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Siadat F, Mansoor M, Hes O, Trpkov K. Kidney Tumors: New and Emerging Kidney Tumor Entities. Clin Lab Med 2023; 43:275-298. [PMID: 37169446 DOI: 10.1016/j.cll.2023.03.003] [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: 05/13/2023]
Abstract
This review summarizes current knowledge on several novel and emerging renal entities, including eosinophilic solid and cystic renal cell carcinoma (RCC), RCC with fibromyomatous stroma, anaplastic lymphoma kinase-rearranged RCC, low-grade oncocytic renal tumor, eosinophilic vacuolated tumor, thyroidlike follicular RCC, and biphasic hyalinizing psammomatous RCC. Their clinical features, gross and microscopic morphology, immunohistochemistry, and molecular and genetic features are described. The diagnosis of most of them rests on recognizing their morphologic features using immunohistochemistry. Accurate diagnosis of these entitles will further reduce the category of "unclassifiable renal carcinomas/tumors" and will lead to better clinical management and improved patient prognostication.
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Affiliation(s)
- Farshid Siadat
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Rockyview General Hospital, 7007 14 Street, Calgary, Alberta T2V 1P9, Canada. https://twitter.com/FSiadat
| | - Mehdi Mansoor
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Rockyview General Hospital, 7007 14 Street, Calgary, Alberta T2V 1P9, Canada
| | - Ondrej Hes
- Department of Pathology, Charles University in Prague, Faculty of Medicine in Plzeň, University Hospital Plzen, Alej Svobody 80, 304 60 Pilsen, Czech Republic
| | - Kiril Trpkov
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Rockyview General Hospital, 7007 14 Street, Calgary, Alberta T2V 1P9, Canada.
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2
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Are Renal Cell Carcinoma with Fibromyomatous Stroma (RCC-FMS) and Thyroid-like Follicular Carcinoma of the Kidney (TLFCK) Really Independent Variants? Diagnostics (Basel) 2022; 13:diagnostics13010086. [PMID: 36611378 PMCID: PMC9818596 DOI: 10.3390/diagnostics13010086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/16/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Renal cell carcinoma with fibromyomatous stroma (RCC-FMS) is a recent provisional entity already recognised in the 2016 WHO Classification of Cancer of the Urinary Tract and Male Genital Organs 4th Edition as renal cell carcinoma with (angio)leiomyomatous stroma, histologically defined as a tumour characterised by clear cells intertwined in a conspicuous vascular stroma. In the casuistry taken into consideration, another proposed variant, thyroid-like follicular carcinoma of the kidney (TLFCK), endowed with a morphology mimicking thyroid parenchyma, was examined. The aim of this work was to parse the theoretical system, experimental data and diagnostic impact of these new entities proposed in the field of renal neoplasms. MATERIALS AND METHODS An analysis of 120 cases of kidney tumours from the Department of Surgical, Medical, Molecular and Critical Area at the University of Pisa was run. Subsequently, all samples were reassessed by two pathologists with expertise in uropathology, whose revaluation provided a histomorphological study combined with subsequent and coherent immunohistochemical analyses of CK7, CD10, CAIX, CK34betaE12, CD117, vimentin, TTF-1 and thyroglobulin. These analyses were performed using the Ventana Benchmark Automated Staining System (Ventana Medical Systems, Tucson, AZ, USA) and Ventana reagents. RESULTS On the one hand, the data, thus brought to light, did not show an immunohistochemical profile consistent with that proposed for RCC-FMS. However, it should be emphasised that the morphological background also unearthed a poor specificity for RCC-FMS. This was specifically due to a stromal component which was, in any case, evident, although characterised by a wide range of presentation, in clear cell renal cell carcinoma (ccRCC). This latter is, indeed, the reference background for this theorised variant. On the other hand, a thyroid-like pattern was highlighted in 11 cases, more specifically in 10 ccRCCs and in one oncocytoma, presenting itself as a type of neoplastic appearance rather than as the peculiar morphological pattern of a standalone cancer. CONCLUSIONS In the light of these results, RCC-FMS and TLFCK appear to be more appropriately variants of already categorised neoplastic entities rather than new independent neoplasias.
