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Suneel R, Gupta P, Sekar A, Gupta N, Saxena A. Unravelling the mysteries of Xp11.2 translocation-associated renal cell carcinoma: A case report with a review of the literature. Cytopathology 2023; 34:367-376. [PMID: 37118914 DOI: 10.1111/cyt.13240] [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: 02/18/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/30/2023]
Abstract
Cytomorphologic and immunocytochemical features of TFE3 translocation-associated renal cell carcinoma.
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Affiliation(s)
- Rachagiri Suneel
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parikshaa Gupta
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aravind Sekar
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Akshay Saxena
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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2
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Feng R, Tao Y, Chen Y, Xu W, Zhang G, Wang H. Renal cancer associated with Xp11.2 translocation/TFE3 gene fusion: Clinicopathological analysis of 13 cases. Ann Diagn Pathol 2022; 58:151908. [DOI: 10.1016/j.anndiagpath.2022.151908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 01/18/2022] [Accepted: 01/30/2022] [Indexed: 11/16/2022]
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Chen HIH, Lapadat R, Lastra RR, Biernacka A, Reeves W, Mueller J, Pambuccian SE, Barkan GA, Wojcik EM, Antic T. Accuracy of Subclassification and Grading of Renal Tumors on Fine Needle Aspiration Cytology Alone. Acta Cytol 2021; 65:140-149. [PMID: 33535202 DOI: 10.1159/000513065] [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: 10/17/2020] [Accepted: 11/12/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fine needle aspiration (FNA) of renal masses can distinguish between benign and malignant neoplasms in 73-94% of cases. Previous studies suggested the correct subclassification of renal cell carcinomas (RCCs) by cytomorphology can be achieved in up to 80% of cases. However, as RCCs become increasingly subclassified by molecular signatures, correct subclassification based on cytology alone is increasingly difficult. DESIGN Two FNA passes (2 stained with Diff-Quik® and 2 with the Papanicolaou method) were performed on all fresh nephrectomy specimens for a 1-year period. There were 30 cases in this study, with 29 primary renal tumors and 1 case of metastatic lung adenocarcinoma. Each case was assigned a random number and came with 2 slides (1 from each staining method). Eight cytopathologists were asked to provide a diagnosis and the World Health Organization/International Society of Urological Pathology (WHO/ISUP) grading if applicable. Fleiss' Kappa and Cohen's Kappa equations were used to look at inter-rater variability. RESULTS When compared to the surgical pathology diagnosis, the average percent correct diagnosis for all cytopathologist was 35%. Chromophobe RCCs had the best average percent accuracy at 72% followed by clearcell RCC at 48%. Average accuracy for grading RCCs was 40%. Inter-rater variability among the cytopathologists for all RCC diagnoses was fair with a Fleiss' Kappa coefficient of 0.28. For the WHO/ISUP grade, the weighted coefficient for each pathologist ranged from 0.11 to 0.45, ranging from fair to moderate, respectively. CONCLUSIONS Renal tumors are difficult to classify on cytopathology alone. Core needle biopsy and ancillary studies are necessary if diagnosis will change management.
