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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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Bian L, Duan J, Wang X, Yang Y, Zhang X, Xiao S. Sarcomatoid Chromophobe Renal Cell Carcinoma: A Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1225-1230. [PMID: 31423007 PMCID: PMC6711265 DOI: 10.12659/ajcr.916651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Patient: Female, 63 Final Diagnosis: Sarcomatoid chromophobe renal cell carcinoma Symptoms: Painless gross hematuria Medication: — Clinical Procedure: — Specialty: Renal Surgery
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Affiliation(s)
- Lihui Bian
- Department of Pathology, The Second Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China (mainland)
| | - Jingling Duan
- Department of Pathology, The Second Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China (mainland)
| | - Xiaoyu Wang
- Department of Pathology, The Second Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China (mainland)
| | - Yang Yang
- Department of Pathology, The Second Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China (mainland)
| | - Xiaoling Zhang
- Department of Physiology, Faculty of Basic Medical Sciences, Guilin Medical University, Guilin, Guangxi, China (mainland)
| | - Shengjun Xiao
- Department of Pathology, The Second Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China (mainland)
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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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McCroskey Z, Sim SJ, Selzman AA, Ayala AG, Ro JY. Primary collision tumors of the kidney composed of oncocytoma and papillary renal cell carcinoma: A review. Ann Diagn Pathol 2017; 29:32-36. [PMID: 28807339 DOI: 10.1016/j.anndiagpath.2017.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 04/27/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND There are well known cases of hybrid tumors of chromophobe renal cell carcinoma (RCC) and oncocytoma in kidney, where both tumors have the same cell of origin - intercalated cell of the collecting duct. However, collision tumors composed of neoplasms originating from different cell lineages such as oncocytoma and papillary RCC are extremely rare. Herein, we made a collective literature review of reported cases of collision tumors composed of oncocytoma and papillary RCC, adding a case that we recently experienced. MATERIAL AND METHODS A PubMed database was search for collision tumors of the kidney composed of oncocytoma and papillary RCC and a collective literature review was made. To this cohort, we also added a recently encountered case with similar, confirmed by immunohistochemistry, morphological features. RESULTS To date 8 cases of a collision tumor composed of papillary RCC and oncocytoma have been described in the literature. All of them had a smaller papillary RCC component present within a larger oncocytoma. CONCLUSION Because of a few cases of such a collision tumors reported, it is difficult to make classification and right clinical management of these patients. None of the reported cases had tumor recurrence or progression on a follow-up. The presence of only small portion of papillary RCC in a large oncocytoma raises a possibility of under-sampling of malignant component in large oncocytomas in core biopsy or surgically resected specimens. We recommend better sampling, particularly at the periphery of otherwise classic oncocytomas to unveil this possible association.
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Affiliation(s)
- Zulfia McCroskey
- Departments of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, United States.
| | - Sue J Sim
- Department of Pathology, Memorial Hermann Hospital, Houston, TX, United States
| | - Andrew A Selzman
- Department of Urology, Memorial Hermann Hospital, Houston, TX, United States
| | - Alberto G Ayala
- Departments of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, United States
| | - Jae Y Ro
- Departments of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, United States.
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Hirsch MS, Signoretti S, Dal Cin P. Adult Renal Cell Carcinoma: A Review of Established Entities from Morphology to Molecular Genetics. Surg Pathol Clin 2016; 8:587-621. [PMID: 26612217 DOI: 10.1016/j.path.2015.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
According to the current World Health Organization (WHO), renal cell carcinomas (RCCs) that primarily affect adults are classified into 8 major subtypes. Additional emerging entities in renal neoplasia have also been recently recognized and these are discussed in further detail by Mehra et al (Emerging Entities in Renal Neoplasia, Surgical Pathology Clinics, 2015, Volume 8, Issue 4). In most cases, the diagnosis of a RCC subtype can be based on morphologic criteria, but in some circumstances the use of ancillary studies can aid in the diagnosis. This review discusses the morphologic, genetic, and molecular findings in RCCs previously recognized by the WHO, and provides clues to distinction from each other and some of the newer subtypes of RCC. As prognosis and therapeutic options vary for the different subtypes of RCC, accurate pathologic distinction is critical for patient care.
