Oncocytic Papillary Renal Cell Carcinoma Research Articles

Oncocytic papillary renal cell carcinoma: a clinicopathological analysis of nineteen cases

Objective: To investigate the clinicopathological characteristics, immunophenotype, and molecular signatures of oncocytic papillary renal cell carcinoma (OPRCC), and to compare these findings with those in type 1 papillary renal cell carcinoma (PRCC 1). Methods: The clinicopathologic data of 19 patients with OPRCC from the Affiliated Hospital of Qingdao University (16 patients) and the 971 Hospital of People's Liberation Army Navy (3 patients) from October 2003 to February 2021 were collected. Histologic, immunohistochemical (IHC) and molecular analyses, together with a control group of 15 cases of PRCC I diagnosed in the same period, were assessed. Results: The cohort included 15 males and 4 females, with a median age of 61 years (range, 47-78 years). In 13 patients the tumors were found at physical examination; four presented with painless gross hematuria and two with low back pain. As for the pathologic stage, 14 patients were pT1, one patient was pT2a, three patients were pT3a and one patient was pT4. The tumor size ranged from 1.7-14.0 cm, with clear boundary and soft texture. The cut surface was grayish-yellow and grayish-red. Microscopically, the tumor cells were mainly arranged in papillary (10%-100%) and acinar (tubular) patterns, with strongly eosinophilic cytoplasm, round or irregular nuclei, and prominent nucleoli (WHO/ISUP grade Ⅲ). Two cases showed sarcomatoid differentiation. Stromal foamy macrophages were visible in all cases. IHC staining showed diffuse strong positivity for AMACR in all cases. RCC (18/19), CD10 (17/19), vimentin (16/19) and PAX8 (17/19) were positive in most tumors. CK7 was expressed in about 50% of cases. Fluorescence in situ hybridization identified trisomy 7 in eight patients, trisomy 17 in seven patients, and the two aberrations occurred simultaneously in seven cases. Eight of 13 men had Y chromosome deletion. All patients were followed up for 8-120 months. Three patients died of metastases at 8, 62 and 82 months postoperatively, respectively, and one patient relapsed 36 months after surgery. Compared with PRCC1, OPRCC tended to have higher nuclear grade, and stromal foam cell aggregation was more commonly found (P<0.05). The expression of CD10 and EMA were different (P<0.01). There was no significant difference in the survival rate between the two groups (P=0.239). Conclusions: OPRCC has unique morphologic features, and its immunophenotype overlaps but differs from PRCC1. The molecular results support that it belongs to a morphologic variation of PRCC. This tumor has similar biologic behavior to PRCC1, and has a poor prognosis when sarcomatoid differentiation occurs.

Papillary renal neoplasm with reverse polarity—a comparative study with CCPRCC, OPRCC, and PRCC1

Papillary renal neoplasm with reverse polarity (PRNRP) is a newly defined entity with distinct histomorphology and recurrent KRAS mutation. In this study, we aimed to identify and analyze the clinicopathological, immunohistochemical (IHC), and molecular features of PRNRP in our center and to evaluate its differential diagnosis with other tumors with which it is easily confused: clear cell papillary renal cell carcinoma (CCPRCC), oncocytic papillary renal cell carcinoma (OPRCC), and papillary renal cell carcinoma type 1 (PRCC1). Nephrectomy specimens of PRNRP (n=15), CCPRCC (n=11), and OPRCC (n=12) were retrieved from our pathology archives. We also selected typical cases of PRCC1 (n=15) as a control group. PRNRP accounted for 3.05% (15/492) of all PRCC cases at our center. The median follow-up period was 41.3 months. All PRNRP cases were pT1N0M0, and only one involved recurrence (1 year after surgery). IHC analysis showed diffuse staining of CK7, EMA, and GATA3 but weak or negative staining of CD10, CD117, p504s, and vimentin in the PRNRP samples and distinctive IHC features in the other three tumor types. KRAS mutation was detected in 4/10 PRNRP cases. Among the 40 most commonly mutated genes identified, 5 (BCLAF1, PDE4DIP, NCOR1, PARP4, and PABPC1) have actionable alterations. Our study supports the suggestion that PRNRP is an entity distinct from CCPRCC, OPRCC, and PRCC1.

