes, which exhibited sarcomatoid transformation in the local area. Routine follow-up demonstrated no local or distant metastasis signs of recurrence at 20 months.
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Affiliation(s)
- Zhiqiang Zhang
- Department of Urology, the Second Affiliated Hospital of Anhui Medical University, Anhui Province, China
| | - Jie Min
- Department of Urology, the Second Affiliated Hospital of Anhui Medical University, Anhui Province, China
| | - Dexin Yu
- Department of Urology, the Second Affiliated Hospital of Anhui Medical University, Anhui Province, China
| | - Haoqiang Shi
- Department of Urology, the Second Affiliated Hospital of Anhui Medical University, Anhui Province, China
| | - Dongdong Xie
- Department of Urology, the Second Affiliated Hospital of Anhui Medical University, Anhui Province, China
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Burch-Smith R, Tannir NM, Resetkova E, Tamboli P, Rao P. Collision tumor of the kidney composed of clear cell carcinoma and collecting duct carcinoma: report of a case with unusual morphology and clinical follow-up. CHINESE JOURNAL OF CANCER 2014; 33:351-5. [PMID: 24589208 PMCID: PMC4110468 DOI: 10.5732/cjc.013.10155] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report the case of a 67-year-old female who presented with a large renal mass. Gross examination of the nephrectomy specimen demonstrated a 6-cm renal mass that invaded into the renal sinus and perinephric fat. Histologic examination revealed two distinct tumor types. The first type was a conventional (clear cell) renal cell carcinoma that was of low nuclear grade and comprised the minority of the overall tumor. The second type was a high-grade collecting duct carcinoma with glandular/tubular differentiation and composed the majority of the tumor. Immunohistochemical studies demonstrated distinctive patterns of the two tumor types, thus confirming two distinct lineages. Five months postoperatively, the patient developed metastasis to the lungs and right hilar lymph node region. A fine needle aspiration of a lung nodule demonstrated a metastatic, poorly differentiated carcinoma, similar to the collecting duct carcinoma component in the kidney. Collision tumors of the kidney are rare with fewer than 10 cases reported in the literature. Our report further expands the spectrum of this rare phenomenon.
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Affiliation(s)
- Rhonda Burch-Smith
- Department of Pathology, MD Anderson Cancer Center, Houston, TX 77030, USA.
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8
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Roy S, Hooda S, Huang GJ, Pantanowitz L, Parwani AV. A novel case of concurrent renal tumors: chromophobe renal cell carcinoma and carcinoid tumor of the kidney with brief review of renal neuroendocrine tumors. Int J Surg Pathol 2012; 20:531-5. [PMID: 22456871 DOI: 10.1177/1066896912438588] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Renal cell carcinoma of chromophobe type is a malignant neoplasm with characteristic large cells that exhibit prominent cell membranes. Primary renal carcinoid tumors are rare tumors with the histological appearance similar to well-differentiated neuroendocrine tumors at other sites. Chromophobe renal cell carcinoma with neuroendocrine differentiation is exceedingly rare. The authors describe a case of a chromophobe renal cell carcinoma and carcinoid tumor of the kidney presenting as distinct masses in the same kidney in a 34-year-old male. The histologic and immunohistochemical features of both the tumors were characteristic with no overlapping features. The carcinoid tumor presented at a higher stage with nodal metastasis. To the best of the authors' knowledge, this is the first case of 2 morphologically distinct tumors, one chromophobe renal cell carcinoma and the other primary carcinoid tumor in the same kidney.