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Siadat F, Mansoor M, Hes O, Trpkov K. Kidney Tumors: New and Emerging Kidney Tumor Entities. Surg Pathol Clin 2022; 15:713-728. [PMID: 36344185 DOI: 10.1016/j.path.2022.07.006] [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: 05/18/2023]
Abstract
This review summarizes current knowledge on several novel and emerging renal entities, including eosinophilic solid and cystic renal cell carcinoma (RCC), RCC with fibromyomatous stroma, anaplastic lymphoma kinase-rearranged RCC, low-grade oncocytic renal tumor, eosinophilic vacuolated tumor, thyroidlike follicular RCC, and biphasic hyalinizing psammomatous RCC. Their clinical features, gross and microscopic morphology, immunohistochemistry, and molecular and genetic features are described. The diagnosis of most of them rests on recognizing their morphologic features using immunohistochemistry. Accurate diagnosis of these entitles will further reduce the category of "unclassifiable renal carcinomas/tumors" and will lead to better clinical management and improved patient prognostication.
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Affiliation(s)
- Farshid Siadat
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Rockyview General Hospital, 7007 14 Street, Calgary, Alberta T2V 1P9, Canada. https://twitter.com/FSiadat
| | - Mehdi Mansoor
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Rockyview General Hospital, 7007 14 Street, Calgary, Alberta T2V 1P9, Canada
| | - Ondrej Hes
- Department of Pathology, Charles University in Prague, Faculty of Medicine in Plzeň, University Hospital Plzen, Alej Svobody 80, 304 60 Pilsen, Czech Republic
| | - Kiril Trpkov
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Rockyview General Hospital, 7007 14 Street, Calgary, Alberta T2V 1P9, Canada.
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Gappoev SV, Khorzhevskii VA, Kirichenko AK, Alymova EV, Vershinin IV, Levkovich LG. [Rare kidney tumor - thyroid-like follicular carcinoma]. Arkh Patol 2022; 84:62-70. [PMID: 35880602 DOI: 10.17116/patol20228404162] [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: 06/15/2023]
Abstract
The literature review provides an analysis of a rare malignant tumor of the kidney: thyroid-like follicular carcinoma of the kidney (TLFCK). In morphology, this tumor is extremely similar to thyroid follicular carcinoma, but the immunophenotype of tumor cells is different. TLFCK has an indolent clinical course, rarely metastasizes, and even the development of metastases does not mean an unfavorable prognosis for the patient. The literature review presents the features of the clinical course of the disease, macroscopic, microscopic, immunohistochemical characteristics of the tumor and typical cytogenetic breakdowns. Particular attention is paid to the issues of differential diagnosis of the tumor with other pathological processes that may microscopically resemble TLFCK.
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Affiliation(s)
- S V Gappoev
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
- Krasnoyarsk State Regional Bureau of Pathology, Krasnoyarsk, Russia
| | - V A Khorzhevskii
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
- Krasnoyarsk State Regional Bureau of Pathology, Krasnoyarsk, Russia
| | - A K Kirichenko
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - E V Alymova
- Krasnoyarsk State Regional Bureau of Pathology, Krasnoyarsk, Russia
| | - I V Vershinin
- Krasnoyarsk State Regional Bureau of Pathology, Krasnoyarsk, Russia
| | - L G Levkovich
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
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Trpkov K, Williamson SR, Gill AJ, Adeniran AJ, Agaimy A, Alaghehbandan R, Amin MB, Argani P, Chen YB, Cheng L, Epstein JI, Cheville JC, Comperat E, da Cunha IW, Gordetsky JB, Gupta S, He H, Hirsch MS, Humphrey PA, Kapur P, Kojima F, Lopez JI, Maclean F, Magi-Galluzzi C, McKenney JK, Mehra R, Menon S, Netto GJ, Przybycin CG, Rao P, Rao Q, Reuter VE, Saleeb RM, Shah RB, Smith SC, Tickoo S, Tretiakova MS, True L, Verkarre V, Wobker SE, Zhou M, Hes O. Novel, emerging and provisional renal entities: The Genitourinary Pathology Society (GUPS) update on renal neoplasia. Mod Pathol 2021; 34:1167-1184. [PMID: 33526874 DOI: 10.1038/s41379-021-00737-6] [Citation(s) in RCA: 107] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 02/07/2023]
Abstract
The Genitourinary Pathology Society (GUPS) undertook a critical review of the recent advances in renal neoplasia, particularly focusing on the newly accumulated evidence post-2016 World Health Organization (WHO) classification. In the era of evolving histo-molecular classification of renal neoplasia, morphology is still key. However, entities (or groups of entities) are increasingly characterized by specific molecular features, often associated either with recognizable, specific morphologies or constellations of morphologies and corresponding immunohistochemical profiles. The correct diagnosis has clinical implications leading to better prognosis, potential clinical management with targeted therapies, may identify hereditary or syndromic associations, which may necessitate appropriate genetic testing. We hope that this undertaking will further facilitate the identification of these entities in practice. We also hope that this update will bring more clarity regarding the evolving classification of renal neoplasia and will further reduce the category of "unclassifiable renal carcinomas/tumors". We propose three categories of