Oncocytic Papillary Renal Cell Carcinoma in an 11-year-old girl

Oncocytic Papillary Renal Cell Carcinoma (OPRCC) is a rare variant of renal cell carcinoma with overlapping characteristics type 1 and 2 of papillary renal carcinoma. Based on the literature, OPRCC is predominantly present in adult males. OPRCC has a specific genetic affiliation with the Fumarate Hydratase gene requiring all patients diagnosed with OPRCC to undergo genetic testing. There isn't any agreement for the treatment of OPRCC due to the rarity of the disease; however, a radical nephrectomy poses as a possible modality. Therefore, we present the rare case of an 11-year-old female found to have OPRCC.

Renal cell carcinomas with tubulopapillary architecture and oncocytic cells: Molecular analysis of 39 difficult tumors to classify

So-called oncocytic papillary renal cell carcinoma (OPRCC) is a poorly defined variant of papillary renal cell carcinoma. Since its first description, several studies were published with conflicting results, and thus precise definition is lacking.A cohort of 39 PRCCs composed of oncocytic cells were analyzed. Cases were divided into 3 groups based on copy number variation (CNV) pattern. The first group consisted of 23 cases with CNV equal to renal oncocytoma. The second group consisted of 7 cases with polysomy of chromosomes 7 and 17 and the last group of 9 cases included those with variable CNV.Epidemiologic, morphologic and immunohistochemical features varied among the groups. There were not any particular histomorphologic features correlating with any of the genetic subgroups. Further, a combination of morphologic, immunohistochemical, and molecular-genetic features did not allow to precisely predict biologic behavior.Owing to variable CNV pattern in OPRCC, strict adherence to morphology and immunohistochemical profile is recommended, particularly in limited samples (i.e., core biopsy). Applying CNV pattern as a part of a diagnostic algorithm can be potentially misleading.OPRCC is a highly variable group of tumors, which might be misdiagnosed as renal oncocytoma. Using the term OPRCC as a distinct diagnostic entity is, thanks to its high heterogeneity, questionable.

The role of Tc-99m MIBI scintigraphy in clinical T1 renal mass assessment: Does it have a real benefit?

IntroductionDespite the increasing accuracy of imaging modalities, the rate of benign renal tumors misclassified as malignant before surgery still non-negligible. Tc-99m sestamibi was demonstrated to be a possible reliable agent in discriminating oncocytoma from renal cell carcinoma (RCC). We aimed to study the efficacy of Tc-99m MIBI tumor scintigraphy in evaluating clinical T1 renal masses. Methods and MaterialsBetween July 2017 and March 2019, patients with clinical T1 renal mass underwent preoperative Tc-99m sestamibi tumor scintigraphy. Tc-99m sestamibi tumor scintigraphy findings were correlated with the postoperative pathology results. ResultsA total of 90 renal masses were included in the study. Male to female ratio was 67/23. The mean age and tumor size were 55.5 ± 11.4 years and 4 ± 1.4 cm, respectively. In pathological evaluation, 20% (18/90) of masses were reported as benign (10 oncocytomas, 4 angiomyolipomas (AML), 2 chronic sclerosis, 1 fibroma and 1 hydatid cyst).While Tc-99m sestamibi uptake was positive in all oncocytomas; 6 patients with chronic sclerosis, fibroma, hydatid cyst and angiomyolipoma pathologies had no uptake. Except for 5 chromophobe cell RCC and 3 oncocytic papillary RCC masses, malignant lesions had no uptake.In predicting benign pathology, Tc-99m sestamibi tumor scintigraphy had positive and negative predictive value of 60% and 91.3%, respectively. The mean Tc-99m 2-methoxy isobutyl isonitrile lesion/normal renal parenchyma ratio of benign and malignant lesions was 0.6 and 0.37, respectively. A relative uptake of 0.49 was an acceptable cutoff point to discriminate oncocytomas from all other pathologies. ConclusionTc-99m sestamibi tumor scintigraphy has a beneficial role in the assessment of clinical T1 renal mass. Masses with negative uptake harbor high probability of being malignant. While evaluating masses with positive uptake, it should be kept in mind that some malignant pathologies may demonstrate similar results.

Management of Metastatic Nonclear Renal Cell Carcinoma: What Are the Options and Challenges?