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Affiliation(s)
- Somak Roy
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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9
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Chromosome 1 analysis in chromophobe renal cell carcinomas with tissue microarray (TMA)-facilitated fluorescence in situ hybridization (FISH) demonstrates loss of 1p/1 which is also present in renal oncocytomas. ACTA ACUST UNITED AC 2008; 17:141-4. [PMID: 18382368 DOI: 10.1097/pdm.0b013e3181577d57] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Morphologic overlap between chromophobe renal cell carcinoma (ChRCC) and renal oncocytomas (RO) has been widely recognized. Whether these tumors are genetically related and represent a spectrum of benign to malignant tumor progression remains an open question. We previously showed by conventional cytogenetics and fluorescent in situ hybridization (FISH) that the most common chromosomal abnormality in RO is loss of chromosome 1 or 1p. In this study, we evaluated chromosome 1 in ChRCC using the same set of FISH probes. Twenty-one ChRCCs from 13 men and 8 women were studied. Formalin-fixed, paraffin-embedded tissue blocks were used to construct tissue microarrays. A subtelomeric 1p36.3 probe was used in tandem with 1q25 probes for FISH studies. The patients ranged in age from 34 to 82 years (mean 62.8 y, median 61 y). FISH analysis showed an abnormal chromosome 1 in 20/21 (95%) ChRCCs as follows: 18 tumors (85%) had loss of entire chromosome 1, 2 tumors (10%) had loss of 1p36.3 only, and 1 tumor (5%) was apparently diploid for chromosome 1. In this study, 95% of ChRCCs showed abnormality of chromosome 1 by FISH. The progression of chromosome 1 abnormalities, from diploid to loss of 1p to loss of entire chromosome, is also present in oncocytomas. These results provide further evidence to support a genetic similarity between chromophobe carcinoma and oncocytoma. Whether abnormalities of chromosome 1 are associated with RO tumorigenesis or its progression to carcinoma requires further studies.
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Kobayashi N, Matsuzaki O, Shirai S, Aoki I, Yao M, Nagashima Y. Collecting duct carcinoma of the kidney: an immunohistochemical evaluation of the use of antibodies for differential diagnosis. Hum Pathol 2008; 39:1350-9. [PMID: 18602672 DOI: 10.1016/j.humpath.2007.11.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Revised: 10/12/2007] [Accepted: 11/13/2007] [Indexed: 11/26/2022]
Abstract
Collecting duct carcinoma is a highly aggressive renal epithelial malignancy, although it accounts for less than 1% of the incidence of renal epithelial neoplasms. Differential diagnoses between collecting duct carcinoma, pelvic urothelial carcinoma with marked invasion to the renal parenchyma (invasive urothelial carcinoma), and papillary renal cell carcinoma is often challenging. In our current study, we examined the utility of using commercially available antibodies, in conjunction with lectin histochemistry, for such differential diagnoses. We examined 17 cases of collecting duct carcinoma, 10 cases of invasive urothelial carcinoma and 15 cases of papillary renal cell carcinoma (type 1, 6 cases; type 2, 9 cases) in these evaluations. Our results indicated that Ulex europaeus agglutinin 1, E-cadherin, and c-KIT were frequently positive in collecting duct carcinoma and invasive urothelial carcinoma, in comparison with papillary renal cell carcinoma, which had negative results for CD10 and alpha-methylacyl CoA racemase. We found, however, that collecting duct carcinoma showed positivity for high-molecular-weight cytokeratin and low-molecular-weight cytokeratin at a low frequency compared with invasive urothelial carcinoma, and that these distinctions need further careful evaluation. In addition, high-molecular-weight cytokeratin positivity was not a reliable marker for collecting duct carcinoma. We conclude that Ulex europaeus agglutinin 1 reactivity and positivity for E-cadherin and c-KIT are effective in distinguishing collecting duct carcinoma from papillary renal cell carcinoma, and that negative results for alpha-methylacyl CoA racemase and CD10 are potentially useful hallmarks of this distinction also. In contrast, a differential diagnosis for collecting duct carcinoma and invasive urothelial carcinoma will require careful examination of multiple routinely stained specimens, particularly in cases of in situ neoplastic lesions in the pelvic mucosa.
