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Difference between revisions of "Chromophobe renal cell carcinoma"
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = Chromophobe renal cell carcinoma -- high mag.jpg | | Image = Chromophobe renal cell carcinoma -- high mag.jpg | ||
| Width = | | Width = | ||
| Caption = Chromophobe renal cell carcinoma showing the characteristic perinuclear clearing and distinctive (plant-like) cellular borders. [[H&E stain]]. | | Caption = Chromophobe renal cell carcinoma showing the characteristic perinuclear clearing and distinctive (plant-like) cellular borders. [[H&E stain]]. | ||
| Micro = pale/clear (or eosinophilic) cytoplasm with wisps of eosinophilic material, perinuclear clearing (a pale halo surrounds the nucleus), periphery of cell distinct (cell membrane is easy to discern -- plant cell-like) | | Micro = pale/clear (or eosinophilic) cytoplasm with wisps of eosinophilic material, perinuclear clearing (a pale halo surrounds the nucleus), periphery of cell distinct (cell membrane is easy to discern -- plant cell-like) | ||
| Subtypes = classic, eosinophilic variant | | Subtypes = classic, eosinophilic variant | ||
| LMDDx = [[clear cell renal cell carcinoma]] (classic), [[renal oncocytoma]], [[clear cell renal cell carcinoma]] eosinophilic variant | | LMDDx = [[clear cell renal cell carcinoma]] (classic), [[renal oncocytoma]], [[clear cell renal cell carcinoma]] eosinophilic variant, [[renal hybrid oncocytic/chromophobe tumour]], other [[renal tumours with eosinophilic cytoplasm]] | ||
| Stains = [[Hale's colloidal iron]] ([[Mueller-Mowry stain]]) +ve | | Stains = [[Hale's colloidal iron]] ([[Mueller-Mowry stain]]) +ve | ||
| IHC = CK7 +ve cell membrane, CD117 +ve, vimentin -ve | | IHC = CK7 +ve cell membrane, CD117 +ve, vimentin -ve | ||
| Line 12: | Line 12: | ||
| Molecular = | | Molecular = | ||
| IF = | | IF = | ||
| Gross = | | Gross = grey-beige, lacks central scar | ||
| Grossing = [[total nephrectomy for tumour grossing]], [[partial nephrectomy grossing]] | | Grossing = [[total nephrectomy for tumour grossing]], [[partial nephrectomy grossing]] | ||
| Staging = [[kidney cancer staging]] | |||
| Site = [[kidney]] - see [[renal tumours]] | | Site = [[kidney]] - see [[renal tumours]] | ||
| Assdx = | | Assdx = | ||
| Line 35: | Line 36: | ||
*[[ISUP nucleolar grade|ISUP nucleolar grading]] (replaces ''Fuhrman grading'') not done for this entity, as it does not appear to have any predictive value.<ref name=pmid17527087>{{Cite journal | last1 = Delahunt | first1 = B. | last2 = Sika-Paotonu | first2 = D. | last3 = Bethwaite | first3 = PB. | last4 = McCredie | first4 = MR. | last5 = Martignoni | first5 = G. | last6 = Eble | first6 = JN. | last7 = Jordan | first7 = TW. | title = Fuhrman grading is not appropriate for chromophobe renal cell carcinoma. | journal = Am J Surg Pathol | volume = 31 | issue = 6 | pages = 957-60 | month = Jun | year = 2007 | doi = 10.1097/01.pas.0000249446.28713.53 | PMID = 17527087 }}</ref> | *[[ISUP nucleolar grade|ISUP nucleolar grading]] (replaces ''Fuhrman grading'') not done for this entity, as it does not appear to have any predictive value.<ref name=pmid17527087>{{Cite journal | last1 = Delahunt | first1 = B. | last2 = Sika-Paotonu | first2 = D. | last3 = Bethwaite | first3 = PB. | last4 = McCredie | first4 = MR. | last5 = Martignoni | first5 = G. | last6 = Eble | first6 = JN. | last7 = Jordan | first7 = TW. | title = Fuhrman grading is not appropriate for chromophobe renal cell carcinoma. | journal = Am J Surg Pathol | volume = 31 | issue = 6 | pages = 957-60 | month = Jun | year = 2007 | doi = 10.1097/01.pas.0000249446.28713.53 | PMID = 17527087 }}</ref> | ||