novel entities: (1) "Novel entity", validated by multiple independent studies; (2) "Emerging entity", good compelling data available from at least two or more independent studies, but additional validation is needed; and (3) "Provisional entity", limited data available from one or two studies, with more work required to validate them. For some entities initially described using different names, we propose new terminologies, to facilitate their recognition and to avoid further diagnostic dilemmas. Following these criteria, we propose as novel entities: eosinophilic solid and cystic renal cell carcinoma (ESC RCC), renal cell carcinoma with fibromyomatous stroma (RCC FMS) (formerly RCC with leiomyomatous or smooth muscle stroma), and anaplastic lymphoma kinase rearrangement-associated renal cell carcinoma (ALK-RCC). Emerging entities include: eosinophilic vacuolated tumor (EVT) and thyroid-like follicular renal cell carcinoma (TLFRCC). Finally, as provisional entities, we propose low-grade oncocytic tumor (LOT), atrophic kidney-like lesion (AKLL), and biphasic hyalinizing psammomatous renal cell carcinoma (BHP RCC).
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Affiliation(s)
- Kiril Trpkov
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Sean R Williamson
- Robert J Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anthony J Gill
- Sydney Medical School, University of Sydney; Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | | | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Reza Alaghehbandan
- Department of Pathology, Faculty of Medicine, University of British Columbia, Royal Columbian Hospital, Vancouver, BC, Canada
| | - Mahul B Amin
- Department of Pathology and Laboratory Medicine and Urology, University of Tennessee Health Science, Memphis, TN, USA
| | - Pedram Argani
- Departments of Pathology and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Ying-Bei Chen
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jonathan I Epstein
- Departments of Pathology, Urology and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | | | - Eva Comperat
- Department of Pathology, Hôpital Tenon, Sorbonne University, Paris, France
| | | | - Jennifer B Gordetsky
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sounak Gupta
- Department of Pathology, Mayo Clinic, Rochester, MN, USA
| | - Huiying He
- Department of Pathology, Health Science Center, Peking University, Beijing, China
| | - Michelle S Hirsch
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter A Humphrey
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Payal Kapur
- Departments of Pathology, Urology, Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Fumiyoshi Kojima
- Department of Human Pathology, Wakayama Medical University, Wakayama, Japan
| | - Jose I Lopez
- Department of Pathology, Cruces University Hospital, Biocruces-Bizkaia Institute, Bizkaia, Spain
| | - Fiona Maclean
- Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.,Anatomical Pathology, Douglass Hanly Moir Pathology, Sydney, Australia
| | | | - Jesse K McKenney
- Robert J Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rohit Mehra
- Department of Pathology and Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Santosh Menon
- Department of Surgical Pathology, Tata Memorial Hospital, Parel, and Homi Bhabha National Institute, Mumbai, India
| | - George J Netto
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christopher G Przybycin
- Robert J Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Priya Rao
- Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Qiu Rao
- Department of Pathology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rola M Saleeb
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Rajal B Shah
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Steven C Smith
- Departments of Pathology and Urology, VCU School of Medicine, Richmond, VA, USA
| | - Satish Tickoo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria S Tretiakova
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Lawrence True
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Virginie Verkarre
- Department of Pathology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris; Université de Paris, PARCC, INSERM, Equipe Labellisée par la Ligue contre le Cancer, F-75015, Paris, France
| | - Sara E Wobker
- Departments of Pathology and Laboratory Medicine and Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ming Zhou
- Department of Pathology, Tufts Medical Center, Boston, MA, USA
| | - Ondrej Hes
- Department of Pathology, Charles University in Prague, Faculty of Medicine and University Hospital in Plzen, Plzen, Czech Republic
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Rao V, Menon S, Bakshi G, Prakash G, Agarwal A, Desai S. Thyroid-Like Follicular Carcinoma of the Kidney With Low-Grade Sarcomatoid Component: A Hitherto Undescribed Case. Int J Surg Pathol 2020; 29:327-333. [PMID: 32648488 DOI: 10.1177/1066896920940406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Thyroid-like follicular carcinoma of the kidney (TLFCK) is a rare subtype of renal cell carcinoma, which closely resembles follicular neoplasms of the thyroid and has a distinctive indolent clinical behavior. Until now, a single case of TLFCK with extensive sarcomatoid differentiation has been documented with aggressive clinical course. We present an unusual case of sarcomatoid TLFCK with a low-grade spindle cell component in a 34-year-old male patient, with an indolent course following radical nephrectomy and regional node dissection.
