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Abdulfatah E, Kunju LP. Diagnostic Approach to and Differential Diagnosis of Clear Cell and Glandular Lesions of the Lower Urinary Tract. Arch Pathol Lab Med 2024; 148:642-648. [PMID: 38244070 DOI: 10.5858/arpa.2023-0059-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 01/22/2024]
Abstract
CONTEXT.— A variety of glandular and clear cell lesions may be seen in the urinary bladder and/or urethra, ranging from benign to malignant primary and secondary tumors. Lesions with no malignant potential include reactive processes, such as nephrogenic metaplasia, and may show similar morphologic features as an infiltrative neoplasm, particularly in small biopsies. Similarly, ectopic tissues of Müllerian origin may be seen in the lower urinary tract, and their distinction from a true glandular neoplasm is essential to avoid overtreatment. A wide variety of primary and secondary malignant tumors exist with varying degrees of glandular and clear cell features. Therefore, surgical pathologists must be aware of the full scope of possible lesions to avoid misdiagnosis. OBJECTIVE.— To provide a practical framework for approaching the diagnosis of clear cell and glandular lesions of the urinary bladder/urethra and prostate, highlighting the strengths and limitations of various diagnostic features and ancillary tests. DATA SOURCES.— A review of the current literature was performed to obtain data regarding up-to-date diagnostic features and ancillary studies. CONCLUSIONS.— In summary, distinct morphologic and immunohistochemical features and clinical and radiologic correlation are essential to establish an accurate diagnosis when such cases with glandular and clear features are encountered in the lower urinary tract.
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Affiliation(s)
- Eman Abdulfatah
- From the Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Lakshmi P Kunju
- From the Department of Pathology, University of Michigan Medical School, Ann Arbor
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2
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Chen S, Song W, Zhang R, Jin Y, Lu Y, Lin L, Ye L, Li T, Wei Y. Analysis of survival and prognostic factors of clear cell adenocarcinoma of the prostate: a case-control study for a rare cancer entity. Sci Rep 2023; 13:10317. [PMID: 37365217 DOI: 10.1038/s41598-023-37092-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023] Open
Abstract
Clear cell adenocarcinoma of the prostate (CCPC) is a rare entity compared to acinar carcinoma of the prostate (APC). The survival rate and prognostic factors of CCPC are still unclear and deserve further study. We downloaded data on prostate cancer from the Surveillance, Epidemiology, and End Results database for 1975-2019. After inclusion and exclusion criteria, we compared APC and analyzed cancer-specific mortality (CSM) and overall mortality (OM) in CCPC patients and prognostic risk factors using a propensity score matching (PSM) study and multivariate Cox regression. We included 408,004 cases of APC as a control group and 130 cases of CCPC as a case group. Compared with APC patients, the incidence of CCPC was extremely low, and the median age of diagnosis was older (72.00 years vs. 69.00 years, p < 0.01). In addition, more rates were diagnosed at an earlier stage (1975-1998, 93.1% vs. 50.2%, p < 0.001), more unstaged or unknown stage ratios (87.7% vs. 42.7%, p < 0.001), and more surgical treatments (66.2% vs. 47.6%, p < 0.001), but the prognosis of CCPC patients was worse. After PSM, the median survival time of CCPC patients was shorter (57.50 month vs. 88.00 month, p < 0.01), the rate of CSM was higher (41.5% vs. 27.7%, p < 0.05), and the rate of OM was higher (99.2% vs. 90.8%, p < 0.01). In the adjusted model 2 after PSM, the CSM risk of CCPC patients reached HR 1.76 (95%CI 1.13-2.72), which was 76% higher than that of APC patients (p < 0.05). It was further found that surgical treatment might benefit CSM in CCPC patients (HR 0.39, 95%CI 0.18-0.82, p < 0.05) in Univariate analysis, but it was insignificant in further multivariate analysis. This is the first large-scale case-control report on the survival risk and prognostic factors of CCPC patients. We found that the prognosis of CCPC patients was significantly worse than that of APC. Surgery might be an effective treatment that may improve its prognosis. Clear cell adenocarcinoma, prostate, acinar carcinoma, survival rate, rare cancer, propensity score matching, case-control study.
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Affiliation(s)
- Sijin Chen
- Department of Urology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, 410005, Hunan Province, China
| | - Wei Song
- Department of Urology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, 410005, Hunan Province, China
| | - Ruochen Zhang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou, China
| | - Yiming Jin
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yan Lu
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan
| | - Le Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou, China
| | - Liefu Ye
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou, China
| | - Tao Li
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.
- Department of Urology, Fujian Provincial Hospital, Fuzhou, China.
| | - Yongbao Wei
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.
- Department of Urology, Fujian Provincial Hospital, Fuzhou, China.
