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Yang WP, Chang KTE, Xu HY, Kuick CH, Ng EHQ, Huang H, Xiong F, Wu Y, Zeng ST, Fan JX, Loh XY. [Eosinophilic solid and cystic renal cell carcinoma with TSC2 gene mutations in children]. Zhonghua Bing Li Xue Za Zhi 2020; 49:693-698. [PMID: 32610380 DOI: 10.3760/cma.j.cn112151-20191217-00807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To study clinical pathological characteristics, immunohistochemical, molecular genetical changes and prognosis in pediatric eosinophilic solid and cystic renal cell carcinoma (ESC RCC) with TSC2 gene mutations. Methods: The tissue samples were collected from two pediatric ESC RCC patients between 2017 and 2018. The tissues were subjected to histological examination and immunohistochemistry using EnVision system. The TFE3, TFEB gene rearrangements were tested using FISH and molecular genetic study. The paraffin sections were used for DNA extraction, PCR amplification and NGS sequencing. Results: The two patients with ESC RCC were both male, aged at 9 years and 8 months, and 13 years, respectively. The tumors were from the right kidney, 5 cm and 7 cm in size, respectively, with solid and cystic changes in cross section, and grey-reddish or grey-whitish fish meat appearance. Microscopic observation revealed the tumors had fibrous capsules, which were infiltrated by the tumor cells. The tumor cells were diffusely distributed, round-shaped, or polygon-shaped, and had voluminous cytoplasm, eosinophilic cytoplasm, various sizes of vacuoles and clear cell-like appearance. There were papillary structures in some areas, with visible fiber septa. The nuclei were round and vesicular, with multi-nucleated cells and megakaryocytes. The mitoses were not seen. A few cystic structures were visible in different sizes, and capsule walls were covered with a single layer of spike-like tumor cells. Thick-walled blood vessels were seen in the stroma, with focal lymphocytic infiltration, eosinophilic necrosis, calcifications and cholesterol crystals. Immunohistochemistry of the tumor cells was positive for PAX8 (diffuse), CK20 (focal), CKpan (focal), CK10 (1 focal, 1 diffuse), INI1, vimentin, CD68, and Ki-67 (5%~10%); the tumor cells were negative for HMB45, S-100, Melan A, p53, desmin, TFE3, CK7, CK19, EMA, CD56, CgA, Syn, CD30, CD117, WT1 and SMA. Molecular genetic study showed that TFE3 and TFEB gene rearrangements were not detected by FISH. NGS sequencing showed TSC2 p.Lys574Ter (0.198) was found in patient one and TSC2 p.Arg406Ter (0.355) in patient two. Conclusions: ESC RCC in children is a rare disease, and can be misdiagnosed easily. It has unique pathological characteristics, and immunohistochemical, molecular and genetic changes. The prognosis is relatively good.
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Affiliation(s)
- W P Yang
- Department of Pathology, Jiangxi Children's Hospital, Nanchang 330006, China
| | - K T E Chang
- Department of Pathology and Laboratory, KK Women's and Children's Hospital, Singapore 229899, Singapore
| | - H Y Xu
- Department of Pathology, Jiangxi Children's Hospital, Nanchang 330006, China
| | - C H Kuick
- Department of Pathology and Laboratory, KK Women's and Children's Hospital, Singapore 229899, Singapore
| | - E H Q Ng
- Department of Pathology and Laboratory, KK Women's and Children's Hospital, Singapore 229899, Singapore
| | - H Huang
- Department of Pathology, Jiangxi Children's Hospital, Nanchang 330006, China
| | - F Xiong
- Department of Pathology, Jiangxi Children's Hospital, Nanchang 330006, China
| | - Y Wu
- Department of Pathology, Jiangxi Children's Hospital, Nanchang 330006, China
| | - S T Zeng
- Department of Pathology, Jiangxi Children's Hospital, Nanchang 330006, China
| | - J X Fan
- Department of Pathology, Jiangxi Children's Hospital, Nanchang 330006, China
| | - X Y Loh
- Department of Pathology and Laboratory, KK Women's and Children's Hospital, Singapore 229899, Singapore
