Difference between revisions of "Renal oncocytoma"

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Renal oncocytoma (view source)

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      = Renal_oncocytoma2.jpg
| Image      = Renal oncocytoma -- intermed mag.jpg  
| Width      =
| Width      =
| Caption    = Renal oncocytoma. [[H&E stain]].
| Caption    = Renal oncocytoma (left of image) and normal kidney (right of image). [[Kidney biopsy]]. [[H&E stain]].
| Micro      = abundant eosinophilic cytoplasm - slightly granular, cells arranged in nests, nuclei uniform and round without significant pleomorphism
| Micro      = abundant eosinophilic cytoplasm - slightly granular, cells arranged in nests, nuclei uniform and round without significant pleomorphism
| Subtypes  =
| Subtypes  =
| LMDDx      = [[chromophobe renal cell carcinoma]] eosinophilic variant, [[clear cell renal cell carcinoma]] eosinophilic variant, [[papillary renal cell carcinoma]] oncocytic variant
| LMDDx      = [[chromophobe renal cell carcinoma]] eosinophilic variant, [[clear cell renal cell carcinoma]] eosinophilic variant, [[papillary renal cell carcinoma]] oncocytic variant, [[tubulocystic carcinoma of the kidney]], other [[renal tumours with eosinophilic cytoplasm]], benign [[liver]]
| Stains    = [[Hale's colloidal iron]] -ve
| Stains    = [[Hale's colloidal iron]] -ve
| IHC        = CK7 -ve/cytoplasmic +ve  
| IHC        = CK7 -ve/cytoplasmic +ve, CD117 +ve, [[PAX8]] +ve  
| EM        = abundant mitochondria
| EM        = abundant mitochondria
| Molecular  =
| Molecular  =
| IF        =
| IF        =
| Gross      = mass, mahogany brown +/- central scar
| Gross      = mass, mahogany brown +/- central scar
| Grossing  =
| Grossing  = [[partial nephrectomy grossing]], [[total nephrectomy for tumour grossing]]
| Site      = [[kidney]] - see [[kidney tumours]]
| Site      = [[kidney]] - see [[kidney tumours]]
| Assdx      =
| Assdx      =
| Syndromes  =
| Syndromes  =
| Clinicalhx =
| Clinicalhx = often incidentally discovered mass
| Signs      =
| Signs      =
| Symptoms  =
| Symptoms  =
| Prevalence =
| Prevalence =
| Bloodwork  =
| Bloodwork  =
| Rads      = central scar
| Rads      = renal mass with central scar (classic)
| Endoscopy  =
| Endoscopy  =
| Prognosis  = benign
| Prognosis  = benign
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** ... and pathologists occasionally struggle like the radiologists.
** ... and pathologists occasionally struggle like the radiologists.
*Benign tumour - the reason it is excised is... one cannot be certain it isn't a RCC.
*Benign tumour - the reason it is excised is... one cannot be certain it isn't a RCC.
*May be seen in the context of [[renal oncocytosis]].<ref name=pmid23018240>{{Cite journal  | last1 = Kuroda | first1 = N. | last2 = Tanaka | first2 = A. | last3 = Ohe | first3 = C. | last4 = Mikami | first4 = S. | last5 = Nagashima | first5 = Y. | last6 = Sasaki | first6 = T. | last7 = Inoue | first7 = K. | last8 = Hes | first8 = O. | last9 = Michal | first9 = M. | title = Review of renal oncocytosis (multiple oncocytic lesions) with focus on clinical and pathobiological aspects. | journal = Histol Histopathol | volume = 27 | issue = 11 | pages = 1407-12 | month = Nov | year = 2012 | doi =  | PMID = 23018240 }}</ref>


