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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = | | Image = Renal mucinous tubular and spindle cell carcinoma - 2 -- high mag.jpg | ||
| Width = | | Width = | ||
| Caption = | | Caption = Renal mucinous tubular and spindle cell carcinoma. [[H&E stain]]. | ||
| Synonyms = | | Synonyms = | ||
| Micro = mucin (foamy macrophages) - may be scant, spindle cells, small tubules - lined by cuboidal epithelium | | Micro = mucin (foamy macrophages) - may be scant, spindle cells, small tubules - lined by cuboidal epithelium | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = | | LMDDx = sarcomatoid [[papillary renal cell carcinoma]], [[papillary renal cell carcinoma]], [[metanephric adenoma]] | ||
| Stains = | | Stains = | ||
| IHC = CK7 +ve, AMACR +ve, CD10 -ve, AE1/AE3 +ve | | IHC = CK7 +ve, AMACR +ve, CD10 -ve, AE1/AE3 +ve | ||
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| Prevalence = rare | | Prevalence = rare | ||
| Bloodwork = | | Bloodwork = | ||
| Rads = | | Rads = features overlap with [[papillary renal cell carcinoma]] | ||
| Endoscopy = | | Endoscopy = | ||
| Prognosis = good | | Prognosis = good | ||
| Other = | | Other = | ||
| ClinDDx = | | ClinDDx = other [[kidney tumours]] | ||
| Tx = surgical excision | | Tx = surgical excision | ||
}} | }} | ||
'''Renal mucinous tubular and spindle cell carcinoma''', abbreviated '''RMTSCC''', is a rare malignant epithelial neoplasm of the [[kidney]]. | '''Renal mucinous tubular and spindle cell carcinoma''', abbreviated '''RMTSCC''' or '''MTSCC''', is a rare malignant epithelial neoplasm of the [[kidney]]. | ||
It is also known as '''renal mucinous tubular spindle cell carcinoma''' and | It is also known as '''renal mucinous tubular spindle cell carcinoma''' and | ||
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==General== | ==General== | ||
*Rare | *Rare<ref name=pmid19494850>{{Cite journal | last1 = Srigley | first1 = JR. | last2 = Delahunt | first2 = B. | title = Uncommon and recently described renal carcinomas. | journal = Mod Pathol | volume = 22 Suppl 2 | issue = | pages = S2-S23 | month = Jun | year = 2009 | doi = 10.1038/modpathol.2009.70 | PMID = 19494850 }}</ref> - largest reported series (published in 2015) has 19 cases.<ref name=pmid25395040/> | ||
*Accepted by WHO in 2004 as a separate entity.<ref name=pmid19805959>{{cite journal |author=Geramizadeh B, Salehipour M, Moradi A |title=Mucinous tubular and spindle cell carcinoma of kidney: a rare case report and review of the literature |journal=Indian J Pathol Microbiol |volume=52 |issue=4 |pages=514–6 |year=2009 |pmid=19805959 |doi=10.4103/0377-4929.56144 |url=}}</ref> | *Accepted by WHO in 2004 as a separate entity.<ref name=pmid19805959>{{cite journal |author=Geramizadeh B, Salehipour M, Moradi A |title=Mucinous tubular and spindle cell carcinoma of kidney: a rare case report and review of the literature |journal=Indian J Pathol Microbiol |volume=52 |issue=4 |pages=514–6 |year=2009 |pmid=19805959 |doi=10.4103/0377-4929.56144 |url=}}</ref> | ||
*Relatively good prognosis. | *Relatively good prognosis. | ||
**In a series of 19 patients: one died, one developed mets, one recurred (post-ablation) and was salvaged by surgery, one observed... remaining 15 cured by surgery or ablation.<ref name=pmid25395040>{{Cite journal | last1 = Kenney | first1 = PA. | last2 = Vikram | first2 = R. | last3 = Prasad | first3 = SR. | last4 = Tamboli | first4 = P. | last5 = Matin | first5 = SF. | last6 = Wood | first6 = CG. | last7 = Karam | first7 = JA. | title = Mucinous tubular and spindle cell carcinoma (MTSCC) of the kidney: a detailed study of radiological, pathological and clinical outcomes. | journal = BJU Int | volume = 116 | issue = 1 | pages = 85-92 | month = Jul | year = 2015 | doi = 10.1111/bju.12992 | PMID = 25395040 }}</ref> | |||
==Gross== | ==Gross== | ||