*May be associated with [[Birt–Hogg–Dubé syndrome]].<ref name=Ref_WMSP290>{{Ref WMSP|290}}</ref> | *May be associated with [[Birt–Hogg–Dubé syndrome]].<ref name=Ref_WMSP290>{{Ref WMSP|290}}</ref> | ||
*Can 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> | |||
===Subtypes=== | ===Subtypes=== | ||
| Line 42: | Line 44: | ||
==Gross== | ==Gross== | ||
* | *Grey-beige colour.<ref name=pmid12507296>{{Cite journal | last1 = Kuroda | first1 = N. | last2 = Toi | first2 = M. | last3 = Hiroi | first3 = M. | last4 = Enzan | first4 = H. | title = Review of chromophobe renal cell carcinoma with focus on clinical and pathobiological aspects. | journal = Histol Histopathol | volume = 18 | issue = 1 | pages = 165-71 | month = Jan | year = 2003 | doi = | PMID = 12507296 }}</ref> | ||
*Solitary, usually.‡ | *Solitary, usually.‡ | ||
*Well-circumscribed. | *Well-circumscribed. | ||
| Line 68: | Line 70: | ||
**Perinuclear clearing is ''not'' seen in clear cell RCC. | **Perinuclear clearing is ''not'' seen in clear cell RCC. | ||
**ChRCC has wisps in the cytoplasm. | **ChRCC has wisps in the cytoplasm. | ||
*Other [[clear cell tumours]]. | |||
*[[Benign clear cell clusters of the kidney]] - somewhat controversial. | |||
====Images==== | ====Images==== | ||
| Line 97: | Line 101: | ||
#*Perinuclear clearing is ''not'' seen in clear cell RCC. | #*Perinuclear clearing is ''not'' seen in clear cell RCC. | ||
#*ChRCC has wisps in the cytoplasm. | #*ChRCC has wisps in the cytoplasm. | ||
#[[Renal hybrid oncocytic/chromophobe tumour]]. | |||
#Other [[renal tumours with eosinophilic cytoplasm]]. | |||
====Images==== | ====Images==== | ||
=====Case 1===== | |||
<gallery> | <gallery> | ||
Image: | Image:Chromophobe renal cell carcinoma, eosinophilic variant - high mag.jpg | Eosinophilic chromophobe RCC. (WC/Nephron) | ||
</gallery> | </gallery> | ||
www | |||
=====Case 2===== | |||
<gallery> | |||
Image: Eosinophilic variant of chromophobe renal cell carcinoma -- low mag.jpg | EVChRCC - low mag. | |||
Image: Eosinophilic variant of chromophobe renal cell carcinoma -- intermed mag.jpg | EVChRCC - intermed. mag. | |||
Image: Eosinophilic variant of chromophobe renal cell carcinoma - alt -- intermed mag.jpg | EVChRCC - intermed. mag. | |||
Image: Eosinophilic variant of chromophobe renal cell carcinoma -- high mag.jpg | EVChRCC - high mag. | |||
Image: Eosinophilic variant of chromophobe renal cell carcinoma -- very high mag.jpg | EVChRCC - very high mag. | |||
Image: Eosinophilic variant of chromophobe renal cell carcinoma - alt -- very high mag.jpg | EVChRCC - very high mag. | |||
</gallery> | |||
=====www===== | |||
*[http://path.upmc.edu/cases/case333.html Chromophobe RCC - several images (upmc.edu)]. | *[http://path.upmc.edu/cases/case333.html Chromophobe RCC - several images (upmc.edu)]. | ||
| Line 118: | Line 134: | ||
==IHC== | ==IHC== | ||
*CK7 +ve cell membrane.<ref name=Ref_GUP293>{{Ref GUP|293}}</ref> | *[[CK7]] +ve cell membrane.<ref name=Ref_GUP293>{{Ref GUP|293}}</ref> | ||