==Gross==
==Gross==
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*Cells arranged in nests.
*Cells arranged in nests.
*Nuclei uniform and round.<ref name=Ref_GUP302>{{Ref GUP|302}}</ref>
*Nuclei uniform and round.<ref name=Ref_GUP302>{{Ref GUP|302}}</ref>
**Slightly enlarged nuclei, but '''no significant''' pleomorphism (size variation) - '''important'''.
**Slightly enlarged nuclei, but '''no significant''' pleomorphism (size variation) - '''important'''.‡


Notes:
Notes:
*May look like eosinophilic variant of chromophobe RCC -- this is the main DDx.
*May look like eosinophilic variant of chromophobe RCC -- this is the main DDx.
**A comparison based on histomorphology: ''[[Kidney_tumours#Tabular_comparison_of_oncocytoma_and_chromophobe_RCC|Tabular comparison between ChRCC & oncocytoma]]''.
**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.
***Oncocytoma typically has: no perinuclear clearing, no raisinoid nuclei, rare or no binucleation.
*May have - according to Trpkov ''et al.'':<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>
**[[Vascular invasion]] ~4% of cases.
**Chromophobe-like foci (<5% of neoplasm) ~12% of cases.
**Focal clear cell changes ~15% of cases.
**Hemorrhage.
*‡ Focal "degenerative" atypia can be present; it is reported in ~20% of cases.<ref>{{cite journal |authors=Tickoo SK, Amin MB |title=Discriminant nuclear features of renal oncocytoma and chromophobe renal cell carcinoma. Analysis of their potential utility in the differential diagnosis |journal=Am J Clin Pathol |volume=110 |issue=6 |pages=782–7 |date=December 1998 |pmid=9844591 |doi=10.1093/ajcp/110.6.782 |url=}}</ref>


DDx:
DDx:
*[[Chromophobe renal cell carcinoma]], eosinophilic variant.
*[[Chromophobe renal cell carcinoma]], eosinophilic variant.
*[[Succinate dehydrogenase-deficient renal cell carcinoma]] - emerging entity as per [[Vancouver classification]] - classically has a flocculent cytoplasm, may have oncocytoma-like areas.
*[[Papillary renal cell carcinoma]], oncocytic variant.
*[[Renal hybrid oncocytic/chromophobe tumour]].
*[[Clear cell renal cell carcinoma]], eosinophilic variant.
*[[Clear cell renal cell carcinoma]], eosinophilic variant.
*[[Tubulocystic carcinoma of the kidney]].
*Other [[renal tumours with eosinophilic cytoplasm]].
*Benign [[liver]].


===Images===
===Images===
====Case 1====
<gallery>
Image: Renal oncocytoma (3).jpg | Oncocytoma. (WC/KGH)
Image: Renal oncocytoma (1).jpg | Oncocytoma. (WC/KGH)
Image: Renal oncocytoma (2).jpg | Oncocytoma. (WC/KGH)
</gallery>
====Case 2====
<gallery>
<gallery>
Image:Renal_oncocytoma2.jpg | Oncocytoma - high mag. (WC/Nephron)
Image:Renal_oncocytoma2.jpg | Oncocytoma - high mag. (WC/Nephron)
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Image:Renal_oncocytoma4.jpg | Oncocytoma - low mag. (WC/Nephron)
Image:Renal_oncocytoma4.jpg | Oncocytoma - low mag. (WC/Nephron)
</gallery>
</gallery>
====Case 3====
<gallery>
Image:Renal oncocytoma -- low mag.jpg | Oncocytoma - low mag. (WC/Nephron)
Image:Renal oncocytoma - alt -- low mag.jpg | Oncocytoma - low mag. (WC/Nephron)
Image:Renal oncocytoma -- intermed mag.jpg | Oncocytoma - intermed. mag. (WC/Nephron)
Image:Renal oncocytoma -- high mag.jpg | Oncocytoma - high mag. (WC/Nephron)
</gallery>
==Stains==
==Stains==
*[[Hale's colloidal iron]] -ve.  
*[[Hale's colloidal iron]] (or [[Mueller-Mowry stain]]) -ve.  
**[[ChRCC]] +ve (blue granular cytoplasmic).
**[[ChRCC]] +ve (blue granular cytoplasmic).