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*Greyish-yellow or tan-yellow. | *Greyish-yellow or tan-yellow. | ||
*Well-circumscribed. | *Well-circumscribed. | ||
Note: | |||
*Imaging characteristics overlap with [[papillary renal cell carcinoma]].<ref name=pmid25395040/> | |||
==Microscopic== | ==Microscopic== | ||
Features:<ref name=pmid19066686>{{cite journal |author=Trabelsi A, Stita W, Yacoubi MT, Rammeh S, Hmissa S, Korbi S |title=Renal mucinous tubular and spindle cell carcinoma |journal=Can Urol Assoc J |volume=2 |issue=6 |pages=635–6 |year=2008 |month=December |pmid=19066686 |pmc=2593603 |doi= |url=}}</ref> | Features:<ref name=pmid19066686>{{cite journal |author=Trabelsi A, Stita W, Yacoubi MT, Rammeh S, Hmissa S, Korbi S |title=Renal mucinous tubular and spindle cell carcinoma |journal=Can Urol Assoc J |volume=2 |issue=6 |pages=635–6 |year=2008 |month=December |pmid=19066686 |pmc=2593603 |doi= |url=}}</ref> | ||
*Mucin | *Mucin - may be scant. | ||
**Often within foamy macrophages. | |||
*Spindle cells - '''key feature'''. | *Spindle cells - '''key feature'''. | ||
**Often seen only focally. | |||
*Small tubules - lined by cuboidal epithelium.<ref name=pmid24330589/> | *Small tubules - lined by cuboidal epithelium.<ref name=pmid24330589/> | ||
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*Sarcomatoid [[papillary renal cell carcinoma]]<ref name=pmid18941398>{{cite journal |author=Dhillon J, Amin MB, Selbs E, Turi GK, Paner GP, Reuter VE |title=Mucinous tubular and spindle cell carcinoma of the kidney with sarcomatoid change |journal=Am. J. Surg. Pathol. |volume=33 |issue=1 |pages=44–9 |year=2009 |month=January |pmid=18941398 |doi=10.1097/PAS.0b013e3181829ed5 |url=}}</ref> (papillary renal cell carcinoma with [[sarcomatoid RCC|sarcomatoid differentiation]]). | *Sarcomatoid [[papillary renal cell carcinoma]]<ref name=pmid18941398>{{cite journal |author=Dhillon J, Amin MB, Selbs E, Turi GK, Paner GP, Reuter VE |title=Mucinous tubular and spindle cell carcinoma of the kidney with sarcomatoid change |journal=Am. J. Surg. Pathol. |volume=33 |issue=1 |pages=44–9 |year=2009 |month=January |pmid=18941398 |doi=10.1097/PAS.0b013e3181829ed5 |url=}}</ref> (papillary renal cell carcinoma with [[sarcomatoid RCC|sarcomatoid differentiation]]). | ||
*[[Papillary renal cell carcinoma]]. | *[[Papillary renal cell carcinoma]]. | ||
*[[Metanephric adenoma]]. | |||
===Grading=== | |||
*Typically [[ISUP nucleolar grade|ISUP nucleolar (Fuhrman) grade]] 2.<ref name=pmid>{{Cite journal | last1 = Gross | first1 = M. | title = Vertical dimension--Part II. | journal = Refuat Hashinayim | volume = 7 | issue = 2 | pages = 8-18 | month = Apr | year = 1989 | doi = | PMID = 2637792 }}</ref> | |||
**Fuhrman grade 3 tumours are described.<ref name=pmid18830937>{{Cite journal | last1 = Kuroda | first1 = N. | last2 = Hes | first2 = O. | last3 = Michal | first3 = M. | last4 = Nemcova | first4 = J. | last5 = Gal | first5 = V. | last6 = Yamaguchi | first6 = T. | last7 = Kawada | first7 = T. | last8 = Imamura | first8 = Y. | last9 = Hayashi | first9 = Y. | title = Mucinous tubular and spindle cell carcinoma with Fuhrman nuclear grade 3: a histological, immunohistochemical, ultrastructural and FISH study. | journal = Histol Histopathol | volume = 23 | issue = 12 | pages = 1517-23 | month = Dec | year = 2008 | doi = | PMID = 18830937 }}</ref><ref>{{Cite journal | last1 = Kuroda | first1 = N. | last2 = Hes | first2 = O. | last3 = Michal | first3 = M. | last4 = Nemcova | first4 = J. | last5 = Gal | first5 = V. | last6 = Yamaguchi | first6 = T. | last7 = Kawada | first7 = T. | last8 = Imamura | first8 = Y. | last9 = Hayashi | first9 = Y. | title = Mucinous tubular and spindle cell carcinoma with Fuhrman nuclear grade 3: a histological, immunohistochemical, ultrastructural and FISH study. | journal = Histol Histopathol | volume = 23 | issue = 12 | pages = 1517-23 | month = Dec | year = 2008 | doi = | PMID = 18830937 }}</ref> | |||
===Images=== | ===Images=== | ||
www | ====Case 1==== | ||
<gallery> | |||
Image: Renal mucinous tubular and spindle cell carcinoma - 2 -- very low mag.jpg | RMTSCC - very low mag. | |||
Image: Renal mucinous tubular and spindle cell carcinoma - 2 -- low mag.jpg | RMTSCC - low mag. | |||
Image: Renal mucinous tubular and spindle cell carcinoma - 2 -- intermed mag.jpg | RMTSCC - intermed. mag. | |||
Image: Renal mucinous tubular and spindle cell carcinoma - 2 -- high mag.jpg | RMTSCC - high mag. | |||
Image: Renal mucinous tubular and spindle cell carcinoma - 2 -- very high mag.jpg | RMTSCC - very high mag. | |||
Image: Renal mucinous tubular and spindle cell carcinoma - 2 alt -- very high mag.jpg | RMTSCC - very high mag. | |||
</gallery> | |||
====Case 2==== | |||
<gallery> | |||
Image: Renal mucinous tubular and spindle cell carcinoma -- low mag.jpg | RMTSCC - low mag. | |||
Image: Renal mucinous tubular and spindle cell carcinoma -- intermed mag.jpg | RMTSCC - intermed. mag. | |||
Image: Renal mucinous tubular and spindle cell carcinoma -- high mag.jpg | RMTSCC - low mag. | |||
Image: Renal mucinous tubular and spindle cell carcinoma -- very high mag.jpg | RMTSCC - very high mag. | |||
</gallery> | |||
====www==== | |||
*[http://moon.ouhsc.edu/kfung/jty1/OPAQ/PathQuiz-Answer/K1A001-PQ01-Ans.htm RMTSCC (ouhsc.edu)]. | *[http://moon.ouhsc.edu/kfung/jty1/OPAQ/PathQuiz-Answer/K1A001-PQ01-Ans.htm RMTSCC (ouhsc.edu)]. | ||
*[http://www.cttr.org/large/02146b.jpg RMTSCC (cttr.org)].<ref>URL: [http://www.cttr.org/cms/?p=1406 http://www.cttr.org/cms/?p=1406]. Accessed on: 28 February 2014.</ref> | *[http://www.cttr.org/large/02146b.jpg RMTSCC (cttr.org)].<ref>URL: [http://www.cttr.org/cms/?p=1406 http://www.cttr.org/cms/?p=1406]. Accessed on: 28 February 2014.</ref> | ||
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*CK7 +ve. | *CK7 +ve. | ||
*AMACR +ve. | *AMACR +ve. | ||
*CD10 -ve ( | *CD10 -ve. | ||
** | **15% +ve (vs. 80% +ve in [[PaRCC]]).<ref name=pmid16330937>{{Cite journal | last1 = Paner | first1 = GP. | last2 = Srigley | first2 = JR. | last3 = Radhakrishnan | first3 = A. | last4 = Cohen | first4 = C. | last5 = Skinnider | first5 = BF. | last6 = Tickoo | first6 = SK. | last7 = Young | first7 = AN. | last8 = Amin | first8 = MB. | title = Immunohistochemical analysis of mucinous tubular and spindle cell carcinoma and papillary renal cell carcinoma of the kidney: significant immunophenotypic overlap warrants diagnostic caution. | journal = Am J Surg Pathol | volume = 30 | issue = 1 | pages = 13-9 | month = Jan | year = 2006 | doi = | PMID = 16330937 }}</ref> | ||
**11% +ve (vs. 80% in PaRCC).<ref>{{Cite journal | last1 = Sarsik | first1 = B. | last2 = Sımşır | first2 = A. | last3 = Karaarslan | first3 = S. | last4 = Sen | first4 = S. | title = Mucinous tubular and spindle cell carcinoma of kidney and problems in diagnosis. | journal = Turk Patoloji Derg | volume = 27 | issue = 2 | pages = 116-26 | month = May | year = 2011 | doi = 10.5146/tjpath.2011.01059 | PMID = 21630197 }}</ref> | |||
*AE1/AE3 +ve. | *AE1/AE3 +ve. | ||
Others: | Others: | ||
* | *[[PAX8]] +ve. | ||
*CAM5.2 +ve. | *[[CAM5.2]] +ve. | ||