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Affiliation(s)
- Michelle S Hirsch
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Paola Dal Cin
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Chen X, Zhu Q, Li B, Cui W, Zhou H, Duan N, Liu Y, Kundra V, Wang Z. Renal cell carcinoma associated with Xp11.2 translocation/TFE gene fusion: imaging findings in 21 patients. Eur Radiol 2016; 27:543-552. [DOI: 10.1007/s00330-016-4421-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 02/29/2016] [Accepted: 05/19/2016] [Indexed: 02/03/2023]
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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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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: 6] [Impact Index Per Article: 0.6] [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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9
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Zhu Q, Zhu W, Wu J, Chen W, Wang S. The clinical and CT imaging features of metanephric adenoma. Acta Radiol 2014; 55:231-8. [PMID: 23884840 DOI: 10.1177/0284185113493411] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with metanephric adenoma have a good prognosis after undergoing total nephrectomy or local resection with kidney preservation. Accurate diagnosing is important for guiding clinical treatment. Only few previous case reports have been found focusing on the imaging findings of metanephric adenoma. PURPOSE To evaluate the multislice computed tomography (MSCT) imaging characteristics of metanephric adenoma. MATERIAL AND METHODS The imaging findings in eight patients with metanephric adenoma were studied retrospectively. MSCT was undertaken to investigate tumor location, size, attenuation, cystic or solid appearance, calcification, capsule sign, and enhancement pattern. RESULTS Tumors (mean diameter, 3.3 ± 1.0 cm) were solitary (8/8), solid (7/8) with cystic components (2/8), no calcifications (7/8), had a poorly-defined margin (8/8), were centered in the renal medulla (7/8), compressed the renal pelvis (3/8), and none had retroperitoneal lymph node metastasis. The attenuation of metanephric adenoma tumors was less or equal compared to the renal cortex or medulla on unenhanced CT (30.6 ± 2.6 vs. 36.3 ± 4.6 vs. 33.2 ± 3.9, P > 0.05), while tumor enhancement after administration of an contrast agent was lower than that of normal renal cortex and medulla during all phases (P < 0.05). CONCLUSION Metanephric adenoma tends to be a solitary, poorly defined margin, isodense or hypodense mass arising from the renal medulla with enhancement less than the cortex and medulla during all phases.
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Affiliation(s)
- Qingqiang Zhu
- Department of Medical Imaging, Subei People’s Hospital, Medical School of Yangzhou University, Yangzhou, China
| | - Wenrong Zhu
- Department of Medical Imaging, Subei People’s Hospital, Medical School of Yangzhou University, Yangzhou, China
| | - Jingtao Wu
- Department of Medical Imaging, Subei People’s Hospital, Medical School of Yangzhou University, Yangzhou, China
| | - Wenxin Chen
- Department of Medical Imaging, Subei People’s Hospital, Medical School of Yangzhou University, Yangzhou, China
| | - Shouan Wang
- Department of Medical Imaging, Subei People’s Hospital, Medical School of Yangzhou University, Yangzhou, China
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Zhu Q, Wu J, Wang Z, Zhu W, Chen W, Wang S. The MSCT and MRI findings of collecting duct carcinoma. Clin Radiol 2013; 68:1002-7. [PMID: 23726725 DOI: 10.1016/j.crad.2013.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 04/05/2013] [Accepted: 04/10/2013] [Indexed: 10/26/2022]
Abstract
AIM To characterize the multi-section computed tomography (MSCT) and magnetic resonance imaging (MRI) features of collecting duct carcinoma (CDC). MATERIALS AND METHODS Twenty patients with CDC were studied retrospectively using MSCT (n = 20), and MSCT and MRI (n = 5). MSCT and MRI were undertaken to investigate tumour location, size, radiodensity, cystic or solid appearance, calcification, capsule, signal, enhancement pattern, and metastases. RESULTS Tumours (mean diameter 3.6 ± 1.7 cm) were solitary (20/20), solid (18/20), had cystic components (12/20), calcifications (12/20), poorly defined (18/20), were centred in the medulla (20/20), compressed the renal pelvis (12/20), and had lymph node metastases (2/20). On unenhanced computed tomography (CT), the radiodensity of the CDC was greater than that of the normal renal cortex or medulla (43.8 ± 2.4 versus 37.6 ± 5.1 or 32.6 ± 4.1, p = 0.041, n = 20). Five patients with CDC underwent MRI, which revealed cystic components (4/5), poorly defined CDC (5/5), and none of the patients had lymph node metastasis. The CDC was isointense on T1-weighted imaging, and iso- or hypointense on T2-weighted imaging. Enhancement was lower within the CDC than the renal cortex and medulla during all enhanced phases (p = 0.032, 0.001, 0.018, respectively, n = 20). CONCLUSION CDC should be considered when a renal tumour is centred in the medulla, with increased radiodensity on unenhanced CT and reduced enhancement compared to the adjacent cortex or medulla.