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Affiliation(s)
- Heather I-Hsuan Chen
- Department of Pathology, The University of Chicago Hospitals, Chicago, Illinois, USA,
| | - Razvan Lapadat
- Department of Pathology, The University of Chicago Hospitals, Chicago, Illinois, USA
| | - Ricardo R Lastra
- Department of Pathology, The University of Chicago Hospitals, Chicago, Illinois, USA
| | - Anna Biernacka
- Department of Pathology, The University of Chicago Hospitals, Chicago, Illinois, USA
| | - Ward Reeves
- Department of Pathology, The University of Chicago Hospitals, Chicago, Illinois, USA
| | - Jeffrey Mueller
- Department of Pathology, The University of Chicago Hospitals, Chicago, Illinois, USA
| | - Stefan E Pambuccian
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Güliz A Barkan
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Eva M Wojcik
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Tatjana Antic
- Department of Pathology, The University of Chicago Hospitals, Chicago, Illinois, USA
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Montella M, Franco R, Aquino G, Ronchi A, Zito Marino F, Di Napoli M, Pignata S, Cozzolino I. Cytological diagnosis of Xp11 translocation renal cell carcinoma: An unusual suspect in bone metastases from unknown primary malignancies. Diagn Cytopathol 2020; 49:11-17. [PMID: 32809251 DOI: 10.1002/dc.24587] [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: 04/30/2020] [Revised: 07/14/2020] [Accepted: 08/03/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Renal cell carcinoma (RCC) constitutes 3% of all cancers, with a higher incidence in patients with age between 60 and 70 years. RCC frequently present as a metastatic tumor at diagnosis, and bones represent one of the most frequent sites. Many cases, mainly in young patients, includes the Xp11 translocation RCC. The cytological diagnosis of Xp11 translocation RCC in adult population it is rarely performed, likely for the morphological overlap with other adult renal cell carcinoma subtypes. METHODS We retrospectively analyze a series of 92 adult patients with metastatic bone tumors, diagnosed on fine-needle aspiration cytology (FNAC) samples, focusing mainly on the cytological, immunophenotypic and molecular features of Xp11 translocation RCC. RESULTS In our series 6 of 92 (6.5%) cases were metastatic RCC (mRCC), among them 2 cases were metastasis from Xp11translocation RCC. Those cases showed a bloody background, with several groups of atypical cells arranged in syncytial groups or in papillary groups composed by atypical cells with abundant cytoplasm, with scattered clear cells. TFE3 was positive on immunocytochemical analysis and specific translocation t(Xp11.23) was detected by FISH analysis. CONCLUSIONS In adult patients with mRCC, it is necessary to consider also Xp11 translocation RCC among the diagnostic hypotheses. FNAC represents a valid tool to investigate bone lesions but cytological features of Xp11 translocation RCC are still poorly described and must necessarily be better defined.
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Affiliation(s)
- Marco Montella
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Gabriella Aquino
- Pathology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione G. Pascale," IRCCS, Naples, Nepal
| | - Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Federica Zito Marino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Marilena Di Napoli
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione G. Pascale," IRCCS, Naples, Italy
| | - Sandro Pignata
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione G. Pascale," IRCCS, Naples, Italy
| | - Immacolata Cozzolino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università della Campania "Luigi Vanvitelli", Naples, Italy
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Jin M, Parwani A, Li Z, Wakely PE. Cytopathology of Xp11 translocation renal cell carcinoma: a report of 5 cases. J Am Soc Cytopathol 2020; 9:95-102. [PMID: 32029406 DOI: 10.1016/j.jasc.2019.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Xp11.2 translocation-associated RCC (Xp11RCC) defined by molecular alterations involving TFE3 genetic rearrangements constitutes a large percentage of primary renal neoplasms in children, but less than 4% of adult cases. Fewer than 10 single case reports constitute the English cytopathology literature regarding this neoplasm. Our objective is to describe and illustrate the cytopathology of this uncommon renal neoplasm from a series of 5 cases using cytologic imprints, effusion specimens, and fine-needle aspiration (FNA) cytology. MATERIALS AND METHODS Review was made of our cytopathology and surgical pathology databases. FNA biopsy smears and imprint smears were performed using a standard technique. Effusion samples were processed using liquid-based slides. RESULTS Five cytologic specimens from 4 patients with histopathologically confirmed Xp11RCC were identified (mean age: 36 years) over a period of 7 years. All cases contained large cells with voluminous amounts of vacuolated cytoplasm arranged in non-descript clusters and as single forms. A "tigroid" pattern consisting of linear strips of detached cytoplasm was seen in both imprint smear cases and the single FNA case. Psammomatous calcifications, true papillary structures, and hyaline globules were absent in all cases. Four examples were diagnosed as Xp11RCC, but 3 represented metastatic disease, and 1 was diagnosed using both cytology and core needle tissue histopathology. The remaining case was diagnosed nonspecifically as a clear cell malignant neoplasm. CONCLUSIONS The cytopathologic features of Xp1RCC are relatively nonspecific, and overlap with other renal cell carcinoma subtypes. A definitive diagnosis is only possible with ancillary immunohistochemistry with or without additional TFE3 fluorescence in situ hybridization.
