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Provided clinical history
62 year old woman, mass lesion
Site
left kidney
Primary image
Low magnification. H&E stain.
Intermediate magnification
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Intermediate magnification. H&E stain.
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High magnification
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High magnification. H&E stain.
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Differential diagnosis
Additional tests
More history
More history
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3.5 cm mass, radiology thinks it is RCC, smoker in teens and twenties, occasionally drinks alcohol, works a truck driver
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Ask a colleague
Ask a colleague
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Holy tumour... it's got halos!
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Stains
Alcian blue/PAS to Bilirubin |
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Test | Result |
Alcian blue/PAS | Dr Torres would ask why! |
Alican blue pH 1.0 | Dr Torres would ask why! |
Alcian blue pH 2.5 | Dr Torres would ask why! |
Auramine | Dr Torres would ask why! |
Bielchowsky | Dr Torres would ask why! |
Bilirubin | Dr Torres would ask why! |
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Colloidal iron to Fontana-Masson |
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Test | Result |
Colloidal iron | tumour stains blue |
Congo red | Dr Torres would ask why! |
Cresyl violet | Dr Torres would ask why! |
Dieterle | Dr Torres would ask why! |
Diff Quik | Dr Torres would ask why! |
Fontana-Masson | Dr Torres would ask why! |
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Gallyas to Gremelius |
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Test | Result |
Gallyas | Dr Torres would ask why! |
Giemsa | Dr Torres would ask why! |
GMS | Dr Torres would ask why! |
Gomori's trichrome | Dr Torres would ask why! |
Gram | Dr Torres would ask why! |
Gremelius | Dr Torres would ask why! |
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JMS to Mucicarmine |
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Test | Result |
JMS | Dr Torres would ask why! |
Jones | Dr Torres would ask why! |
Kinyoun | Dr Torres would ask why! |
Luxol fast blue | Dr Torres would ask why! |
Masson trichrome | Dr Torres would ask why! |
M-MAS | Dr Torres would ask why! |
Movat | Dr Torres would ask why! |
Mucicarmine | Dr Torres would ask why! |
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Oil red O to Prussian blue |
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Test | Result |
Oil red O | Dr Torres would ask why! |
Orecein | Dr Torres would ask why! |
PAS | Dr Torres would ask why! |
PASD | Dr Torres would ask why! |
PASF | Dr Torres would ask why! |
PTAH | Dr Torres would ask why! |
Prussian blue | Dr Torres would ask why! |
|
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Reticulin to Ziehl-Neelsen |
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Test | Result |
Reticulin | Dr Torres would ask why! |
Sudan black B | Dr Torres would ask why! |
Toluidine blue | Dr Torres would ask why! |
Verhoeff | Dr Torres would ask why! |
Von Kossa | Dr Torres would ask why! |
Warthin-Starry | Dr Torres would ask why! |
Ziehl-Neeslen | Dr Torres would ask why! |
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IHC
Alpha-1 AT to Cathepsin K |
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Test | Result |
alpha-1 AT | Dr Torres would ask why! |
ACTH | Dr Torres would ask why! |
AE1/AE1 | Dr Torres would ask why! |
alpha-fetoprotein | Dr Torres would ask why! |
Alk-I | Dr Torres would ask why! |
AMACR | Dr Torres would ask why! |
AR | Dr Torres would ask why! |
ATRX | Dr Torres would ask why! |
Beta2-microglobulin | Dr Torres would ask why! |
B72.3 | Dr Torres would ask why! |
Beta-catenin | Dr Torres would ask why! |
BCL2 | Dr Torres would ask why! |
BCL6 | Dr Torres would ask why! |
BCLxL | Dr Torres would ask why! |
C3 comp | Dr Torres would ask why! |
CA9 | Dr Torres would ask why! |
Calcitonin | Dr Torres would ask why! |
Calponin | Dr Torres would ask why! |
Calretinin | Dr Torres would ask why! |
CAM5.2 | Dr Torres would ask why! |
Cathepsin K | Dr Torres would ask why! |
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|
CD10 to Chromogranin |
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Test | Result |
CD10 | Dr Torres would ask why! |
CD117 | POSITIVE |
CD138 | Dr Torres would ask why! |
CD15 | Dr Torres would ask why! |
CD1a | Dr Torres would ask why! |
CD20 | Dr Torres would ask why! |
CD21 | Dr Torres would ask why! |
CD23 | Dr Torres would ask why! |
CD3 | Dr Torres would ask why! |
CD30 | Dr Torres would ask why! |
