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Webster BR, Ricketts CJ, Vocke CD, Gamble D, Crooks DR, Yang Y, Friedman L, Toubaji A, Msaouel P, Hernandez JM, Linehan WM, Ball MW. Molecular Characterization of Metastatic Oncocytoma With Exceptional Response to Treatment: A Case Report. JCO Precis Oncol 2024; 8:e2400188. [PMID: 39038244 PMCID: PMC11323308 DOI: 10.1200/po.24.00188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/15/2024] [Accepted: 06/12/2024] [Indexed: 07/24/2024] Open
Abstract
Comprehensive molecular characterization and effective therapy in a rare case of metastatic renal oncocytoma.
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Affiliation(s)
- Bradley R. Webster
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892
| | - Christopher J. Ricketts
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892
| | - Cathy D. Vocke
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892
| | - Dionna Gamble
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892
| | - Daniel R. Crooks
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892
| | - Ye Yang
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892
| | - Lindsay Friedman
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892
| | - Antoun Toubaji
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892
| | - Pavlos Msaouel
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030
- Department of Translational Molecular Pathology, Division of Pathology/Lab Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030
| | - Jonathan M. Hernandez
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892
| | - W. Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892
| | - Mark W. Ball
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892
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Sangoi AR, Nova-Camacho LM, Akgul M, Queipo FJ, Aisa G, Garcia-Martos M, Panizo A. Scars Run Deep: Problematic Morphology and Immunoprofile of Scars in Renal Oncocytomas. Int J Surg Pathol 2024; 32:83-90. [PMID: 37143313 DOI: 10.1177/10668969231171683] [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] [Indexed: 05/06/2023]
Abstract
In some instances, the central scar of renal oncocytoma can demonstrate entrapped cells with unusual morphology and aberrant immunoprofile creating potential diagnostic confusion. Herein, 100 renal oncocytomas containing scars with embedded epithelial cells were identified from 6 institutions, including nephrectomies (64% partial, 36% radical) of similar laterality (left = 51%) and sex distribution (male = 56%), with patient ages ranging from 38 to 86 years (mean = 64.3years) and tumor sizes ranging from 2 to 16 cm (mean = 5.3 cm). Immunohistochemistry was performed on all tumors for KRT7, KIT, vimentin, and CA9 with staining intensity and extensity separately analyzed. Of 4 architectural patterns of cells within the scar, 60% showed tubular pattern. Of 4 cytologies within the scar, flat/elongated (49%) and cuboidal cells (40%) predominated. Within the scar, 62% showed eosinophilic cytoplasm, with 38% showing both cleared and eosinophilic cytoplasm; notably, 79% showed higher grade nuclei than typical oncocytes. A subset of scar cells showed mucinous-like basophilic secretions (19%). Compared to background renal oncocytoma, tumor cells within the scar were more often positive for vimentin, KRT7, and CA9 and more frequently negativity for KIT. Specifically, of the notable "aberrant" immunoprofiles, 79% showed KRT7 positivity/KIT negativity/vimentin positive, 84% showed vimentin positivity/CA9 positivity, and 78% showed KIT negativity/vimentin positivity/CA9 positivity. While encountering scars within renal oncocytomas is not uncommon, what is not well appreciated is the unique morphology and immunohistochemistry of tumor cells within the scar. Comparing tumor morphology and immunoprofile of the scar to the background oncocytoma is helpful to avoid interpretative confusion.
