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Sangoi AR, Nova-Camacho LM, Akgul M, Queipo FJ, Aisa G, Garcia-Martos M, Panizo A. Scars Run Deep: Problematic Morphology and Immunoprofile of Scars in Renal Oncocytomas. Int J Surg Pathol 2024; 32:83-90. [PMID: 37143313 DOI: 10.1177/10668969231171683] [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] [Indexed: 05/06/2023]
Abstract
In some instances, the central scar of renal oncocytoma can demonstrate entrapped cells with unusual morphology and aberrant immunoprofile creating potential diagnostic confusion. Herein, 100 renal oncocytomas containing scars with embedded epithelial cells were identified from 6 institutions, including nephrectomies (64% partial, 36% radical) of similar laterality (left = 51%) and sex distribution (male = 56%), with patient ages ranging from 38 to 86 years (mean = 64.3years) and tumor sizes ranging from 2 to 16 cm (mean = 5.3 cm). Immunohistochemistry was performed on all tumors for KRT7, KIT, vimentin, and CA9 with staining intensity and extensity separately analyzed. Of 4 architectural patterns of cells within the scar, 60% showed tubular pattern. Of 4 cytologies within the scar, flat/elongated (49%) and cuboidal cells (40%) predominated. Within the scar, 62% showed eosinophilic cytoplasm, with 38% showing both cleared and eosinophilic cytoplasm; notably, 79% showed higher grade nuclei than typical oncocytes. A subset of scar cells showed mucinous-like basophilic secretions (19%). Compared to background renal oncocytoma, tumor cells within the scar were more often positive for vimentin, KRT7, and CA9 and more frequently negativity for KIT. Specifically, of the notable "aberrant" immunoprofiles, 79% showed KRT7 positivity/KIT negativity/vimentin positive, 84% showed vimentin positivity/CA9 positivity, and 78% showed KIT negativity/vimentin positivity/CA9 positivity. While encountering scars within renal oncocytomas is not uncommon, what is not well appreciated is the unique morphology and immunohistochemistry of tumor cells within the scar. Comparing tumor morphology and immunoprofile of the scar to the background oncocytoma is helpful to avoid interpretative confusion.
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Affiliation(s)
- Ankur R Sangoi
- Department of Pathology, Stanford Medical Center, Stanford, CA, USA
| | | | - Mahmut Akgul
- Dpartment of Pathology, Albany Medical Center, Albany, NY, USA
| | - Francisco J Queipo
- Department of Pathology, Hospital Universitario de A Coruna, A Coruna, Spain
| | - Gregorio Aisa
- Department of Pathology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Maria Garcia-Martos
- Department of Pathology, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - Angel Panizo
- Department of Pathology, Hospital Universitario de Navarra, Pamplona, Spain
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2
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Matar S, El Ahmar N, Laimon YN, Ghandour F, Signoretti S. The Role of the Pathologist in Renal Cell Carcinoma Management. Hematol Oncol Clin North Am 2023; 37:849-862. [PMID: 37258353 DOI: 10.1016/j.hoc.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Recent advances in our understanding of the molecular alterations underlying different types of renal cell carcinoma (RCC), as well as the implementation of immune checkpoint inhibitors in the treatment of patients with advanced disease, have significantly expanded the role of pathologists in the management of RCC patients and in the identification of predictive biomarkers that can guide patient treatment. In this chapter, we examine pathologists' evolving role in patient care and the development of precision medicine strategies for RCC.
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Affiliation(s)
- Sayed Matar
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Nourhan El Ahmar
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Yasmin Nabil Laimon
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Fatme Ghandour
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Broad Institute of MIT and Harvard, Merkin Building, 415 Main Street, Cambridge, MA 02142, USA; Department of Oncologic Pathology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
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3
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Nassar AH, Abou Alaiwi S, Baca SC, Adib E, Corona RI, Seo JH, Fonseca MAS, Spisak S, El Zarif T, Tisza V, Braun DA, Du H, He M, Flaifel A, Alchoueiry M, Denize T, Matar SG, Acosta A, Shukla S, Hou Y, Steinharter J, Bouchard G, Berchuck JE, O'Connor E, Bell C, Nuzzo PV, Mary Lee GS, Signoretti S, Hirsch MS, Pomerantz M, Henske E, Gusev A, Lawrenson K, Choueiri TK, Kwiatkowski DJ, Freedman ML. Epigenomic charting and functional annotation of risk loci in renal cell carcinoma. Nat Commun 2023; 14:346. [PMID: 36681680 PMCID: PMC9867739 DOI: 10.1038/s41467-023-35833-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/04/2023] [Indexed: 01/22/2023] Open
Abstract
While the mutational and transcriptional landscapes of renal cell carcinoma (RCC) are well-known, the epigenome is poorly understood. We characterize the epigenome of clear cell (ccRCC), papillary (pRCC), and chromophobe RCC (chRCC) by using ChIP-seq, ATAC-Seq, RNA-seq, and SNP arrays. We integrate 153 individual data sets from 42 patients and nominate 50 histology-specific master transcription factors (MTF) to define RCC histologic subtypes, including EPAS1 and ETS-1 in ccRCC, HNF1B in pRCC, and FOXI1 in chRCC. We confirm histology-specific MTFs via immunohistochemistry including a ccRCC-specific TF, BHLHE41. FOXI1 overexpression with knock-down of EPAS1 in the 786-O ccRCC cell line induces transcriptional upregulation of chRCC-specific genes, TFCP2L1, ATP6V0D2, KIT, and INSRR, implicating FOXI1 as a MTF for chRCC. Integrating RCC GWAS risk SNPs with H3K27ac ChIP-seq and ATAC-seq data reveals that risk-variants are significantly enriched in allelically-imbalanced peaks. This epigenomic atlas in primary human samples provides a resource for future investigation.
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Affiliation(s)
- Amin H Nassar
- Department of Hematology/Oncology, Yale New Haven Hospital, New Haven, CT, 06510, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Sarah Abou Alaiwi
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Center for Functional Cancer Epigenetics, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Sylvan C Baca
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Elio Adib
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Rosario I Corona
- Women's Cancer Research Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Center for Bioinformatics and Functional Genomics, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ji-Heui Seo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Marcos A S Fonseca
- Women's Cancer Research Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sandor Spisak
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Center for Functional Cancer Epigenetics, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- The Eli and Edythe L. Broad Institute, Cambridge, MA, 02142, USA
| | - Talal El Zarif
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Viktoria Tisza
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Center for Functional Cancer Epigenetics, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- The Eli and Edythe L. Broad Institute, Cambridge, MA, 02142, USA
| | - David A Braun
- Department of Hematology/Oncology, Yale New Haven Hospital, New Haven, CT, 06510, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- The Eli and Edythe L. Broad Institute, Cambridge, MA, 02142, USA
| | - Heng Du
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Monica He
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Abdallah Flaifel
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Michel Alchoueiry
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Thomas Denize
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Sayed G Matar
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Andres Acosta
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Sachet Shukla
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Translational Immunogenomics Lab, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Yue Hou
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Translational Immunogenomics Lab, Dana-Farber Cancer Institute, Boston, MA, USA
| | - John Steinharter
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Gabrielle Bouchard
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Jacob E Berchuck
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Edward O'Connor
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Connor Bell
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Pier Vitale Nuzzo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Gwo-Shu Mary Lee
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Michelle S Hirsch
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Mark Pomerantz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Elizabeth Henske
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Alexander Gusev
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- McGraw/Patterson Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA, 02115, USA
| | - Kate Lawrenson
- Women's Cancer Research Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Center for Bioinformatics and Functional Genomics, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Toni K Choueiri
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA.
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA.
| | - David J Kwiatkowski
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA.
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA.
| | - Matthew L Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA.
- Center for Functional Cancer Epigenetics, Dana-Farber Cancer Institute, Boston, MA, 02215, USA.
- The Eli and Edythe L. Broad Institute, Cambridge, MA, 02142, USA.
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4
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Lobo J, Ohashi R, Amin MB, Berney DM, Compérat EM, Cree IA, Gill AJ, Hartmann A, Menon S, Netto GJ, Raspollini MR, Rubin MA, Tan PH, Tickoo SK, Tsuzuki T, Turajlic S, Zhou M, Srigley JR, Moch H. WHO 2022 landscape of papillary and chromophobe renal cell carcinoma. Histopathology 2022; 81:426-438. [PMID: 35596618 DOI: 10.1111/his.14700] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/04/2022] [Accepted: 05/18/2022] [Indexed: 12/01/2022]
Abstract
The 5th edition of the WHO Classification of Tumours of the Urinary and Male Genital Systems contains relevant revisions and introduces a group of molecularly defined renal tumour subtypes. Herein we present the World Health Organization (WHO) 2022 perspectives on papillary and chromophobe renal cell carcinoma with emphasis on their evolving classification, differential diagnosis, and emerging entities. The WHO 2022 classification eliminated the type 1/2 papillary renal cell carcinoma (pRCC) subcategorization, given the recognition of frequent mixed tumour phenotypes and the existence of entities with a different molecular background within the type 2 pRCC category. Additionally, emerging entities such as biphasic squamoid alveolar RCC, biphasic hyalinising psammomatous RCC, papillary renal neoplasm with reverse polarity, and Warthin-like pRCC are included as part of the pRCC spectrum, while additional morphological and molecular data are being gathered. In addition to oncocytomas and chromophobe renal cell carcinoma (chRCC), a category of 'other oncocytic tumours' with oncocytoma/chRCC-like features has been introduced, including emerging entities, most with TSC/mTOR pathway alterations (eosinophilic vacuolated tumour and so-called 'low-grade' oncocytic tumour), deserving additional research. Eosinophilic solid and cystic RCC was accepted as a new and independent tumour entity. Finally, a highly reproducible and clinically relevant universal grading system for chRCC is still missing and is another niche of ongoing investigation. This review discusses these developments and highlights emerging morphological and molecular data relevant for the classification of renal cell carcinoma.