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Affiliation(s)
- Vidya Rao
- Department of Pathology, 221116Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Santosh Menon
- Department of Pathology, 221116Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Ganesh Bakshi
- Department of Urology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai India
| | - Gagan Prakash
- Department of Urology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai India
| | - Archi Agarwal
- Department of Nuclear Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sangeeta Desai
- Department of Pathology, 221116Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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7
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Agrawal V, Neyaz Z, Kapoor R. Thyroid-Like Follicular Carcinoma of the Kidney With Oncocytic Cells: A Case Report and Review of Metastatic and Non-metastatic Tumors. Int J Surg Pathol 2020; 28:913-917. [PMID: 32484016 DOI: 10.1177/1066896920930283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Thyroid-like follicular carcinoma of kidney (TLFCK) is a morphological subtype of renal cell carcinoma, which is included as an emerging/provisional entity in the classification of renal tumors, with only about 40 cases reported in literature. It has a distinct histological appearance and immunohistochemical profile as compared with other renal cell cancers. However, these tumors, while appearing distinctive, have not been characterized fully either morphologically or by ancillary techniques. The reported cases show variable demographical and clinical features. Most are indolent, while some present with metastasis. The histological, immunohistochemical, and ultrastructural features of a case of TLFCK with clusters of oncocytic cells and pseudosarcomatous stroma are presented. Follow-up of 5 years was uneventful. A review of literature to analyze features in metastatic as compared with non-metastatic TLFCK is discussed. We report a patient of TLFCK and compare the clinicopathological features of metastatic and non-metastatic tumors.
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Affiliation(s)
- Vinita Agrawal
- Department of Pathology, 30093Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Zafar Neyaz
- Radiodiagnosis, 30093Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rakesh Kapoor
- Urology and Renal Transplantation, 30093Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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8
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de Jesus LE, Fulgêncio C, Leve T, Dekermacher S. Thyroid-like follicular carcinoma of the kidney presenting on a 10 year-old prepubertal girl. Int Braz J Urol 2019; 45:834-842. [PMID: 31063281 PMCID: PMC6837619 DOI: 10.1590/s1677-5538.ibju.2018.0471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 03/17/2019] [Indexed: 12/18/2022] Open
Abstract
The very rare thyroid-like carcinoma of the kidney (TLCK) is microscopically similar to thyroid follicular cell carcinoma (TFCC). Differential diagnosis with secondary thyroid tumors depends on non-reactivity to immunohistochemical (IHC) markers for TFCC (thyroglobulin - TG and TTF1). We herein describe the fourth Pediatric case in literature and extensively review the subject. Only 29 cases were published to the moment. Most cases were asymptomatic and incidentally detected. Most tumors are hyperechoic and hyperdense with low grade heterogenous enhancement on CT and MRI. Most patients were treated with radical nephrectomy, but partial nephrectomy was used in some cases, apparently with the same results. Metastases are uncommon and apparently do not change prognosis, but follow-ups are limited. Up to the moment, TLCK presents as a low grade malignancy that may be treated exclusively with surgery and frequently with partial kidney renal preservation. A preoperative percutaneous biopsy is a common procedure to investigate atypical tumors in childhood and adult tumors. To recognize the possibility of TLCK is fundamental to avoid unnecessary thyroidectomies in those patients, supposing a primary thyroid tumor.
