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Monroe HL, Patadji Santiago S, Williams HJ, El Naili R. Renal Neuroendocrine Tumor: A Case Report with Evaluation of Grading Criteria and Relationship with Carbonic Anhydrase 9 Immunoreactivity. Int J Surg Pathol 2024; 32:570-577. [PMID: 37461831 DOI: 10.1177/10668969231186931] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Neuroendocrine tumors (NETs) are only exceptionally primary to the kidney. At present, scant information is known regarding the behavior and prognosis of renal NETs, especially according to the assessment of grading parameters used for NETs originating from other more commonplace sites such as the pancreas and lungs. There are only rare reports of grade assessment in renal NETs, with most of these reports relying upon now antiquated World Health Organization gastroenteropancreatic and lung/thymus criteria. As an additional prognostic factor, positive CA9 staining in NETs may correlate with elevated grade, stage and risk of metastasis while serving as a potential target of chemotherapy and immunotherapy and indicator of Von Hippel-Lindau Syndrome. Rarer still are descriptions of renal NETs presenting with renal cell carcinoma in the ipsilateral or contralateral kidney. Thus, we present a patient with a primary renal NET of the right kidney with regional lymphovascular invasion and distant metastasis with an emphasis on grading criteria concordant with the World Health Organization 2022 gastroenteropancreatic and lung/thymus systems. In addition, we discuss unusual staining for CA9 in the patient's tumor and a concomitant left kidney clear cell renal cell carcinoma that may act as a clinicopathologic mimic of Von Hippel-Lindau Syndrome.
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Affiliation(s)
- Hunter L Monroe
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown, WV, USA
| | - Stell Patadji Santiago
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown, WV, USA
| | - H James Williams
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown, WV, USA
| | - Reima El Naili
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown, WV, USA
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Luketich SK, Zekan DS, Prisneac I, Howell DM, El Naili R, Zaslau S. EBV-positive diffuse large B-cell lymphoma presenting as symptomatic masses in the bladder trigone and unilateral kidney. Urol Case Rep 2023; 47:102355. [PMID: 36866338 PMCID: PMC9970884 DOI: 10.1016/j.eucr.2023.102355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/11/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) of the genitourinary tract is a rare diagnosis. A 66-year-old male with a history of multiple myeloma and prostate cancer presented with gross hematuria and concern for urinary clot retention. Imaging demonstrated an incidental mass in the left kidney and urinary bladder. Resection of the urinary bladder tumor and biopsy of the kidney revealed Epstein-Barr Virus positive DLBCL. Significant lymphadenopathy was found during staging, and this lymphoma was classified as stage IV. The patient was referred to medical oncology, initiated on chemotherapy, and scheduled for follow up with urology for the renal mass.
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Affiliation(s)
- Samuel K. Luketich
- West Virginia University School of Medicine, Morgantown, WV, 26505, USA,Corresponding author.
| | - David S. Zekan
- Department of Urology, West Virginia University Medicine, Morgantown, WV, 26505, USA
| | - Ion Prisneac
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University Medicine, Morgantown, WV, 26505, USA
| | - David M. Howell
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University Medicine, Morgantown, WV, 26505, USA
| | - Reima El Naili
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University Medicine, Morgantown, WV, 26505, USA
| | - Stanley Zaslau
- Department of Urology, West Virginia University Medicine, Morgantown, WV, 26505, USA
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Shakesprere J, El Naili R, Sadiq M, Haider A. Pseudo Primary Aldosteronism as Initial Presentation of Ectopic ACTH Syndrome in Metastatic Small Cell Lung Cancer. JCEM Case Rep 2023; 1:luac020. [PMID: 37908248 PMCID: PMC10578378 DOI: 10.1210/jcemcr/luac020] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Indexed: 11/02/2023]
Abstract
Ectopic adrenocorticotropic hormone (ACTH)-secreting syndrome (EAS) is a rare but often aggressive paraneoplastic syndrome. Patients with EAS typically present with high ACTH levels and rapid clinical progression in the setting of acute cortisol elevation, which can delay diagnosis due to a lack of typical Cushingoid features. High levels of ACTH have also been shown to stimulate the adrenal zona glomerulosa to oversecrete aldosterone. We present the case of a 58-year-old male individual presenting with new-onset hypertension and severe metabolic alkalosis with spontaneous hypokalemia, in the setting of elevated aldosterone and low renin levels, suggestive of primary aldosteronism. Subsequent biochemical testing, imaging, and pathology, however, revealed suppression of aldosterone with evidence of hypercortisolism in the setting of metastatic small cell lung cancer. This was, therefore, suggestive of pseudo primary aldosteronism in the setting of a paraneoplastic ectopic ACTH-producing syndrome. This case highlights that hypercortisolism, in the setting of EAS, can initially present with a clinical picture suggestive of hyperaldosteronism. The use of a dexamethasone suppression test can allow the clinician to differentiate between idiopathic bilateral adrenal hyperplasia and ectopic ACTH syndrome.