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Affiliation(s)
- Q Zhu
- Department of Medical Imaging, Subei People's Hospital, Medical School of Yangzhou University, Yangzhou, China
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Zhu QQ, Wang ZQ, Zhu WR, Chen WX, Wu JT. The multislice CT findings of renal carcinoma associated with XP11.2 translocation/TFE gene fusion and collecting duct carcinoma. Acta Radiol 2013; 54:355-62. [PMID: 23446748 DOI: 10.1258/ar.2012.120255] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Renal cell carcinoma associated with Xp11.2 translocation and TFE gene fusion (Xp11.2/TFE RCC), and collecting duct carcinoma (CDC) are uncommon subtypes of renal cell carcinomas. PURPOSE To investigate the multislice CT (MSCT) characteristics of these two tumor types. MATERIAL AND METHODS Nine patients with Xp11.2/TFE RCC and 10 patients with CDC were studied retrospectively. MSCT was undertaken to investigate differences in tumor characteristics and enhancement patterns. RESULTS All patients had single tumors centered in the renal medulla. Two patients with each tumor type had lymph node involvement and there was a single case of hepatic metastasis (Xp11.2/TFE RCC). The mean tumor diameter of Xp11.2/TFE RCC tumors was significantly larger than for CDC tumors. Two patients with Xp11.2/TFE RCC had cystic components as did eight patients with CDC (P < 0.05). Calcifications were present in six patients, each with CDC. Clear tumor boundaries were visible in two patients with CDC and in nine with Xp11.2/TFE RCC (P < 0.05). The density of Xp11.2/TFE RCC tumors was greater than that of CDC tumors, normal renal cortex, or medulla on unenhanced CT. Enhancement was higher with Xp11.2/TFE RCC than with CDC tumors during all phases. Xp11.2/TFE RCC enhancement was higher than in the renal medulla during cortical and medullary phase but lower than in normal renal medulla during the delayed phase. CDC tumor enhancement was lower than that for normal renal medulla during all enhanced phases. CONCLUSION Both tumor types originated from the renal medulla. Distinguishing features included density on unenhanced CT, enhancement patterns, and capsule signs. Identifying these differences may aid diagnosis.
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Affiliation(s)
- Qing-Qiang Zhu
- Subei People's Hospital, Clinical School of Medical College, Yangzhou
| | - Zhong-Qiu Wang
- Department of Radiology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wen-Rong Zhu
- Subei People's Hospital, Clinical School of Medical College, Yangzhou
| | - Wen-Xin Chen
- Subei People's Hospital, Clinical School of Medical College, Yangzhou
| | - Jing-Tao Wu
- Subei People's Hospital, Clinical School of Medical College, Yangzhou
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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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13
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Rajandram R, Bennett N, Morais C, Johnson D, Gobe G. Renal cell carcinoma: Resistance to therapy, role of apoptosis, and the prognostic and therapeutic target potential of TRAF proteins. Med Hypotheses 2012; 78:330-6. [DOI: 10.1016/j.mehy.2011.11.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 10/17/2011] [Accepted: 11/13/2011] [Indexed: 12/25/2022]
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Picken MM. The Evolving Concept of Renal Neoplasia: Impact of Emerging Molecular and Electron Microscopic Studies. Ultrastruct Pathol 2009; 29:277-82. [PMID: 16036881 DOI: 10.1080/01913120590951266] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The classification of renal tumors has evolved from one that initially encompassed only 2 types of tumors, i.e., clear and granular cell carcinomas, to the markedly expanded recent classification that incorporates new entities, some of which are primarily defined by specific molecular abnormalities. Despite these advances, a single tumor category, clear cell carcinoma, still incorporates the majority (approximately 70%) of renal tumors. It is, however, postulated that this single category is likely to encompass several different tumor types that are, at present, undifferentiated. Electron microscopic studies have been pivotal in defining the spectrum of oncocytoma-chromophobe renal cell carcinoma. Cytoplasmic eosinophilia found in some renal cell carcinomas currently classified as clear cell type is under intense study. Tumors that have recently emerged from this group include tumors with translocations involving chromosome Xp11.2, carcinomas associated with neuroblastoma and epithelioid angiomyolipoma. The spectrum of renal tumors seen in younger patients is wider than among older patients, with rare and unusual tumors being more likely seen in younger patients. The author concludes that although the routine application of electron microscopy to kidney tumor diagnosis may not be practical, systematic ultrastructural studies of these tumors may aid in the definition of new entities.