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Affiliation(s)
- João Lobo
- Department of Pathology, Portuguese Oncology Institute of Porto (IPOP), Porto, Portugal
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (GEBC CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (P.CCC), Porto, Portugal
- Department of Pathology and Molecular Immunology, ICBAS-School of Medicine and Biomedical Sciences, University of Porto (ICBAS-UP), Porto, Portugal
| | - Riuko Ohashi
- Histopathology Core Facility, Niigata University Faculty of Medicine, Niigata, Japan
- Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Mahul B Amin
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Sciences Center, Memphis, USA
- Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Daniel M Berney
- Centre for Molecular Oncology, Barts and the London School of Medicine and Dentistry, London, UK
| | - Eva M Compérat
- Department of Pathology, Hôpital Tenon, Sorbonne University, Paris, France
| | - Ian A Cree
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Anthony J Gill
- Sydney Medical School, The University of Sydney, Sydney, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, NSW Health Pathology, St Leonards, New South Wales, Australia
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - George J Netto
- Department of Pathology, University of Alabama, Birmingham, AL, USA
| | - Maria R Raspollini
- Histopathology and Molecular Diagnostics, Careggi University Hospital, Florence, Italy
| | - Mark A Rubin
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
- Department for BioMedical Research, University of Bern, Bern, Switzerland
- Englander Institute for Precision Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore
| | - Satish K Tickoo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan
| | - Samra Turajlic
- Renal and Skin Units, The Royal Marsden Hospital NHS Foundation Trust, London, UK
- The Francis Crick Institute, London, UK
| | - Ming Zhou
- Department of Pathology, Tufts Medical Center, Boston, Massachusetts, USA
| | - John R Srigley
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University and University Hospital Zurich, Zurich, Switzerland
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5
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Kriegsmann M, Casadonte R, Maurer N, Stoehr C, Erlmeier F, Moch H, Junker K, Zgorzelski C, Weichert W, Schwamborn K, Deininger SO, Gaida M, Mechtersheimer G, Stenzinger A, Schirmacher P, Hartmann A, Kriegsmann J, Kriegsmann K. Mass Spectrometry Imaging Differentiates Chromophobe Renal Cell Carcinoma and Renal Oncocytoma with High Accuracy. J Cancer 2020; 11:6081-6089. [PMID: 32922548 PMCID: PMC7477404 DOI: 10.7150/jca.47698] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/29/2020] [Indexed: 12/18/2022] Open
Abstract
Background: While subtyping of the majority of malignant chromophobe renal cell carcinoma (cRCC) and benign renal oncocytoma (rO) is possible on morphology alone, additional histochemical, immunohistochemical or molecular investigations are required in a subset of cases. As currently used histochemical and immunohistological stains as well as genetic aberrations show considerable overlap in both tumors, additional techniques are required for differential diagnostics. Mass spectrometry imaging (MSI) combining the detection of multiple peptides with information about their localization in tissue may be a suitable technology to overcome this diagnostic challenge. Patients and Methods: Formalin-fixed paraffin embedded (FFPE) tissue specimens from cRCC (n=71) and rO (n=64) were analyzed by MSI. Data were classified by linear discriminant analysis (LDA), classification and regression trees (CART), k-nearest neighbors (KNN), support vector machine (SVM), and random forest (RF) algorithm with internal cross validation and visualized by t-distributed stochastic neighbor embedding (t-SNE). Most important variables for classification were identified and the classification algorithm was optimized. Results: Applying different machine learning algorithms on all m/z peaks, classification accuracy between cRCC and rO was 85%, 82%, 84%, 77% and 64% for RF, SVM, KNN, CART and LDA. Under the assumption that a reduction of m/z peaks would lead to improved classification accuracy, m/z peaks were ranked based on their variable importance. Reduction to six most important m/z peaks resulted in improved accuracy of 89%, 85%, 85% and 85% for RF, SVM, KNN, and LDA and remained at the level of 77% for CART. t-SNE showed clear separation of cRCC and rO after algorithm improvement. Conclusion: In summary, we acquired MSI data on FFPE tissue specimens of cRCC and rO, performed classification and detected most relevant biomarkers for the differential diagnosis of both diseases. MSI data might be a useful adjunct method in the differential diagnosis of cRCC and rO.
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Affiliation(s)
- Mark Kriegsmann
- Institute of Pathology, Heidelberg University, Heidelberg, Germany
| | | | - Nadine Maurer
- Institute of Pathology, University Hospital Erlangen-Nürnberg, Erlangen, Germany
| | - Christine Stoehr
- Institute of Pathology, University Hospital Erlangen-Nürnberg, Erlangen, Germany
| | - Franziska Erlmeier
- Institute of Pathology, University Hospital Erlangen-Nürnberg, Erlangen, Germany
| | - Holger Moch
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Switzerland
| | - Klaus Junker
- Department of Urology and Pediatric Urology, University of Saarland, Homburg/Saar, Germany
| | | | | | | | | | | | | | | | | | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen-Nürnberg, Erlangen, Germany
| | - Joerg Kriegsmann
- Proteopath Trier, Trier, Germany.,Centre for Histology, Cytology and molecular Diagnostics Trier, Trier, Germany.,Danube Private University, Krems, Austria
| | - Katharina Kriegsmann
- Department Hematology, Oncology and Rheumatology, Heidelberg University, Heidelberg, Germany
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6
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Major Subtypes of Renal Cell Carcinoma. KIDNEY CANCER 2020. [DOI: 10.1007/978-3-030-28333-9_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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7
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Ng KL, Ellis RJ, Samaratunga H, Morais C, Gobe GC, Wood ST. Utility of cytokeratin 7, S100A1 and caveolin-1 as immunohistochemical biomarkers to differentiate chromophobe renal cell carcinoma from renal oncocytoma. Transl Androl Urol 2019; 8:S123-S137. [PMID: 31236330 DOI: 10.21037/tau.2018.11.02] [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] [Indexed: 12/20/2022] Open
Abstract
Background Differentiation of chromophobe renal cell carcinoma (chRCC) from benign renal oncocytoma (RO) can be challenging especially when there are overlapping histological and morphological features. In this study we have investigated immunohistochemical biomarkers (cytokeratin 7/CK7, Caveolin-1/Cav-1 and S100 calcium-binding protein A1/S100A1) to aid in this difficult differentiation and attempted to validate their use in human renal tumour tissue to assess their discriminatory ability, particularly for chRCC and RO, in an Australian cohort of patients. Methods Retrospective study was carried out of archived formalin-fixed paraffin-embedded renal tumours from tumour nephrectomy specimens of 75 patients: 30 chRCC, 15 RO and 30 clear cell RCC (ccRCC). Sections were cut and immunostained with specific polyclonal antibodies of CK7, Cav-1 and S100A1. Morphometry was used to determine expression patterns of the biomarkers using Aperio ImageScope. Results were assessed with student t-test and ANOVA with significance at P<0.05. Results From this cohort, male-to-female ratio was 1.9:1. Median age was 64 (45-88 years) and median tumour size was 3.8 cm (range, 1.2-18 cm). There were 47 (62.7%) T1, 7 T2, 20 T3 and one T4 stage of RCC; with 2 patients presenting with M1 stage. There was significantly higher CK7 expression in chRCC compared to RO (P=0.03), and chRCC also had a different staining pattern and higher expression of Cav-1 compared to RO. There was higher expression of S100A1 in RO compared to chRCC. Conclusions Immunohistochemical staining and standard morphometry of CK7, Cav-1 and S100A1 can aid in the differentiation of chRCC and RO. This may guide clinicians in management of patients when faced with difficult diagnostic histological distinction between the two tumour subtypes.
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Affiliation(s)
- Keng Lim Ng
- Department of Urology, Frimley Park Hospital, Frimley, UK.,Department of Urology, Princess Alexandra Hospital, Brisbane, Australia.,Centre for Kidney Disease and Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Robert J Ellis
- Department of Urology, Princess Alexandra Hospital, Brisbane, Australia.,Centre for Kidney Disease and Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | | | - Christudas Morais
- Department of Urology, Princess Alexandra Hospital, Brisbane, Australia.,Centre for Kidney Disease and Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Glenda C Gobe
- Centre for Kidney Disease and Research, Faculty of Medicine, University of Queensland, Brisbane, Australia.,School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, Australia.,NHMRC Centre for Research Excellence CKD.QLD, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Simon T Wood
- Department of Urology, Princess Alexandra Hospital, Brisbane, Australia.,Centre for Kidney Disease and Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
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8
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Kowalewski A, Szylberg Ł, Tyloch J, Antosik P, Neska-Długosz I, Frąckowski Ł, Tyloch D, Purpurowicz P, Grzanka D. Caspase 3 as a Novel Marker to Distinguish Chromophobe Renal Cell Carcinoma from Oncocytoma. Pathol Oncol Res 2018; 25:1519-1524. [PMID: 30467700 PMCID: PMC6815282 DOI: 10.1007/s12253-018-0548-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 11/16/2018] [Indexed: 12/23/2022]
Abstract
Despite advances in our understanding of the biology of chromophobe renal cell carcinoma (ChRCC) and renal oncocytoma (RO), the differential diagnosis among these tumors remains one of the most problematic in renal pathology. Today, CK7 is the most recommended marker to distinguish these entities, however it appears insufficiently accurate by itself. This study aimed to find an easily accessible IHC stain that might out-compete CK7 in this field. Expressions of CK7, cyclin D1, p16, survivin, CD138, Ki-67 and caspase 3 (CASP3) were analyzed in a total of 27 cases (20 ROs and 7 ChRCCs). Immunoreactivity was assessed based on a combined score of the extent and intensity of staining. Compared to RO, a higher percentage of the total ChRCCs stained positive for CK7 (67% vs. 22%, respectively) and CASP3 (86% vs. 25%) (P < 0.005). The differences in staining with cyclin D1, p16, survivin, CD138 and Ki-67 turned out to be statistically insignificant in differentiating ChRCC from RO. CASP3 is a promising marker in distinguishing ChRCC from RO and may represent an alternative for CK7. Cyclin D1, p16, survivin, CD138 and Ki-67 cannot be used to distinguish these neoplasms.
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Affiliation(s)
- Adam Kowalewski
- Department of Clinical Pathomorphology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, ul. Sklodowskiej-Curie Str. 9, 85-094, Bydgoszcz, Poland.
