Hereditary leiomyomatosis and renal cell carcinoma syndrome
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Renal cell carcinoma in the context of HLRCC showing the characteristic hyalinized papillary cores. H&E stain. (WC/Nephron)
Hereditary leiomyomatosis and renal cell carcinoma syndrome (abbreviated HLRCC), also hereditary leiomyomatosis and renal cell cancer, is an uncommon syndrome caused by fumarate hydratase (FH) gene mutations.[1][2]
HLRCC is classically described as:[3]
- Papillary renal cell carcinoma type 2.
- Benign leiomyomas skin/uterus.
- Uterine leiomyosarcoma.
General
- Autosomal dominant inheritance[4] with variable penetration.[5]
- In one series of 21 families: 62% renal cancer, 76% had cutaneous leiomyomas and 100% had uterine leiomyomas.[6]
Clinical:
- Leiomyomas seen in many patients.
- The associated renal cell carcinoma is often aggressive and significant cause of mortality.[8]
Microscopic
Features - renal cell carcinoma:[8]
- Large 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.
- Papillary - classic description.
Notes:
- Not common: psammoma bodies, foamy macrophages.[9]
DDx:
- Papillary renal cell carcinoma (type 2).
- Tubulocystic carcinoma of the kidney.
- Collecting duct carcinoma.[6]
- Renal medullary carcinoma - cells also have a prominent nucleolus.
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.[8]
- 2SC = S-(2-succino)-cysteine.
Others:
- CK7 -ve (0 +ve/38 cases[4]).
- CD10 -ve.
- May be positive in clear cell RCC-like areas.
- CK20 -ve (0 +ve/38 cases[4]).
- UEA-1 -ve.[4]
- TFE3 -ve (0 +ve/38 cases[4]).
- CK34betaE12 -ve (0 +ve/38 cases[4]).
See also
References
- ↑ Online 'Mendelian Inheritance in Man' (OMIM) 136850
- ↑ Online 'Mendelian Inheritance in Man' (OMIM) 150800
- ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 290. ISBN 978-0781765275.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 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.
- ↑ 5.0 5.1 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.
- ↑ 6.0 6.1 6.2 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.
- ↑ Toon, CW.; Hasovits, C.; Paik, J.; Field, M.; Chou, A.; Hugh, TJ.; Pavlakis, N.; Gill, AJ. (Jul 2014). "Skin rash, a kidney mass and a family mystery dating back to World War II.". Med J Aust 201 (1): 58-60. PMID 24999901.
- ↑ 8.0 8.1 8.2 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.
- ↑ 9.0 9.1 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.