CD31 | Dr Torres would ask why! |
CD34 | Dr Torres would ask why! |
CD35 | Dr Torres would ask why! |
CD4 | Dr Torres would ask why! |
CD43 | Dr Torres would ask why! |
CD45 (LCA) | Dr Torres would ask why! |
CD5 | Dr Torres would ask why! |
CD56 | Dr Torres would ask why! |
CD57 | Dr Torres would ask why! |
CD68 | Dr Torres would ask why! |
CD7 | Dr Torres would ask why! |
CD79a | Dr Torres would ask why! |
CD8 | Dr Torres would ask why! |
CD99 | Dr Torres would ask why! |
CDX2 | Dr Torres would ask why! |
CEA-m | Dr Torres would ask why! |
Chromogranin | Dr Torres would ask why! |
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CK17 to Glypican 3 |
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Test | Result |
CK17 | Dr Torres would ask why! |
CK19 | Dr Torres would ask why! |
CK20 | Dr Torres would ask why! |
CK34betaE12 | Dr Torres would ask why! |
CK5/6 | Dr Torres would ask why! |
CK7 | POSITIVE - strong membranous |
CMV | Dr Torres would ask why! |
c-MYC | Dr Torres would ask why! |
Cyclin D1 | Dr Torres would ask why! |
D2-40 | Dr Torres would ask why! |
Desmin | Dr Torres would ask why! |
DOG1 | Dr Torres would ask why! |
EBV | Dr Torres would ask why! |
EMA | Dr Torres would ask why! |
ER and PR | Dr Torres would ask why! |
Factor VIII | Dr Torres would ask why! |
Factor XIIIa | Dr Torres would ask why! |
Fascin | Dr Torres would ask why! |
FH | Dr Torres would ask why! |
FSH | Dr Torres would ask why! |
Gastrin | Dr Torres would ask why! |
GATA3 | Dr Torres would ask why! |
GCDFP-15 (BRST2) | Dr Torres would ask why! |
GFAP | Dr Torres would ask why! |
GH | Dr Torres would ask why! |
Glucagon | Dr Torres would ask why! |
Glypican-3 | Dr Torres would ask why! |
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HBME-1 to IgM |
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Test | Result |
HBME-1 | Dr Torres would ask why! |
HBV core | Dr Torres would ask why! |
HBV surface | Dr Torres would ask why! |
H-caldesmon | Dr Torres would ask why! |
HCG | Dr Torres would ask why! |
Helicobacter | Dr Torres would ask why! |
Hepatocyte | Dr Torres would ask why! |
HER2/neu | Dr Torres would ask why! |
HHV-8 | Dr Torres would ask why! |
HMB-45 | Dr Torres would ask why! |
HNF1beta | Dr Torres would ask why! |
HPV | Dr Torres would ask why! |
HSV-I | Dr Torres would ask why! |
HSV-II | Dr Torres would ask why! |
IDH-1 | Dr Torres would ask why! |
Inhibin | Dr Torres would ask why! |
INI1 (BAF47) | Dr Torres would ask why! |
Insulin | Dr Torres would ask why! |
Kappa | Dr Torres would ask why! |
Ki-67 | Dr Torres would ask why! |
Lambda | Dr Torres would ask why! |
Leu 7 | Dr Torres would ask why! |
IgA | Dr Torres would ask why! |
IgG | Dr Torres would ask why! |
IgM | Dr Torres would ask why! |
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LH to PDGFR |
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Test | Result |
LH | Dr Torres would ask why! |
LIN28 | Dr Torres would ask why! |
Lysozyme | Dr Torres would ask why! |
mammoglobin | Dr Torres would ask why! |
MAP2 | Dr Torres would ask why! |
MCV | Dr Torres would ask why! |
Melanin A | Dr Torres would ask why! |
MHC class I | Dr Torres would ask why! |
MITF | Dr Torres would ask why! |
MUM1 | Dr Torres would ask why! |
Myeloperoxidase | Dr Torres would ask why! |
MYO D1 | Dr Torres would ask why! |
Myoglobin | Dr Torres would ask why! |
Napsin | Dr Torres would ask why! |
NF | Dr Torres would ask why! |
NKX3.1 | Dr Torres would ask why! |
NSE | Dr Torres would ask why! |
OCT3/4 | Dr Torres would ask why! |
p16 | Dr Torres would ask why! |
P501S | Dr Torres would ask why! |
p53 | Dr Torres would ask why! |
p57 | Dr Torres would ask why! |
p63 | Dr Torres would ask why! |
Pankeratin | Dr Torres would ask why! |
PAX2 | Dr Torres would ask why! |
PAX5 | Dr Torres would ask why! |
PAX8 | POSITIVE |
PCNA | Dr Torres would ask why! |
PDGFR | Dr Torres would ask why! |
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PLAP to WT1 |
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Test | Result |
PLAP | Dr Torres would ask why! |
PNL-2C | Dr Torres would ask why! |
Prolactin | Dr Torres would ask why! |
PSA | Dr Torres would ask why! |
PSAP | Dr Torres would ask why! |
RCC | Dr Torres would ask why! |
S-100 | Dr Torres would ask why! |
SALL4 | Dr Torres would ask why! |
Smooth muscle actin | Dr Torres would ask why! |
Somatostatin | Dr Torres would ask why! |
STAT6 | Dr Torres would ask why! |
Synaptophysin | Dr Torres would ask why! |
TdT | Dr Torres would ask why! |
TFE3 | Dr Torres would ask why! |
TFEB | Dr Torres would ask why! |
Thyroglobulin | Dr Torres would ask why! |
Toxoplasma | Dr Torres would ask why! |
TSH | Dr Torres would ask why! |
TTF-1 | Dr Torres would ask why! |
Ubiquitin | Dr Torres would ask why! |