This case presents a 68-yr-old female patient with primary metastatic nonclear renal cell carcinoma (RCC) with multiple bone lesions. The patient underwent a single resection of skull bone lesion (diagnostic for poorly differentiated carcinoma of unknown origin) and cytoreductive nephrectomy. The pathology of the kidney specimen demonstrated an oncocytic papillary RCC. Within 3 mo, she developed skeletal progressive disease and was started on systemic therapy (sunitinib). After initial stabilization, bone metastasis progressed during the third cycle of sunitinib and required second-line therapy (cabozantinib). One of the major unmet needs in non–clear cell RCC is the lack of specific systemic therapy. Data on immunotherapy are still limited. Inclusion of these patients in clinical trials is strongly recommended. Patient summaryPatients with metastatic kidney cancer who present with the less common histological subtype (non–clear cell) have poor survival. In this case, the patient responded to second-line therapy. Very few therapies provide response to treatment. Patients should be offered participation in clinical trials testing combinations with immunotherapy.

Ultrastructural characteristics of primary renal epithelial tumours with granular oncocytic cytoplasm

Background/Aim. Ultrastructural analysis of tumours has shown many common characteristics of certain neoplasms, as well as their specificities. Primary renal epithelial tumours with granular oncocytic cytoplasm is a very heterogeneous group in their histological origin and biological behaviour, which results in a difference in treatment and prognosis of the disease, making accurate morphological diagnosis necessary. The aim of this study was to determine ultrastructural similarities and differences among primary renal epithelial tumours with granular oncocytic cytoplasm. Methods. The analysis of archival and routine material in the archives of the Department of Pathology, University Hospital in Plzen, Czech Republic, as well as archival and routine material in the Centre for Pathology and Histology, Clinical Centre of Vojvodina in Novi Sad, discovered 346 primary renal epithelial tumours with granular oncocytic cytoplasm and divided them into 5 groups: 1) renal oncocytoma (RO) (234 tumours), 2) oncocytic papillary renal cell carcinoma (OPRCC) (12 tumours), 3. sporadic renal hybrid oncocytic/ chromophobe tumour (HOCT) without evidence of Birt Hogg Dub? syndrome (BHD) (14 tumours), 4) chromophobe renal cell carcinoma (ChRCC) (21 tumours) and 5) granular renal cell carcinoma (RCC) [64 tumours + 1 clear cell RCC (CRCC) with hyaline globules]. Ultrastructural analysis of tumour cells at the subcellular level was done using electron microscope (Philips electron microscope TEM 208) at the Department of Pathology, University Hospital in Plzen, Czech Republic. Cellular organelles and pigments were evaluated in 5 tumours from each group according to the simple random sample principle with a total of 30 analysed tumours. Results. In all analysed primary renal epithelial tumours with granular oncocytic, cytoplasm dominant organelles were mitochondria. Specific ultrastructural characteristics of RO were round mitochondria with lamellar cristae, whereas ChRCC had numerous typical cytoplasmic microvesicles 100?700 nm large and mitochondria with tubulovesicular, lamellar and circular cristae. Ultrastructural specificity of hybrid tumours were rare microvesicles and numerous mitochondria of O-PRCC mitochondria with lamellar cristae and small intracytoplasmic vesicles, 100?200 nm large, and of granular RCC, in addition to mitochondria, also glassy hyaline globules (GHG). Conclusion. Ultrastructural analysis indicates mitochondria as the dominant organelle in the analysed tumours. Electron microscopy showed specificities, i.e., differences in appearance of cristae, presence and size of vesicles as well as deposition of pigment in and out of cytoplasm and glassy hyaline globules.

Warthin-like papillary renal cell carcinoma: Clinicopathologic, morphologic, immunohistochemical and molecular genetic analysis of 11 cases.

