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Renal hybrid oncocytic/chromophobe tumour (view source)

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'''Renal hybrid oncocytic/chromophobe tumour''', also '''hybrid tumour''', is a rare [[kidney tumour]] with features of [[chromophobe renal cell carcinoma]] and [[renal oncocytoma]].<ref>{{Cite journal  | last1 = Hes | first1 = O. | last2 = Petersson | first2 = F. | last3 = Kuroda | first3 = N. | last4 = Hora | first4 = M. | last5 = Michal | first5 = M. | title = Renal hybrid oncocytic/chromophobe tumors - a review. | journal = Histol Histopathol | volume = 28 | issue = 10 | pages = 1257-64 | month = Oct | year = 2013 | doi =  | PMID = 23740406 }}</ref>
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Hybrid tumour of the kidney -- high mag.jpg
| Width      =
| Caption    = Hybrid oncocytic/chromophobe tumour of the kidney. [[H&E stain]].
| Synonyms  = hybrid tumour
| Micro      = features of [[renal oncocytoma]] and [[chromophobe renal cell carcinoma]] - varies by subtype
| Subtypes  = as per Hes ''et al.'': (1) [[collision tumour]]-type, (2) renal oncocytoma with scattered chromophobe cells-type, (3) large eosinophilic cells with intracytoplasmic vacuoles-type
| LMDDx      = [[renal oncocytoma]], [[chromophobe renal cell carcinoma]], [[renal cell carcinoma, unclassified]], [[SDH-deficient renal cell carcinoma]], other [[renal tumours with eosinophilic cytoplasm]]
| Stains    = Hale's colloidal iron +ve
| IHC        = CD117 +ve, CK7 +ve (variable)
| EM        =
| Molecular  = no features of [[ChRCC]]
| IF        =
| Gross      =
| Grossing  = [[partial nephrectomy grossing]], [[total nephrectomy for tumour grossing]]
| Site      = [[kidney]] - see ''[[kidney tumours]]''
| Assdx      =
| Syndromes  = [[Birt–Hogg–Dubé syndrome]]
| Clinicalhx = renal mass
| Signs      =
| Symptoms  =
| Prevalence = very rare
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = good on very limited data
| Other      =
| ClinDDx    =
| Tx        = surgical excision
}}
'''Renal hybrid oncocytic/chromophobe tumour''', also '''hybrid oncocytic/chromophobe tumour''' (abbreviated '''HOCT''') and '''hybrid tumour''', is a rare [[kidney tumour]] with features of [[chromophobe renal cell carcinoma]] and [[renal oncocytoma]].<ref name=pmid23740406>{{Cite journal  | last1 = Hes | first1 = O. | last2 = Petersson | first2 = F. | last3 = Kuroda | first3 = N. | last4 = Hora | first4 = M. | last5 = Michal | first5 = M. | title = Renal hybrid oncocytic/chromophobe tumors - a review. | journal = Histol Histopathol | volume = 28 | issue = 10 | pages = 1257-64 | month = Oct | year = 2013 | doi =  | PMID = 23740406 }}</ref>
 
==General==
*Rare.
*Molecular heterogeneous group<ref name=pmid23740406/> - may represent several different entities.
*Prognosis good - based on one series of 11 cases.<ref name=pmid23708994/>
 
May be seen in several contexts:<ref name=pmid23740406/>
*Sporadic.
*[[Birt–Hogg–Dubé syndrome]].
*[[Renal oncocytosis]].
 
==Microscopic==
Three morphologic patterns as per Hes ''et al.'':<ref name=pmid23740406/>
# [[Renal oncocytoma]] and [[chromophobe renal cell carcinoma]] [[collision tumour]].
#* Different fields viewed in isolation would be compatible with the different diagnoses. Tumour component do not intermingle.
# Renal oncocytoma with scattered chromophobe cells.
# Large eosinophilic cell with intracytoplasmic vacuoles - this is the evolving entity ''[[eosinophilic vacuolated tumour]]''.
#* Prominent nucleoli ([[ISUP nucleolar grade]] 3).
#* Perinuclear halos (occasional).
#* Nested architecture.
 