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Affiliation(s)
- Jonathan Shakesprere
- Department of Internal Medicine, West Virginia University School of Medicine, Morgantown, WV 26505, USA
| | - Reima El Naili
- Section of Endocrinology and Metabolism, Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University School of Medicine, Morgantown, WV 26505, USA
| | - Mehjabeen Sadiq
- Department of Internal Medicine, West Virginia University School of Medicine, Morgantown, WV 26505, USA
| | - Adnan Haider
- Department of Internal Medicine, West Virginia University School of Medicine, Morgantown, WV 26505, USA
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Mitchell K, El Naili R, Pillai L, Lopez EM, Riordan J, Marsh W, Luchey A, Hajiran A. Triple Threat: Three Primary Malignancies Simultaneously Involving Three Genitourinary Organs. Case Rep Urol 2023; 2023:3242986. [PMID: 37101564 PMCID: PMC10125746 DOI: 10.1155/2023/3242986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 04/28/2023] Open
Abstract
Statistically, the chance of having concurrent renal cell carcinoma (RCC), urothelial carcinoma of the bladder (UC), and a neuroendocrine tumor (NET) of the renal parenchyma is less than one in a trillion. Herein, we describe an unusual case of a 67-year-old female who presented with bilateral flank pain and severe gross hematuria. Cross-sectional imaging revealed two large heterogeneous, endophytic renal masses with a single enlarged paracaval lymph node. Diagnostic cystoscopy was performed for completion of gross hematuria evaluation and revealed a concurrent papillary bladder tumor. Percutaneous biopsies of bilateral renal masses revealed clear cell RCC involving the left kidney and well-differentiated NET involving the right kidney, and transurethral resection of the bladder tumor revealed high-grade nonmuscle invasive urothelial carcinoma. The patient elected to undergo bilateral nephroureterectomy, radical cystectomy, and retroperitoneal and pelvic lymphadenectomy. Final pathology confirmed the presence of three different malignancies: noninvasive high-grade papillary UC of the bladder (pTaN0), left renal clear cell RCC (pT2bN0), right renal well-differentiated NET, and a single paracaval lymph nodes positive for metastatic NET (pT2aN1).