Oncocytic papillary renal cell carcinoma (PRCC) is a distinct subtype of PRCC, listed as a possible new variant of PRCC in the 2016 WHO classification. It is composed of papillae aligned by large single-layered eosinophilic cells showing linearly arranged oncocytoma-like nuclei. We analyzed clinicopathologic, morphologic, immunohistochemical and molecular-genetic characteristics of 11 oncocytic PRCCs with prominent tumor lymphocytic infiltrate, morphologically resembling Warthin's tumor. The patients were predominantly males (8/11, 73%), with an average age of 59years (range 14-76), and a mean tumor size of 7cm (range 1-22cm). Tumors had the features of oncocytic PRCCs with focal pseudostratification in 8/11 cases and showed dense stromal inflammatory infiltration in all cases. Papillary growth pattern was predominant, comprising more than 60% of tumor volume. Tubular and solid components were present in 5 and 3 cases, respectively. Uniform immunohistochemical positivity was found for AMACR, PAX-8, MIA, vimentin, and OSCAR. Tumors were mostly negative for carboanhydrase 9, CD117, CK20, and TTF-1. Immunohistochemical stains for DNA mismatch repair proteins MLH1 and PMS2 were retained in all cases, while MSH2 and MSH6 were negative in 1 case. Tumor infiltrating lymphocytes (TILs) consisted of both B and T cells. Chromosomal copy number variation analysis showed great variability in 5 cases, ranging from a loss of one single chromosome to complex genome rearrangements. Only one case showed gains of chromosomes 7 and 17, among other aberrations. In 4 cases no numerical imbalance was found. Follow up data was available for 9 patients (median 47.6months, range 1-132). In 6 patients no lethal progression was noted, while 3 died of disease. In conclusion, Warthin-like PRCC is morphologically very close to oncocytic PRCC, from which it differs by the presence of dense lymphoid stroma. Chromosomal numerical aberration pattern of these tumors is variable; only one case showed gains of chromosomes 7 and 17. Warthin-like PRCC is a potentially aggressive tumor since a lethal outcome was recorded in 3/9 cases.

オンコサイト様乳頭状腎細胞癌出血を契機に透析導入となった結節性硬化症の1例

オンコサイト様乳頭状腎細胞癌出血を契機に透析導入となった結節性硬化症の1例

Oncocytic papillary renal cell carcinoma: A clinicopathological and genetic analysis and indolent clinical course in 14 cases

A sort of PRCC with distinct eosinophilic cytoplasm named Oncocytic Papillary Renal Cell Carcinoma (OPRCC) has been increasingly attracting the attention of researchers recently. However, owing to the rarity of OPRCC, the clinicopathological and genetic features of the tumor have still not been well elucidated and whether it should be regarded as an independent subtype of PRCC remains controversial. Herein, a cohort of 14 OPRCCs was studied with the aim of revealing the distinct clinicopathological features, facilitating the classification and correct diagnosis of OPRCC. Men and women each accounted for a half of the cohort with the median age of 64 years old. The majority of patients (9/14) were identified by medical examination and the remaining presented with macroscopic haematuria or lumbar pain. Grossly, tumors were well demarcated and varied from 1.5 to 9cm in diameter. Microscopically, typical OPRCC possessed fine papillary structures with delicate fibrovascular cores, lined with a single layer cell with large, deeply eosinophilic granular cytoplasm and round or polygonal-shaped nucleus exhibiting low nuclear grade in 10 cases (WHO/ISUP grade I-II). Most cases (12/14) possessed hemosiderin-laden and foam-like cells. Focal necrosis presented in 5 cases. Furthermore, solid oncocytoma-like areas appeared in 5 cases and focal sarcomatoid differentiation was identified in 1 case. Immunohistochemically, the majority of tumors presented high expression rates of alpha-methylacylCoA racemase (AMACR), CD10 and vimentin, which were similar to type 2 PRCC. The immune markers including cytokeratin-7 (CK7), KSP-cadherin and EMA exhibited variable positive immunostaining. Genetically, FISH analysis demonstrated trisomy of chromosome 7 in 7 OPRCCs and trisomy of chromosome 17 in 6 OPRCCs. Among 7 male cases, loss of chromosome Y was revealed in 2 cases. Follow-up data was available in 13 patients and only 1 patient died of bone metastasis of the tumor. The other 12 patients were all alive uneventfully at a mean follow-up time of 37 months, indicating that OPRCC is a unique subtype of PRCC with indolent clinical behavior. In conclusion, OPRCCs show a single layer tumor cell of low nuclear grade similar to type 1 PRCC, and abundant eosinophilic cytoplasm resembling type 2 PRCC. Furthermore, the tumor presents the same immunophynotype as type 2 PRCC but the same genetic features and prognosis as type 1 PRCC. OPRCC should be classified as an independent subtype of PRCC with different features from both type 1 and type 2 PRCC.