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Affiliation(s)
- Lisieux Eyer de Jesus
- Departamento de Cirurgia e Urologia Pediátrica, Hospital Estadual dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Celine Fulgêncio
- Departamento de Cirurgia e Urologia Pediátrica, Hospital Estadual dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Thais Leve
- Departamento de Cirurgia e Urologia Pediátrica, Hospital Estadual dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Samuel Dekermacher
- Departamento de Cirurgia e Urologia Pediátrica, Hospital Estadual dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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9
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Jenkins TM, Rosenbaum J, Zhang PJ, Schwartz LE, Nayak A, Cooper K, Tickoo SK, Lal P. Thyroid-Like Follicular Carcinoma of the Kidney With Extensive Sarcomatoid Differentiation: A Case Report and Review of the Literature. Int J Surg Pathol 2019; 27:678-683. [PMID: 31032708 DOI: 10.1177/1066896919845490] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Thyroid-like follicular carcinoma of the kidney (TLFCK) is an extremely rare primary renal malignancy that typically has an indolent course and good prognosis. Histologically, this tumor mimics follicular carcinoma of the thyroid; however, typical thyroid markers are negative. There are fewer than 40 cases reported in the literature, and thus, the prognosis and course of disease is not well understood. Sarcomatoid differentiation has never been reported in a case of TLFCK. We present a case of a 48-year-old woman with an aggressive TLFCK with extensive sarcomatoid differentiation and metastatic disease at presentation. We performed targeted next-generation sequencing of both the thyroid-like component and the poorly differentiated sarcomatoid component using our solid tumor panel to evaluate for any disease-associated mutations and to better understand the molecular profile of these tumors.
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Affiliation(s)
- Taylor M Jenkins
- 1 Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jason Rosenbaum
- 1 Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Paul J Zhang
- 1 Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Anupma Nayak
- 1 Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kumarasen Cooper
- 1 Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Priti Lal
- 1 Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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10
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Trpkov K, Hes O. New and emerging renal entities: a perspective post-WHO 2016 classification. Histopathology 2018; 74:31-59. [DOI: 10.1111/his.13727] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Kiril Trpkov
- University of Calgary and Calgary Laboratory Services; Calgary Alberta Canada
| | - Ondřej Hes
- Charles University and University Hospital Pilsen; Pilsen Czech Republic
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11
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Zhang Y, Yang J, Zhang M, Meng Z, Song W, Yang L, Li L, Wang D, Shi T. Thyroid follicular carcinoma-like renal tumor: A case report and literature review. Medicine (Baltimore) 2018; 97:e10815. [PMID: 29794767 PMCID: PMC6392547 DOI: 10.1097/md.0000000000010815] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Thyroid follicular carcinoma-like renal tumor (TFCLRT) is a rare primary renal epithelial tumor that was first reported in 2006. We report a case diagnosed of TFCLRT by us to observe the pathological feature and analyze comparatively the clinical and pathologic characteristics with all cases of reviewed literatures. PATIENT CONCERNS A 54-year-old female patient had the urinary frequency with the symptom of right flank pain with a history of more than half a year of hypertension and received uterine fibroid resection 12 years ago. B-mode ultrasound examination and renal magnetic resonance showed a right renal sinus nodule. DIAGNOSES Histopathology revealed thyroid follicle-like structures of different sizes, containing a colloid-like substance, while the periodic acid-Schiff (PAS) and diastase-resistant PAS staining confirmed that it was mucus protein. Immunohistochemical staining showed that it expresses the transcription factor PAX-8 but does not express the thyroid-specific antibodies TG and TTF-1. INTERVENTIONS The patient underwent a tumor enucleation of right kidney. No other treatment was conducted after surgery. OUTCOMES No metastases to lymph nodes and other organs were found, and 9-months of follow-up did not reveal any tumor progression. LESSONS We should differentially diagnose the renal metastasis of thyroid follicular carcinoma or papillary carcinoma. Some related literatures reported that the tumour cells had significant heteromorphism, several of which metastasized to lymph nodes or distal organs. Its biological behavior need to be studied intensively by further expanding the number of cases.
