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Difference between revisions of "Renal oncocytoma"
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| 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, [[tubulocystic carcinoma of the kidney]], other [[renal tumours with eosinophilic cytoplasm]] | | 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 = | ||
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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: | ||
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**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, rare or 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]]. | *[[Tubulocystic carcinoma of the kidney]]. | ||
*Other [[renal tumours with eosinophilic cytoplasm]]. | *Other [[renal tumours with eosinophilic cytoplasm]]. | ||
*Benign [[liver]]. | |||
===Images=== | ===Images=== | ||
| Line 86: | Line 95: | ||
==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]]. | |||
Others: | Others: | ||
*CD10 -ve/+ve. | *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> | *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> | *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: | A panel: | ||
*CK7, PAX8, CD117, CD10, [[Mueller-Mowry stain]]. | *CK7, PAX8, CD117, CD10, [[Mueller-Mowry stain]], GATA-3. | ||
===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: | ||