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Affiliation(s)
- Ming Jin
- Department of Pathology, The Ohio State University College of Medicine, Wexner Medical Center, Columbus, Ohio
| | - Anil Parwani
- Department of Pathology, The Ohio State University College of Medicine, Wexner Medical Center, Columbus, Ohio
| | - Zaibo Li
- Department of Pathology, The Ohio State University College of Medicine, Wexner Medical Center, Columbus, Ohio
| | - Paul E Wakely
- Department of Pathology, The Ohio State University College of Medicine, Wexner Medical Center, Columbus, Ohio.
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Robila V, Kraft AO, Smith SC. New entities, new technologies, new findings: A review of the cytologic features of recently established subtypes of renal cell carcinoma. Cancer Cytopathol 2019; 127:79-97. [PMID: 30690877 DOI: 10.1002/cncy.22093] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/08/2018] [Accepted: 11/26/2018] [Indexed: 02/06/2023]
Abstract
Several new renal tumor types with distinctive pathologic, epidemiologic, and genetic signatures have recently been adopted in the fourth edition of the World Health Organization classification. In succeeding years, the cytologic features of most of these new types have been described, adding to the trend of increasing diagnostic accuracy for most common renal cell carcinoma subtypes and the important diagnostic role of cytologic sampling in the management and personalization of therapy. The current article reviews the cytologic findings from these recently established renal cell carcinoma subtypes. Emphasis is placed on cytologic diagnostic clues, confirmatory ancillary testing, salient differential diagnoses, and challenges that can be encountered in an attempt to render accurate interpretations in small samples.
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Affiliation(s)
- Valentina Robila
- Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Adele O Kraft
- Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Steven Christopher Smith
- Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond, Virginia.,Division of Urology, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
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Chung EM, Lattin GE, Fagen KE, Kim AM, Pavio MA, Fehringer AJ, Conran RM. Renal Tumors of Childhood: Radiologic-Pathologic Correlation Part 2. The 2nd Decade: From the Radiologic Pathology Archives. Radiographics 2017; 37:1538-1558. [PMID: 28898190 DOI: 10.1148/rg.2017160189] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Malignant renal tumors account for 7% of childhood cancers, and Wilms tumors are by far the most common-but not in older children and adolescents. Among individuals in the latter half of their 2nd decade of life, renal cell carcinoma (RCC) is more common than Wilms tumor. The histopathologic spectrum of RCCs in children differs from that in adults. The most common subtype of RCC in children and adolescents is Xp11.2 translocation RCC, which is distinguished by hyperattenuation at nonenhanced computed tomography, a defined capsule, and associated retroperitoneal lymphadenopathy. Papillary RCC is the second most common histologic subtype. It enhances less intensely compared with the adjacent renal parenchyma and has a propensity for calcification. Clear cell RCC is seen in patients with von Hippel-Lindau disease and is distinguished by its relatively hypervascular nature. Medullary carcinoma affects adolescents with the sickle cell trait and is characterized by an infiltrative growth pattern and extensive metastasis at presentation. Angiomyolipoma is seen in children with tuberous sclerosis complex and is often multifocal and hypervascular, with macroscopic fat. Metanephric tumors are central, circumscribed, and typically calcified. Lymphoma usually manifests as multifocal masses, but it may involve a solitary mass or infiltrative pattern. Extensive adenopathy and involvement of the gastrointestinal tract or other organs also may be seen. Primitive neuroectodermal tumor is an aggressive neoplasm that is typically quite large at diagnosis. Knowledge of the clinical, biologic, and histopathologic features of renal tumors in older children and adolescents and their effects on the imaging appearance can help the radiologist offer a useful preoperative differential diagnosis.