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Affiliation(s)
- Yujie Zhang
- Department of Pathology, Tianjin Medical University General Hospital
| | - Jing Yang
- Department of Pathology, Tianjin Medical University
| | | | | | - Wenjing Song
- Department of Pathology, Tianjin Medical University
| | - Long Yang
- Department of Urinary Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Liming Li
- Department of Urinary Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Dan Wang
- Department of Pathology, Tianjin Medical University General Hospital
| | - Tao Shi
- Department of Pathology, Tianjin Medical University General Hospital
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12
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Eble JN, Delahunt B. Emerging entities in renal cell neoplasia: thyroid-like follicular renal cell carcinoma and multifocal oncocytoma-like tumours associated with oncocytosis. Pathology 2017; 50:24-36. [PMID: 29132724 DOI: 10.1016/j.pathol.2017.09.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/11/2017] [Indexed: 12/12/2022]
Abstract
The list of accepted entities of renal cell neoplasia has burgeoned since the turn of the century through recognition of rare tumour types and the discovery of genetic mutations driving renal neoplasia syndromes. This growth has not finished and in this report we present examples of each of these types which were not included in the 2016 World Health Organization classification of renal neoplasia, but are candidates for inclusion in the next edition of the classification. Thyroid-like follicular renal cell carcinoma is a rare tumour type with a distinctive microscopic appearance resembling follicles of the thyroid gland. Thirty-nine cases have been described and the findings have been reasonably consistent. Oncocytoma-like tumours associated with oncocytosis arise as a result of somatic mutations in the mitochondrial genome. The differential diagnosis is mainly with the renal lesions of the Birt-Hogg-Dubé syndrome, which is the result of germline mutations in the folliculin gene. Patients with oncocytoma-like tumours associated with oncocytosis are at great risk of developing renal failure as the proliferating lesions replace the renal parenchyma. Oncocytoma-like tumours have never been found to metastasise.
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Affiliation(s)
- John N Eble
- Indiana University Health, Central Pathology Laboratory, Indianapolis, IN, United States.
| | - Brett Delahunt
- Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
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Dong L, Huang J, Huang L, Shi O, Liu Q, Chen H, Xue W, Huang Y. Thyroid-Like Follicular Carcinoma of the Kidney in a Patient with Skull and Meningeal Metastasis: A Unique Case Report and Review of the Literature. Medicine (Baltimore) 2016; 95:e3314. [PMID: 27082575 PMCID: PMC4839819 DOI: 10.1097/md.0000000000003314] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Thyroid-like follicular carcinoma of the kidney (TLFCK) is an extremely rare subtype of renal cell carcinoma with close resemblance to the well-differentiated thyroid follicular neoplasms. TLFCK has not been included in the 2004 World Health Organization (WHO) classification due to the limited data available. Only 27 cases have been reported in the literature to date. Herein, we report a unique case of TLFCK that presented as a striking skull and meningeal metastasis 5 years after the initial diagnosis; this is the first case of TLFCK with such a novel metastasis pattern. A 68-year-old woman was found to have a right renal lesion using computed tomography (CT) during her regular clinical follow-up visit for bladder cancer, but she exhibited no obvious clinical symptoms. The CT scan showed a 4.4-cm diameter, slightly lobulated soft tissue mass in the right lower kidney, the pathological findings of which showed a TLFCK. Five years later, the patient had progressed to skull and meningeal metastasis. Both the renal tumor and the metastasis lesion were composed almost entirely of follicles with a dense, colloid-like material that resembled thyroid follicular carcinoma. However, no lesion was found in the thyroid gland. The neoplastic epithelial cells were strongly immunoreactive for cytokeratin 7 (and vimentin but negative for thyroid transcription factor-1 and thyroglobulin. This is the first reported case of TLFCK to consist of widespread metastases to the skull and meninges and provides evidence that this rare variant of renal cell carcinoma has uncertain malignant potential and can be more clinically aggressive than previously believed.
