Difference between revisions of "Hereditary leiomyomatosis and renal cell carcinoma syndrome-associated renal cell carcinoma"

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| Caption    = [[Hereditary leiomyomatosis and renal cell carcinoma syndrome-associated renal cell carcinoma]] showing the characteristic hyalinized papillary cores. [[H&E stain]]. (WC/Nephron)
| Caption    = [[Hereditary leiomyomatosis and renal cell carcinoma syndrome-associated renal cell carcinoma]] showing the characteristic hyalinized papillary cores. [[H&E stain]]. (WC/Nephron)
| Synonyms  =
| Synonyms  =
| Micro      = cells with large (often eosinophilic) nucleolus with perinucleolar clearing (may be focal), variable architecture: papillary (classic description) +/-hyaline material within the fibrovascular cores (characteristic), tubulopapillary, tubular, solid, sieve-like pattern/cribriform
| Micro      = cells with large (usually eosinophilic) nucleolus with perinucleolar clearing (may be focal), variable architecture: papillary (classic description) +/-hyaline material within the fibrovascular cores (characteristic), tubulopapillary, tubular, solid, sieve-like pattern/cribriform
| Subtypes  =
| Subtypes  =
| LMDDx      = [[papillary renal cell carcinoma]] (type 2), [[tubulocystic carcinoma of the kidney]], [[collecting duct carcinoma]], [[renal medullary carcinoma]]
| LMDDx      = [[papillary renal cell carcinoma]] (type 2), [[tubulocystic carcinoma of the kidney]], [[collecting duct carcinoma]], [[renal medullary carcinoma]]
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==Microscopic==
==Microscopic==
Features - renal cell carcinoma:<ref name=pmid24441663>{{Cite journal  | last1 = Chen | first1 = YB. | last2 = Brannon | first2 = AR. | last3 = Toubaji | first3 = A. | last4 = Dudas | first4 = ME. | last5 = Won | first5 = HH. | last6 = Al-Ahmadie | first6 = HA. | last7 = Fine | first7 = SW. | last8 = Gopalan | first8 = A. | last9 = Frizzell | first9 = N. | title = Hereditary leiomyomatosis and renal cell carcinoma syndrome-associated renal cancer: recognition of the syndrome by pathologic features and the utility of detecting aberrant succination by immunohistochemistry. | journal = Am J Surg Pathol | volume = 38 | issue = 5 | pages = 627-37 | month = May | year = 2014 | doi = 10.1097/PAS.0000000000000163 | PMID = 24441663 }}</ref>
Features - renal cell carcinoma:<ref name=pmid24441663>{{Cite journal  | last1 = Chen | first1 = YB. | last2 = Brannon | first2 = AR. | last3 = Toubaji | first3 = A. | last4 = Dudas | first4 = ME. | last5 = Won | first5 = HH. | last6 = Al-Ahmadie | first6 = HA. | last7 = Fine | first7 = SW. | last8 = Gopalan | first8 = A. | last9 = Frizzell | first9 = N. | title = Hereditary leiomyomatosis and renal cell carcinoma syndrome-associated renal cancer: recognition of the syndrome by pathologic features and the utility of detecting aberrant succination by immunohistochemistry. | journal = Am J Surg Pathol | volume = 38 | issue = 5 | pages = 627-37 | month = May | year = 2014 | doi = 10.1097/PAS.0000000000000163 | PMID = 24441663 }}</ref>
*Large eosinophilic nucleolus with perinucleolar clearing - proposed hallmark - '''important'''.
*Large, (usually) eosinophilic, nucleolus with perinucleolar clearing - proposed hallmark - '''important'''.
**May be focal.
**May be focal.
*Variable architecture:
*Variable architecture:

Revision as of 20:54, 17 March 2016

Hereditary leiomyomatosis and renal cell carcinoma syndrome-associated renal cell carcinoma
Diagnosis in short

Hereditary leiomyomatosis and renal cell carcinoma syndrome-associated renal cell carcinoma showing the characteristic hyalinized papillary cores. H&E stain. (WC/Nephron)
LM cells with large (usually eosinophilic) nucleolus with perinucleolar clearing (may be focal), variable architecture: papillary (classic description) +/-hyaline material within the fibrovascular cores (characteristic), tubulopapillary, tubular, solid, sieve-like pattern/cribriform
LM DDx papillary renal cell carcinoma (type 2), tubulocystic carcinoma of the kidney, collecting duct carcinoma, renal medullary carcinoma
IHC FH -ve, 2SC +ve, CK7 -ve, TFE3 -ve, CK20 -ve, CD10 -ve, UEA-1 -ve
Molecular FH mutation
Grossing notes total nephrectomy for tumour grossing, partial nephrectomy grossing
Staging kidney cancer staging
Site kidney - see kidney tumours
Associated Dx uterine leiomyomas (women), skin leiomyomas
Syndromes hereditary leiomyomatosis and renal cell carcinoma syndrome
Clinical history +/-family history of kidney cancer
Signs +/-"skin rash", signs of renal cancer (+/-hematuria, +/-palpable abdominal mass)
Prevalence rare
Prognosis poor
Clin. DDx other kidney tumours
Treatment resection

Hereditary leiomyomatosis and renal cell carcinoma syndrome-associated renal cell carcinoma is a malignant epithelial tumour of the kidney associated with the hereditary leiomyomatosis and renal cell carcinoma syndrome.