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Affiliation(s)
- Ellen M Chung
- From the Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine (A.J.F.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814 (E.M.C., G.E.L.); Pediatric Radiology Section (E.M.C.) and Genitourinary Radiology Section (G.E.L.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology (K.E.F.) and Office of Graduate Medical Education (A.M.K., M.A.P.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Pathology, Eastern Virginia Medical School, Norfolk, Va (R.M.C.)
| | - Grant E Lattin
- From the Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine (A.J.F.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814 (E.M.C., G.E.L.); Pediatric Radiology Section (E.M.C.) and Genitourinary Radiology Section (G.E.L.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology (K.E.F.) and Office of Graduate Medical Education (A.M.K., M.A.P.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Pathology, Eastern Virginia Medical School, Norfolk, Va (R.M.C.)
| | - Kimberly E Fagen
- From the Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine (A.J.F.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814 (E.M.C., G.E.L.); Pediatric Radiology Section (E.M.C.) and Genitourinary Radiology Section (G.E.L.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology (K.E.F.) and Office of Graduate Medical Education (A.M.K., M.A.P.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Pathology, Eastern Virginia Medical School, Norfolk, Va (R.M.C.)
| | - Andrew M Kim
- From the Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine (A.J.F.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814 (E.M.C., G.E.L.); Pediatric Radiology Section (E.M.C.) and Genitourinary Radiology Section (G.E.L.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology (K.E.F.) and Office of Graduate Medical Education (A.M.K., M.A.P.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Pathology, Eastern Virginia Medical School, Norfolk, Va (R.M.C.)
| | - Michael A Pavio
- From the Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine (A.J.F.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814 (E.M.C., G.E.L.); Pediatric Radiology Section (E.M.C.) and Genitourinary Radiology Section (G.E.L.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology (K.E.F.) and Office of Graduate Medical Education (A.M.K., M.A.P.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Pathology, Eastern Virginia Medical School, Norfolk, Va (R.M.C.)
| | - Adam J Fehringer
- From the Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine (A.J.F.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814 (E.M.C., G.E.L.); Pediatric Radiology Section (E.M.C.) and Genitourinary Radiology Section (G.E.L.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology (K.E.F.) and Office of Graduate Medical Education (A.M.K., M.A.P.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Pathology, Eastern Virginia Medical School, Norfolk, Va (R.M.C.)
| | - Richard M Conran
- From the Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine (A.J.F.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814 (E.M.C., G.E.L.); Pediatric Radiology Section (E.M.C.) and Genitourinary Radiology Section (G.E.L.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology (K.E.F.) and Office of Graduate Medical Education (A.M.K., M.A.P.), Walter Reed National Military Medical Center, Bethesda, Md; and Department of Pathology, Eastern Virginia Medical School, Norfolk, Va (R.M.C.)
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Manucha V, Sessums MT, Lewin J, Akhtar I. Cyto-histological correlation of Xp11.2 translocation/TFE3 gene fusion associated renal cell carcinoma: Report of a case with review of literature. Diagn Cytopathol 2017; 46:267-270. [PMID: 29024535 DOI: 10.1002/dc.23839] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/18/2017] [Accepted: 09/27/2017] [Indexed: 01/02/2023]
Abstract
The MiT family translocation renal cell carcinomas (RCCs) are relatively rare in comparison to the conventional RCC. The cytologic features overlap with conventional clear cell RCC and papillary RCCs, thereby making the diagnosis extremely challenging. Here, we describe a case of TFE3 translocation associated RCC in a 58-year-old patient, with emphasis on cytomorphologic features and clues toward this diagnostic entity. Correlating the cytohistologic findings and review of touch imprints revealed that presence of hyaline nodules resembling leisegang rings and psammoma bodies in cytologic smears from kidney tumors serve as an important clue in raising a suspicion for the diagnosis of MiT family translocation RCCs.