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Yin MZ, Ma J, He Q, Shen P, Chen JF, Jin XT, Zhang ZD, Kuick CH, Chen HY, Ng EHQ, Aw SJ, Chang KTE. [Clinicopathological characteristics of NTRK-rearranged mesenchymal tumors in childhood]. Zhonghua Bing Li Xue Za Zhi 2020; 49:675-680. [PMID: 32610377 DOI: 10.3760/cma.j.cn112151-20200214-00095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the clinical and pathological features of pediatric NTRK-rearranged tumors. Methods: Four NTRK-rearranged soft tissue tumors and one renal tumor at Shanghai Children's Medical Center, Shanghai Jiaotong University and Singapore KK Women's and Children's Hospital from January 2017 to September 2019 were identified. Pan-TRK immunohistochemistry, and the ALK and ETV6 gene break-apart fluorescence in situ hybridizations (FISH) were performed. NTRK gene rearrangement was detected using sequencing-based methods. Results: There were 3 males and 2 females in this study. The patients were between 3 months and 13 years of age. Histologically, the tumors were infiltrative spindle cell tumors with variable accompanying inflammatory cells. Immunohistochemistry showed positive reactivity for pan-TRK in all tumors, with nuclear staining for NTRK3 fusion, and cytoplasmic staining for NTRK1 fusion. The molecular testing revealed NTRK gene fusions (one each of TPM3-NTRK1, ETV6-NTRK3 and DCTN1-NTRK1, and two cases of LMNA-NTRK1). Two patients were receiving larotrectinib. The others were are well without disease, with follow-up durations of 9 to 29 months. Conclusions: NTRK-rearranged mesenchymal tumors from soft tissue sites and kidney are identified. A novel DCTN1-NTRK1 fusion is described. Pan-TRK immunohistochemistry is useful for diagnosis. NTRK-targeted therapy may be an option for unresectable, recurrent or metastatic cases.
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Affiliation(s)
- M Z Yin
- Department of Pathology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - J Ma
- Department of Pathology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Q He
- Department of Pathology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - P Shen
- Department of Pathology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - J F Chen
- Department of Pathology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - X T Jin
- Department of Pathology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Z D Zhang
- Department of Pathology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - C H Kuick
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore 229899, Singapore
| | - H Y Chen
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore 229899, Singapore
| | - E H Q Ng
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore 229899, Singapore
| | - S J Aw
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore 229899, Singapore
| | - K T E Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore 229899, Singapore
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Loke BN, Wong MK, Tawng KD, Kuick CH, Jain S, Lian D, Wagner E, Zou Y, Ganesan V, Sim SW, Lee YT, Chin F, Chan MY, Tan AM, Teh BT, Soh SY, Chang KT, Loh AH. Clinical, pathological and loss of heterozygosity differences in Wilms tumors between Asian and non-Asian children. Int J Cancer 2018; 144:1234-1242. [DOI: 10.1002/ijc.31946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/27/2018] [Accepted: 10/10/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Benjamin N. Loke
- Department of Biological Sciences; National University of Singapore; Singapore Singapore
| | - Meng Kang Wong
- VIVA-KKH Paediatric Solid Tumour Research Laboratory; KK Women's and Children's Hospital; Singapore Singapore
| | - Khawn D. Tawng
- Department of Paediatric Subspecialties Haematology/Oncology Service; KK Women's and Children's Hospital; Singapore Singapore
| | - Chick Hong Kuick
- Department of Pathology and Laboratory Medicine; KK Women's and Children's Hospital; Singapore Singapore
| | - Sudhanshi Jain
- Department of Pathology and Laboratory Medicine; KK Women's and Children's Hospital; Singapore Singapore
| | - Derrick Lian
- Department of Pathology and Laboratory Medicine; KK Women's and Children's Hospital; Singapore Singapore
| | - Elizabeth Wagner
- Institute for Genomic Medicine; Nationwide Children's Hospital; Columbus OH
| | - Yuhan Zou
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
| | - Visveswari Ganesan
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
| | - Siam Wee Sim
- Department of Paediatric Surgery; KK Women's and Children's Hospital; Singapore Singapore
| | - York Tien Lee
- Department of Paediatric Surgery; KK Women's and Children's Hospital; Singapore Singapore
| | - Francis Chin
- Division of Radiation Oncology, National Cancer Centre Singapore; Singapore Singapore
| | - Mei Yoke Chan
- Department of Paediatric Subspecialties Haematology/Oncology Service; KK Women's and Children's Hospital; Singapore Singapore