Fluorescence in situ hybridization as an adjunct tool in the diagnosis of primary and metastatic renal cell carcinoma in fine needle aspiration specimens

We investigated the role of fluorescence in situ hybridization (FISH) in the diagnosis of primary renal neoplasms and lesions suspicious for metastatic renal cell carcinoma. Consecutive fine-needle aspiration biopsies (FNAB) of 39 renal masses and 41 metastatic tumours suspicious for renal cell origin were assessed with an immunohistochemical panel for CK7, RCC antigen, CD10, AMACR, PAX8, vimentin, and CD117. In addition, FISH was performed using probes for chromosomes 1p, 3p, 7, 17, X, and Y. A total of 31 of 39 primary renal masses and 33 of 41 metastatic tumors suspicious for renal origin demonstrated typical cytological and immunohistochemical (IHC) features of subtypes of renal neoplasms (40 clear cell renal cell carcinoma (RCC), 20 papillary RCC, and 4 renal oncocytomas). FISH analysis of 15 randomly selected cases each of primary and metastatic lesions revealed chromosomal abnormalities consistent with the diagnosis in 73% of these cases. Of 8 primary renal masses demonstrating atypical microscopic features and noncontributory IHC profiles, FISH was helpful in subtyping 5 (62%) of these lesions (2 clear cell RCC, 1 solid variant of oncocytic papillary RCC, 1 mixed clear cell and papillary RCC, and 1 chromophobe RCC with papillary architecture). Of 8 metastatic tumors clinically suspicious for renal cell origin and supportive, but nondiagnostic IHC, FISH revealed supportive chromosomal changes in 6 (75%) cases. In conclusion FISH analysis on FNAB material, even with limited tissue, may be contributory to the diagnosis and subtyping of RCC in diagnostically challenging biopsies.

A novel oncocytoid papillary renal cell carcinoma, type 2, with aberrant cytogenetic abnormalities: oncocytic papillary renal cell carcinoma?

A novel oncocytoid papillary renal cell carcinoma, type 2, with aberrant cytogenetic abnormalities: oncocytic papillary renal cell carcinoma?

Classification of oncocytic papillary renal cell carcinoma.

467 Background: Over the past decade, genitourinary pathologists have increasingly recognized an oncocytic variant of papillary renal cell carcinoma (PRC) that can complicate classification as Type 1 or Type 2 PRC. The International Society of Urological Pathology recently proposed reclassifying oncocytic papillary renal cell carcinoma (OPRC) as a separate subtype. We set out to test the validity of separating oncocytic tumors from other PRC. Methods: 70 consecutive cases of PRC with sufficient tissue for analysis were reviewed from patients undergoing surgery at The University of Virginia (1992 to 2007). All cases were classified by type, including those with oncocytic features. Histologic, clinical, and outcomes data were analyzed based on type and the presence of oncocytic features. Results: A total of 15 (21.4%) tumors displayed oncocytic differentiation, the majority of which were Type 2 tumors (11 or 73.3%) (p &lt; 0.001). The male to female ratio of OPRC cases was nearly 1:1 in contrast to a significant male bias historically seen in PRC. The presence of oncocytic features was significantly associated with higher Fuhrman grade (p &lt; 0.001) and no OPRC tumors were multifocal as opposed to 13 (23.6%) of non-OPRC tumors. At a median follow-up of 79.9 months for the entire cohort, 5-yr disease specific survival (DSS) for OPRC patients was 79.0% which was intermediate between patients with Type 1 (93.4%) and Type 2 (44.4%) tumors. By Cox proportional hazards regression analysis, DSS of OPRC patients was significantly better than Type 2 patients (HR 0.12; 95% CI 0.03, 0.52, p = 0.004), but tended to be worse than Type 1 patients (HR 2.58; 95% CI 0.78, 8.50, p = 0.12). Conclusions: We report the largest cohort of OPRC patients to date. Patients with OPRC demonstrate a survival rate intermediate between that of patients with non-oncocytic Type 1 and Type 2 PRC. Though the majority of OPRC tumors were classified as Type 2 PRC, oncocytic features complicate histomorphologic typing. Therefore, classification of OPRC separately would clarify typing of PRC and improve the validity of Fuhrman nuclear grading for PRC. Our results support separation of OPRC from Type 1 and Type 2 PRC, based on both histomorphologic typing and patient survival.