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Affiliation(s)
| | - Reima El Naili
- West Virginia University Department of Pathology, Morgantown, WV, USA
| | - Lakshmikumar Pillai
- West Virginia University Department of Vascular Surgery, Morgantown, WV, USA
| | | | - John Riordan
- West Virginia University Department of Urology, Morgantown, WV, USA
| | - Wallis Marsh
- West Virginia University Department of Surgical Oncology, Morgantown, WV, USA
| | - Adam Luchey
- West Virginia University Department of Urology, Morgantown, WV, USA
| | - Ali Hajiran
- West Virginia University Department of Urology, Morgantown, WV, USA
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Kővári B, El Naili R, Pereira DV, Kumarasinghe P, De Boer WB, Jiang K, Pimiento JM, Fukuda M, Misdraji J, Kushima R, Lauwers GY. Fundic gland polyps related to diverse aetiologies show subtle morphologic differences: A multicentre retrospective study. Histopathology 2022; 80:827-835. [DOI: 10.1111/his.14623] [Citation(s) in RCA: 1] [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: 11/01/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Bence Kővári
- Department of Pathology H. Lee Moffitt Cancer Center & Research Institute
- Department of Pathology University of Szeged, Albert Szent‐Györgyi Medical School
| | | | | | | | - W. Bastiaan De Boer
- Department of Pathology PathWest Laboratory –University of Western Australia
| | - Kun Jiang
- Department of Pathology H. Lee Moffitt Cancer Center & Research Institute
| | - Jose M. Pimiento
- Department of Gastrointestinal Oncology H. Lee Moffitt Cancer Center & Research Institute
| | | | | | - Ryoji Kushima
- Department of Pathology Shiga University of Medical Science
| | - Gregory Y Lauwers
- Department of Pathology H. Lee Moffitt Cancer Center & Research Institute
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Mitchell K, Elbakry AA, Naili RE, AL-Omar O. Dysfunctional Voiding- Presentation of a Rare Case of Pediatric Non Muscle Invasive Urothelial Bladder Carcinoma. Urology 2022; 166:233-235. [DOI: 10.1016/j.urology.2022.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
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El Naili R, Nicolas M, Gorena A, Policarpio-Nicolas MLC. Fine-needle aspiration findings of Xp11 translocation renal cell carcinoma metastatic to a hilar lymph node. Diagn Cytopathol 2017; 45:456-462. [PMID: 28185421 DOI: 10.1002/dc.23676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 12/30/2016] [Accepted: 01/18/2017] [Indexed: 01/11/2023]
Abstract
Xp11 translocation renal cell carcinoma (RCC) is a specific type of renal cell carcinoma recently placed under the "MiT family translocation RCC" at the last 2013 ISUP Vancouver classification of renal neoplasia. This tumor contains variable proportions of clear cells and could easily mimic papillary RCC, clear cell type, and clear cell papillary RCC. Given the small number of published cytologic findings of this tumor, it could easily present as a diagnostic pitfall. We describe a case of a 23-year-old man with a history of prior nephrectomy who presented with multiple mediastinal lymphadenopathies on imaging surveillance follow-up. Fine-needle aspiration of the lymph node showed tumor cells with voluminous clear to eosinophilic cytoplasm, well-defined cell borders and hyperchromatic nuclei arranged in papillary architecture. Review of the prior nephrectomy specimen showed papillary cores surrounded by cells with voluminous clear to finely granular eosinophilic cytoplasm and distinct cell borders. Immunohistochemical stains performed on the nephrectomy specimen showed tumor positivity for CD10, E-cadherin, a-methylacyl coenzyme A racemase, and TFE3 supporting the diagnosis of Xp11 translocation renal cell carcinoma. Although this tumor was initially described predominantly in children, it could also occur in adults, as seen in this case. Familiarity with the cytologic findings of this tumor, use of immunohistochemical stains, or cytogenetic test to determine the type of gene fusion will be extremely useful in arriving at the correct diagnosis. Diagn. Cytopathol. 2017;45:456-462. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Reima El Naili
- Department of Pathology, University of Texas Health Science Center, San Antonio, Texas
| | - Marlo Nicolas
- Department of Pathology, University of Texas Health Science Center, San Antonio, Texas
| | - Amanda Gorena
- Pathology Group of Louisiana, Baton Rouge, Louisiana