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Affiliation(s)
- Varsha Manucha
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Mary T Sessums
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Jack Lewin
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Israh Akhtar
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi
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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] [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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Tanaka T, Hirai K, Etori F, Matsuyama M, Watanabe N, Kondo H, Tamaki M, Yamashita T, Yasue S, Noda M, Shinoda K, Komeda H. Renal Cell Carcinoma Associated with Xp11.2 Translocation/TFE3 Gene Fusion: A Case Report with Immunohistochemical and Cytological Features. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojpathology.2016.61004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Validation and utilization of a TFE3 break-apart FISH assay for Xp11.2 translocation renal cell carcinoma and alveolar soft part sarcoma. Diagn Pathol 2015; 10:179. [PMID: 26415891 PMCID: PMC4587681 DOI: 10.1186/s13000-015-0412-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 09/20/2015] [Indexed: 11/20/2022] Open
Abstract
Background Xp11.2 or TFE3 translocation renal cell carcinomas (RCC) and alveolar soft part sarcoma (ASPS) are characterized by chromosome translocations involving the Xp11.2 breakpoint resulting in transcription factor TFE3 gene fusions. The most common translocations documented in TFE3 RCCs are t(X;1) (p11.2;q21) and t(X;17) (p11.2;q25) which leads to fusion of TFE3 gene on Xp11.2 with PRCC or ASPL respectively. TFE3 immunohistochemistry (IHC) has been inconsistent over time due to background staining problems in part related to fixation issues. Karyotyping to detect TFE3 gene rearrangement requires typically unavailable fresh tissue. Reverse transcriptase-polymerase chain reaction (RT-PCR) is generally very challenging due to degradation of RNA in archival material. The study objective was to develop and validate a TFE3 break-apart fluorescence in situ hybridization (FISH) assay to confirm Xp11 translocation RCCs and ASPS. Methods Representative sections of formalin-fixed paraffin-embedded tissue blocks were selected in 40 possible cases. Approximately 60 tumor cells were analyzed in the targeted region. The validation of TFE3 FISH was done with 11 negative and two positive cases. Cut off for a positive result was validated as >7.15 % positive nuclei with any pattern of break-apart signals. FISH evaluation was done blinded of the immunohistochemical or karyotype data. Results Three out of forty cases were positive for the TFE3 break-apart signals by FISH. The negative cases were reported as clear cell RCC with papillary features (10), clear cell RCC with sarcomatoid areas (2), Papillary RCC with clear cell areas (9), Chromophobe RCC (2), RCC, unclassified type (3) and renal medullary carcinoma (1). 3 of the negative cases were consultation cases for renal tumor with unknown histology. Seven negative cases were soft tissue tumor suspicious for ASPS. Conclusion Our study validates the utility of TFE3 break-apart FISH on formalin-fixed paraffin-embedded tissue sections for diagnosis and confirmation of Xp11.2 translocation RCCs and ASPS.
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Kuwamoto S, Murai Y, Endo Y, Masago T, Kuroda N, Horie Y. Cytologic Features of Renal Carcinoma Associated with Xp11.2 Translocations/ TFE3 Gene Fusions: A Case Report with Voided and Catheterized Urine Cytology and a Literature Review. Acta Cytol 2014; 58:406-12. [PMID: 25227872 DOI: 10.1159/000366406] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 07/25/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Renal carcinomas associated with Xp11.2 translocations/TFE3 gene fusions are rare subtypes of renal neoplasm that predominantly occur in younger individuals. There are very few reports describing the cytologic features of these tumors. CASE A 27-year-old man presented with hematuria and was found to have a mass in the lower part of the right kidney. Cytology of catheterized urine obtained from the right renal pelvis showed clusters of cells with abundant clear or eosinophilic granular cytoplasm, large round nuclei and prominent nucleoli. Papillary clusters containing thin fibrous stroma were occasionally seen. Voided urine cytology showed similar cell clusters but degeneration made the features obscure. Nephroureterectomy revealed a renal tumor showing a mixed papillary and nested architecture. The diagnosis was confirmed by immunohistochemistry and fluorescence in situ hybridization. CONCLUSION The present case indicates that the characteristic features of these tumor subtypes can be retained in urine cytology. Cytology may be enough to suspect these tumors as part of the differential diagnosis when the patient's age and imaging findings are taken into account and may facilitate further studies for a definitive diagnosis.
