Difference between revisions of "Chromophobe renal cell carcinoma"

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#redirect [[Kidney_tumours#Chromophobe_renal_cell_carcinoma]]
'''Chromophobe renal cell carcinoma''', abbreviated ''ChRCC'', is a relatively common form of [[renal cell carcinoma]].


==General==
*Least common of the common types of RCC ([[clear cell RCC]], [[papillary RCC]], [[chromophobe RCC]]).
*''Fuhrman grading'' for this entity is controversial, as it does not appear to have any predictive value.<ref name=pmid17527087>{{Cite journal  | last1 = Delahunt | first1 = B. | last2 = Sika-Paotonu | first2 = D. | last3 = Bethwaite | first3 = PB. | last4 = McCredie | first4 = MR. | last5 = Martignoni | first5 = G. | last6 = Eble | first6 = JN. | last7 = Jordan | first7 = TW. | title = Fuhrman grading is not appropriate for chromophobe renal cell carcinoma. | journal = Am J Surg Pathol | volume = 31 | issue = 6 | pages = 957-60 | month = Jun | year = 2007 | doi = 10.1097/01.pas.0000249446.28713.53 | PMID = 17527087 }}</ref>
There are two subtypes:<ref name=Ref_GUP293>{{Ref GUP|293}}</ref>
*Classic.
*Eosinophilic variant.
==Gross==
*Tan, light-brown.
*Solitary.
*Well-circumscribed.
Image:
*[http://www.flickr.com/photos/35441329@N05/4273199789/in/photostream/ Chromophobe RCC (flickr.com)].
==Microscopic==
===Classic===
Features - classic type (3 P's [[mnemonic]]):<ref>{{Ref PBoD|1016-7}}</ref><ref name=Ref_GUP293>{{Ref GUP|293}}</ref>
*Pale cytoplasm, with wisps of eosinophilic material; the cells are not completely clear, they have "cobwebs".
*Perinuclear clearing, i.e. a pale halo surrounds the nucleus - '''key feature'''.
*Periphery of cell distinct, i.e. cell membrane is easy to discern.
Notes:
*May have [[psammoma bodies]].
*May be described as "plant-like"; plant cells have (thick) cell walls.
*The perinuclear clearing is often somewhat patchy, i.e. it is usually not present in very tumour cell.
DDx:
*Clear cell RCC (classic).
**Perinuclear clearing is ''not'' seen in clear cell RCC.
**ChRCC has wisps in the cytoplasm.
===Eosinophilic variant===
Features - eosinophilic variant:<ref name=Ref_GUP293>{{Ref GUP|293}}</ref>
*'''Eosinophilic''' (finely granular) cytoplasm.
*Perinuclear clearing - '''key feature'''.
*Periphery of cell distinct.
*'''Smaller cells''' than classic subtype.
Notes:
#May have [[psammoma bodies]].
DDx:
#[[Renal oncocytoma|Oncocytoma]] - particularly the eosinophilic variant.
#*IHC may be useful to differentiate (CK7: oncocytoma = cytoplasm +ve, chromophobe = cell membrane +ve).
#*A comparison based on histomorphology: ''[[Kidney_tumours#Tabular_comparison_of_oncocytoma_and_chromophobe_RCC|Tabular comparison between ChRCC & oncocytoma]]''.
#**Oncocytoma typically has: no perinuclear clearing, no raisinoid nuclei, no binucleation.
#Clear cell RCC, eosinophilic variant.
#*Perinuclear clearing is ''not'' seen in clear cell RCC.
#*ChRCC has wisps in the cytoplasm.
===Image===
<gallery>
Image:Oncocytic_chromophobe_rcc_high_mag.jpg | Oncocytic chromophobe RCC. (WC/Nephron)
</gallery>
www:
*[http://path.upmc.edu/cases/case333.html Chromophobe RCC - several images (upmc.edu)].
==Stains==
*[[Hale's colloidal iron]] +ve (blue granular cytoplasmic).
Images:
*[http://www.nature.com/modpathol/journal/v18/n2/fig_tab/3800286f1.html ChRCC Hale's colloidal iron - several images (nature.com)].
*[http://www.ultrapath.org/oldsite/cases99/sep99/images/figure-3.jpg ChRCC Hale's colloidal iron (ultrapath.org)].<ref>URL: [http://www.ultrapath.org/oldsite/cases99/sep99/cotm9-2.html http://www.ultrapath.org/oldsite/cases99/sep99/cotm9-2.html]. Accessed on: 9 October 2011.</ref>
*[http://www.diagnosticpathology.org/content/4/1/21/figure/f1?highres=n ChRCC Hale's colloidal iron (diagnosticpathology.org)].
==IHC==
*CK7 +ve cell membrane.<ref name=Ref_GUP293>{{Ref GUP|293}}</ref>
*CD117 +ve.
*Vimentin -ve.
==Molecular==
*Extensive aneusomy (monosomy?):<ref name=Ref_WMSP292>{{Ref WMSP|292}}</ref>
**Loss of chromosomes: 1, 2, 6, 10, 13, 17, 21.
==Sign out==
<pre>
KIDNEY, RIGHT UPPER POLE, PARTIAL NEPHRECTOMY:
- CHROMOPHOBE RENAL CELL CARCINOMA.
COMMENT:
The sections show a mix of clear cells with wispy cytoplasm, and cells with eosinophilic
cytoplasm and perinuclear halos. There are no true papillae.
Stains and immunostains:
Positive: CK7, CAM5.2, EMA, pankeratin, CD117, colloidal iron.
Negative: AMACR, CD10, CD68, RCC, vimentin.
</pre>
==See also==
*[[Kidney tumours]]
==References==
{{Reflist|2}}
[[Category:Kidney tumours]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]