| | - Łukasz Szylberg
- Department of Clinical Pathomorphology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, ul. Sklodowskiej-Curie Str. 9, 85-094, Bydgoszcz, Poland
| | - Janusz Tyloch
- Department of General and Oncologic Urology, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Paulina Antosik
- Department of Clinical Pathomorphology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, ul. Sklodowskiej-Curie Str. 9, 85-094, Bydgoszcz, Poland
| | - Izabela Neska-Długosz
- Department of Clinical Pathomorphology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, ul. Sklodowskiej-Curie Str. 9, 85-094, Bydgoszcz, Poland
| | - Łukasz Frąckowski
- Department of General and Oncologic Urology, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Dominik Tyloch
- Department of General and Oncologic Urology, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Piotr Purpurowicz
- Department of General and Oncologic Urology, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Dariusz Grzanka
- Department of Clinical Pathomorphology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, ul. Sklodowskiej-Curie Str. 9, 85-094, Bydgoszcz, Poland
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9
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Amin J, Xu B, Badkhshan S, Creighton TT, Abbotoy D, Murekeyisoni C, Attwood KM, Schwaab T, Hendler C, Petroziello M, Roche CL, Kauffman EC. Identification and Validation of Radiographic Enhancement for Reliable Differentiation of CD117(+) Benign Renal Oncocytoma and Chromophobe Renal Cell Carcinoma. Clin Cancer Res 2018; 24:3898-3907. [PMID: 29752278 DOI: 10.1158/1078-0432.ccr-18-0252] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/23/2018] [Accepted: 05/07/2018] [Indexed: 12/13/2022]
Abstract
Purpose: The diagnostic differential for CD117/KIT(+) oncocytic renal tumor biopsies is limited to benign renal oncocytoma versus chromophobe renal cell carcinoma (ChRCC); however, further differentiation is often challenging and requires surgical resection. We investigated clinical variables that might improve preoperative differentiation of CD117(+) renal oncocytoma versus ChRCC to avoid the need for benign tumor resection.Experimental Design: A total of 124 nephrectomy patients from a single institute with 133 renal oncocytoma or ChRCC tumors were studied. Patients from 2003 to 2012 comprised a retrospective cohort to identify clinical/radiographic variables associated with renal oncocytoma versus ChRCC. Prospective validation was performed among consecutive renal oncocytoma/ChRCC tumors resected from 2013 to 2017.Results: Tumor size and younger age were associated with ChRCC, and multifocality with renal oncocytoma; however, the most reliable variable for ChRCC versus renal oncocytoma differentiation was the tumor:cortex peak early-phase enhancement ratio (PEER) using multiphase CT. Among 54 PEER-evaluable tumors in the retrospective cohort [19 CD117(+), 13 CD117(-), 22 CD117-untested], PEER classified each correctly as renal oncocytoma (PEER >0.50) or ChRCC (PEER ≤0.50), except for four misclassified CD117(-) ChRCC variants. Prospective study of PEER confirmed 100% accuracy of renal oncocytoma/ChRCC classification among 22/22 additional CD117(+) tumors. Prospective interobserver reproducibility was excellent for PEER scoring (intraclass correlation coefficient, ICC = 0.97) and perfect for renal oncocytoma/ChRCC assignment (ICC = 1.0).Conclusions: In the largest clinical comparison of renal oncocytoma versus ChRCC to our knowledge, we identified and prospectively validated a reproducible radiographic measure that differentiates CD117(+) renal oncocytoma from ChRCC with potentially 100% accuracy. PEER may allow reliable biopsy-based diagnosis of CD117(+) renal oncocytoma, avoiding the need for diagnostic nephrectomy. Clin Cancer Res; 24(16); 3898-907. ©2018 AACR.
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Affiliation(s)
- Jay Amin
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York
| | - Bo Xu
- Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York
| | - Shervin Badkhshan
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York
| | | | - Daniel Abbotoy
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York
| | | | - Kristopher M Attwood
- Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, New York
| | - Thomas Schwaab
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.,Department of Immunology, Roswell Park Cancer Institute, Buffalo, New York.,Department of Urology, State University of New York at Buffalo, Buffalo, New York
| | - Craig Hendler
- Department of Diagnostic Radiology, Roswell Park Cancer Institute, Buffalo, New York
| | - Michael Petroziello
- Department of Diagnostic Radiology, Roswell Park Cancer Institute, Buffalo, New York
| | - Charles L Roche
- Department of Diagnostic Radiology, Roswell Park Cancer Institute, Buffalo, New York
| | - Eric C Kauffman
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York. .,Department of Urology, State University of New York at Buffalo, Buffalo, New York.,Department of Cancer Genetics, Roswell Park Cancer Institute, Buffalo, New York
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10
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Guo R, Liang Y, Yan L, Xu Z, Ren J. Erythrocytosis caused by giant chromophobe renal cell carcinoma: a case report indicating a 9-year misdiagnosis of polycythemia vera. CHINESE JOURNAL OF CANCER 2017; 36:72. [PMID: 28877745 PMCID: PMC5588672 DOI: 10.1186/s40880-017-0238-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 07/17/2017] [Indexed: 12/24/2022]
Abstract
Background Erythrocytosis, a rare paraneoplastic syndrome, generally occurs in patients with clear cell renal cell carcinoma and has never been reported in patients with chromophobe renal cell carcinoma. Case presentation We report a case of a young man suffering from a giant (22-cm) mass on his left kidney. Because of a history of polycythemia vera, the patient had been treated for the condition for 9 years. Radical nephrectomy was successfully performed, and the postoperative pathologic examination confirmed a diagnosis of chromophobe renal cell carcinoma. Unexpectedly, the symptom of erythrocytosis disappeared after the surgery. Further examination and analysis were performed, and we finally attributed his erythrocytosis to chromophobe renal cell carcinoma. Conclusions Chromophobe renal cell carcinoma could cause erythrocytosis, but the clear-cut mechanism needs further research. Secondary erythrocytosis such as those related with renal tumors should be taken into consideration during the diagnosis of polycythemia vera.
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Affiliation(s)
- Renbo Guo
- Department of Urology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, 250117, Shandong, P. R. China
| | - Yiran Liang
- Department of Breast Surgery, QiLu Hospital, Shandong University, Jinan, 250012, Shandong, P. R. China
| | - Lei Yan
- Department of Urology, QiLu Hospital, Shandong University, Jinan, 250012, Shandong, P. R. China
| | - Zhonghua Xu
- Department of Urology, QiLu Hospital, Shandong University, Jinan, 250012, Shandong, P. R. China
| | - Juchao Ren
- Department of Urology, QiLu Hospital, Shandong University, Jinan, 250012, Shandong, P. R. China.
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11
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Udager AM, Mehra R. Morphologic, Molecular, and Taxonomic Evolution of Renal Cell Carcinoma: A Conceptual Perspective With Emphasis on Updates to the 2016 World Health Organization Classification. Arch Pathol Lab Med 2017; 140:1026-37. [PMID: 27684973 DOI: 10.5858/arpa.2016-0218-ra] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Molecular and morphologic interrogation has driven a much-needed reexamination of renal cell carcinoma (RCC). Indeed, the recently released 2016 World Health Organization classification now recognizes 12 distinct RCC subtypes, as well as several other emerging/provisional RCC entities. From a clinical perspective, accurate RCC classification may have important implications for patients and their families, including prognostic risk stratification, targeted therapeutics selection, and identification for genetic testing. In this review, we provide a conceptual framework for approaching RCC diagnosis and classification by categorizing RCCs as tumors with clear cytoplasm, papillary architecture, and eosinophilic (oncocytic) cytoplasm. The currently recognized 2016 World Health Organization classification for RCC subtypes is briefly discussed, including new diagnostic entities (clear cell papillary RCC, hereditary leiomyomatosis and RCC-associated RCC, succinate dehydrogenase-deficient RCC, tubulocystic RCC, and acquired cystic disease-associated RCC) and areas of evolving RCC classification, such as transcription elongation factor B subunit 1 (TCEB1)-mutated RCC/RCC with angioleiomyoma-like stroma/RCC with leiomyomatous stroma, RCC associated with anaplastic lymphoma receptor tyrosine kinase (ALK) gene rearrangement, thyroidlike follicular RCC, and RCC in neuroblastoma survivors. For each RCC subtype, relevant clinical, molecular, gross, and microscopic findings are reviewed, and ancillary studies helpful for its differential diagnosis are presented, providing a practical approach to modern RCC classification.
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Affiliation(s)
- Aaron M Udager
- From the Department of Pathology (Drs Udager and Mehra) and the Comprehensive Cancer Center (Dr Mehra), University of Michigan Health System, Ann Arbor; and the Michigan Center for Translational Pathology, Ann Arbor (Dr Mehra)
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12
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Foix MP, Dunatov A, Martinek P, Mundó EC, Suster S, Sperga M, Lopez JI, Ulamec M, Bulimbasic S, Montiel DP, Alaghehbandan R, Peckova K, Pivovarcikova K, Ondrej D, Rotterova P, Skenderi F, Prochazkova K, Dusek M, Hora M, Michal M, Hes O. Morphological, immunohistochemical, and chromosomal analysis of multicystic chromophobe renal cell carcinoma, an architecturally unusual challenging variant. Virchows Arch 2016; 469:669-678. [PMID: 27631338 DOI: 10.1007/s00428-016-2022-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/27/2016] [Accepted: 09/05/2016] [Indexed: 12/11/2022]
Abstract
Chromophobe renal cell carcinoma (ChRCC) is typically composed of large leaf-like cells and smaller eosinophilic cells arranged in a solid-alveolar pattern. Eosinophilic, adenomatoid/pigmented, or neuroendocrine variants have also been described. We collected 10 cases of ChRCC with a distinct multicystic pattern out of 733 ChRCCs from our registry, and subsequently analyzed these by morphology, immunohistochemistry, and array comparative genomic hybridization. Of the 10 patients, 6 were males with an age range of 50-89 years (mean 68, median 69). Tumor size ranged between 1.2 and 20 cm (mean 5.32, median 3). Clinical follow-up was available for seven patients, ranging 1-19 years (mean 7.2, median 2.5). No aggressive behavior was documented. We observed two growth patterns, which were similar in all tumors: (1) variable-sized cysts, resembling multilocular cystic neoplasm of low malignant potential and (2) compressed cystic and tubular pattern with slit-like spaces. Raisinoid nuclei were consistently present while necrosis was absent in all cases. Half of the cases showed eosinophilic/oncocytic cytology, deposits of pigment (lipochrome) and microcalcifications. The other half was composed of pale or mixed cell populations. Immunostains for epithelial membrane antigen (EMA), CK7, OSCAR, CD117, parvalbumin, MIA, and Pax 8 were positive in all tumors while negative for vimentin, TFE3, CANH 9, HMB45, cathepsin K, and AMACR. Ki67 immunostain was positive in up to 1 % of neoplastic cells. Molecular genetic examination revealed multiple chromosomal losses in two fifths analyzable tumors, while three cases showed no chromosomal numerical aberrations. ChRCC are rarely arranged in a prominent multicystic pattern, which is probably an extreme form of the microcystic adenomatoid pigmented variant of ChRCC. The spectrum of tumors entering the differential diagnosis of ChRCC is quite different from that of conventional ChRCC. The immunophenotype of ChRCC is identical with that of conventional ChRCC. Chromosomal numerical aberration pattern was variable; no chromosomal numerical aberrations were found in three cases. All the cases in this series have shown an indolent and non-aggressive behavior.
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Affiliation(s)
- Maria Pané Foix
- Department of Pathology, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Ana Dunatov
- Department of Pathology, University of Split, Split, Croatia
| | - Petr Martinek
- Department of Pathology, , Medical Faculty and Charles University Hospital Plzen, Charles University, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - Enric Condom Mundó
- Department of Pathology, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Maris Sperga
- Department of Pathology, East University, Riga, Latvia
| | - Jose I Lopez
- Department of Pathology, Cruces University Hospital, Biocruces Research Institute, University of the Basque Country, Barakaldo, Spain
| | - Monika Ulamec
- "Ljudevit Jurak" Pathology Department, Clinical Hospital Center "Sestre milosrdnice", Zagreb, Croatia
| | - Stela Bulimbasic
- Department of Pathology, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Delia Perez Montiel
- Department of Pathology, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Reza Alaghehbandan
- Department of Pathology, Faculty of Medicine, Royal Columbian Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Kvetoslava Peckova
- Department of Pathology, , Medical Faculty and Charles University Hospital Plzen, Charles University, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - Krystina Pivovarcikova
- Department of Pathology, , Medical Faculty and Charles University Hospital Plzen, Charles University, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - Daum Ondrej
- Department of Pathology, , Medical Faculty and Charles University Hospital Plzen, Charles University, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - Pavla Rotterova
- Department of Pathology, , Medical Faculty and Charles University Hospital Plzen, Charles University, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - Faruk Skenderi
- Department of Pathology, Clinical Center of the University of Srajevo, Sarajevo, Bosnia and Herzegovina
| | - Kristyna Prochazkova
- Department of Urology, Medical Faculty and Charles University Hospital, Charles University, Plzen, Czech Republic
| | - Martin Dusek
- Department of Pathology, , Medical Faculty and Charles University Hospital Plzen, Charles University, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - Milan Hora
- Department of Urology, Medical Faculty and Charles University Hospital, Charles University, Plzen, Czech Republic
| | - Michal Michal
- Department of Pathology, , Medical Faculty and Charles University Hospital Plzen, Charles University, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - Ondrej Hes
- Department of Pathology, , Medical Faculty and Charles University Hospital Plzen, Charles University, Alej Svobody 80, 304 60, Pilsen, Czech Republic.