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Affiliation(s)
- Satoshi Kuwamoto
- Department of Pathology, Tottori University Hospital, Yonago, Japan
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13
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Wakely PE, McDermott JE, Ali SZ. Cytopathology of alveolar soft part sarcoma: a report of 10 cases. Cancer 2010; 117:500-7. [PMID: 19787801 DOI: 10.1002/cncy.20054] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Alveolar soft part sarcoma (ASPS) rarely is subjected to cytopathologic evaluation. With the exception of some very small series, the literature is limited to case reports. The objectives of the current study were to evaluate the cytomorphology of 10 ASPS cases on fine-needle aspiration (FNA) or imprint cytology, review the literature, and highlight potential diagnostic pitfalls. METHODS The authors searched their files for all lesions that were signed out as ASPS or suspicious for ASPS and searched the surgical pathology files for any cases of ASPS that had corresponding cytology. FNA was performed using the standard technique. Scrape preparations were performed on tissues that were sent fresh for frozen section examination. RESULTS Ten cases of ASPS were retrieved from 7 patients (male-to-female ratio, 4:3; mean age, 22 years). All had subsequent tissue confirmation. Six specimens were from primary lesions, 3 specimens were from metastases, and 1 intraoperative smear was from a previously aspirated primary mass in a newly diagnosed patient. Anatomic sites of involvement included extremities (5 specimens), trunk/pelvis (3 specimens), oral cavity (1 specimen), and lung (1 specimen). Eight specimens were aspirates, and 2 specimens were intraoperative smears. Nine cases were diagnosed correctly as ASPS/consistent with ASPS, and 1 specimen was diagnosed as "tumor, not otherwise specified". Cytomorphology included variably cellular smears composed of large cells with an enormous amount of finely granular or vacuolated cytoplasm, markedly enlarged nuclei/nucleoli, and bare nuclei. The cytomorphology of some cases revealed a strong similarity to renal cell carcinoma, clear cell type. CONCLUSIONS The results of the current study indicated that ASPS has cytomorphology that overlaps with several other neoplasms, including renal cell carcinoma. Nonetheless, the morphologic features, when combined with the clinical presentation, radiologic findings, and ancillary testing, may allow for a specific diagnosis.
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Affiliation(s)
- Paul E Wakely
- Department of Pathology, The Ohio State University College of Medicine, Columbus, Ohio, USA.
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Abstract
Abstract
Xp11.2 translocation renal cell carcinomas (RCCs), a recently recognized distinct subtype, are rare tumors predominantly reported in young patients. They comprise at least one-third of pediatric RCCs, and only few adult cases have been reported. They are characterized by various translocations involving chromosome Xp11.2, all resulting in gene fusions involving the transcription factor E3 (TFE3) gene. In recent years, at least 6 different Xp11.2 translocation RCCs have been identified and characterized at the molecular level. These include a distinctive RCC that bears a translocation with the identical chromosomal breakpoints (Xp11.2, 17q25) and identical resulting ASPL-TFE3 gene fusion as alveolar soft part sarcoma. They typically have papillary or nested architecture and are composed of cells with voluminous, clear, or eosinophilic cytoplasm. Their most distinctive immunohistochemical feature is nuclear labeling for TFE3 protein. Although only limited data are available so far, they are believed to be rather indolent, but there have been increasing, recent reports of an aggressive clinical course in adult cases. The consistent immunohistochemical staining for TFE3 in all RCC with unusual histology, regardless of patient age, is likely to expand the spectrum of Xp11.2 translocation RCC with respect to age, clinical behavior, and molecular abnormalities.