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Affiliation(s)
- Maria M Picken
- Department of Pathology, Loyola University Medical Center, Chicago, Illinois 60153, USA.
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Abstract
Chromophobe renal cell carcinoma was described by Thoenes et al. in 1986, and associations with carcinoma of collecting ducts, conventional renal cell carcinoma and sarcomatoid renal cell carcinoma have been described. We report a case of chromophobe renal cell carcinoma which showed neuroendocrine differentiation. This is the first known case to be clearly identified as such. The patient was a 56-year-old man with constant right flank pain and hematuria; CT scan revealed an 8.5 cm nonhomogeneous mass involving the right kidney. Right radical nephrectomy was performed. The tumor showed a mixture of classical and eosinophilic patterns of chromophobe cell carcinoma. Additionally, it showed insular, glandular and rosetoid-like formations embedded in a dense eosinophilic hyaline stroma. The cells were cuboid or cylindrical with well-defined boundaries, finely stippled chromatin and a small nucleolus. The appearance of the cytoplasm varied from faintly eosinophilic to coarsely granular eosinophilic. Immunohistochemically, the neuroendocrine areas were reactive for C-kit, epithelial membrane antigen, cytokeratin, cytokeratin 7, chromogranin A, neuron-specific enolase, CD56 and S-100 protein. Our case represents a typical chromophobe carcinoma with neuroendocrine differentiation. Additionally, the immunohistochemical profile in both types of lesion suggests a common origin from renal tubular cells.
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Affiliation(s)
- David D Parada
- Department of Pathology, Vargas Hospital, San Francisquito a Monte Carmelo, Esquina El Recodo, San José, Apdo. 1010, Caracas. Venezuela.
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Viswanathan S, Desai SB, Prabhu SR, Amin MB. Squamous differentiation in a sarcomatoid chromophobe renal cell carcinoma: an unusual case report with review of the literature. Arch Pathol Lab Med 2008; 132:1672-4. [PMID: 18834228 DOI: 10.5858/2008-132-1672-sdiasc] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2008] [Indexed: 11/06/2022]
Abstract
We describe an extremely rare occurrence of a squamous differentiation in a sarcomatoid chromophobe renal cell carcinoma in a 45-year-old woman with nodal and lung metastasis at presentation. The tumor on histology showed all 3 components intimately admixed with each other, which to the best of our knowledge is the first such case to be reported in the literature. The renal pelvis was smooth walled and uninvolved. Kidney-specific cadherin was positive in the chromophobe renal cell carcinoma areas and negative in the sarcomatoid and squamous areas.
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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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Mete O, Kilicaslan I, Ozcan F, Uysal V. Sarcomatoid chromophobe renal cell carcinoma with squamous differentiation. Pathology 2007; 39:598-9. [DOI: 10.1080/00313020701684342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fúnez R, Pereda T, Rodrigo I, Robles L, González C. Simultaneous chromophobe renal cell carcinoma and squamous renal cell carcinoma. Diagn Pathol 2007; 2:30. [PMID: 17711572 PMCID: PMC2045079 DOI: 10.1186/1746-1596-2-30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Accepted: 08/21/2007] [Indexed: 11/10/2022] Open
Abstract
Chromophobe renal cell carcinoma (CHRC) is a neoplasm of the kidney with clinicopathologic peculiarities that seems to be of better prognosis than conventional renal cell carcinoma. Classical and eosinophilic types are the two histological variants recorded. Also, it has been described in association with carcinoma of collecting ducts, conventional renal cell carcinoma and sarcomatoid renal cell carcinoma. Squamous renal carcinoma is a very rare neoplasm with a malignant course. We describe a case of simultaneous chromophobe renal cell carcinoma with squamous cell carcinoma, finding which, to the best of our knowledge, has not previously been reported.