- Biomedical Centre, Faculty of Medicine in Lzen, Charles University in Prague, Plzen, Czech Republic.
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13
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Badowska-Kozakiewicz AM, Budzik MP, Koczkodaj P, Przybylski J. Selected tumor markers in the routine diagnosis of chromophobe renal cell carcinoma. Arch Med Sci 2016; 12:856-63. [PMID: 27478468 PMCID: PMC4947610 DOI: 10.5114/aoms.2015.51188] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/15/2014] [Indexed: 01/09/2023] Open
Abstract
Renal cell carcinoma is one of the most malignant tumors, affecting men more frequently than women and constituting nearly 90% of all kidney tumors. Chromophobe renal cell carcinoma has been described as a new histological type of renal cell carcinoma. Chromophobe renal cell carcinoma constitutes up to 5% of all cases of kidney cancer. It is characterized by a significant number of deletions in many chromosomes, as well as the loss of entire chromosomes. Chromophobe renal cell carcinoma arises from tubular cells or cells of the macula densa. In contrast to other types of kidney cancer, it occurs with equal frequency in men and women, mostly in the sixth decade of life. It is characterized by a relatively good prognosis and exhibits a low degree of malignancy. Histopathologic diagnosis of ChRCC can be a diagnostic challenge because these tumors may resemble oncocytoma or conventional cancer. Research by Mathers et al. proposed the use of cytokeratin 7 as a marker useful in the differentiation of these changes.
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Affiliation(s)
| | - Michał P. Budzik
- Student Scientific Group of Cancer Cell Biology, Department of Human Biophysics and Physiology, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Koczkodaj
- Department of Human Biophysics and Physiology, Medical University of Warsaw, Warsaw, Poland
| | - Jacek Przybylski
- Department of Human Biophysics and Physiology, Medical University of Warsaw, Warsaw, Poland
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14
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Diagnostic utility of vimentin, CD117, cytokeratin-7 and caveolin-1 in differentiation between clear cell renal cell carcinoma, chromophobe renal cell carcinoma and oncocytoma. J Microsc Ultrastruct 2016; 5:90-96. [PMID: 30023241 PMCID: PMC6025761 DOI: 10.1016/j.jmau.2016.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 06/18/2016] [Accepted: 07/19/2016] [Indexed: 11/23/2022] Open
Abstract
Overlapping morphological characteristics pose some difficulties in making a proper diagnosis of clear cell renal cell carcinoma (CCRCC), chromophobe renal cell carcinoma (ChRCC), and oncocytoma, on the basis of hematoxylin-eosin-stained tissue sections. Our objective was to find out a fast, reliable panel of immunohistochemical markers for differentiation between them. The study was carried out on 55 selected renal tumor specimens: 36 cases of CCRCC, seven cases of ChRCC, and 12 cases of oncocytoma. The specimens were stained immunohistochemically for vimentin, CD117, cytokeratin (CK)7, and caveolin (Cav)-1. Sensitivity and specificity for each marker were calculated. Vimentin expression was exclusively observed in CCRCC (100%) and negative in ChRCC and oncocytoma. CD117 was absent in CCRCC, but it was strongly expressed in ChRCC (85.5%) and oncocytoma (91.7%), with high sensitivity and specificity. Most CCRCCs and oncocytomas were negative for CK7 (91.7% and 83.3%, respectively), in contrast to ChRCCs, which showed positivity in nearly 86% of the cases. Good sensitivity and specificity were calculated for CK7 in differentiating studied oncocytic tumors. Cav-1 was positive in ~78% of the CCRCCs and in all ChRCCs, whereas the vast majority of oncocytomas were negative. So the immunoprofile of CCRCC was vimentin+/CD117-/CK7-/Cav-1±, ChRCC was vimentin-/CD117+/CK7+/Cav-1+, and oncocytoma was vimentin-/CD117+/CK7±/Cav-1-. So, by using combination of four markers (vimentin, CD117, CK7, and Cav-1), we achieved excellent sensitivity and specificity for differential diagnosis of CCRCC, ChRCC and oncocytoma.
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15
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Immunohistochemical analysis of cytochrome C oxidase facilitates differentiation between oncocytoma and chromophobe renal cell carcinoma. Appl Immunohistochem Mol Morphol 2015; 23:54-9. [PMID: 25265428 DOI: 10.1097/pai.0000000000000036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this study, immunohistochemical staining pattern of cytochrome c oxidase subunit 1 (CCO1) was investigated in the differentiation of renal oncocytoma (RO) from eosinophilic (EoC) and classic chromophobe renal cell carcinoma (ChRCC). A feature found in ChRCC/EoC but not in RO is the predominance of a perinuclear halo when stained for CCO1. In a cohort of 103 mixed cases including 44 RO, 37 classic ChRCC and 22 EoC, the diagnosis based on this immunohistochemical feature alone was consistent with the previous routine diagnosis in 95.7%. We reached 100% specificity and 81.4% sensitivity of this pattern in ChRCC. Specificity for RO was 93.2% and sensitivity correspondingly 95.5%. We propose a novel and easily interpretable immunohistochemical method for the discrimination of benign RO from certain subtypes of malignant ChRCC. Because of strong similarity in morphology of the 2 entities the diagnosis often cannot be made based on standard histopathology alone. The study describes for the first time the formation of a perinuclear halo in CCO1 immunohistochemistry as a highly specific marker for the diagnosis of ChRCC. We think this method can be a strong amendment for routine diagnostics in renal cell carcinoma.
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16
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Zhao W, Tian B, Wu C, Peng Y, Wang H, Gu WL, Gao FH. DOG1, cyclin D1, CK7, CD117 and vimentin are useful immunohistochemical markers in distinguishing chromophobe renal cell carcinoma from clear cell renal cell carcinoma and renal oncocytoma. Pathol Res Pract 2015; 211:303-7. [DOI: 10.1016/j.prp.2014.12.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 12/14/2014] [Accepted: 12/23/2014] [Indexed: 11/29/2022]
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17
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Conner JR, Hirsch MS, Jo VY. HNF1β and S100A1 are useful biomarkers for distinguishing renal oncocytoma and chromophobe renal cell carcinoma in FNA and core needle biopsies. Cancer Cytopathol 2015; 123:298-305. [DOI: 10.1002/cncy.21530] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/08/2015] [Accepted: 01/28/2015] [Indexed: 12/30/2022]
Affiliation(s)
- James R. Conner
- Department of Pathology; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts
| | - Michelle S. Hirsch
- Department of Pathology; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts
| | - Vickie Y. Jo
- Department of Pathology; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts
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18
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Shinohara M, Samma S, Matsumoto Y, Kagebayashi Y, Nakai Y, Torimoto K, Shimada K. Renal cell neoplasm of oncocytosis: a type of unclassified renal cell carcinoma. CEN Case Rep 2014; 3:10-13. [PMID: 28509236 DOI: 10.1007/s13730-013-0075-0] [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: 07/13/2012] [Accepted: 03/13/2013] [Indexed: 11/30/2022] Open
Abstract
A 69-year-old woman was referred to us because a cyst in the lower pole of the left kidney had been pointed out on screening ultrasound. Computed tomography (CT) demonstrated a mural nodule of the wall of the cyst with an enhancement effect, suggesting cystic renal cell carcinoma (cT1aN0M0). The patient underwent retroperitoneoscopic non-ischemic partial nephrectomy using a microwave tissue coagulator. A hematoxylin-eosin-stained specimen showed that the wall of the cystic tumor consisted of the proliferation of large cells with rich eosinophilic granules in the cytoplasm and round-shaped nuclei, which were the characteristics of oncocytoma. This was followed by immunohistochemical studies, because of findings of local cell invasion, mitosis, and necrosis, suggesting malignancy. The results were: CK7, strongly positive; PAX2, negative; colloidal iron stain, negative; c-kit, weakly positive; vimentin, positive; and RCC marker, negative. Thus, although the tumor showed characteristics of oncocytoma and/or chromophobe renal cell carcinoma (pT1a), it could not be classified according to the known categories: it should be designated as renal cell carcinoma (neoplasm) of oncocytosis, a novel category of unclassified renal cell carcinomas. The present case indicated the fact that renal cell carcinomas resembling oncocytoma certainly exist.
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Affiliation(s)
- Masatake Shinohara
- Department of Urology, Nara Prefectural Nara Hospital, 1-30-1 Hiramatsu, Nara, Nara, 631-0846, Japan
| | - Shoji Samma
- Department of Urology, Nara Prefectural Nara Hospital, 1-30-1 Hiramatsu, Nara, Nara, 631-0846, Japan.