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Affiliation(s)
- Liang Dong
- From the Department of Urology, Ren Ji Hospital, School of Medicine (LD, HC, WX, YH); School of Medicine (JH, LH); School of Public Health (OS); and Department of Pathology (QL), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Chen F, Wang Y, Wu X, Zhu Y, Jiang X, Chen S, Zhang Z, Zou Z, Yang Y, Zhu K, Wang Y, Cui J, Shi BK. Clinical characteristics and pathology of thyroid-like follicular carcinoma of the kidney: Report of 3 cases and a literature review. Mol Clin Oncol 2015; 4:143-150. [PMID: 26893850 PMCID: PMC4733963 DOI: 10.3892/mco.2015.682] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 11/10/2015] [Indexed: 12/20/2022] Open
Abstract
Thyroid-like follicular carcinoma (TLFC) of the kidney is an extremely rare type of renal tumor, which has not been classified under a known subtype of renal cell carcinoma. It is histologically similar to the primary thyroid follicular carcinoma; however, the characteristics lack thyroid immunohistochemical markers. The aim of the present study was to illustrate the clinical characteristics of 3 new cases along with a review of the literature. The patients were compared with regards to gender, age, location and size of the tumor, imageology, morphology, immunohistochemistry and prognosis. According to the limited data, TLFC occurs mainly in young women and its clinical manifestations have no difference with other renal tumors. Its imageological features resemble a large spectrum of benign and malignant renal and extra-renal conditions, which should be eliminated in the diagnostic process. Confirmed diagnosis depends on the examination of pathology and immunohistochemistry. Surgical ablation is the preferred therapeutic method. Currently, TLFC has a relatively good prognosis; however, this conclusion requires further cases and long-term follow-ups. Improving the understanding of TLFC can help avoid misdiagnosis and prevent inappropriate treatment.
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Affiliation(s)
- Fan Chen
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Yang Wang
- Department of Urology, Affiliated Hospital of Chengdu University, Chengdu, Sichuan 610000, P.R. China
| | - Xiuzhen Wu
- Department of Pathology, The People's Hospital of Linqu, Zibo, Shandong 262600, P.R. China
| | - Yaofeng Zhu
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Xuewen Jiang
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Shouzhen Chen
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Zhaocun Zhang
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Zhichuan Zou
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Yue Yang
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Kejia Zhu
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Yong Wang
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Jianfeng Cui
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Ben-Kang Shi
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
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Dawane R, Grindstaff A, Parwani AV, Brock T, White WM, Nodit L. Thyroid-like follicular carcinoma of the kidney: one case report and review of the literature. Am J Clin Pathol 2015; 144:796-804. [PMID: 26486745 DOI: 10.1309/ajcp6p0staahottg] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES Thyroid-like follicular carcinoma of the kidney continues to confound the practicing pathologist with its close resemblance to the follicular variant of thyroid carcinoma, as well as other benign and malignant entities. Our goal is to expand the knowledge of this rare renal cell carcinoma subtype, which is morphologically similar to follicular carcinoma of the thyroid but lacks expression of characteristic thyroid immunohistochemical markers such as TTF-1 and thyroglobulin. METHODS We evaluated the gross, histologic, immunohistochemical, and fluorescence in situ hybridization (FISH) studies of a new case and performed a comprehensive review of the literature. RESULTS The lesion was spongy and well-circumscribed. Microscopically it showed variably sized follicular structures, filled with abundant, deeply eosinophilic, colloid-like material. At the periphery, it displayed areas resembling metanephric adenoma and early stages of nephrogenesis. The tumor cells strongly expressed CK7, PAX-8, PAX-2, vimentin, EMA, and CK19 immunostains. Other markers, such as CD10, RCC, HBME-1, thyroglobulin, and TTF-1, were not immunoreactive. The tumor was negative for trisomy of both 7 and 17 and showed borderline monosomies (losses) of both chromosomes in FISH studies. CONCLUSIONS Five years of preoperative observation and lack of recurrence bring further insight into the slow progressive nature of this neoplasm and support a low malignant potential. Proper identification is important to secure adequate treatment and follow-up.