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Affiliation(s)
- Rafael Fúnez
- Department of Pathology, Hospital Costa del Sol, Marbella, Spain
| | - Teresa Pereda
- Department of Pathology, Hospital Costa del Sol, Marbella, Spain
| | - Isabel Rodrigo
- Department of Pathology, Hospital Costa del Sol, Marbella, Spain
| | - Luis Robles
- Department of Pathology, Hospital Costa del Sol, Marbella, Spain
| | - Carlos González
- Department of Pathology, Hospital Costa del Sol, Marbella, Spain
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20
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Dundr P, Pesl M, Povýsil C, Tvrdík D, Pavlík I, Soukup V, Dvorácek J. Pigmented microcystic chromophobe renal cell carcinoma. Pathol Res Pract 2007; 203:593-7. [PMID: 17658700 DOI: 10.1016/j.prp.2007.05.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2007] [Revised: 04/23/2007] [Accepted: 05/02/2007] [Indexed: 11/21/2022]
Abstract
We report a case of a 60-year-old female with a pigmented microcystic chromophobe renal cell carcinoma (PMCRCC). The tumor was 4.5 cm in diameter, and was located in the right kidney. Grossly, on cross section, the tumor was light gray with multiple small brown to black pigmented foci up to 0.2 cm in diameter. Histologically, the tumor showed a microcystic arrangement with cribriform areas and formation of adenomatous structures. The microcystic and cribriform areas were composed of larger pale cells and smaller eosinophilic cells, with cytological features of conventional chromophobe renal cell carcinoma (CRCC). The cytological features of the cells within the adenomatous structures were different. These cells were mostly columnar with nuclei at the base, and had a variable amount of pale to eosinophilic cytoplasm. There were foci of ample brown pigmentation located in the cytoplasm of the tumor cells and extracellularly. In addition, microscopic calcifications were present. Immunohistochemically, the tumor cells were positive for EMA, E-cadherin, cytokeratin CAM5.2, and cytokeratin AE1/AE3. Cytokeratin 7 was positive only focally. S-100 protein, melan A, HMB 45, vimentin, and CD117 were negative. PMCRCC is a rare tumor. To the best of our knowledge, only one series containing 20 cases of this variant of CRCC has been described to date. The important feature is that PMCRCC seems to have a relatively benign biological behavior, and distant metastases and sarcomatoid transformation are absent.
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Affiliation(s)
- Pavel Dundr
- Institute of Pathology, 1st Medical Faculty and General Faculty Hospital, Charles University, Studnickova 2, Prague 128 00, Czech Republic.
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21
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Algaba F, Arce Y, Trias I, Santaularia JM, Antonio Rosales A. Aplicación clínica de las actuales clasificaciones del cáncer renal. Actas Urol Esp 2006; 30:372-85. [PMID: 16838609 DOI: 10.1016/s0210-4806(06)73461-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of classifying neoplasias is to recognize groups with similar progress and prognosis and, if possible, receiving the same treatment. This is why those classifications are systematically being submitted to review and improvement through the new technologies. Differentiation of various entities in renal cancer has been comparatively fast, as the new genetic and molecular discoveries have confirmed the morphologic criteria of the different cell types, thus making it possible to open new therapeutic pathways. Using the current WHO classification we recognize subtypes with excellent prognosis (Multilocular cystic renal carcinoma, Type I renal papillary carcinoma, Tubular and fusocellular mucinous carcinoma), other very aggressive ones (Bellini's collecting duct carcinoma, Medullary carcinoma), and also that the sarcomatoid transformation, even in small areas, impacts the prognosis negatively. Childhood-characteristic renal carcinomas associated with chromosome translocations have been recognized (genetic fusion TFE3 or TFEB), as well as the family forms of renal carcinoma. Regarding the UICC (International Union Against Cancer) classification, there are a series of aspects under argument (size, venous invasion, microvascular invasion, invasion of the adipous tissue of the renal sinus) that shall be discussed too, since it is possible that some modifications of the TNM might occur in the near future.
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MESH Headings
- Adenocarcinoma, Mucinous/epidemiology
- Adenocarcinoma, Mucinous/genetics
- Adenocarcinoma, Mucinous/pathology
- Adolescent
- Adult
- Biomarkers, Tumor/analysis
- Carcinoma/chemistry
- Carcinoma/classification
- Carcinoma/epidemiology
- Carcinoma/genetics
- Carcinoma/pathology
- Carcinoma, Papillary/chemistry
- Carcinoma, Papillary/epidemiology
- Carcinoma, Papillary/genetics
- Carcinoma, Papillary/pathology
- Carcinoma, Renal Cell/classification
- Carcinoma, Renal Cell/epidemiology
- Carcinoma, Renal Cell/pathology
- Cell Differentiation
- Cell Nucleus/ultrastructure
- Child
- Chromosomes, Human/genetics
- Chromosomes, Human/ultrastructure
- Female
- Humans
- Kidney Neoplasms/chemistry
- Kidney Neoplasms/classification
- Kidney Neoplasms/epidemiology
- Kidney Neoplasms/genetics
- Kidney Neoplasms/pathology
- Kidney Tubules, Collecting/pathology
- Male
- Neoplasm Proteins/analysis
- Neoplasms, Germ Cell and Embryonal/classification
- Neoplasms, Germ Cell and Embryonal/pathology
- Neoplastic Syndromes, Hereditary/genetics
- Prognosis
- Translocation, Genetic
- World Health Organization
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Affiliation(s)
- F Algaba
- Sección de Patologia, Fundació Puigvert-Barcelona.