Revision as of 02:28, 3 November 2013

Chromophobe renal cell carcinoma, abbreviated ChRCC, is a relatively common form of renal cell carcinoma.

General

There are two subtypes:[2]

  • Classic.
  • Eosinophilic variant.

Gross

  • Tan, light-brown.
  • Solitary.
  • Well-circumscribed.

Image:

Microscopic

Classic

Features - classic type (3 P's mnemonic):[3][2]

  • Pale cytoplasm, with wisps of eosinophilic material; the cells are not completely clear, they have "cobwebs".
  • Perinuclear clearing, i.e. a pale halo surrounds the nucleus - key feature.
  • Periphery of cell distinct, i.e. cell membrane is easy to discern.

Notes:

  • May have psammoma bodies.
  • May be described as "plant-like"; plant cells have (thick) cell walls.
  • The perinuclear clearing is often somewhat patchy, i.e. it is usually not present in very tumour cell.

DDx:

  • Clear cell RCC (classic).
    • Perinuclear clearing is not seen in clear cell RCC.
    • ChRCC has wisps in the cytoplasm.

Eosinophilic variant

Features - eosinophilic variant:[2]

  • Eosinophilic (finely granular) cytoplasm.
  • Perinuclear clearing - key feature.
  • Periphery of cell distinct.
  • Smaller cells than classic subtype.

Notes:

  1. May have psammoma bodies.

DDx:

  1. Oncocytoma - particularly the eosinophilic variant.
    • IHC may be useful to differentiate (CK7: oncocytoma = cytoplasm +ve, chromophobe = cell membrane +ve).
    • A comparison based on histomorphology: Tabular comparison between ChRCC & oncocytoma.
      • Oncocytoma typically has: no perinuclear clearing, no raisinoid nuclei, no binucleation.
  2. Clear cell RCC, eosinophilic variant.
    • Perinuclear clearing is not seen in clear cell RCC.
    • ChRCC has wisps in the cytoplasm.

Image

  • Oncocytic chromophobe RCC. (WC/Nephron)

www:

Stains

Images:

IHC

  • CK7 +ve cell membrane.[2]
  • CD117 +ve.
  • Vimentin -ve.

Molecular

  • Extensive aneusomy (monosomy?):[5]
    • Loss of chromosomes: 1, 2, 6, 10, 13, 17, 21.

Sign out

KIDNEY, RIGHT UPPER POLE, PARTIAL NEPHRECTOMY:
- CHROMOPHOBE RENAL CELL CARCINOMA.

COMMENT:
The sections show a mix of clear cells with wispy cytoplasm, and cells with eosinophilic
cytoplasm and perinuclear halos. There are no true papillae. 

Stains and immunostains:
Positive: CK7, CAM5.2, EMA, pankeratin, CD117, colloidal iron.
Negative: AMACR, CD10, CD68, RCC, vimentin.

See also

References

  1. ↑ Delahunt, B.; Sika-Paotonu, D.; Bethwaite, PB.; McCredie, MR.; Martignoni, G.; Eble, JN.; Jordan, TW. (Jun 2007). "Fuhrman grading is not appropriate for chromophobe renal cell carcinoma.". Am J Surg Pathol 31 (6): 957-60. doi:10.1097/01.pas.0000249446.28713.53. PMID 17527087.
  2. ↑ 2.0 2.1 2.2 2.3 Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 293. ISBN 978-0443066771.
  3. ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1016-7. ISBN 0-7216-0187-1.
  4. ↑ URL: http://www.ultrapath.org/oldsite/cases99/sep99/cotm9-2.html. Accessed on: 9 October 2011.
  5. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 292. ISBN 978-0781765275.
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