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Mansoor M, Young-Speirs M, Ren B, Gotto G, Merten L, Sawhney S, Siadat F, Acosta AM, Agaimy A, Trpkov K. Extra-renal renal cell carcinoma arising in the kidney proximity but without an identifiable renal primary - an intriguing dilemma: Report of three cases and review of the literature. Histopathology 2022; 81:635-643. [PMID: 35941718 DOI: 10.1111/his.14736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/18/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022]
Abstract
We report three patients with extra-renal renal cell carcinomas (RCC) found in the renal proximity, but unattached to the kidney. None had a history of RCC or an identifiable primary renal neoplasm at the time of the diagnosis and on follow-up. The patients included two males and one female aged 57, 77 and 63 years, respectively. One carcinomas was found in the perirenal tissue adjacent to the adrenal, one involved the adrenal gland, and one was a retroperitoneal mass found within the lymph nodes. Two extra-renal RCCs represented clear cell RCCs and one was an unclassifiable RCC. No patient had evidence of metastases at presentation and disease progression during the follow-up. This report adds to the literature on this unusual clinical scenario and further supports the concept of extra-renal RCC, which is not a well-recognized clinical phenomenon. We also reviewed other similar reports documenting the absence of identifiable renal primaries in the setting of either disseminated metastatic disease or isolated distant metastases of presumed renal origin. Similarly, some carcinomas of apparent renal derivation have been also identified during a work-up of metastatic carcinomas of unknown primary. The aim of this study is to raise further awareness of this unusual and intriguing clinical scenario that currently lacks a definitive explanation and standardized therapy strategies. Establishing a correct diagnosis may allow treatment with specific targeted therapies in selected clinical cases.
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Affiliation(s)
- Mehdi Mansoor
- Cumming School of Medicine, University of Calgary and Alberta Precision Laboratories, Calgary, AB, Canada
| | - Morgan Young-Speirs
- Cumming School of Medicine, University of Calgary and Alberta Precision Laboratories, Calgary, AB, Canada
| | - Bing Ren
- Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Geoffrey Gotto
- Cumming School of Medicine, University of Calgary and Alberta Precision Laboratories, Calgary, AB, Canada
| | - Larissa Merten
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander University (FAU), 91058, Erlangen, Germany
| | - Summit Sawhney
- Cumming School of Medicine, University of Calgary and Alberta Precision Laboratories, Calgary, AB, Canada
| | - Farshid Siadat
- Cumming School of Medicine, University of Calgary and Alberta Precision Laboratories, Calgary, AB, Canada
| | - Andres M Acosta
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander University (FAU), 91058, Erlangen, Germany
| | - Abbas Agaimy
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kiril Trpkov
- Cumming School of Medicine, University of Calgary and Alberta Precision Laboratories, Calgary, AB, Canada
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Petrinec B, Vargas BM, Harik LR, Master VA. Renal Cancer Without Primary Cancer in the Kidney: Extra-Renal TFE3 Translocation Associated Renal Cell Carcinoma. KIDNEY CANCER 2021. [DOI: 10.3233/kca-200102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a case of an isolated para-aortic retroperitoneal renal cell carcinoma (RCC) in the absence of a primary cancer in the kidney. Single case reports in the literature have described extra-renal RCC in different locations with no evidence of primary renal tumor. We present the initial presentation, diagnostic imaging, surgical treatment, and pathologic evaluation. Immunohistochemistry demonstrated positivity for TFE3 and TFEB, both of which are Microphthalmia associated transcription factors (MiT) associated with translocation RCCs. We hypothesize these few cases of extra-renal RCC represent rare forms of translocation RCC.
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Affiliation(s)
- Benjamin Petrinec
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Lara R. Harik
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Viraj A. Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
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Abstract
Clear cell adenocarcinoma (CCA) is a rare tumor in the genitourinary tract with female predominance and few reports in men. We identified 15 cases of CCA in men evaluated at our institution. Five arose in the bladder, 7 in the prostate or prostatic urethra, 2 in the membranous urethra (1 multifocal in the prostatic and membranous urethra), 1 periprostatic (likely from an embryologic remnant), and 1 between rectum and bladder (likely in a prostatic utricle cyst). No cases showed associated Müllerian structures. One case showed separate foci of nephrogenic adenoma at diagnosis, and 1 case showed urothelial carcinoma in situ on a later follow-up biopsy. Four tumors extended into other organs (prostate to seminal vesicle and periprostatic soft tissue, periprostatic soft tissue to prostate, prostatic urethra to bladder and rectum, and prostate to bladder neck). One tumor showed extraprostatic extension alone. Four tumors metastasized to lymph nodes, with 3 also metastasizing to other sites (bladder, lung and adrenal, and right flank). Eleven patients underwent resection, including 3 transurethral resections. Seven underwent other treatments, including radiation (5 [1 for recurrence]), chemotherapy (3), hormonal therapy (3), immunotherapy with nivolumab (1), and targeted therapy with gefitinib (1). The mean follow-up was 35 months (range: 1 to 138 mo). At the last follow-up, 7 patients showed no evident disease and 3 were alive with disease. Four died with the cause of death unknown, with 2 cases having confirmed disease at the time of death and the remaining 2 dying less than a year after diagnosis. The mean time to death was 16 months (range: 6 to 39 mo). No follow-up was available on 1 patient. All patients who died in this series had CCA of the prostate or prostatic urethra. Pathologists need to be attuned to CCA occurring in males, given that the literature emphasizes its occurrence in females. In addition to established sites such as bladder and urethra, our series demonstrates that tumor may present in unusual adjacent sites, such as in periprostatic embryologic remnants or prostatic utricle.