==IHC==
==IHC==
*CK7 -ve<ref name=pmid17683191>{{Cite journal  | last1 = Liu | first1 = L. | last2 = Qian | first2 = J. | last3 = Singh | first3 = H. | last4 = Meiers | first4 = I. | last5 = Zhou | first5 = X. | last6 = Bostwick | first6 = DG. | title = Immunohistochemical analysis of chromophobe renal cell carcinoma, renal oncocytoma, and clear cell carcinoma: an optimal and practical panel for differential diagnosis. | journal = Arch Pathol Lab Med | volume = 131 | issue = 8 | pages = 1290-7 | month = Aug | year = 2007 | doi = 10.1043/1543-2165(2007)131[1290:IAOCRC]2.0.CO;2 | PMID = 17683191 }}</ref>/+ve (cytoplasmic) .
*[[CK7]] -ve<ref name=pmid17683191>{{Cite journal  | last1 = Liu | first1 = L. | last2 = Qian | first2 = J. | last3 = Singh | first3 = H. | last4 = Meiers | first4 = I. | last5 = Zhou | first5 = X. | last6 = Bostwick | first6 = DG. | title = Immunohistochemical analysis of chromophobe renal cell carcinoma, renal oncocytoma, and clear cell carcinoma: an optimal and practical panel for differential diagnosis. | journal = Arch Pathol Lab Med | volume = 131 | issue = 8 | pages = 1290-7 | month = Aug | year = 2007 | doi = 10.1043/1543-2165(2007)131[1290:IAOCRC]2.0.CO;2 | PMID = 17683191 }}</ref>/+ve (cytoplasmic).
**[[Chromophobe renal cell carcinoma]] = cell membrane +ve.
**[[Chromophobe renal cell carcinoma]] = cell membrane +ve.
**Based on a mRNA study it was suggested that <50% CK7 immunostaining favours oncocytoma.<ref name=pmid16927643>{{Cite journal  | last1 = Adley | first1 = BP. | last2 = Papavero | first2 = V. | last3 = Sugimura | first3 = J. | last4 = Teh | first4 = BT. | last5 = Yang | first5 = XJ. | title = Diagnostic value of cytokeratin 7 and parvalbumin in differentiating chromophobe renal cell carcinoma from renal oncocytoma. | journal = Anal Quant Cytol Histol | volume = 28 | issue = 4 | pages = 228-36 | month = Aug | year = 2006 | doi =  | PMID = 16927643 }}</ref>
*PAX8 +ve.<ref name=pmid22135028>{{Cite journal  | last1 = Hu | first1 = Y. | last2 = Hartmann | first2 = A. | last3 = Stoehr | first3 = C. | last4 = Zhang | first4 = S. | last5 = Wang | first5 = M. | last6 = Tacha | first6 = D. | last7 = Montironi | first7 = R. | last8 = Lopez-Beltran | first8 = A. | last9 = Cheng | first9 = L. | title = PAX8 is expressed in the majority of renal epithelial neoplasms: an immunohistochemical study of 223 cases using a mouse monoclonal antibody. | journal = J Clin Pathol | volume = 65 | issue = 3 | pages = 254-6 | month = Mar | year = 2012 | doi = 10.1136/jclinpath-2011-200508 | PMID = 22135028 }}</ref>
*[[CD117]] +ve.<ref>{{Cite journal  | last1 = Krüger | first1 = S. | last2 = Sotlar | first2 = K. | last3 = Kausch | first3 = I. | last4 = Horny | first4 = HP. | title = Expression of KIT (CD117) in renal cell carcinoma and renal oncocytoma. | journal = Oncology | volume = 68 | issue = 2-3 | pages = 269-75 | month =  | year = 2005 | doi = 10.1159/000086783 | PMID = 16015044 }}</ref>
**ChRCC also +ve.
*GATA-3 usually -ve (38 cases negative of 47 cases).<ref name=pmid2431520>{{cite journal |authors=Gonzalez-Roibon N, Faraj SF, Munari E, Bezerra SM, Albadine R, Sharma R, Argani P, Allaf ME, Netto GJ |title=Comprehensive profile of GATA binding protein 3 immunohistochemical expression in primary and metastatic renal neoplasms |journal=Hum Pathol |volume=45 |issue=2 |pages=244–8 |date=February 2014 |pmid=24315206 |doi=10.1016/j.humpath.2013.08.020 |url=}}</ref>
**+ve in [[low-grade oncocytic renal tumour]].