Immunohistochemical application of S100A1 in renal oncocytoma, oncocytic papillary renal cell carcinoma, and two variants of chromophobe renal cell carcinoma

S100A1 is a calcium-binding protein and a member of the S100 family. Recently, S100A1 immunohistochemistry may be an available marker in the differential diagnosis between renal oncocytoma and chromophobe renal cell carcinoma (RCC). However, there are no reports on S100A1 expression in oncocytic papillary RCC that has been recently identified. In this article, we immunohistochemically examined the expression of S100A1 protein in 18 renal tumors including 4 renal oncocytoma, 10 chromophobe RCCs, and 4 oncocytic papillary RCCs. All the cases of renal oncocytoma and oncocytic papillary RCC showed a positive reaction for S100A1 with cytoplasmic pattern. In chromophobe RCC, 3 of 4 tumors with typical variant and 4 of 6 tumors in eosinophilic variant were completely negative for S100A1. Finally, S100A1 immunohistochemistry may be useful in distinguishing renal oncocytoma from chromophobe RCC, but it may be of no use in the differential diagnosis between renal oncocytoma and oncocytic papillary RCC.

Typical signs of oncocytic papillary renal cell carcinoma in everyday clinical praxis

Types 1 and 2 by Delahunt of papillary renal cell carcinoma (PRCC) are traditionally differentiated. An oncocytic variant of PRCC (O-PRCC) has recently been described. We compare clinical data of O-PRCC with other subtypes of PRCC such as the main tumour size, necrotic changes, presence of pseudocapsula and real extrarenal growth in retrospective study. From 1/1992 to 10/2009, 1,398 patients with 1,436 renal tumours were surgically treated in our institution. PRCCs were described in 109 (7.6%). Among PRCC, O-PRCCs were in 12 (11%), PRCC type 1 in 86 (78.9%), PRCC type 2 in 8 (7.3%) and others in 3 (2.8%) cases. The patient's mean age with O-PRCC (M:F ratio = 2:1) was 67.5 +/- 10.9 versus 63.5 +/- 14.1 in type 1 and 57.9 +/- 5.7 in type 2, the mean tumour size was 35 +/- 12 mm versus 47 +/- 22 and 37 +/- 17, respectively. The follow-up of O-PRCC is 35.3 +/- 12.3 months and all cases are without recurrence. We did not find any pseudocapsula in O-PRCC but it was a major sign of PRCC type 1 (32.6%). Huge microscopic necrotic changes were described in 33.3% of O-PRCC, in 33.7% of PRCC type 1 and 62.5% of PRCC type 2. Extrarenal growth was found only in 16.7% O-PRCC versus 40.7% in PRCC type I. None of the O-PRCC had pseudocapsula and none had massive necroses in comparison of O-PRCC with PRCC types I and II. Extrarenal growth in O-PRCC is relatively rare. The malignant potential of O-PRCC is low.

Multidetector Computed Tomographic Features of Oncocytic Papillary Renal Cell Carcinoma, a New Subtype

The following report describes the computed tomographic (CT) features of oncocytic papillary renal cell carcinoma (OPRCC), a new subtype. An experienced genitourinary pathologist identified each tumor as type 1 or 2, oncocytic, or other. Two radiologists independently reviewed CT images and assessed maximal tumor diameter, degree of homogeneity, calcification, enhancement, and growth pattern. The 6 OPRCC lesions varied from 1.8 to 5 cm in diameter with a mean of 3.5 cm. Three of the oncocytic lesions were staged T1a, 2 T1b, and 1 T3a. All lesions displayed exophytic growth and were confined to the kidney. Five of the 6 lesions were smooth, and 1 was lobular. Four were homogenously enhancing, whereas 2 were heterogeneously enhancing. The mean (SD) corticomedullary phase enhancement was 70.6 (21.7) HU, nephrographic phase was 69.9 (13.3) HU, and excretory phase was 58.7 (6) HU. In conclusion, OPRCC is a newly described subtype that has CT features similar to type 1 papillary renal cell carcinoma.