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Affiliation(s)
- Ankur R Sangoi
- Department of Pathology, Stanford Medical Center, Stanford, CA, USA
| | | | - Mahmut Akgul
- Dpartment of Pathology, Albany Medical Center, Albany, NY, USA
| | - Francisco J Queipo
- Department of Pathology, Hospital Universitario de A Coruna, A Coruna, Spain
| | - Gregorio Aisa
- Department of Pathology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Maria Garcia-Martos
- Department of Pathology, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - Angel Panizo
- Department of Pathology, Hospital Universitario de Navarra, Pamplona, Spain
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Abstract
Computed tomography (CT) of the abdomen is usually appropriate for the initial imaging of many urinary tract diseases, due to its wide availability, fast scanning and acquisition of thin slices and isotropic data, that allow the creation of multiplanar reformatted and three-dimensional reconstructed images of excellent anatomic details. Non-enhanced CT remains the standard imaging modality for assessing renal colic. The technique allows the detection of nearly all types of urinary calculi and the estimation of stone burden. CT is the primary diagnostic tool for the characterization of an indeterminate renal mass, including both cystic and solid tumors. It is also the modality of choice for staging a primary renal tumor. Urolithiasis and urinary tract malignancies represent the main urogenic causes of hematuria. CT urography (CTU) improves the visualization of both the upper and lower urinary tract and is recommended for the investigation of gross hematuria and microscopic hematuria, in patients with predisposing factors for urologic malignancies. CTU is highly accurate in the detection and staging of upper tract urothelial malignancies. CT represents the most commonly used technique for the detection and staging of bladder carcinoma and the diagnostic efficacy of CT staging improves with more advanced disease. Nevertheless, it has limited accuracy in differentiating non-muscle invasive bladder carcinoma from muscle-invasive bladder carcinoma. In this review, clinical indications and the optimal imaging technique for CT of the urinary tract is reviewed. The CT features of common urologic diseases, including ureterolithiasis, renal tumors and urothelial carcinomas are discussed.
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Qu J, Zhang Q, Song X, Jiang H, Ma H, Li W, Wang X. CT differentiation of the oncocytoma and renal cell carcinoma based on peripheral tumor parenchyma and central hypodense area characterisation. BMC Med Imaging 2023; 23:16. [PMID: 36707788 PMCID: PMC9881251 DOI: 10.1186/s12880-023-00972-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/18/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Although the central scar is an essential imaging characteristic of renal oncocytoma (RO), its utility in distinguishing RO from renal cell carcinoma (RCC) has not been well explored. The study aimed to evaluate whether the combination of CT characteristics of the peripheral tumor parenchyma (PTP) and central hypodense area (CHA) can differentiate typical RO with CHA from RCC. METHODS A total of 132 tumors on the initial dataset were retrospectively evaluated using four-phase CT. The excretory phases were performed more than 20 min after the contrast injection. In corticomedullary phase (CMP) images, all tumors had CHAs. These tumors were categorized into RO (n = 23), clear cell RCC (ccRCC) (n = 85), and non-ccRCC (n = 24) groups. The differences in these qualitative and quantitative CT features of CHA and PTP between ROs and ccRCCs/non-ccRCCs were statistically examined. Logistic regression filters the main factors for separating ROs from ccRCCs/non-ccRCCs. The prediction models omitting and incorporating CHA features were constructed and evaluated, respectively. The effectiveness of the prediction models including CHA characteristics was then confirmed through a validation dataset (8 ROs, 35 ccRCCs, and 10 non-ccRCCs). RESULTS The findings indicate that for differentiating ROs from ccRCCs and non-ccRCCs, prediction models with CHA characteristics surpassed models without CHA, with the corresponding areas under the curve (AUC) being 0.962 and 0.914 versus 0.952 and 0.839 respectively. In the prediction models that included CHA parameters, the relative enhancement ratio (RER) in CMP and enhancement inversion, as well as RER in nephrographic phase and enhancement inversion were the primary drivers for differentiating ROs from ccRCCs and non-ccRCCs, respectively. The prediction models with CHA characteristics had the comparable diagnostic ability on the validation dataset, with respective AUC values of 0.936 and 0.938 for differentiating ROs from ccRCCs and non-ccRCCs. CONCLUSION The prediction models with CHA characteristics can help better differentiate typical ROs from RCCs. When a mass with CHA is discovered, particularly if RO is suspected, EP images with longer delay scanning periods should be acquired to evaluate the enhancement inversion characteristics of CHA.
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Affiliation(s)
- Jianyi Qu
- Yuhuangding Hospital, Qingdao University School of Medicine, Shandong, Yantai, China
| | - Qianqian Zhang
- Yuhuangding Hospital, Qingdao University School of Medicine, Shandong, Yantai, China
| | - Xinhong Song
- Yuhuangding Hospital, Qingdao University School of Medicine, Shandong, Yantai, China
| | - Hong Jiang
- Yuhuangding Hospital, Qingdao University School of Medicine, Shandong, Yantai, China
| | - Heng Ma
- Yuhuangding Hospital, Qingdao University School of Medicine, Shandong, Yantai, China
| | - Wenhua Li
- Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Xiaofei Wang
- Yantaishan Hospital, Binzhou Medical University, Shandong, Yantai, China.