| | - Yoshihiro Matsumoto
- Department of Urology, Nara Prefectural Nara Hospital, 1-30-1 Hiramatsu, Nara, Nara, 631-0846, Japan
| | - Yoriaki Kagebayashi
- Department of Urology, Nara Prefectural Nara Hospital, 1-30-1 Hiramatsu, Nara, Nara, 631-0846, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Prefectural Nara Hospital, 1-30-1 Hiramatsu, Nara, Nara, 631-0846, Japan
| | | | - Keiji Shimada
- Department of Pathology, Nara Medical University, Nara, Japan
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Amylase α-1A (AMY1A): a novel immunohistochemical marker to differentiate chromophobe renal cell carcinoma from benign oncocytoma. Am J Surg Pathol 2013; 37:1824-30. [PMID: 24225843 DOI: 10.1097/pas.0000000000000108] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Chromophobe renal cell carcinoma (ChRCC) and oncocytoma present with a perplexing overlap of morphologic and immunohistochemical features. ChRCC have deletions in the 1p21.1 region including the amylase α-1A gene (AMY1A). No such deletions are found in oncocytoma. Instead, oncocytomas shared other deletions on chromosome 1: 1p31.3, 1q25.2, and 1q44. We performed AMY1A immunostaining on 75 oncocytomas (57 tissue microarray [TMA] cores, 18 whole slides) and 54 ChRCCs (20 TMA cores, 34 whole slides). Staining was assessed using the H-score method. The intensity was graded as follows: no staining=0, weak=1, moderate=2, and strong=3. The AMY1A immunostain preferentially stained the distal tubules and collecting ducts of normal kidney. All oncocytomas (100%) expressed AMY1A with an H-score that varied from 100 to 300 (mean 205). Mild to moderate heterogeneity in staining intensity was noted within a given oncocytoma. For oncocytomas, 87% (65/75) cases had H-scores of at least 120 with a mean score of 221. Notably, the 13% (10/75) of oncocytoma cases that had an H-score of 100 were derived from the TMA. A total of 87% (47/54) of the ChRCC cases were negative for the AMY1A immunostain. Of the ChRCC cases, 4% (2/54) showed very weak cytoplasmic staining (H-score of 70 each), which was less than the lowest H-score of oncocytoma cases. All 5 cases of ChRCC, which showed an H-score of 100 or more, were referred to as eosinophilic variants of ChRCC. Three of these 5 cases showed a very nondescript, diffuse staining of the cytoplasm. Two of these 5 cases showed an H-score of 130. We think that as the staining pattern of these 2 cases is similar to that of oncocytoma, they should be put in a category of renal oncocytic neoplasms favoring oncocytoma. This result shows that AMY1A staining could be very helpful in further classifying even a subset of the eosinophilic variants of ChRCC. The difference between ChRCC and oncocytoma was statistically significant (χ test, P<0.0001). All cases of clear cell RCC and papillary RCC were negative for AMY1A expression. Overall, sensitivity and specificity of AMY1A staining for oncocytoma was 100% (95% confidence interval, 0.95-1.00) and 96.75% (95% confidence interval, 0.93-0.99), respectively. Similarly, the sensitivity and specificity for distinguishing oncocytoma from ChRCC was 100% (95% confidence interval, 0.95-1.00) and 90.74% (95% confidence interval, 0.80-0.97), respectively. These data show that the novel marker AMY1A can be of great diagnostic utility when trying to differentiate ChRCC (classic and eosinophilic variant) and oncocytoma.
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Kuroda N, Tamura M, Hes O, Michal M, Gatalica Z. Chromophobe renal cell carcinoma with neuroendocrine differentiation and sarcomatoid change. Pathol Int 2013; 61:552-4. [PMID: 21884307 DOI: 10.1111/j.1440-1827.2011.02689.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Din NU, Fatima S, Ahmad Z. Chromophobe renal cell carcinoma: a morphologic and immunohistochemical study of 45 cases. Ann Diagn Pathol 2013; 17:508-13. [PMID: 24095630 DOI: 10.1016/j.anndiagpath.2013.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 06/14/2013] [Accepted: 06/24/2013] [Indexed: 01/27/2023]
Abstract
The aim of this study was to evaluate the morphological spectrum of chromophobe renal cell carcinoma (CRCC) and diagnostic utility of a panel of three immunohistochemical stains. All cases of CRCC reported between 2002 and 2012 in the Section of Histopathology, Aga Khan University Hospital, were retrieved. A total of 45 cases were identified. Slides were reviewed and immunohistochemical stains (CK7, CD117, and vimentin) were performed. Ages ranged from 18 to 90 years (mean, 48.5 years). Male-to-female ratio was 0.8:1. The tumor was located in the left kidney in 24 patients and the right kidney in 20 patients. The tumor size ranged from 3.5 to 22 cm (mean 10 cm). Histologically, 4 were classic, 22 were eosinophilic, 16 were mixed, and 3 were sarcomatoid type. Morphologic patterns included broad alveolar, solid, nested, tubular, tubulocystic, trabecular, papillary, and microglandular. Binucleation and perinuclear halos were seen in all cases. Nuclear grooves and pseudoinclusions were seen in 17 and 6 cases, respectively. Multinucleated cells were seen in 19 cases. Mitoses ranged from 1 to 11/10 HPFs (mean 3/10 HPFs). Hyalinized stroma was seen in 38 cases and calcification in 26 cases. Necrosis was seen in 18 cases. Palisading of smaller cells around the broad alveolar pattern was noted in 5 cases. The Furhman's nuclear grade was I (11), II (26), III (5), and IV (3). Hale's colloidal iron was positive in all cases. Immunohistochemical stain CK7 and CD117 were positive in 100% and 95.5% of cases respectively. Vimentin was negative in all cases, except in the sarcomatoid areas of 3 cases. In conclusion, chromophobe renal cell carcinoma has certain unique morphological features and immunohistochemical profile which help to distinguish it from conventional renal cell carcinoma and oncocytoma. We identified nuclear pseudoinclusions, microglandular pattern and palisading of smaller cells, which have not been reported earlier.
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Affiliation(s)
- Nasir Ud Din
- Histopathology, Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, Pakistan.
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CD10+ and CK7/RON- immunophenotype distinguishes renal cell carcinoma, conventional type with eosinophilic morphology from its mimickers. Appl Immunohistochem Mol Morphol 2013; 20:454-61. [PMID: 22417859 DOI: 10.1097/pai.0b013e31823fecd3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The distinction between renal cell carcinoma conventional (clear cell) type with eosinophilic morphology (ccRCC), chromophobe renal cell carcinoma eosinophilic variant (chRCC), and renal oncocytoma (RO) is a common diagnostic dilemma. We aimed to identify an immunohistochemical panel to discriminate ccRCC from its morphologic mimics. MATERIALS AND METHODS Fifty-three renal neoplasms (19 ccRCC, 18 chRCC, and 16 RO) were selected. Immunohistochemical stains for CD10, cytokeratin 7 (CK7), c-Kit, E-cadherin, N-cadherin, kidney-specific cadherin (Ksp-cadherin), and Recepteur d'origine nantais (RON) were performed. RESULTS Ten (53%) of 19 ccRCC were positive for CD10, 11 (58%) for E-cadherin, 8 (42%) for N-cadherin, 5 (26%) for Ksp-cadherin, 9 (47%) for RON, 6 (32%) for CK7, and 5 (26%) for c-Kit. In chRCC/RO group, 5 of 34 (15%) were positive for CD10, 32 (94%) for E-cadherin, 2 (6%) for N-cadherin, 1 (3%) for Ksp-cadherin, 22 (65%) for RON, 14 (41%) for CK7, and 25 (25/32, 76%) for c-kit. Univariately, negative c-Kit [odds ratio (OR)=8.75, P=0.001, area under the receiver operating characteristic curve (AUC)=0.747], negative E-cadherin (OR=11.64, P=0.005, AUC=0.681), positive N-cadherin (OR=11.64, P=0.005, AUC=0.681), positive Ksp-cadherin (OR=11.79, P=0.031, AUC=0.617), and positive CD10 (OR=6.44, P=0.005, AUC=0.690) detects ccRCC versus chRCC/RO. Multivariate analysis showed significant association between CD10 positivity and ccRCC (OR=16.90, P=0.007) and between RON negativity and ccRCC (OR=7.17, P=0.047) when CK7 is negative. CONCLUSIONS The best single predictors for ccRCC are negative c-Kit, negative E-cadherin, positive N-cadherin, positive Ksp-cadherin, and positive CD10. However, considering the studied markers, a combination of positive CD10 and negative CK7 and RON is considered the best immunohistochemical panel in distinguishing ccRCC from chRCC/RO.
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BCA2 is differentially expressed in renal oncocytoma: an analysis of 158 renal neoplasms. Tumour Biol 2012; 34:787-91. [DOI: 10.1007/s13277-012-0608-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 11/22/2012] [Indexed: 10/27/2022] Open
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Yeshvanth SK, Permi HS, Laxminarayana KPH, Shrinivas T, Shetty JK. Two cases of eosinophilic variant chromophobe renal cell carcinoma, with a rare association of right atrial myxoma in one of them. J Lab Physicians 2012; 3:116-8. [PMID: 22219567 PMCID: PMC3249708 DOI: 10.4103/0974-2727.86846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chromophobe renal cell carcinoma is a relatively uncommon variant of renal cell carcinoma. Eosinophilic variant of chromophobe renal cell carcinoma (EVCRCC) is still less frequent and is composed predominantly of small to medium-sized cells with abundant granular eosinophilic cytoplasm. We report two cases of EVCRCC, with one having a rare association of right atrial myxoma. We present these cases, due to the rarity of EVCRCC and an unusual association of right atrial myxoma in one of them. Both patients recovered well after surgery, with no recurrence or metastasis after 2 years of follow-up.
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Affiliation(s)
- Sunil Kumar Yeshvanth
- Department of Pathology, K. S. Hegde Medical Academy of Nitte University, Deralakatte, Mangalore, India
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Ohe C, Kuroda N, Takasu K, Senzaki H, Shikata N, Yamaguchi T, Miyasaka C, Nakano Y, Sakaida N, Uemura Y. Utility of immunohistochemical analysis of KAI1, epithelial-specific antigen, and epithelial-related antigen for distinction of chromophobe renal cell carcinoma, an eosinophilic variant from renal oncocytoma. Med Mol Morphol 2012; 45:98-104. [DOI: 10.1007/s00795-011-0546-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 04/28/2011] [Indexed: 11/29/2022]
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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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Teresa P, Grazia ZM, Doriana M, Irene P, Michele S. Malignant effusion of chromophobe renal-cell carcinoma: cytological and immunohistochemical findings. Diagn Cytopathol 2011; 40:56-61. [PMID: 22180239 DOI: 10.1002/dc.21599] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 10/15/2010] [Indexed: 12/26/2022]
Abstract
Malignant effusions because of renal-cell carcinoma (RCC) are an unusual event and occur in patients with papillary and clear cell tumors. We have studied a 65-year-old man who underwent right renal tumorectomy, diagnosed as chromophobe RCC (pT1). After 16 months, the patient presented cough and fever. Positron emission computed tomography demonstrated extensive mediastinal lymphadenopathy. Chest radiograph showed right pleural effusion. The cytological examination of the fluid showed malignant cells. Immunohistochemistry had been performed on primary renal tumor and on cell block of pleural effusion. The renal tumor showed positivity for parvalbumin, cytokeratin (CK) 7, C-kit (CD117), E-cadherin, and RCC marker. The neoplastic cells of pleural effusion showed positive immunohistochemical staining for parvalbumin, RCC marker, pancytokeratin, epithelial membrane antigen, CK7, C-kit (CD117), E-cadherin, and CD10. They were negative for thyroid transcription factor-1, CK20, calretinin, CK5, D2-40 podoplanin, CDX2, and Wilms' tumor suppressor gene. Malignant effusion secondary to RCC is rare. In several studies, RCC had been the cause of 1-2.2% of malignant pleural fluids. Chromophobe RCC tends to be localized into the kidney and to be of nuclear grade 2 at presentation, factors that probably explain its more favorable outlook. In our case, the chromophobe RCC was asymptomatic and was discovered because abdominal pain due to stone in the gallbladder. The tumor had an unusual aggressive clinical behavior. Immunohistochemistry performed on the cell block let to establish the renal origin and the chromophobe histotype of malignant cells found in the pleural fluid.
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Affiliation(s)
- Pusiol Teresa
- Rovereto Hospital, Institute of Anatomic Pathology, Rovereto, Italy.
