Acquired cystic disease-associated renal cell carcinoma

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Acquired cystic disease-associated renal cell carcinoma
Diagnosis in short

Acquired cystic disease-associated renal cell carcinoma. H&E stain.

LM sieve-like architecture (tubular structures/cribriforming), tumour cells with prominent nucleoli and eosinophilic cytoplasm, oxalate crystals - seen best in polarized light, acquired cystic disease in background, +/-papillary structures - common minor component
LM DDx acquired cystic renal disease, papillary renal cell carcinoma, hereditary leiomyomatosis renal cell carcinoma syndrome associated renal cell carcinoma
IHC AMACR +ve, CD10 +ve, pankeratin +ve, CK7 +ve (heterogeneous), EMA -ve
Gross kidney with cystic changes, thinned cortex
Grossing notes total nephrectomy for tumour grossing, partial nephrectomy grossing
Staging kidney cancer staging
Site kidney - see kidney tumours

Associated Dx acquired cystic disease of the kidney, end-stage renal disease
Prevalence rare
Radiology renal mass and cysts
Treatment nephrectomy

Acquired cystic disease-associated renal cell carcinoma, abbreviated ACD-RCC, is a rare kidney cancer that arises in the context of chronic renal failure.

It was added to the WHO classification of renal neoplasia in the Vancouver modification of 2012/2013.[1]

General

Gross

  • Cysts.

Microscopic

Features:

  • Fused tubular structures/cribriforming/sieve-like architecture.[4]
    • Focal papillary architecture - common.[3]
    • Tumour cells have prominent nucleoli (ISUP nucleolar grade 3) and eosinophilic cytoplasm.
  • Oxalate crystals - important.
  • Acquired cystic disease in background - required.
    • Changes of end-stage kidney (obsolete glomeruli, thyroidization, interstitial fibrosis).

DDx:

Images

Case

www

IHC

Features:[2]

  • AMACR +ve.
  • CD10 +ve.
  • Pankeratin +ve.
  • CK7 +ve (heterogeneous).

Others:[2]

  • CD68 -ve.
  • PAX2 -ve.
  • EMA -ve.[6]
  • HMWCK -ve.[6]
  • Vimentin +ve/-ve.[6]
  • CAM5.2 +ve/-ve.[6]

See also

References

  1. Srigley, JR.; Delahunt, B.; Eble, JN.; Egevad, L.; Epstein, JI.; Grignon, D.; Hes, O.; Moch, H. et al. (Oct 2013). "The International Society of Urological Pathology (ISUP) Vancouver Classification of Renal Neoplasia.". Am J Surg Pathol 37 (10): 1469-89. doi:10.1097/PAS.0b013e318299f2d1. PMID 24025519.
  2. 2.0 2.1 2.2 Ahn, S.; Kwon, GY.; Cho, YM.; Jun, SY.; Choi, C.; Kim, HJ.; Park, YW.; Park, WS. et al. (Mar 2013). "Acquired cystic disease-associated renal cell carcinoma: further characterization of the morphologic and immunopathologic features.". Med Mol Morphol. doi:10.1007/s00795-013-0028-x. PMID 23471757.
  3. 3.0 3.1 Tickoo, SK.; dePeralta-Venturina, MN.; Harik, LR.; Worcester, HD.; Salama, ME.; Young, AN.; Moch, H.; Amin, MB. (Feb 2006). "Spectrum of epithelial neoplasms in end-stage renal disease: an experience from 66 tumor-bearing kidneys with emphasis on histologic patterns distinct from those in sporadic adult renal neoplasia.". Am J Surg Pathol 30 (2): 141-53. PMID 16434887.
  4. Srigley, JR.; Delahunt, B.; Eble, JN.; Egevad, L.; Epstein, JI.; Grignon, D.; Hes, O.; Moch, H. et al. (Oct 2013). "The International Society of Urological Pathology (ISUP) Vancouver Classification of Renal Neoplasia.". Am J Surg Pathol 37 (10): 1469-89. doi:10.1097/PAS.0b013e318299f2d1. PMID 24025519.
  5. 5.0 5.1 URL: https://www.auanet.org/education/modules/pathology/kidney-carcinomas/acquired-cystic.cfm. Accessed on: 13 May 2015.
  6. 6.0 6.1 6.2 6.3 Amin, Mahul B.; Eble, John; Grignon, David; Srigley, John. (2013). Urological Pathology (1st ed.). Wolters Kluwer. pp. 113. ISBN 978-0781782814.