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Jiang X, Xu W, Zhao Y. Application of CT Imaging in Differential Diagnosis and Nursing of Endocrine Tumors. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:4071081. [PMID: 36043145 PMCID: PMC9377953 DOI: 10.1155/2022/4071081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/13/2022] [Accepted: 07/21/2022] [Indexed: 11/18/2022]
Abstract
In order to investigate the value of preoperative X-ray computed tomography (CT) in predicting the pathological grade of pancreatic neuroendocrine tumors. This paper retrospectively analyzed the CT image examination of pancreatic neuroendocrine tumors, the image characteristics of G-NEC detected by CT image, and the detection of GST by spiral CT. In order to clearly diagnose and evaluate the size and scope of the focus, whether there is adjacent tissue invasion, metastasis, and treatment effect, CT, MR, PET-CT, nuclide specific imaging, and other imaging methods are widely used in the medical treatment of pNEN patients. These imaging methods have the advantages of noninvasive, rapid imaging, objective image medium, and strong repeatability. If the pathological grade of pNEN patients can be obtained by imaging examination before operation, it will be of great benefit to the formulation of treatment strategies and the prediction of clinical outcomes. Combining CT image performance with imaging omics characteristics to establish a prediction model that can develop a better auxiliary decision-making tool for clinical practice. Different pathological grades prompt clinicians to provide personalized and accurate medical treatment for patients, and reduce excessive medical treatment or wrong judgment caused by unclear preoperative diagnostic information.
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Affiliation(s)
- Xue Jiang
- Department of Endocrinology, The Second Hospital of Jilin University, Changchun, Jinlin 130000, China
| | - Weiwei Xu
- Department of Oncology and Hematology, The Second Hospital of Jilin University, Changchun 130000, China
| | - Ying Zhao
- Department of Endocrinology, The Second Hospital of Jilin University, Changchun, Jinlin 130000, China
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Trevisani F, Floris M, Minnei R, Cinque A. Renal Oncocytoma: The Diagnostic Challenge to Unmask the Double of Renal Cancer. Int J Mol Sci 2022; 23:2603. [PMID: 35269747 PMCID: PMC8910282 DOI: 10.3390/ijms23052603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022] Open
Abstract
Renal oncocytoma represents the most common type of benign neoplasm that is an increasing concern for urologists, oncologists, and nephrologists due to its difficult differential diagnosis and frequent overtreatment. It displays a variable neoplastic parenchymal and stromal architecture, and the defining cellular element is a large polygonal, granular, eosinophilic, mitochondria-rich cell known as an oncocyte. The real challenge in the oncocytoma treatment algorithm is related to the misdiagnosis due to its resemblance, at an initial radiological assessment, to malignant renal cancers with a completely different prognosis and medical treatment. Unfortunately, percutaneous renal biopsy is not frequently performed due to the possible side effects related to the procedure. Therefore, the majority of oncocytoma are diagnosed after the surgical operation via partial or radical nephrectomy. For this reason, new reliable strategies to solve this issue are needed. In our review, we will discuss the clinical implications of renal oncocytoma in daily clinical practice with a particular focus on the medical diagnosis and treatment and on the potential of novel promising molecular biomarkers such as circulating microRNAs to distinguish between a benign and a malignant lesion.
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Affiliation(s)
- Francesco Trevisani
- Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy;
- Unit of Urology, San Raffaele Scientific Institute, 20132 Milan, Italy
- Biorek S.r.l., San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Matteo Floris
- Nephrology, Dialysis and Transplantation, G. Brotzu Hospital, Università degli Studi di Cagliari, 09134 Cagliari, Italy; (M.F.); (R.M.)
| | - Roberto Minnei
- Nephrology, Dialysis and Transplantation, G. Brotzu Hospital, Università degli Studi di Cagliari, 09134 Cagliari, Italy; (M.F.); (R.M.)
| | - Alessandra Cinque
- Biorek S.r.l., San Raffaele Scientific Institute, 20132 Milan, Italy
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