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Strojan Fležar M, Gutnik H, Jeruc J, Srebotnik Kirbiš I. Typing of renal tumors by morphological and immunocytochemical evaluation of fine needle aspirates. Virchows Arch 2011; 459:607-14. [PMID: 22052200 DOI: 10.1007/s00428-011-1156-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 09/01/2011] [Accepted: 10/04/2011] [Indexed: 10/15/2022]
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Role of immunohistochemistry in the evaluation of needle core biopsies in adult renal cortical tumors: an ex vivo study. Am J Surg Pathol 2011; 35:949-61. [PMID: 21677535 DOI: 10.1097/pas.0b013e31821e25cd] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Multiple therapeutic options for renal tumors that are now available have put pathologists under increasing pressure to render diagnosis on limited material. Results on biopsies by hematoxylin and eosin (H&E) have historically not been encouraging. Currently, multiple immunohistochemical markers with differential expression in these renal tumors are available. We studied the utility of such markers on needle biopsies that were obtained ex vivo. After nephrectomy, two 18-guage cores were obtained and processed routinely. Expressions of carbonic anhydrase (CA) IX, CD117, α-methylacyl-CoA racemase (AMACR), cytokeratin 7 (CK7), and CD10 were evaluated. Results, with or without immunostaining, were compared with the final nephrectomy diagnosis. We studied 145 tumors, including 119 renal cell carcinomas (83 clear cell, 18 papillary, 14 chromophobe, and 4 type unclassified), 11 oncocytomas, and 15 miscellaneous tumors. Adequate evaluable material was present in 123 (85%) cases. In such biopsies, 81% of cases were correctly classified by H&E alone, with correct diagnosis in 90% of cases in the most common tumor subtypes (clear cell, papillary and chromophobe renal cell carcinoma, and oncocytoma). By adding immunostains, the accuracy was 90% overall and 99% among the 4 most common subtypes. The following extent and patterns of immuneexpression were highly useful in the diagnoses: diffuse, membranous CAIX expression in clear cell renal cell carcinoma, diffuse positivity for AMACR in papillary renal cell carcinoma, distinct peripheral cytoplasmic accentuation for CD117 in chromophobe renal cell carcinoma, widespread and intense positivity for CK7 in chromophobe and papillary renal cell carcinoma, and diffuse membranous reactivity in clear cell and patchy/luminal in papillary renal cell carcinoma for CD10. In conclusion, utilizing immunostains improves classification of renal tumors on needle biopsy, which may be of particular help for pathologists with limited experience. Both extent and patterns must be considered for a definitive diagnosis.
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Kuroda N, Kanomata N, Yamaguchi T, Imamura Y, Ohe C, Sakaida N, Hes O, Michal M, Shuin T, Lee GH. Immunohistochemical application of S100A1 in renal oncocytoma, oncocytic papillary renal cell carcinoma, and two variants of chromophobe renal cell carcinoma. Med Mol Morphol 2011; 44:111-5. [DOI: 10.1007/s00795-009-0461-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Accepted: 06/16/2009] [Indexed: 11/24/2022]
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Carvalho JC, Wasco MJ, Kunju LP, Thomas DG, Shah RB. Cluster analysis of immunohistochemical profiles delineates CK7, vimentin, S100A1 and C-kit (CD117) as an optimal panel in the differential diagnosis of renal oncocytoma from its mimics. Histopathology 2011; 58:169-79. [PMID: 21323945 DOI: 10.1111/j.1365-2559.2011.03753.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To develop an immunohistochemical strategy for distinguishing renal oncocytoma (RO) from the eosinophilic variant of chromophobe (ChRCC), and papillary (PRCC) and clear cell (CRCC) renal cell carcinoma containing eosinophilic cytoplasm in core biopsy specimens. METHODS AND RESULTS Cluster analysis was performed on immunohistochemical data from 21 RO, 16 ChRCC, 16 CRCC and 20 PRCC patients. A panel of CK7, C-kit, S100A1 and vimentin clustered into four groups. Cluster A (94% ChRCC) expressed C-kit and CK7 and lacked S100A1 and vimentin. Cluster B (95% RO) expressed C-kit, S100A1, focal CK7 (single or small clusters of cells) and lacked vimentin. Cluster C comprised a mixture of PRCC and CRCC with no expression of C-kit or CK7 and variable S100A1 and vimentin. PRCC with strong expression of CK7 clustered into group D. A panel of S100A1 (positive) and focal CK7 expression distinguished RO from ChRCC with 91% sensitivity and 93% specificity. A panel of vimentin (negative) and C-kit (positive) distinguished RO from CRCC with 83% sensitivity and 86% specificity and RO from PRCC with 79% sensitivity and 88% specificity. CONCLUSIONS Hierarchical cluster analysis is an effective approach to analyse high-volume immunohistochemical data to generate an optimal panel in the differential diagnosis of oncocytoma from its mimics.
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Affiliation(s)
- Jason C Carvalho
- Department of Pathology, University of Michigan Medical Center, Ann Arbor, MI, USA
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Trpkov K, Yilmaz A, Uzer D, Dishongh KM, Quick CM, Bismar TA, Gokden N. Renal oncocytoma revisited: a clinicopathological study of 109 cases with emphasis on problematic diagnostic features. Histopathology 2011; 57:893-906. [PMID: 21166703 DOI: 10.1111/j.1365-2559.2010.03726.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To evaluate problematic diagnostic features in renal oncocytoma. METHODS AND RESULTS One hundred and nine cases of oncocytoma were reviewed and the problematic gross and microscopic features recorded. Multifocal and bilateral neoplasms were found in 12 (11%) and five (4.6%) cases, respectively. Haemorrhage was seen grossly in 30 (27.5%) neoplasms and a central scar was identified in 35 (32.1%). On microscopy, perinephric fat extension was present in 17 (15.6%) neoplasms and vascular extension was identified in four (3.7%) oncocytomas. Rare mitoses and focal coagulative necrosis were identified in two (1.8%) cases each. Focal clear cell changes were found in 16 (14.7%) oncocytomas, typically within hyalinized areas. Limited foci with chromophobe-like histology (not exceeding 5% of the neoplasm) were found in 13 (11.9%) oncocytomas. In 12 (11%) oncocytomas, rare papillary formations were noted in the lumina of microcysts. Significant nuclear atypia, oncoblasts and entrapped tubules were identified in 27 (24.8%), 41 (37.6%) and 40 (36.7%) neoplasms, respectively. After a median follow-up of 52 months (range 1-113 months), there was no disease recurrence, progression or death attributed to oncocytoma. CONCLUSIONS The recognition of the spectrum of morphological changes observed in renal oncocytoma should help pathologists establish a diagnosis of oncocytoma in problematic cases.
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Affiliation(s)
- Kiril Trpkov
- Department of Pathology and Laboratory Medicine, Calgary Laboratory Services and University of Calgary, Calgary, Alberta, Canada.
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Ray ER, Goodwill J, Chandra A, O'Brien TS. Exploring the Potential of Immunohistochemistry to Identify Renal Oncocytoma. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.bjmsu.2010.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective: To determine the potential for a novel immunohistochemistry panel to accurately distinguish oncocytoma from other renal tumour subtypes. Material and methods: Forty renal tumours removed by surgery between 2000 and 2006 in a single tertiary referral centre in the UK were studied retrospectively. Paraffin blocks from 10 each of oncocytoma, papillary RCC, clear cell RCC and chromophobe RCC were examined. The tumours were tested using a panel of antibodies comprising CK7, CK18, CD15, N-cadherin, E-cadherin and EpCAM. The primary outcome measure was the number of each tumour type staining positively with each marker. The immunohistochemistry marker was considered to be positive if more than 10% of the tumour cells stained positively. No staining or focal staining (<10% of the tumour cells) was considered a negative test. Results: CK7, CD15 and EpCAM were able to distinguish between renal oncocytoma and chromophobe RCC: no oncocytoma stained with either CK7 or EpCAM, however 7/10 (70%) stained positive for CD15. Conversely, 8/10 (80%) chromophobe RCC stained positive with CK7 and EpCAM but none stained for CD15. Conclusions: In this preliminary study the immunohistochemistry panel shows promise in differentiating between renal oncocytoma and chromophobe RCC. The panel deserves prospective evaluation on needle biopsy specimens.
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Affiliation(s)
- Eleanor R. Ray
- The Urology Centre, Guy's Hospital, St. Thomas' Street, London SE1 9RT, UK
| | - Joe Goodwill
- Department of Histopathology, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Ashish Chandra
- Department of Histopathology, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Tim S. O'Brien
- The Urology Centre, Guy's Hospital, St. Thomas' Street, London SE1 9RT, UK
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Abstract
The recognition of chromophobe renal cell carcinoma (RCC) among other distinct types of renal cell tumors (RCT) based on light-microscopic features, such as cytoplasmic and nuclear characteristics, might pose a dilemma in some cases because of morphological pattern overlapping with renal oncocytoma or conventional RCC. The present article reviews chromophobe RCC with focus on aspects of its molecular pathology, which was shown using ancillary modern microarray-based technology that can distinguish it from its mimics and therefore be helpful for its correct diagnosis. Although the high resolution DNA-microarray analyses excluded with all certainty the occurrence of small specific alterations, the loss of entire chromosomes 2, 10, 13, 17 and 21 occurs exclusively in chromophobe RCC and therefore probes localized at these chromosomes might be used to establish the diagnosis of chromophobe RCC in cases with uncertain histology. The usefulness of proposed candidate genes selected by the global gene expression analyses in the diagnostic pathology is far below expectations. The conflicting staining patterns, together with the poor specificity of used antibodies, leads us to believe that these candidate immunomarkers might not help in the separation of chromophobe RCC, with the exception of CD82, which has recently been suggested to be used for routine histological diagnosis.
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Affiliation(s)
- Maria V Yusenko
- Laboratory of Molecular Oncology, Medical Faculty, Ruprecht-Karls University, Heidelberg, Germany.
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Renal Cell Neoplasms of Oncocytosis Have Distinct Morphologic, Immunohistochemical, and Cytogenetic Profiles. Am J Surg Pathol 2010; 34:620-6. [DOI: 10.1097/pas.0b013e3181d73293] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Williams AA, Higgins JPT, Zhao H, Ljunberg B, Brooks JD. CD 9 and vimentin distinguish clear cell from chromophobe renal cell carcinoma. BMC Clin Pathol 2009; 9:9. [PMID: 19922654 PMCID: PMC2788570 DOI: 10.1186/1472-6890-9-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 11/18/2009] [Indexed: 12/24/2022] Open
Abstract
Background Clear cell renal cell carcinoma (ccRCC) and chromophobe renal cell carcinoma (chRCC) can usually be distinguished by histologic characteristics. Occasionally, diagnosis proves challenging and diagnostic difficulty will likely increase as needle biopsies of renal lesions become more common. Methods To identify markers that aid in differentiating ccRCC from chRCC, we used gene expression profiles to identify candidate markers that correlate with histology. 39 antisera and antibodies, including 35 for transcripts identified from gene expression profiling, were evaluated. Promising markers were tested on a tissue microarray (TMA) containing 428 renal neoplasms. Strength of staining of each core on the TMA was formally scored and the distribution of staining across different types of renal neoplasms was analyzed. Results Based on results from initial immunohistochemical staining of multitissue titer arrays, 23 of the antisera and antibodies were selected for staining of the TMA. For 7 of these markers, strength of staining of each core on the TMA was formally scored. Vimentin (positive in ccRCC) and CD9 (positive in chRCC) best distinguished ccRCC from chRCC. The combination of vimentin negativity and CD9 positivity was found to distinguish chRCC from ccRCC with a sensitivity of 100.0% and a specificity of 95.2%. Conclusion Based on gene expression analysis, we identify CD9 and vimentin as candidate markers for distinguishing between ccRCC and chRCC. In difficult cases and particularly when the amount of diagnostic tissue is limited, vimentin and CD9 staining could serve as a useful adjunct in the differential diagnosis of ccRCC and chRCC.