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Affiliation(s)
- Naohito Kobayashi
- Department of Molecular Pathology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
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Murakami T, Sano F, Huang Y, Komiya A, Baba M, Osada Y, Nagashima Y, Kondo K, Nakaigawa N, Miura T, Kubota Y, Yao M, Kishida T. Identification and characterization of Birt-Hogg-Dubé associated renal carcinoma. J Pathol 2007; 211:524-531. [PMID: 17323425 DOI: 10.1002/path.2139] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The Birt-Hogg-Dubé (BHD) gene is responsible for BHD syndrome, a rare autosomal dominant disease, characterized by benign hair follicle tumours, spontaneous pneumothorax and renal neoplasms with diverse histology. To elucidate its involvement in the development of renal neoplasms, we examined a total of 100 sporadic renal tumours with various histological subtypes for BHD mutation by SSCP-sequencing analyses. We found one germline insertion mutation in the C8 hotspot of exon 11 (c.1733insC), which is known to have a strong association with renal tumour occurrence. The germline-mutated patient suffered from solitary renal cell carcinoma (RCC) but did not have any other BHD manifestations or family history. The tumour revealed heterogeneous cytomorphology, mainly a mixture of eosinophilic and focally clear cells with tubulopapillary architecture. In this tumour, both BHD alleles were inactivated by germline mutation concomitant with loss of heterozygosity, and the amount of BHD mRNA detected by real-time quantitative PCR (RQ-PCR) was very low. Renal tumour subtype/nephron segment-specific gene expression detected by RQ-PCR demonstrated that the tumour expressed relatively high amounts of alpha-methylacyl-CoA racemase (AMACR) and the KIT oncogene, but relatively low amounts of carbonic anhydrase IX (CA9), aquaporin 1 (AQP1), claudin 7 (CLDN7), parvalbumin (PVALB), chloride channel Kb (CLCNKB) and 11-beta-hydroxysteroid dehydrogenase 2 (HSD11B2), suggesting diverse mRNA signatures. Further clustering analysis of 88 renal tumours based on expression of these eight genes sub-classified the tumour as close to oncocytomas and chromophobe RCCs, which are considered distal nephron-associated tumours. These data suggest that somatic mutation of BHD is relatively rare in Japanese patients. The BHD-mutated RCC identified in this study, which exhibits heterogeneous biological features in both morphology and gene expression signatures, seems to deviate from our current understanding of renal tumour classification.
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Affiliation(s)
- T Murakami
- Department of Urology and Molecular Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - F Sano
- Department of Urology and Molecular Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Y Huang
- Department of Urology and Molecular Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - A Komiya
- Department of Urology and Molecular Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - M Baba
- Department of Urology and Molecular Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Y Osada
- Department of Urology, Kanagawa Cancer Centre, Yokohama, Japan
| | - Y Nagashima
- Department of Molecular Pathology and Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - K Kondo
- Department of Urology, Yokohama City University Medical Centre, Yokohama, Japan
| | - N Nakaigawa
- Department of Urology and Molecular Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - T Miura
- Department of Urology, Kanagawa Cancer Centre, Yokohama, Japan
| | - Y Kubota
- Department of Urology and Molecular Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - M Yao
- Department of Urology and Molecular Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - T Kishida
- Department of Urology, Yokohama City University Medical Centre, Yokohama, Japan
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Roehrl MHA, Selig MK, Nielsen GP, Dal Cin P, Oliva E. A renal cell carcinoma with components of both chromophobe and papillary carcinoma. Virchows Arch 2006; 450:93-101. [PMID: 17124599 DOI: 10.1007/s00428-006-0331-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2006] [Revised: 10/13/2006] [Accepted: 10/16/2006] [Indexed: 11/29/2022]
Abstract
We report a case of a morphologically unusual renal cell carcinoma with features of both chromophobe and papillary carcinoma. Immunohistochemical analysis of high molecular weight cytokeratins (HMWCK), cytokeratin 7 (CK7), cytokeratin 19 (CK19), c-Kit, and alpha-methylacyl-CoA racemase (AMACR) demonstrated differential profiles for the two components of the tumor, consistent with the respective patterns commonly observed for pure chromophobe and papillary renal cell carcinomas. Specifically, the chromophobe tumor cells expressed CK7 and c-Kit weakly, while HMWCK, CK19, and AMACR were not detectable. In contrast, the papillary tumor cells expressed uniformly HMWCK, CK7, and c-Kit and focally CK19 and AMACR. Fluorescence in situ hybridization analysis of nuclei isolated from paraffin-embedded tumor tissue detected monosomy 1, disomy 7, and monosomy 17, a common and characteristic finding in chromophobe carcinomas, in a majority of, but not all tumor cells, whereas a population characterized by disomy 1, trisomy 7, and trisomy 17, a frequent finding in papillary carcinoma, was not identifiable. Electron microscopic analysis revealed numerous characteristic small cytoplasmic vesicles in the chromophobe areas, which were absent in the papillary component. This case illustrates the rare coexistence of two distinct and admixed histologic types of renal cell carcinoma.
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Affiliation(s)
- Michael H A Roehrl
- Department of Pathology and Laboratory Medicine, James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Warren 2, 55 Fruit Street, Boston, MA 02114, USA.
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