*PAX2 +ve .<ref name=pmid17210525>{{cite journal |author=Memeo L, Jhang J, Assaad AM, ''et al.'' |title=Immunohistochemical analysis for cytokeratin 7, KIT, and PAX2: value in the differential diagnosis of chromophobe cell carcinoma |journal=Am. J. Clin. Pathol. |volume=127 |issue=2 |pages=225–9 |year=2007 |month=February |pmid=17210525 |doi=10.1309/9KWEA4W9Y94D1AEE |url=http://ajcp.ascpjournals.org/cgi/pmidlookup?view=long&pmid=17210525}}</ref>
Others:
*CD10 -ve/+ve.
*Amylase α-1A +ve.<ref name=pmid24225843>{{Cite journal  | last1 = Jain | first1 = S. | last2 = Roy | first2 = S. | last3 = Amin | first3 = M. | last4 = Acquafondata | first4 = M. | last5 = Yin | first5 = M. | last6 = Laframboise | first6 = W. | last7 = Bastacky | first7 = S. | last8 = Pantanowitz | first8 = L. | last9 = Dhir | first9 = R. | title = Amylase α-1A (AMY1A): A Novel Immunohistochemical Marker to Differentiate Chromophobe Renal Cell Carcinoma From Benign Oncocytoma. | journal = Am J Surg Pathol | volume = 37 | issue = 12 | pages = 1824-30 | month = Dec | year = 2013 | doi = 10.1097/PAS.0000000000000108 | PMID = 24225843 }}</ref>
*PAX2 +ve.<ref name=pmid17210525>{{cite journal |author=Memeo L, Jhang J, Assaad AM, ''et al.'' |title=Immunohistochemical analysis for cytokeratin 7, KIT, and PAX2: value in the differential diagnosis of chromophobe cell carcinoma |journal=Am. J. Clin. Pathol. |volume=127 |issue=2 |pages=225–9 |year=2007 |month=February |pmid=17210525 |doi=10.1309/9KWEA4W9Y94D1AEE |url=http://ajcp.ascpjournals.org/cgi/pmidlookup?view=long&pmid=17210525}}</ref>
**Oncocytoma 20 of 23 +ve versus ChRCC 1 of 11 +ve.
**Oncocytoma 20 of 23 +ve versus ChRCC 1 of 11 +ve.
*AMACR -ve.<ref name=pmid26925847>{{Cite journal  | last1 = Lüders | first1 = C. | last2 = Kristiansen | first2 = G. | title = [Oncocytoma versus chromophobe renal cell carcinoma : Is there something in between?]. | journal = Pathologe | volume = 37 | issue = 2 | pages = 153-8 | month = Mar | year = 2016 | doi = 10.1007/s00292-016-0145-0 | PMID = 26925847 }}</ref>
*Vimentin -ve.<ref name=pmid26925847/>
A panel:
*CK7, PAX8, CD117, CD10, [[Mueller-Mowry stain]], GATA-3.