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El Naili R, Gonzalez G, Dahia P, Nicolas M. Decreased Expression of OCT3/4 in Paragangliomas of the Carotid Body and Middle Ear. Am J Clin Pathol 2016. [DOI: 10.1093/ajcp/aqw159.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Nicolas M, Naili RE. Paraganglia in Prostate Biopsy: Is OCT3/4 Helpful In Identifying Them? Am J Clin Pathol 2015. [DOI: 10.1093/ajcp/144.suppl2.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Naili RE, Nicolas M. Fibrosarcoma-like Lipomatous Neoplasm. Am J Clin Pathol 2015. [DOI: 10.1093/ajcp/144.suppl2.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Thomas SL, Schultz CR, Mouzon E, Golembieski WA, El Naili R, Radakrishnan A, Lemke N, Poisson LM, Gutiérrez JA, Cottingham S, Rempel SA. Loss of Sparc in p53-null Astrocytes Promotes Macrophage Activation and Phagocytosis Resulting in Decreased Tumor Size and Tumor Cell Survival. Brain Pathol 2015; 25:391-400. [PMID: 24862407 PMCID: PMC4520390 DOI: 10.1111/bpa.12161] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/19/2014] [Indexed: 12/26/2022] Open
Abstract
Both the induction of SPARC expression and the loss of the p53 tumor suppressor gene are changes that occur early in glioma development. Both SPARC and p53 regulate glioma cell survival by inverse effects on apoptotic signaling. Therefore, during glioma formation, the upregulation of SPARC may cooperate with the loss of p53 to enhance cell survival. This study determined whether the loss of Sparc in astrocytes that are null for p53 would result in reduced cell survival and tumor formation and increased tumor immunogenicity in an in vivo xenograft brain tumor model. In vitro, the loss of Sparc in p53‐null astrocytes resulted in an increase in cell proliferation, but a loss of tumorigenicity. At 7 days after intracranial implantation, Sparc‐null tumors had decreased tumor cell survival, proliferation and reduced tumor size. The loss of Sparc promoted microglia/macrophage activation and phagocytosis of tumor cells. Our results indicate that the loss of p53 by deletion/mutation in the early stages of glioma formation may cooperate with the induction of SPARC to potentiate cancer cell survival and escape from immune surveillance.
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Affiliation(s)
- Stacey L Thomas
- Department of Neurosurgery, Barbara Jane Levy Laboratory of Molecular Neuro-Oncology and Hermelin Brain Tumor Center, Henry Ford Hospital, Detroit, MI.,Department of Clinical Neurosciences, Laboratory of Molecular Neuro-Oncology, Division of Neurosurgery, Spectrum Health System, Grand Rapids, MI
| | - Chad R Schultz
- Department of Neurosurgery, Barbara Jane Levy Laboratory of Molecular Neuro-Oncology and Hermelin Brain Tumor Center, Henry Ford Hospital, Detroit, MI.,Department of Clinical Neurosciences, Laboratory of Molecular Neuro-Oncology, Division of Neurosurgery, Spectrum Health System, Grand Rapids, MI
| | - Ezekiell Mouzon
- Department of Neurosurgery, Barbara Jane Levy Laboratory of Molecular Neuro-Oncology and Hermelin Brain Tumor Center, Henry Ford Hospital, Detroit, MI
| | - William A Golembieski
- Department of Neurosurgery, Barbara Jane Levy Laboratory of Molecular Neuro-Oncology and Hermelin Brain Tumor Center, Henry Ford Hospital, Detroit, MI.,Department of Clinical Neurosciences, Laboratory of Molecular Neuro-Oncology, Division of Neurosurgery, Spectrum Health System, Grand Rapids, MI
| | - Reima El Naili
- Department of Neurosurgery, Barbara Jane Levy Laboratory of Molecular Neuro-Oncology and Hermelin Brain Tumor Center, Henry Ford Hospital, Detroit, MI
| | - Archanna Radakrishnan
- Department of Neurosurgery, Barbara Jane Levy Laboratory of Molecular Neuro-Oncology and Hermelin Brain Tumor Center, Henry Ford Hospital, Detroit, MI
| | - Nancy Lemke
- Department of Neurosurgery, Barbara Jane Levy Laboratory of Molecular Neuro-Oncology and Hermelin Brain Tumor Center, Henry Ford Hospital, Detroit, MI
| | - Laila M Poisson
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI
| | | | - Sandra Cottingham
- Department of Neuropathology and Clinical Neurosciences, Spectrum Health System, Grand Rapids, MI
| | - Sandra A Rempel
- Department of Neurosurgery, Barbara Jane Levy Laboratory of Molecular Neuro-Oncology and Hermelin Brain Tumor Center, Henry Ford Hospital, Detroit, MI.,Department of Clinical Neurosciences, Laboratory of Molecular Neuro-Oncology, Division of Neurosurgery, Spectrum Health System, Grand Rapids, MI
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