**Useful for differentiating from oncocytoma. | **Useful for differentiating from oncocytoma. | ||
*CD117 +ve. | *[[CD117]] +ve. | ||
*Vimentin -ve.<ref name=pmid22455881>{{Cite journal | last1 = Zhang | first1 = W. | last2 = Yu | first2 = WJ. | last3 = Jiang | first3 = YX. | last4 = Li | first4 = YJ. | last5 = Han | first5 = F. | last6 = Liu | first6 = Y. | last7 = Han | first7 = ZL. | title = [Chromophobe renal cell carcinoma: a clinicopathologic study and immunophenotypes of 42 cases]. | journal = Zhonghua Bing Li Xue Za Zhi | volume = 41 | issue = 2 | pages = 76-80 | month = Feb | year = 2012 | doi = | PMID = 22455881 }}</ref><ref name=pmid24095630>{{Cite journal | last1 = Din | first1 = NU. | last2 = Fatima | first2 = S. | last3 = Ahmad | first3 = Z. | title = Chromophobe renal cell carcinoma: a morphologic and immunohistochemical study of 45 cases. | journal = Ann Diagn Pathol | volume = 17 | issue = 6 | pages = 508-13 | month = Dec | year = 2013 | doi = 10.1016/j.anndiagpath.2013.06.005 | PMID = 24095630 }}</ref> | *Vimentin -ve.<ref name=pmid22455881>{{Cite journal | last1 = Zhang | first1 = W. | last2 = Yu | first2 = WJ. | last3 = Jiang | first3 = YX. | last4 = Li | first4 = YJ. | last5 = Han | first5 = F. | last6 = Liu | first6 = Y. | last7 = Han | first7 = ZL. | title = [Chromophobe renal cell carcinoma: a clinicopathologic study and immunophenotypes of 42 cases]. | journal = Zhonghua Bing Li Xue Za Zhi | volume = 41 | issue = 2 | pages = 76-80 | month = Feb | year = 2012 | doi = | PMID = 22455881 }}</ref><ref name=pmid24095630>{{Cite journal | last1 = Din | first1 = NU. | last2 = Fatima | first2 = S. | last3 = Ahmad | first3 = Z. | title = Chromophobe renal cell carcinoma: a morphologic and immunohistochemical study of 45 cases. | journal = Ann Diagn Pathol | volume = 17 | issue = 6 | pages = 508-13 | month = Dec | year = 2013 | doi = 10.1016/j.anndiagpath.2013.06.005 | PMID = 24095630 }}</ref> | ||
Others:<ref name=pmid18603673>{{Cite journal | last1 = Geramizadeh | first1 = B. | last2 = Ravanshad | first2 = M. | last3 = Rahsaz | first3 = M. | title = Useful markers for differential diagnosis of oncocytoma, chromophobe renal cell carcinoma and conventional renal cell carcinoma. | journal = Indian J Pathol Microbiol | volume = 51 | issue = 2 | pages = 167-71 | month = | year = | doi = | PMID = 18603673 }}</ref> | |||
*CD10 -ve. | |||
*RCC -ve. | |||
Uncommon stains for ChRCC versus oncocytoma: | Uncommon stains for ChRCC versus oncocytoma: | ||
*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> | *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> | ||
| Line 132: | Line 152: | ||
*CD117 +ve. | *CD117 +ve. | ||
**-ve in CCRCC. | **-ve in CCRCC. | ||
* | *CA9 ([[carbonic anhydrase 9]]) -ve. | ||
**+ve (strong membranous) in CCRCC.<ref name=pmid21677535>{{cite journal |author=Al-Ahmadie HA, Alden D, Fine SW, ''et al.'' |title=Role of immunohistochemistry in the evaluation of needle core biopsies in adult renal cortical tumors: an ex vivo study |journal=Am. J. Surg. Pathol. |volume=35 |issue=7 |pages=949–61 |year=2011 |month=July |pmid=21677535 |doi=10.1097/PAS.0b013e31821e25cd |url=}}</ref> | **+ve (strong membranous) in CCRCC.<ref name=pmid21677535>{{cite journal |author=Al-Ahmadie HA, Alden D, Fine SW, ''et al.'' |title=Role of immunohistochemistry in the evaluation of needle core biopsies in adult renal cortical tumors: an ex vivo study |journal=Am. J. Surg. Pathol. |volume=35 |issue=7 |pages=949–61 |year=2011 |month=July |pmid=21677535 |doi=10.1097/PAS.0b013e31821e25cd |url=}}</ref> | ||
*CK7 +ve. | *CK7 +ve. | ||