DDx:
*[[Renal oncocytoma]] - may have limited chromophobe-like areas (<=5% of tumour).<ref name=pmid21166703>{{Cite journal  | last1 = Trpkov | first1 = K. | last2 = Yilmaz | first2 = A. | last3 = Uzer | first3 = D. | last4 = Dishongh | first4 = KM. | last5 = Quick | first5 = CM. | last6 = Bismar | first6 = TA. | last7 = Gokden | first7 = N. | title = Renal oncocytoma revisited: a clinicopathological study of 109 cases with emphasis on problematic diagnostic features. | journal = Histopathology | volume = 57 | issue = 6 | pages = 893-906 | month = Dec | year = 2010 | doi = 10.1111/j.1365-2559.2010.03726.x | PMID = 21166703 }}</ref>
*[[Chromophobe renal cell carcinoma]], eosinophilic variant.
*[[SDH-deficient renal cell carcinoma]] - lower nuclear grade, not nested.
*[[Eosinophilic vacuolated tumour]] - evolving entity.
*Other [[renal tumours with eosinophilic cytoplasm]].
*[[Renal cell carcinoma, unclassified]].
 
===Images===
====Case 1====
<gallery>
Image: Hybrid tumour of the kidney -- low mag.jpg | HOCT - low mag. (WC)
Image: Hybrid tumour of the kidney -- intermed mag.jpg | HOCT - intermed. mag. (WC)
Image: Hybrid tumour of the kidney -- high mag.jpg | HOCT - high mag. (WC)
</gallery>
====Case 2====
<gallery>
Image: Renal hybrid tumour - 2 -- intermed mag.jpg | HOCT - intermed. mag. (WC)
Image: Renal hybrid tumour - 2 -- high mag.jpg | HOCT - high mag. (WC)
Image: Renal hybrid tumour - 2 -- very high mag.jpg | HOCT - very high mag. (WC)
 
Image: Renal hybrid tumour - nests - 2 -- intermed mag.jpg | HOCT - intermed. mag. (WC)
Image: Renal hybrid tumour - nests - 2 -- high mag.jpg | HOCT - high mag. (WC)
Image: Renal hybrid tumour - nests - 2 -- very high mag.jpg | HOCT - very high mag. (WC)
</gallery>
 
==Stains==
Features:<ref name=pmid23708994>{{Cite journal  | last1 = Poté | first1 = N. | last2 = Vieillefond | first2 = A. | last3 = Couturier | first3 = J. | last4 = Arrufat | first4 = S. | last5 = Metzger | first5 = I. | last6 = Delongchamps | first6 = NB. | last7 = Camparo | first7 = P. | last8 = Mège-Lechevallier | first8 = F. | last9 = Molinié | first9 = V. | title = Hybrid oncocytic/chromophobe renal cell tumours do not display genomic features of chromophobe renal cell carcinomas. | journal = Virchows Arch | volume = 462 | issue = 6 | pages = 633-8 | month = Jun | year = 2013 | doi = 10.1007/s00428-013-1422-4 | PMID = 23708994 }}</ref>
*[[Hale's colloidal iron]] +ve (apical pattern).
 
==IHC==
Features:
*CD117 +ve (practically definitional<ref name=pmid23740406/>).
*CK7 +ve - often variable/patchy (oncocytoma-like).<ref name=pmid23708994/>
 
Others:
*Vimentin -ve.
*EMA +ve.
*CD10 +ve.
*PAX8 +ve.
 
==Molecular==
*No features characteristic of [[chromophobe RCC]] on array-CGH analysis.<ref name=pmid23708994/>
 
==Sign out==
<pre>
Left Kidney, Partial Nephrectomy:
- Renal tumour with eosinophilic cytoplasm of undetermined malignant potential
  in keeping with the so called "hybrid oncocytic/chromophobe tumour", see comment.
-- Resection margins clear.
-- Tumour limited to kidney.
 
Comment:
The tumour may be seen in the context of Birt–Hogg–Dubé syndrome.
</pre>


==See also==
==See also==
*[[Renal tumours with eosinophilic cytoplasm]].
*[[Renal tumours with eosinophilic cytoplasm]].
*[[Renal oncocytoma]].
*[[High-grade oncocytic renal tumour]].


==References==
==References==
{{Reflist|1}}
{{Reflist|2}}


[[Category:Genitourinary pathology]]
[[Category:Genitourinary pathology]]
[[Category:Diagnosis]]
Michael
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