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Abstract
The classification of renal cell neoplasia is morphologically based; however, this has evolved over the last 35 years with the incorporation of genetic characteristics into the diagnostic features of some tumors. The 2013 Vancouver classification recognized 17 morphotypes of renal parenchymal malignancy and two benign tumors. This classification included the newly established entities tubulocystic renal cell carcinoma (RCC)), acquired cystic disease-associated RCC, clear cell (tubulo) papillary RCC, microphthalmia transcription factor family translocation RCC and hereditary leiomyomatosis RCC syndrome-associated RCC. In addition to these newly described forms of RCC there are a number of novel tumors that are currently recognized as emerging entities. These are likely to be incorporated into subsequent classifications and include thyroid-like follicular RCC, succinate dehydrogenase B mutation-associated RCC, ALK translocation RCC, tuberous sclerosis complex-associated RCC, and RCC with (angio) leiomyomatous stroma.
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Affiliation(s)
- Brett Delahunt
- Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago Wellington, PO Box 7343, Wellington, New Zealand.
| | - John R Srigley
- Department of Pathology and Molecular Medicine, McMaster University, Toronto, Canada
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Ghaouti M, Roquet L, Baron M, Pfister C, Sabourin JC. Thyroid-like follicular carcinoma of the kidney: a case report and review of the literature. Diagn Pathol 2014; 9:186. [PMID: 25293503 PMCID: PMC4190304 DOI: 10.1186/s13000-014-0186-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 09/07/2014] [Indexed: 01/18/2023] Open
Abstract
Thyroid-like follicular carcinoma of the kidney is an extremely rare histological variant of renal cell carcinoma. It was described only recently and is not included in the World Health Organization classification of renal tumors. This tumor characteristically shows similar histology to thyroid follicular carcinoma but lacks typical thyroid markers. Herein, we report a new case of thyroid-like follicular carcinoma of the kidney diagnosed in a partial nephrectomy specimen in a 68-year-old-woman. We present typical histological and immunohistochemical findings, discuss differential diagnosis and provide a review of the literature. Virtual Slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_186
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Affiliation(s)
- Merieme Ghaouti
- Department of Cytopathology, Charles-Nicole Hospital, Rouen University Hospital, Rouen, France.
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Wu WW, Chu JT, Nael A, Rezk SA, Romansky SG, Shane L. Thyroid-like follicular carcinoma of the kidney in a young patient with history of pediatric acute lymphoblastic leukemia. Case Rep Pathol 2014; 2014:313974. [PMID: 25133003 PMCID: PMC4123569 DOI: 10.1155/2014/313974] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 06/26/2014] [Indexed: 02/06/2023] Open
Abstract
Thyroid-like follicular carcinoma of the kidney (TLFCK) is a rare histological variant of renal cell carcinoma not currently included in the World Health Organization classification of renal tumors. Only 24 previous cases of TLFCK have been reported to date. We report a case of TLFCK in a 19-year-old woman with history of pediatric acute lymphoblastic leukemia. This patient is the youngest with TLFCK to be reported to date and the first with history of lymphoblastic leukemia. The development of TLFCK in a young patient with history of lymphoblastic leukemia is interesting and suggests that genes involved in leukemogenesis may also be important for TLFCK pathogenesis. Recognition of TLFCK is important to distinguish it from other conditions that show thyroid-like features, as a misdiagnosis can result in adverse patient care.
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Affiliation(s)
- William W. Wu
- Department of Pathology & Laboratory Medicine, University of California Irvine Medical Center, Orange, CA 92868, USA
| | - Julia T. Chu
- Department of Pathology & Laboratory Medicine, University of California Irvine Medical Center, Orange, CA 92868, USA
| | - Ali Nael
- Department of Pathology & Laboratory Medicine, University of California Irvine Medical Center, Orange, CA 92868, USA
| | - Sherif A. Rezk
- Department of Pathology & Laboratory Medicine, University of California Irvine Medical Center, Orange, CA 92868, USA
| | - Stephen G. Romansky
- Department of Pathology, Long Beach Memorial Medical Center, 2801 Atlantic Avenue, Long Beach, CA 90801, USA
| | - Lisa Shane
- Department of Pathology, Long Beach Memorial Medical Center, 2801 Atlantic Avenue, Long Beach, CA 90801, USA
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