*p63 -ve. | *[[p63]] -ve. | ||
*CK20 -ve.<ref name=pmid17058608>{{Cite journal | last1 = Arias | first1 = LF. | last2 = Blanco | first2 = J. | last3 = Hernández | first3 = S. | last4 = Bocardo | first4 = G. | last5 = González | first5 = L. | title = [Immunohistochemical profile and clinical features of mucinous tubular and spindle renal cell carcinoma]. | journal = Actas Urol Esp | volume = 30 | issue = 7 | pages = 649-54 | month = | year = | doi = | PMID = 17058608 }}</ref> | *[[CK20]] -ve.<ref name=pmid17058608>{{Cite journal | last1 = Arias | first1 = LF. | last2 = Blanco | first2 = J. | last3 = Hernández | first3 = S. | last4 = Bocardo | first4 = G. | last5 = González | first5 = L. | title = [Immunohistochemical profile and clinical features of mucinous tubular and spindle renal cell carcinoma]. | journal = Actas Urol Esp | volume = 30 | issue = 7 | pages = 649-54 | month = | year = | doi = | PMID = 17058608 }}</ref> | ||
*[[CD57]] +ve.<ref name=pmid18459456>{{Cite journal | last1 = Okoń | first1 = K. | last2 = Klimkowska | first2 = A. | last3 = Pawelec | first3 = A. | last4 = Dobrowolski | first4 = Z. | last5 = Kohla | first5 = Z. | last6 = Stachura | first6 = J. | title = Immunophenotype and cytogenetics of mucinous tubular and spindle cell carcinoma of the kidney. | journal = Pol J Pathol | volume = 58 | issue = 4 | pages = 227-33 | month = | year = 2007 | doi = | PMID = 18459456 }}</ref><ref name=pmid14989744>{{Cite journal | last1 = Kuroda | first1 = N. | last2 = Nakamura | first2 = S. | last3 = Miyazaki | first3 = E. | last4 = Hayashi | first4 = Y. | last5 = Taguchi | first5 = T. | last6 = Hiroi | first6 = M. | last7 = Yamasaki | first7 = Y. | last8 = Shuin | first8 = T. | last9 = Enzan | first9 = H. | title = Low-grade tubular-mucinous renal neoplasm with neuroendocrine differentiation: a histological, immunohistochemical and ultrastructural study. | journal = Pathol Int | volume = 54 | issue = 3 | pages = 201-7 | month = Mar | year = 2004 | doi = 10.1111/j.1440-1827.2004.01608.x | PMID = 14989744 }}</ref> | |||
*CK19 +ve.<ref name=pmid14989744/> | |||
Note: | Note: | ||
*Immunophenotype overlaps with [[papillary renal cell carcinoma]].<ref name= | *Immunophenotype overlaps with [[papillary renal cell carcinoma]].<ref name=pmid16330937>{{Cite journal | last1 = Paner | first1 = GP. | last2 = Srigley | first2 = JR. | last3 = Radhakrishnan | first3 = A. | last4 = Cohen | first4 = C. | last5 = Skinnider | first5 = BF. | last6 = Tickoo | first6 = SK. | last7 = Young | first7 = AN. | last8 = Amin | first8 = MB. | title = Immunohistochemical analysis of mucinous tubular and spindle cell carcinoma and papillary renal cell carcinoma of the kidney: significant immunophenotypic overlap warrants diagnostic caution. | journal = Am J Surg Pathol | volume = 30 | issue = 1 | pages = 13-9 | month = Jan | year = 2006 | doi = | PMID = 16330937 }}</ref> | ||
==Sign out== | |||
<pre> | |||
Left Kidney, Partial Nephrectomy: | |||
- RENAL MUCINOUS TUBULAR AND SPINDLE CELL CARCINOMA (RMTSCC). | |||
-- Margins clear. | |||
-- ISUP nucleolar grade 2. | |||
-- TNM stage: pT1a pNx. | |||
-- Please see tumour summary. | |||
Comment: | |||
The stains are as follows: | |||
POSITIVE: CK7, AMACR, AE1/AE3, mucicarmine. | |||
NEGATIVE: WT-1, CD56, CD57, CD10, CD68. | |||
</pre> | |||
Notes: | |||
*The (bland) spindle areas are not ''sarcomatoid'' as per the synoptic report. | |||
===Micro=== | |||
The tumour consists of small cells with mild pleomorphism and mild-to-moderate cytoplasm. A tubular architecture is predominant and mucin is present. Focal spindled areas are also seen. | |||
==See also== | ==See also== |
edits