It is formally recognized a distinct entity by the WHO as of 2013.[1]

General

Microscopic

Features - renal cell carcinoma:[2]

  • Large, (usually) eosinophilic, nucleolus with perinucleolar clearing - proposed hallmark - important.
    • May be focal.
  • Variable architecture:
    • Papillary - classic description.
      • Hyaline material within the fibrovascular cores - characteristic.
    • Tubulopapillary.
    • Tubular.
    • Solid.
    • Sieve-like pattern/cribriform.

Notes:

DDx:

Images

RCC

  • HLRCC - low mag. (WC)

  • HLRCC - intermed mag. (WC)

  • HLRCC - high mag. (WC)

  • HLRCC - high mag. (WC)

  • HLRCC - very high mag. (WC)

  • HLRCC - very high mag. (WC)

  • HLRCC - TC-like - low mag.

  • HLRCC - TC-like - intermed mag.

  • HLRCC - TC-like - high mag.

  • HLRCC - TC-like - very high mag.

www

IHC

  • Fumarate hydratase (FH) -ve.
  • 2SC +ve -- cytoplasmic,[5] cytoplasmic and nuclear.[2]
    • 2SC = S-(2-succino)-cysteine.

Others:

See also

References

  1. ↑ Srigley, JR.; Delahunt, B.; Eble, JN.; Egevad, L.; Epstein, JI.; Grignon, D.; Hes, O.; Moch, H. et al. (Oct 2013). "The International Society of Urological Pathology (ISUP) Vancouver Classification of Renal Neoplasia.". Am J Surg Pathol 37 (10): 1469-89. doi:10.1097/PAS.0b013e318299f2d1. PMID 24025519.
  2. ↑ 2.0 2.1 2.2 Chen, YB.; Brannon, AR.; Toubaji, A.; Dudas, ME.; Won, HH.; Al-Ahmadie, HA.; Fine, SW.; Gopalan, A. et al. (May 2014). "Hereditary leiomyomatosis and renal cell carcinoma syndrome-associated renal cancer: recognition of the syndrome by pathologic features and the utility of detecting aberrant succination by immunohistochemistry.". Am J Surg Pathol 38 (5): 627-37. doi:10.1097/PAS.0000000000000163. PMID 24441663.
  3. ↑ 3.0 3.1 Launonen, V.; Vierimaa, O.; Kiuru, M.; Isola, J.; Roth, S.; Pukkala, E.; Sistonen, P.; Herva, R. et al. (Mar 2001). "Inherited susceptibility to uterine leiomyomas and renal cell cancer.". Proc Natl Acad Sci U S A 98 (6): 3387-92. doi:10.1073/pnas.051633798. PMID 11248088.
  4. ↑ Pithukpakorn, M.; Wei, MH.; Toure, O.; Steinbach, PJ.; Glenn, GM.; Zbar, B.; Linehan, WM.; Toro, JR. (Sep 2006). "Fumarate hydratase enzyme activity in lymphoblastoid cells and fibroblasts of individuals in families with hereditary leiomyomatosis and renal cell cancer.". J Med Genet 43 (9): 755-62. doi:10.1136/jmg.2006.041087. PMID 16597677.
  5. ↑ Reyes, C.; Karamurzin, Y.; Frizzell, N.; Garg, K.; Nonaka, D.; Chen, YB.; Soslow, RA. (Jul 2014). "Uterine smooth muscle tumors with features suggesting fumarate hydratase aberration: detailed morphologic analysis and correlation with S-(2-succino)-cysteine immunohistochemistry.". Mod Pathol 27 (7): 1020-7. doi:10.1038/modpathol.2013.215. PMID 24309325.
  6. ↑ 6.0 6.1 6.2 6.3 6.4 Merino, MJ.; Torres-Cabala, C.; Pinto, P.; Linehan, WM. (Oct 2007). "The morphologic spectrum of kidney tumors in hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome.". Am J Surg Pathol 31 (10): 1578-85. doi:10.1097/PAS.0b013e31804375b8. PMID 17895761.
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