| | - Ah Moy Tan
- Department of Paediatric Subspecialties Haematology/Oncology Service; KK Women's and Children's Hospital; Singapore Singapore
| | - Bin Tean Teh
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore; Singapore Singapore
| | - Shui Yen Soh
- Department of Paediatric Subspecialties Haematology/Oncology Service; KK Women's and Children's Hospital; Singapore Singapore
| | - Kenneth T.E. Chang
- VIVA-KKH Paediatric Solid Tumour Research Laboratory; KK Women's and Children's Hospital; Singapore Singapore
- Department of Pathology and Laboratory Medicine; KK Women's and Children's Hospital; Singapore Singapore
| | - Amos H.P. Loh
- VIVA-KKH Paediatric Solid Tumour Research Laboratory; KK Women's and Children's Hospital; Singapore Singapore
- Department of Paediatric Surgery; KK Women's and Children's Hospital; Singapore Singapore
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Lian DWQ, Li FX, Ong CCP, Kuick CH, Chang KTE. Pseudomembranous trigonitis in a male with Klinefelter syndrome: a case report and evidence of a hormonal etiology. Int J Clin Exp Pathol 2014; 7:3375-3379. [PMID: 25031763 PMCID: PMC4097231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 05/26/2014] [Indexed: 06/03/2023]
Abstract
Klinefelter syndrome is a clinical syndrome with a distinct 47, XXY karyotype. Patients are characterized by a tall eunuchoid stature, small testes, hypergonotrophic hypogonadism, gynecomastia, learning difficulties and infertility. These patients have also been found to have raised estrogen levels. We report a 16 year old boy with Klinefelter syndrome presenting to our institution with gross hematuria. Cystoscopy and biopsy revealed the diagnosis of pseudomembranous trigonitis. Immunohistochemical stains showed an increase in estrogen and progesterone receptors in the trigone area but not in the rest of the bladder. In view of the patient's mildly raised estrogen levels and the histological findings, we postulate that estrogen is the driver of the development of pseudomembranous trigonitis. This is the first reported case of pseudomembranous trigonitis seen in association with Klinefelter syndrome, and also the first case of pseudomembranous trigonitis occurring within the male adolescent age group.
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Affiliation(s)
- Derrick WQ Lian
- Department of Pathology and Laboratory Medicine, KK Women’s and Children’s HospitalSingapore
| | - Fay X Li
- Department of Paediatric Surgery, KK Women’s and Children’s HospitalSingapore
| | - Caroline CP Ong
- Department of Paediatric Surgery, KK Women’s and Children’s HospitalSingapore
| | - CH Kuick
- Department of Pathology and Laboratory Medicine, KK Women’s and Children’s HospitalSingapore
| | - Kenneth TE Chang
- Department of Pathology and Laboratory Medicine, KK Women’s and Children’s HospitalSingapore
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Fernandopulle SM, Hwang JSG, Kuick CH, Lui J, Tan PH, Siow WY, Wong M. Rosai-Dorfman disease of the testis: an unusual entity that mimics testicular malignancy. J Clin Pathol 2006; 59:325-7. [PMID: 16505287 PMCID: PMC1860335 DOI: 10.1136/jcp.2005.028423] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A 47 year old Chinese man with diabetes mellitus and previously treated pulmonary tuberculosis presented with painless right testicular enlargement of 1 month's duration. He underwent an orchidectomy for presumed testicular neoplasm corroborated clinicoradiologically. Histological examination of the testicular mass revealed an inflammatory lesion comprising lymphocytes, plasma cells and sheets of pale staining histiocytes, some containing lymphocytes within their ample cytoplasm, suggestive of emperipolesis. S100 immunohistochemistry stained the histiocytes, while ultrastructural examination confirmed emperipolesis. A diagnosis of Rosai-Dorfman disease was made, an exceedingly rare testicular lesion. Clinicoradiological findings mimicked a neoplasm, while the inflammatory histological appearances with occasionally discerned multinucleated cells raised the possibility of xanthogranulomatous orchitis. Tuberculous orchitis was excluded through negative Ziehl-Neelsen stains and PCR for mycobacterium, while seminoma, which sometimes features a predominant inflammatory component obscuring neoplastic cells, was excluded by absent immunostaining for placental alkaline phosphatase and CD117.
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