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22
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Kawano N, Inayama Y, Nakaigawa N, Yao M, Ogawa T, Aoki I, Kitamura H, Nakatani Y, Nagashima Y. Composite distal nephron-derived renal cell carcinoma with chromophobe and collecting duct carcinomatous elements. Pathol Int 2005; 55:360-5. [PMID: 15943794 DOI: 10.1111/j.1440-1827.2005.01837.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Chromophobe renal cell carcinoma (RCC) and collecting duct carcinoma (CDC) are derived from the collecting duct epithelia, although their morphology, molecular biologic characteristics and clinical behaviors are quite different. Herein is presented a case of RCC possessing the chromophobe RCC and CDC elements occurring in a 64 year-old Japanese woman. The patient was referred to Yokohama City University Hospital with complaints of persistent back pain and fever. Radiologic examinations revealed a left renal tumor, and radical nephrectomy was performed. The patient died with multiple metastases, 8 months after the operation. The resected tumor showed an invasive growth, and its cut surface was heterogenous with hemorrhage and necrosis. Histologically, the tumor was composed of chromophobe elements with dedifferentiation, and CDC elements. The chromophobe and CDC elements had obvious histological transition. Lectin histochemistry and immunohistochemistry confirmed that this tumor was derived from the distal nephron. c-KIT, p53 and Ki67 antigen showed differential localization between the chromophobe and CDC elements, even in the transitional areas. Along with the previous reports, the present case seemed to be composite RCC derived from the collecting duct, which might present clues to elucidate carcinogenesis in the distal nephron.
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Affiliation(s)
- Naomi Kawano
- Division of Anatomical and Surgical Pathology, Yokohama City University Hospital, Yokohama, Japan
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Magro G, Lopes M, Amico P, Puzzo L. Chromophobe renal cell carcinoma with extensive rhabdomyosarcomatous component. Virchows Arch 2005; 447:894-6. [PMID: 16021511 DOI: 10.1007/s00428-005-0026-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Accepted: 06/10/2005] [Indexed: 10/25/2022]
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Lindgren V, Paner GP, Flanigan RC, Clark JI, Campbell SC, Picken MM. Renal Tumor With Overlapping Distal Nephron Morphology and Karyotype. Arch Pathol Lab Med 2004; 128:1274-8. [PMID: 15504063 DOI: 10.5858/2004-128-1274-rtwodn] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Although most renal epithelial tumors are derived from the proximal nephron, approximately 10% are believed to originate in the distal nephron. This latter group encompasses oncocytoma, chromophobe renal cell carcinoma, and several rare types, including collecting duct carcinoma and renal medullary carcinoma. Despite progress in the classification of renal tumors, a small subset of renal carcinomas remains unclassified (ie, renal cell carcinoma, not otherwise specified). We describe a metastatic tumor consisting of cells with overlapping distal nephron morphologies, including foci of oncocytoma, chromophobe renal cell carcinoma, and collecting duct carcinoma, as well as sarcomatoid dedifferentiation. Special stains were inconclusive, and ultrastructural study demonstrated abundant mitochondria and no microvesicles. The karyotype was hypodiploid with 41 chromosomes and abnormalities reported in all 3 phenotypes present. Rearrangements of 1p and of 11q13 previously seen in divergent subsets of oncocytomas were concomitantly present in the current tumor. Thus, this malignancy has features consistent with distal nephron derivation and demonstrates the convergence of the varied tumor morphologies arising within this site. Furthermore, this case exemplifies the value of cytogenetic analysis in the characterization of renal cell carcinoma, not otherwise specified. In view of recent advances in treatment approach, especially for collecting duct carcinoma, further categorization of this nondescript and heterogeneous group of renal cell carcinomas, not otherwise specified, at least by its derivation in relationship to the renal nephron (distal vs proximal), may be of value in the choice of treatment modality.
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Affiliation(s)
- Valerie Lindgren
- Department of Pathology, University of Illinois at Chicago, Chicago, Ill, USA.
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