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Han SI, Lim SC. Rare Case of Renal-type Clear Cell Carcinoma of the Prostate and Review of the Literature. IN VIVO (ATHENS, GREECE) 2020. [PMID: 32871810 DOI: 10.21873/invivo.12098.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Renal-type clear cell carcinoma (RTCCC) occurring as a primary tumor in an extra-renal location, especially in the prostate, is very rare. In this report, we present a rare case of RTCCC of the prostate and review the current literature on this condition. CASE REPORT The patient was a 76-year-old man who presented with urinary symptoms. Cystoscopic findings showed tumor-like lesions in the dome, neck, and anterior wall of the urinary bladder. Biopsy revealed clear cell carcinoma (CCC). Transrectal needle biopsy of the prostate revealed prostatic adenocarcinoma with CCC features. Immunohistochemically, tumor cells of the bladder and prostate were compatible with prostatic carcinoma. The whole-body radiologic workup did not reveal any renal or other organ malignancies. Transurethral resection of the prostate and bladder tumor was performed. The patient underwent regular follow-up cystoscopic examination and urine cytology. No recurrence was observed 19 months after the diagnosis. CONCLUSION This was a case of RTCCC arising in the prostate. RTCCC of the prostate is extremely rare and shows very similar histological and immunohistochemical features to those of CCC occurring in the kidney. Pathologists should be aware of such an entity whenever they see clear cells in urinary tract malignancies.
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Affiliation(s)
- Song Iy Han
- Division of Premedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Sung-Chul Lim
- Department of Pathology, College of Medicine, Chosun University, Gwangju, Republic of Korea
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Han SI, Lim SC. Rare Case of Renal-type Clear Cell Carcinoma of the Prostate and Review of the Literature. In Vivo 2020; 34:2751-2756. [PMID: 32871810 DOI: 10.21873/invivo.12098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIM Renal-type clear cell carcinoma (RTCCC) occurring as a primary tumor in an extra-renal location, especially in the prostate, is very rare. In this report, we present a rare case of RTCCC of the prostate and review the current literature on this condition. CASE REPORT The patient was a 76-year-old man who presented with urinary symptoms. Cystoscopic findings showed tumor-like lesions in the dome, neck, and anterior wall of the urinary bladder. Biopsy revealed clear cell carcinoma (CCC). Transrectal needle biopsy of the prostate revealed prostatic adenocarcinoma with CCC features. Immunohistochemically, tumor cells of the bladder and prostate were compatible with prostatic carcinoma. The whole-body radiologic workup did not reveal any renal or other organ malignancies. Transurethral resection of the prostate and bladder tumor was performed. The patient underwent regular follow-up cystoscopic examination and urine cytology. No recurrence was observed 19 months after the diagnosis. CONCLUSION This was a case of RTCCC arising in the prostate. RTCCC of the prostate is extremely rare and shows very similar histological and immunohistochemical features to those of CCC occurring in the kidney. Pathologists should be aware of such an entity whenever they see clear cells in urinary tract malignancies.
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Affiliation(s)
- Song Iy Han
- Division of Premedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Sung-Chul Lim
- Department of Pathology, College of Medicine, Chosun University, Gwangju, Republic of Korea
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Abu-Salha YM, Rose TL, Wobker SE, McCormick B, Bjurlin MA. The Surgical Treatment and Genomic Analysis of a Rare Case of Oligometastatic Renal Cell Carcinoma of the Prostate. Urology 2020; 142:e11-e14. [PMID: 32437772 DOI: 10.1016/j.urology.2020.04.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Yousef M Abu-Salha
- University of North Carolina at Chapel Hill (UNC) Department of Urology, Chapel Hill, NC
| | - Tracy L Rose
- UNC Division of Oncology, Chapel Hill, NC; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Sara E Wobker
- University of North Carolina at Chapel Hill (UNC) Department of Urology, Chapel Hill, NC; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; UNC Departments of Pathology and Laboratory Medicine, Chapel Hill, NC
| | - Benjamin McCormick
- University of North Carolina at Chapel Hill (UNC) Department of Urology, Chapel Hill, NC
| | - Marc A Bjurlin
- University of North Carolina at Chapel Hill (UNC) Department of Urology, Chapel Hill, NC; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC.