UCHL1 (PGP9.5) | Dr Torres would ask why! |
Ulex Europaeus | Dr Torres would ask why! |
Vimentin | Dr Torres would ask why! |
VIP | Dr Torres would ask why! |
VZV | Dr Torres would ask why! |
WT-1 | Dr Torres would ask why! |
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Molecular testing
Chromosomal translocations
Translocations Chr 1-10 |
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Test | Result |
t(1;13) PAX7-FKHR | Dr Torres would ask why! |
t(2,13) PAX3-FKHR | Dr Torres would ask why! |
t(8;14) MYC-IGH | Dr Torres would ask why! |
t(9;22) BCR-ABL | Dr Torres would ask why! |
t(9;22) CHN-EWS | Dr Torres would ask why! |
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Translocations Chr 11-13 |
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Test | Result |
t(11;14) CCND1-IGH | Dr Torres would ask why! |
t(11;22) EWS-WT1 | Dr Torres would ask why! |
t(11;22) FLI1-EWS | Dr Torres would ask why! |
t(12;15) ETV6-NTRK3 | Dr Torres would ask why! |
t(12;16) FUS-ATF1 | Dr Torres would ask why! |
t(12;16) CHOP-TLS | Dr Torres would ask why! |
t(12;22) EWS-ATF1 | Dr Torres would ask why! |
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Translocations Chr 14-22 |
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Test | Result |
t(14,18) IGH-BCL2 | Dr Torres would ask why! |
t(15;17) PML-RARA | Dr Torres would ask why! |
t(16;21) FUS-ERG | Dr Torres would ask why! |
t(17;22) COLA1-PDGFB | Dr Torres would ask why! |
t(21;22) EWS-ERG | Dr Torres would ask why! |
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Translocations Chr X & Y |
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Test | Result |
t(X;1) PRCC-TFE3 | Dr Torres would ask why! |
t(X;17) TFE3-ASPL | Dr Torres would ask why! |
t(X;18) SYT-SSX | Dr Torres would ask why! |
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Other molecular tests
Molecular tests (A-B) |
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Test | Result |
ALK sequencing | Dr Torres would ask why! |
B cell clonality Southern / PCR | Dr Torres would ask why! |
BCL2 PCR | Dr Torres would ask why! |
BRAF sequencing | Dr Torres would ask why! |
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Molecular tests (C-H) |
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Test | Result |
EBV PCR | Dr Torres would ask why! |
EGRF sequencing | Dr Torres would ask why! |
H3F3A sequencing | Dr Torres would ask why! |
HHV-8 PCR | Dr Torres would ask why! |
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Molecular tests (I-J) |
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Test | Result |
Identity testing PCR | Dr Torres would ask why! |
IDH1/2 PCR | Dr Torres would ask why! |
JAK2 V617F ARMS | Dr Torres would ask why! |
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Molecular tests (K-Z) |
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Test | Result |
KIT sequencing | Dr Torres would ask why! |
LOH 1p/19q PCR | Dr Torres would ask why! |
T cell clonality Southern / PCR | Dr Torres would ask why! |
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Diagnosis
Diagnosis
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Chromophobe renal cell carcinoma, eosinophilic variant
Comment:
The main differential diagnosis is renal oncocytoma. Hale's colloidal iron (blue in ChRCC), and CK7 (strong membranous in ChRCC versus weak/patchy in oncocytoma) are quite useful.
Morphologically, ChRCC typically has perinuclear halos (may be focal), frequent binucleation and wrinkled nuclear membranes (raisinoid nuclei).[1]
Reference
- ↑ Tickoo, SK.; Amin, MB. (Dec 1998). "Discriminant nuclear features of renal oncocytoma and chromophobe renal cell carcinoma. Analysis of their potential utility in the differential diagnosis.". Am J Clin Pathol 110 (6): 782-7. PMID 9844591.
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Other cases
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| Number | |
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| Subspecialty (Difficulty) |
Autopsy pathology (jr,sr, f/e)
Breast pathology (jr,sr, f/e)
Cardiovascular pathology (jr,sr, f/e)
Cytopathology (jr,sr, f/e)
Dermatopathology (jr,sr, f/e)
Endocrine pathology (jr,sr, f/e)
Forensic pathology (jr,sr, f/e)
Gastrointestinal pathology (jr,sr, f/e)
Genitourinary pathology (jr,sr, f/e)
Gynecologic pathology (jr,sr, f/e)
Hematopathology (jr,sr, f/e)
Head and neck pathology (jr,sr, f/e)
Lymph node pathology (jr,sr, f/e)
Medical kidney pathology (jr,sr, f/e)
Molecular pathology (jr,sr, f/e)
Neuropathology (jr,sr, f/e)
Pediatric pathology (jr,sr, f/e)
Pulmonary pathology (jr,sr, f/e)
Placental pathology (jr,sr, f/e)
Soft tissue pathology (jr,sr, f/e) |
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| Difficulty | |
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