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Affiliation(s)
- Henry B. Armah
- From the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Anil V. Parwani
- From the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Suciu V, Fabre M, Klijanienko J, Pohar-Marinsek Z, Vielh P. Childhood tumours. Diagn Cytopathol 2010. [DOI: 10.1016/b978-0-7020-3154-0.00033-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Armah HB, Parwani AV, Surti U, Bastacky SI. Xp11.2 translocation renal cell carcinoma occurring during pregnancy with a novel translocation involving chromosome 19: a case report with review of the literature. Diagn Pathol 2009; 4:15. [PMID: 19450277 PMCID: PMC2690580 DOI: 10.1186/1746-1596-4-15] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 05/18/2009] [Indexed: 11/15/2022] Open
Abstract
The recently recognized renal cell carcinomas (RCCs) associated with Xp11.2 translocations (TFE3 transcription factor gene fusions) are rare tumors predominantly reported in children. They comprise at least one-third of pediatric RCCs and only few adult cases have been reported. Here, we present a case of Xp11.2 translocation RCC in 26-year-old pregnant female. Her routine antenatal ultrasonography accidentally found a complex cystic right renal mass. Further radiologic studies revealed unilocular cyst with multiple mural nodules at inferior pole of right kidney, which was suspicious for RCC. She underwent right radical nephrectomy at 15 weeks gestation. Macroscopically, the cystic tumor was well encapsulated with multiple friable mural nodules on its inner surface. Microscopically, the tumor consisted of clear and eosinophilic/oncocytic voluminous cells arranged in papillary, trabecular, and nested/alveolar patterns. Occasional hyaline nodules and numerous psammoma bodies were present. Immunohistochemically, the tumor showed strong nuclear positivity for TFE3. Epithelial membrane antigen, CD10, and E-cadherin were strongly positive. Cytokeratin AE1/AE3, cytokeratin CAM-5.2, calveolin, and parvalbumin were moderately positive. Cytokeratin 7, renal cell carcinoma antigen, and colloidal iron were focally weakly positive. BerEP4 and carbonic anhydrase IX were negative. Cytogenetically, the tumor harbored a novel variant translocation involving chromosomes X and 19, t(X;19)(p11.2;q13.1). Interphase FISH analysis performed on cultured and uncultured tumor cells using a dual-color break-apart DNA probe within the BCL3 gene on 19q13.3 was negative for the BCL3 gene rearrangement. She received no adjuvant therapy, delivered a normal term baby five months later, and is alive without evidence of disease 27 months after diagnosis and surgery. Unlike most recently reported Xp11.2 translocation RCCs in adult patients with aggressive clinical course, this adult case occurring during pregnancy with a novel translocation involving chromosome 19 followed an indolent clinical course.
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Affiliation(s)
- Henry B Armah
- Department of Pathology, Presbyterian-Shadyside Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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Renal translocation carcinomas: clinicopathologic, immunohistochemical, and gene expression profiling analysis of 31 cases with a review of the literature. Am J Surg Pathol 2008; 32:656-70. [PMID: 18344867 DOI: 10.1097/pas.0b013e3181609914] [Citation(s) in RCA: 196] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We report clinicopathologic features of a large series of renal translocation carcinomas from a multicentric study. Diagnosis was performed by cytogenetic examination of fresh material and/or by immunochemistry with antibodies directed against the C-terminal part of transcription factor E3 (TFE3) and native transcription factor EB (TFEB) proteins. Clinical data, follow-up, and histologic features were assessed. Antibodies against CK7, CD10, vimentin, epithelial membrane antigen, AE1-AE3, E-cadherin, alpha-methylacyl-coenzyme A racemase, melan A, and HMB45 were tested on tissue microarrays. Whole-genome microarray expression profiling was performed on 4 tumors. Twenty-nine cases were diagnosed as TFE3 and 2 as TFEB renal translocation carcinomas, including 13 males and 18 females, mean age 24.6 years. Two patients had a previous history of chemotherapy and 1 had a history of renal failure. Mean size of the tumor was 6.9 cm. Thirteen cases were > or = pT3 stage. Twelve cases were N+ or M+. Mean follow-up was 29.5 months. Three patients presented metastases and 5 have died. Mixed papillary and nested patterns with clear and/or eosinophilic cells represented the most consistent histologic appearance, with common foci of calcifications regardless of the type of translocation. Using a 30 mn incubation at room temperature, TFE3 immunostainings were positive in only 82% of our TFE3 translocation carcinomas. Both TFE3 and TFEB renal translocation carcinomas expressed CD10 and alpha-methylacyl-coenzyme A racemase in all cases. An expression of E-cadherin was observed in two-third of cases. Cytokeratins were expressed in less than one-third of cases. Melanocytic markers were expressed at least weakly in all cases except two. Unsupervised clustering on the basis of the gene expression profiling indicated a distinct subgroup of tumors. TRIM 63 glutathione S-transferase A1 and alanyl aminopeptidase are the main differentially expressed genes for this group of tumors. Our results suggest that these differentially expressed genes may serve as novel diagnostic or prognostic markers.
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Armah HB, Parwani AV. Renal cell carcinoma in a 33-year-old male with an unusual morphology and an aggressive clinical course possible Xp11.2 translocation. Pathology 2008; 40:306-8. [DOI: 10.1080/00313020701816373] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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