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Abstract
Percutaneous image-guided biopsy of renal masses is a safe and accurate procedure. Although once reserved for the diagnosis of unresectable renal cell carcinoma, metastases, lymphoma, and infection, today percutaneous image-guided biopsy has an expanded role. There is increasing awareness that a substantial proportion of small, solid renal masses are benign neoplasms. Although imaging can be used to diagnose most of them, some are incorrectly believed to represent renal cell carcinoma and unnecessary surgery may be performed. Based largely on advances in cytological techniques, percutaneous biopsy can be now be used to diagnose benign neoplasms and thus prevent them from being treated unnecessarily. Concurrent advances in percutaneous ablation have also promoted its use. As a result, there are 8 established indications for percutaneous biopsy, and reason to believe that the number of indications will expand further in the future.
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Affiliation(s)
- V Anik Sahni
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Pradhan D, Kakkar N, Bal A, Singh SK, Joshi K. Sub-typing of renal cell tumours; contribution of ancillary techniques. Diagn Pathol 2009; 4:21. [PMID: 19558708 PMCID: PMC2714064 DOI: 10.1186/1746-1596-4-21] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 06/28/2009] [Indexed: 12/16/2022] Open
Abstract
Background Adult renal epithelial neoplasms are a heterogeneous group with varying prognosis and outcome requiring sub-classification. Methods Cases of renal cell carcinoma (RCC) in a 10 years period were analyzed with regard to the clinical features and histology. Sections were reviewed by four pathologists and the discordant cases were resolved with the help of Hale's colloidal iron stain, vimentin, CK 7, and vinculin immunostains and electron microscopy. Results Amongst the total of 278 cases, clear cell renal cell carcinoma was the commonest tumor with 74.8% cases, followed by papillary RCC 12.2%, chromophobe RCC 7.9%, oncocytoma 1.8%, and one case of collecting duct RCC. Eight cases were of sarcomatoid renal cell carcinoma. In 28/278 cases, diagnoses varied amongst the four pathologists and the discordance was resolved by Hale's colloidal iron stain, CK7 immunostain and electron microscopy. Vimentin and vinculin did not contribute much in differentiating subtypes of renal cell carcinomas. Relative incidence of sub-types of RCCs was compared with other series Conclusion To accurately subclassify renal cell carcinomas, simple ancillary techniques would possibly resolve all difficult cases. The relative incidence of sub-types of renal cell carcinoma is relatively consistent the world over. However, in India, RCCs afflict the patients two decades earlier.
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Affiliation(s)
- Dinesh Pradhan
- Department of Histopathology, Post Graduate Institute of Medical Sciences & Research, Chandigarh, India.
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40
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Kim SS, Choi YD, Jin XM, Cho YM, Jang JJ, Juhng SW, Choi C. Immunohistochemical stain for cytokeratin 7, S100A1 and claudin 8 is valuable in differential diagnosis of chromophobe renal cell carcinoma from renal oncocytoma. Histopathology 2009; 54:633-5. [PMID: 19302533 DOI: 10.1111/j.1365-2559.2009.03271.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Abstract
In the past few years, a much better understanding of the morphologic spectrum of renal cortical tumors has resulted in a clinically highly relevant contemporary classification system of these tumors. The current and still evolving era of targeted therapies in kidney cancer further highlights the importance of the appropriate pathologic classification. The recently gained knowledge about molecular-driven antigen expression almost certainly will have a major role to play in the characterization, development, and evaluation of targeted therapies in kidney cancer in the future.
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Affiliation(s)
- Satish K Tickoo
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Stephen M Rohan
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Chromophobe renal cell carcinoma: histomorphologic characteristics and evaluation of conventional pathologic prognostic parameters in 145 cases. Am J Surg Pathol 2009; 32:1822-34. [PMID: 18813125 DOI: 10.1097/pas.0b013e3181831e68] [Citation(s) in RCA: 171] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The aggregate literature suggests that chromophobe renal cell carcinoma (RCC) is biologically a tumor of low malignant potential with reported 5-year and 10-year survival rates of 78% to 100% and 80% to 90%, respectively. The conventional prognostic parameters that determine the outcome of the tumors that progress remain to be fully characterized. Clinicopathologic features of 145 cases were correlated with outcome. The mean age of the patients was 59 years (range, 27 to 82) and the male to female ratio was 1.1:1. Most tumors were well circumscribed and averaged 8.0 cm (range, 1.0 to 30.0 cm); multifocality and bilaterality were present in 8% and 3% of patients. Sixty (41%) were eosinophilic variant (greater than 80% eosinophilic cells), 18 (12%) were classic type (greater than 80% pale cells), and 67 (46%) were mixed (containing variable admixture of pale and eosinophilic cells). A subset of eosinophilic chromophobe RCC contained or had areas similar to renal oncocytomas. These tumors tended to be more commonly bilateral (11%) and multifocal (22%) and were not associated with necrosis or sarcomatoid change. Sarcomatoid change was present in 12/145 (8%) tumors. By histologic grade, 1%, 19%, 74%, 6% were Fuhrman nuclear grade 1, 2, 3, and 4. Nineteen percent, 21%, 28%, 13%, 4%, 1%, and 3% were pT (2002) stage pT1a, pT1b, pT2, pT3a, pT3b, pT3c, and pT4 tumors. Two percent tumors were pN1 at presentation and 2.8% tumors were M1 at presentation. Follow-up (1 to 182 mo, mean 48 mo, median 37 mo) was available in 123 cases. Disease progression (local recurrence 4, metastasis 15, and/or death 10) was seen in 20 patients. In univariable analysis, tumor size (P=0.025), pT stage (P<0.001), broad alveolar architecture (P=0.012), Fuhrman nuclear grade (P<0.001), microscopic tumor necrosis (P=0.001), vascular invasion (P=0.020), and sarcomatoid change (P< or =0.001) were associated with progression. A multivariable Cox regression model revealed sarcomatoid change (P=0.013, estimated relative hazard 4.7), microscopic necrosis (P=0.020, relative hazard=3.5), and pT stage (P=0.025, relative hazard 3.4) as independent predictors of aggressive chromophobe RCC. Although the large majority of chromophobe RCCs have a favorable prognosis, a distinct subset of patients progress. The pT stage of tumor, tumor necrosis, and sarcomatoid change all predict aggressive phenotype of chromophobe RCC. The adverse presence of these features in a nephrectomy specimen with chromophobe RCC warrants active surveillance, and these patients may be candidates for adjuvant therapies as they become available.
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Gobbo S, Brunelli M, Eccher A, Bonetti F, Menestrina F, Martignoni G. Molecular diagnosis of renal cell neoplasms: the usefulness of immunohistochemistry and fluorescence in situ hybridization. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2008; 2:665-76. [PMID: 23495777 DOI: 10.1517/17530059.2.6.665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The classification of renal cell neoplasms includes different subtypes of tumors characterized by different outcome. Some overlapping morphological features and the increasing recognition of new entities are making the traditional histologic distinction of renal cell neoplasms difficult and more tools improving the specificity of the correct identification are needed. Among molecular analyses, immunohistochemistry and fluorescence in situ hybridization have become the most helpful procedures, solving many issues in the differential diagnosis of the renal cell neoplasms. OBJECTIVE The aim of this review is to merge the large amount of recent knowledge regarding molecular markers of renal cell neoplasms into a helpful diagnostic algorithm. CONCLUSION It is proposed that immunoreactions for CD10, Alpha-methylacyl-CoA racemase, cytokeratin 7, parvalbumin and S100A1, and the cytogenetical analysis of chromosomes 3p, 1, 2, 6, 7, 10, 17 and Y can now offer the most specific tools for the classification of renal cell tumors.
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Affiliation(s)
- Stefano Gobbo
- Università di Verona, Dipartimento di Patologia - Sezione di Anatomia Patologica, Strada Le Grazie n. 8, Italy +39 045 8124323 ; +39 045 8027136 ; ,
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Arias LF, Hernández S, Bocardo G, González L, Vélez M, Arteta A, Blanco J. [Ancillary studies in the differential diagnosis of epithelial renal cell tumors with granular cells]. Actas Urol Esp 2008; 32:194-201. [PMID: 18409469 DOI: 10.1016/s0210-4806(08)73813-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES Differential diagnosis of renal neoplasms with granular cells may pose difficulties and implications on ontogeny and prognosis. Our aims are to characterize the pattern of immunostaining and to search for a useful diagnosis panel. METHODS We studied with colloidal iron staining (Mowry's modified method) and 22 commonly used immunomarkers 22 conventional carcinomas (CC), 37 chromophobe carcinomas (CPC), 8 oncocytomas (OC), and 7 collecting duct carcinomas (CDC) with granular cells. Cases with not entirely clear diagnosis were excluded. RESULTS Colloidal iron staining was diffuse, strong, reticular, and cytoplasmic in 32 CPC cases, the diffuse and strong pattern was not observed in other tumors. The more useful diagnostic panel was cytokeratin 7 (CK7)/CD10/vimentine (vim). The 8 OC were negative for the three antibodies. The most common profile for CC was CK7-/CD10+/vim+, the CPC profile was CK7+/CD10-/vim-, and CDC did not show a particular profile. With these three antibodies specificity was >90% for the differential diagnosis. Adding colloidal iron staining specificity was 100%. CONCLUSIONS Morphologic features, colloidal iron staining (modified Mowry's method), and immunostaining with CK7/CD10/vim permit the final diagnosis with high specificity. However, a 100% specific marker does not exist at the present time.
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Affiliation(s)
- L F Arias
- Departamento de Patología, Hospital Clínico San Carlos, Madrid, España.