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Liao G, Zhang X, Li Z, Lan S, Huang M, Huang W. Renal-type clear cell carcinoma of prostate: A case report and review of literature. INDIAN J PATHOL MICR 2018; 61:431-433. [PMID: 30004074 DOI: 10.4103/ijpm.ijpm_396_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We analyzed the clinicopathological features of renal-type clear cell carcinoma (RTCCC) in the prostate and its diagnosis according to the example in our hospital and review of the literature. Clinicopathological features of RTCCC in the prostate were observed in a patient from our hospital combining with a review of the literature. Microscopically, the tumor was composed of cells with abundant and translucent cytoplasm, arranged in the form of the vesicular nest or glandular structure. Therefore, it was necessary to distinguish between metastatic clear cell renal cell carcinoma and primary RTCCC in the prostate. Immunohistochemistry (IHC) of this case showed tumor cells were positive expression for cytokeratin (CKpan), low-molecular weight cytokeratin, epithelial membrane antigen, and prostate-specific antigen (PSA), P504S, prostate-specific membrane antigen and partial positive expression for vimentin and CD10. The tumor cells displayed negative expression of high molecular weight cytokeratin, cytokeratin 7 (CK7), CK34, PAX8, and renal cell carcinoma. The morphological and immunohistochemical features of this tumor were in correspondence with RTCCC of the prostate. This tumor is a rare variant of the prostate carcinomas. To the best of our knowledge, this type of extrarenal tumor has only been reported in six previous studies. Combination of histology, IHC, imaging, and serum PSA is needed to perform a suitable diagnosis.
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Affiliation(s)
- Guangjie Liao
- Department of Pathology, Red Cross Hospital of Yulin, Yulin, China
| | - Xinke Zhang
- Department of Pathology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Zhongjian Li
- Department of Pathology, Red Cross Hospital of Yulin, Yulin, China
| | - Su Lan
- Department of Pathology, Red Cross Hospital of Yulin, Yulin, China
| | - Miaoli Huang
- Department of Pathology, Red Cross Hospital of Yulin, Yulin, China
| | - Weijian Huang
- Department of Pathology, Red Cross Hospital of Yulin, Yulin, China
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Sato Y, Kataoka M, Hata J, Akaihata H, Ogawa S, Kojima Y. Renal-type Clear Cell Carcinoma Occurring in the Prostate With Zinner Syndrome. Urol Case Rep 2016; 5:9-12. [PMID: 26793589 PMCID: PMC4719893 DOI: 10.1016/j.eucr.2015.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 11/23/2015] [Indexed: 11/12/2022] Open
Abstract
We report a case of clear cell carcinoma occurring in the prostate with Zinner syndrome in a 64-year-old man. Based on the immunohistochemical findings, it was concluded that this tumor represented primary renal-type clear cell carcinoma arising in the prostate. After receiving radical cystoprostatectomy, he was treated with tyrosine kinase inhibitor (TKI) therapy for local recurrence in accordance with the protocol of renal cell carcinoma (RCC) treatment, because microarray cluster analysis using a resected sample demonstrated that the present case belonged to the cluster group of RCC.
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Affiliation(s)
- Yuichi Sato
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masao Kataoka
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Junya Hata
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hidenori Akaihata
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Soichiro Ogawa
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yoshiyuki Kojima
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
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Renal-type clear cell carcinoma of the prostate: a diagnostic challenge. Diagn Pathol 2015; 10:193. [PMID: 26498435 PMCID: PMC4619329 DOI: 10.1186/s13000-015-0432-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 10/17/2015] [Indexed: 11/10/2022] Open
Abstract
A 72-year-old male presented with urinary symptoms. His serum prostate specific antigen level was 65.2 ng/ml. His radical prostatectomy specimen showed clear cell lesion reminiscent of the clear cell renal cell carcinoma along with acinar type of prostatic adenocarcinoma, Gleason score 4 + 4. The lesional clear cells were positive for pancytokeratin, epithelial membrane antigen, CD10, vimentin, and AMACR while negative for 34βE12, CK7, prostate specific antigen, and PAX8. The final diagnosis was renal-type clear cell carcinoma of the prostate. A follow-up of 20 months did not show metastasis. We herein report fifth case of renal-type clear cell carcinoma of the prostate.
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