*Amylase α-1A +ve.<ref name=pmid24225843>{{Cite journal  | last1 = Jain | first1 = S. | last2 = Roy | first2 = S. | last3 = Amin | first3 = M. | last4 = Acquafondata | first4 = M. | last5 = Yin | first5 = M. | last6 = Laframboise | first6 = W. | last7 = Bastacky | first7 = S. | last8 = Pantanowitz | first8 = L. | last9 = Dhir | first9 = R. | title = Amylase α-1A (AMY1A): A Novel Immunohistochemical Marker to Differentiate Chromophobe Renal Cell Carcinoma From Benign Oncocytoma. | journal = Am J Surg Pathol | volume = 37 | issue = 12 | pages = 1824-30 | month = Dec | year = 2013 | doi = 10.1097/PAS.0000000000000108 | PMID = 24225843 }}</ref>
===Comparison between some renal tumours with eosinophilic cytoplasm===
{| class="wikitable sortable"
!Tumour
![[CK7]]
![[CD117]]
![[GATA3]]
|-
| Renal oncocytoma
| -ve †
| +ve
| -ve/+ve
|-
| [[Chromophobe renal cell carcinoma]]
| +ve ‡
| +ve
| -ve
|-
| [[Low-grade oncocytic tumour]]
| +ve
| -ve
| +ve
|-
|}
† may have scattered positive cells<br>
‡ diffuse and strong


==Sign out==
==Sign out==
===Biopsy===
===Biopsy===
<pre>
Kidney Mass, Left, Core Biopsy:
- Renal tumour with oncocytic cytoplasm, favour oncocytoma.
COMMENT:
The tumour is stains as follows:
POSITIVE: CD117.
NEGATIVE: Hale's colloidal iron, CK7.
</pre>
====Block letters====
<pre>
<pre>
KIDNEY MASS, RIGHT, CORE BIOPSY:
KIDNEY MASS, RIGHT, CORE BIOPSY:
- RENAL TUMOUR WITH ONCOCYTIC CYTOPLASM, FAVOUR ONCOCYTOMA.
- RENAL TUMOUR WITH ONCOCYTIC CYTOPLASM, FAVOUR ONCOCYTOMA.
COMMENT:
The tumour is CK7 negative and Hale's colloidal iron negative.
</pre>
</pre>


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===Resection===
===Resection===
<pre>
<pre>
PORTION OF KIDNEY, RIGHT, PARTIAL NEPHRECTOMY:
PORTION OF KIDNEY, LEFT, PARTIAL NEPHRECTOMY:
- ONCOCYTOMA.
- ONCOCYTOMA.
COMMENT:
The tumour is CK7 negative and Hale's colloidal iron negative.
</pre>
</pre>


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The sections show a tumour with cells arranged in nests. The tumour cells have abundant
The sections show a tumour with cells arranged in nests. The tumour cells have abundant
eosinophilic cytoplasm. The tumour cell nuclei are round and have round nucleoli. No
eosinophilic cytoplasm. The tumour cell nuclei are round and have round nucleoli. No
perinuclear halos are apparent. Binucleation is not apparent. No zonal necrosis is
perinuclear halos are apparent. Binucleation is not common. No zonal necrosis is
identified. Focally, tumour nests are spaced reminiscent of an archipelago. Mitoses are not
identified. Focally, tumour nests are spaced reminiscent of an archipelago. Mitoses are not
apparent. The tumour is moderately circumscribed.
apparent. The tumour is moderately circumscribed and is completely excised in the planes of
section.
 
The thin rim of renal parenchyma has no apparent glomerular pathology on the H&E stained
sections.  Mild-to-moderate atherosclerosis is present. Mild arteriolar hyalinization is
identified.


The thin rim of renal parenchyma has no apparent pathology on the H&E stained sections.
The Hale's colloidal iron stain is negative in the tumour. A CK7 immunostain has very rare positive cells within the tumour; this is interpreted overall as negative.


==See also==
==See also==
Michael
48,470

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