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Montironi R, Scarpelli M, Martignoni G, Cheng L, Lopez-Beltran A. Splitting and Lumping Adult Renal Epithelial Tumours: Is That What the Urologists Want? Eur Urol 2008; 53:673-5; discussion 676-80. [DOI: 10.1016/j.eururo.2007.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 11/05/2007] [Indexed: 11/26/2022]
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Allory Y, Bazille C, Vieillefond A, Molinié V, Cochand-Priollet B, Cussenot O, Callard P, Sibony M. Profiling and classification tree applied to renal epithelial tumours. Histopathology 2007; 52:158-66. [PMID: 18036175 DOI: 10.1111/j.1365-2559.2007.02900.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Selection of the relevant combination from a growing list of candidate immunohistochemical biomarkers constitutes a real challenge. The aim was to establish the minimal subset of antibodies to achieve classification on the basis of 12 antibodies and 309 renal tumours. METHODS AND RESULTS Seventy-nine clear cell (CC), 88 papillary (PAP) and 50 chromophobe (CHRO) renal cell carcinomas, and 92 oncocytomas (ONCO) were immunostained for renal cell carcinoma antigen, vimentin, cytokeratin (CK) AE1-AE3, CK7, CD10, epithelial membrane antigen, alpha-methylacyl-CoA racemase (AMACR), c-kit, E-cadherin, Bcl-1, aquaporin 1 and mucin-1 and analysed by tissue microarrays. First, unsupervised hierarchical clustering performed with immunohistochemical profiles identified four main clusters-cluster 1 (CC 67%), 2 (PAP 98%), 3 (CHRO 67%) and 4 (ONCO 100%)-demonstrating the intrinsic classifying potential of immunohistochemistry. A series of classification trees was then automatically generated using Classification And Regression Tree software. The most powerful of these classification trees sequentially used AMACR, CK7 and CD10 (with 86% CC, 87% PAP, 79% CHRO and 78% ONCO correctly classified in a leave-one-out cross-validation test). The classifier was also helpful in 22/30 additional cases with equivocal features. CONCLUSION The classification tree method using immunohistochemical profiles can be applied successfully to construct a renal tumour classifier.
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Affiliation(s)
- Y Allory
- AP-HP, Hôpital Henri Mondor, Département de Pathologie, INSERM, IMRB U841, Créteil, France.
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Kuehn A, Paner GP, Skinnider BF, Cohen C, Datta MW, Young AN, Srigley JR, Amin MB. Expression analysis of kidney-specific cadherin in a wide spectrum of traditional and newly recognized renal epithelial neoplasms: diagnostic and histogenetic implications. Am J Surg Pathol 2007; 31:1528-33. [PMID: 17895753 DOI: 10.1097/pas.0b013e318058818c] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Kidney-specific cadherin (Ksp-cad) is a membrane-associated cell adhesion glycoprotein expressed by the distal nephron tubular cells in its later developmental stages. Chromophobe renal cell carcinoma and renal oncocytoma are reported to be variably positive for Ksp-cad with some studies suggesting a discriminatory role for Ksp-cad. Immunoreactivity in other tumors with granular eosinophilic cytoplasm including clear cell and papillary renal cell carcinomas needs to be clearly elucidated and its expression in emerging novel and other unusual renal epithelial neoplasm subtypes including tumors with uncertain histogenesis is not yet known. In this study, we performed a detailed immunohistochemical analysis for Ksp-cad in a broad range of 136 renal epithelial neoplasms. Reactivity with Ksp-cad was observed in the following tumors: chromophobe renal cell carcinoma [23/25 (92%), diffuse (>50% of tumor cells)] positivity and membranous characteristically accentuating the "plant cell-like" histomorphology of the typical (clear) type, renal oncocytoma [15/20 (75%), usually diffuse staining with predominantly membranous accentuation], papillary renal cell carcinoma [5/17 (29%) all focal to moderate, eosinophilic type or type 2-3/7 (43%), basophilic type or type 1-2/10 (20%)], Xp11 translocation carcinoma [1/4 (25%), diffuse positivity] and clear cell renal cell carcinoma [6/36 (17%) all focal, clear cell renal cell carcinoma with prominent eosinophilic cells 1/7 (14%)]. Immunoreactivity was higher when evaluating whole histologic sections than with tissue microarrays for both chromophobe renal cell carcinoma (100% vs. 60%) and renal oncocytoma (100% vs. 55%). No immunoreactivity was observed in mucinous tubular and spindle cell carcinomas (0/23), high-grade collecting duct carcinomas (of Bellini) (0/3), renal medullary carcinomas (0/2), and urothelial carcinomas (0/6). Our study documents the immunoreactivity of Ksp-cad in the range of contemporarily classified renal epithelial neoplasms. The findings argue against the use of Ksp-cad in differentiating chromophobe renal cell carcinoma and renal oncocytomas and further support their relationship to the distal nephron. Ksp-cad may be helpful in distinguishing these two tumor types from clear cell renal cell carcinoma with prominent eosinophilic cells particularly in cases with limited tissue samples (ie, needle core biopsy). In the similar diagnostic setting, caution must be exercised, however, in differentiating chromophobe renal cell carcinoma and renal oncocytoma from the eosinophilic variant of papillary renal cell carcinoma as moderate expression of Ksp-cad may be observed in papillary renal cell carcinoma. The histogenesis of mucinous tubular and spindle cell carcinoma remains debatable as this tumor does not express Ksp-cad, which is highly expressed normally in the thick ascending loop of Henle and the distal convoluted tubules. In conclusion, Ksp-cad is a useful tumor type associated marker for distinguishing chromophobe renal cell carcinoma and renal oncocytoma from the wide range of nonintercalated cell-related adult renal epithelial neoplasms; addition of this marker to a panel comprised of other histologic subtype-associated markers may greatly facilitate histologic subclassification of adult renal epithelial neoplasms.
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MESH Headings
- Adenocarcinoma/metabolism
- Adenocarcinoma/pathology
- Adenocarcinoma, Clear Cell/metabolism
- Adenocarcinoma, Clear Cell/pathology
- Adenocarcinoma, Mucinous/metabolism
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Papillary/metabolism
- Adenocarcinoma, Papillary/pathology
- Adenoma, Oxyphilic/metabolism
- Adenoma, Oxyphilic/pathology
- Biomarkers, Tumor/metabolism
- Cadherins/metabolism
- Carcinoma/metabolism
- Carcinoma/pathology
- Carcinoma, Medullary/metabolism
- Carcinoma, Medullary/pathology
- Carcinoma, Renal Cell/metabolism
- Carcinoma, Renal Cell/pathology
- Carcinoma, Transitional Cell/metabolism
- Carcinoma, Transitional Cell/pathology
- Eosinophilia/metabolism
- Eosinophilia/pathology
- Humans
- Immunoenzyme Techniques
- Immunohistochemistry/methods
- Kidney Neoplasms/metabolism
- Kidney Neoplasms/pathology
- Tissue Array Analysis
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Affiliation(s)
- Adam Kuehn
- Department of Pathology, Emory University Hospital, Atlanta, GA, USA
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Liu L, Qian J, Singh H, Meiers I, Zhou X, Bostwick DG. Immunohistochemical analysis of chromophobe renal cell carcinoma, renal oncocytoma, and clear cell carcinoma: an optimal and practical panel for differential diagnosis. Arch Pathol Lab Med 2007; 131:1290-7. [PMID: 17683191 DOI: 10.5858/2007-131-1290-iaocrc] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2007] [Indexed: 11/06/2022]
Abstract
CONTEXT The separation of chromophobe renal cell carcinoma, oncocytoma, and clear cell renal cell carcinoma using light microscopy remains problematic in some cases. OBJECTIVE To determine a practical immunohistochemical panel for the differential diagnosis of chromophobe carcinoma. DESIGN Vimentin, glutathione S-transferase alpha (GST-alpha), CD10, CD117, cytokeratin (CK) 7, and epithelial cell adhesion molecule (EpCAM) were investigated in 22 cases of chromophobe carcinoma, 17 cases of oncocytoma, and 45 cases of clear cell carcinoma. RESULTS Vimentin and GST-alpha expression were exclusively observed in clear cell carcinoma. CD10 staining was more frequently detected in clear cell carcinoma (91%) than in chromophobe carcinoma (45%) and oncocytoma (29%). CD117 was strongly expressed in chromophobe carcinoma (82%) and oncocytoma (100%), whereas none of the cases of clear cell carcinomas were immunoreactive. Cytokeratin 7 was positive in 18 (86%) of 22 cases of chromophobe carcinoma, whereas all oncocytomas were negative for CK7. EpCAM protein was expressed in all 22 cases of chromophobe carcinoma in more than 90% of cells, whereas all EpCAM-positive oncocytomas (5/17; 29%) displayed positivity in single cells or small cell clusters. CONCLUSIONS Using the combination of 3 markers (vimentin, GST-alpha, and EpCAM), we achieved 100% sensitivity and 100% specificity for the differential diagnosis of chromophobe carcinoma, oncocytoma, and clear cell carcinoma. The pattern of "vimentin(-)/GST-alpha(-)" effectively excluded clear cell carcinoma, and homogeneous EpCAM expression confirmed the diagnosis of chromophobe carcinoma rather than oncocytoma. CD117 and CK7 were also useful markers and could be used as second-line markers for the differential diagnosis, with high specificity (100%) and high sensitivity (90% and 86%, respectively).
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Affiliation(s)
- Lina Liu
- Bostwick Laboratories, Inc, 4355 Innslake Dr, Glen Allen, VA 23060, USA
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Adley BP, Gupta A, Lin F, Luan C, Teh BT, Yang XJ. Expression of Kidney-Specific Cadherin in Chromophobe Renal Cell Carcinoma and Renal Oncocytoma. Am J Clin Pathol 2006. [DOI: 10.1309/jfe2b57yqfpwpl10] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
Renal neoplasms comprise several distinct clinicopathologic entities with potential prognostic and the rapeutic differences. Although careful morphologic examination using sections stained with hematoxylin and eosin will allow for the correct diagnosis in the majority of cases, there is sufficient overlap between several entities such that ancillary techniques may be necessary to arrive at the correct diagnosis. In routine diagnostic surgical pathology practice of renal tumors, immunohistochemistry is the foremost ancillary technique. Using an approach based on common histologic patterns (tumors with clear cytoplasm, granular cytoplasm, tubulopapillary architecture, spindle cell morphology, small round-cell morphology, and infiltrating poorly differentiated carcinoma), we will discuss the utility of immunohistochemistry in the differential diagnosis of renal neoplasms. In recent years, needle biopsies from renal masses are being increasingly performed. In these small biopsies, the entire range of cytoarchitectural features that are generally necessary to make a diagnosis may not be fully appreciated. Immunohistochemistry may be helpful in this setting to narrow the differential diagnosis or to arrive at a definitive diagnosis. Finally, the use of immunohistochemistry for the confirmation of metastatic renal cell carcinoma presenting at distant sites will be discussed. Panels of immunohistochemical stains are proposed for different settings, including renal cell carcinoma (RCC) marker, CD10, and vimentin to suggest renal origin of a metastatic tumor, and markers to aid in subclassification of RCC, including parvalbumin and c-kit for chromophobe RCC, and cytokeratin 7 and alpha-methyl-acyl-CoA racemase for papillary RCC.
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Affiliation(s)
- Brian F Skinnider
- Department of Pathology, Vancouver General Hospital and University of British Columbia, Canada
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