**-ve in CCRCC. | **-ve in CCRCC. | ||
Others: | |||
*[[DOG1]] +ve (Swalchick ''et al.''<ref name=pmid26678977>{{Cite journal | last1 = Swalchick | first1 = W. | last2 = Shamekh | first2 = R. | last3 = Bui | first3 = MM. | title = Is DOG1 Immunoreactivity Specific to Gastrointestinal Stromal Tumor? | journal = Cancer Control | volume = 22 | issue = 4 | pages = 498-504 | month = Oct | year = 2015 | doi = | PMID = 26678977 }}</ref> 32 +ve of 37 cases; Zhao ''et al.''<ref name=pmid25596994>{{Cite journal | last1 = Zhao | first1 = W. | last2 = Tian | first2 = B. | last3 = Wu | first3 = C. | last4 = Peng | first4 = Y. | last5 = Wang | first5 = H. | last6 = Gu | first6 = WL. | last7 = Gao | first7 = FH. | title = DOG1, cyclin D1, CK7, CD117 and vimentin are useful immunohistochemical markers in distinguishing chromophobe renal cell carcinoma from clear cell renal cell carcinoma and renal oncocytoma. | journal = Pathol Res Pract | volume = 211 | issue = 4 | pages = 303-7 | month = Apr | year = 2015 | doi = 10.1016/j.prp.2014.12.014 | PMID = 25596994 }}</ref> 32 +ve of 32 cases). | |||
**Useful in ChRCC versus clear cell RCC. | |||
A panel: | |||
*CK7, [[PAX8]], CD117, CD10, [[Mueller-Mowry stain]]. | |||
===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 | |||
==Molecular== | ==Molecular== | ||
*Extensive aneusomy (monosomy?):<ref name=Ref_WMSP292>{{Ref WMSP|292}}</ref> | *Extensive aneusomy (monosomy?):<ref name=Ref_WMSP292>{{Ref WMSP|292}}</ref> | ||
**Loss of chromosomes: 1, 2, 6, 10, 13, 17, 21. | **Loss of chromosomes: 1, 2, 6, 10, 13, 17, 21. | ||
==EM== | |||
Ultrastructural features:<ref name=pmid21713152>{{Cite journal | last1 = Lee | first1 = W. | title = Imprint cytology of the chromophobe renal cell carcinoma: Correlation with the histological and ultrastructural features. | journal = J Cytol | volume = 28 | issue = 2 | pages = 77-80 | month = Apr | year = 2011 | doi = 10.4103/0970-9371.80749 | PMID = 21713152 }}</ref> | |||
*Microvesicles. | |||
*Complex plicated cell membrane. | |||
===Images=== | |||
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3111713/figure/F5/ Microvesicles in ChRCC (nih.gov)].<ref name=pmid21713152/> | |||
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3111713/figure/F6/ Cell membrane in ChRCC (nih.gov)]. | |||
==Sign out== | ==Sign out== | ||
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Negative: AMACR, CD10, CD68, RCC, vimentin. | Negative: AMACR, CD10, CD68, RCC, vimentin. | ||
</pre> | </pre> | ||
===Micro=== | |||
The sections show a sheeting tumour with abundant and eosinophilic cytoplasm. The tumour cell cell membranes are prominent and plant-like. Perinuclear clearing is present. Binucleation is frequent and the nuclear membranes moderately irregular. No definite papillae or macrophages are present. Nucleoli are not prominent. Small blood vessels are not prominent. | |||
====Alternate==== | |||
The sections show a tumour composed of compact nests. The cytoplasm is abundant and eosinophilic. Perinuclear clearing is prominent. Binucleation is frequent and the nuclear membranes moderately irregular to round. No definite papillae or macrophages are present. Nucleoli are not prominent. | |||
==See also== | ==See also== | ||