633 CLINICAL CHARACTERISTICS OF ONCOCYTIC PAPILLARY RENAL CELL CARCINOMA

You have accessJournal of UrologyKidney Cancer: Advanced II1 Apr 2010633 CLINICAL CHARACTERISTICS OF ONCOCYTIC PAPILLARY RENAL CELL CARCINOMA Tomas Ürge, Hora Milan, Ondrej Hes, Jiri Ferda, Zdenek Chudacek, Viktor Eret, Jiri Klecka, Michal Michal, and Petr Stransky Tomas ÜrgeTomas Ürge More articles by this author , Hora MilanHora Milan More articles by this author , Ondrej HesOndrej Hes More articles by this author , Jiri FerdaJiri Ferda More articles by this author , Zdenek ChudacekZdenek Chudacek More articles by this author , Viktor EretViktor Eret More articles by this author , Jiri KleckaJiri Klecka More articles by this author , Michal MichalMichal Michal More articles by this author , and Petr StranskyPetr Stransky More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.969AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Two variants (type 1, 2 by Delahunt) of papillary renal cell carcinoma (PRCC) are traditionally differentiated. Type 1 has a more favourable survival rate than type 2 as asserted by some authors. A new histopathologic variant of PRCC was described in 2005 and named oncocytic PRCC (O-PRCC). Articles about O-PRCC have to date been published in pathological literature. We have compared clinical data of O-PRCC and other types of PRCC. METHODS From January 1992 to October 2009, 1398 patients with 1436 renal tumours were surgically treated in our institution. We have valorised some clinical data of different types of PRCCs (mainly tumour size, necrotic changes, presence of pseudocapsula and real extrarenal growth defined, when at least 2/3 of the mass is outside the kidney's border on a CT). RESULTS PRCCs were described in 109 (7.6%) cases. O-PRCC was in 12 (11%), PRCC type 1 in 86 (78.9%), PRCC type 2 in 8 (7.3%) and others in 3 (2.8%) cases. O-PRCCs was more frequent in men (66.7%). The patient's mean age with O-PRCC was 67.5 ± 10.9, in other PRCC 65.8 ± 7.5 years, the mean tumour size was 35 ± 12, in others 43 ± 17 mm. Necrotic changes were described on CTs only in PRCC type 1 and 2 (31.6%), more common were sight in gross pathology (35.8% vs 33.3% in O-PRCC). We did not find statistical significant divergence in frequency of necrotic changes in PRCC's variants (Kruskal – Wallis test p = 0.3679). Real extrarenal growth was found only in two O-PRCCs (16.7%) vs. 40.7% in PRCC type 1, but we did not see any pseudocapsula in O-PRCC. O-PRCC had more frequent invasive type of growth than PRCC type 1 (category pT3a 16.7% vs. 11.8%; category pT3b 25% vs. 14.2%) and nephrectomy was more often provided (7/12, 58.3%). PRCC type 2 category pT3b we had in 25% cases and nephrectomy we provided in 75% cases. Nobody with O-PRCC had recurrence. Fifteen patients with PRCC type 1 (17.4%) died for metastases. Three patients of those had the sarcomatoid variant PRCC type 1 (category pT3b, pT3b pN1 and pT2). Patients died 3.7, 4.7 and 6.7 months later for metastases. CONCLUSIONS We are able to differentiate three variants of PRCC by morphology and by using immunohistochemical methods: type I, II and oncocytic. In comparison of O-PRCC with PRCC type I and II, none of the O-PRCC had pseudocapsula and none had massive necroses, we supposed the probability of rupture to be very low. Extrarenal growth is relatively rare and nephrectomy is often necessary. The malignant potential is low. The work was supported by Czech government research project MSM 0021620819 Plzen, Czech Republic© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e248-e249 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.The work was supported by Czech government research projectMSM 0021620819MetricsAuthor Information Tomas Ürge More articles by this author Hora Milan More articles by this author Ondrej Hes More articles by this author Jiri Ferda More articles by this author Zdenek Chudacek More articles by this author Viktor Eret More articles by this author Jiri Klecka More articles by this author Michal Michal More articles by this author Petr Stransky More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Papillary renal cell carcinoma with lipocyte-like cells: A rare morphological variant or an indication of aggressiveness?

Papillary renal cell carcinoma (PRCC) is the second most common carcinoma of the kidney, which is classified into two types. Type 1 displays single layer of cells with scanty pale cytoplasm and type 2 has pseudostratified high-grade nuclei with eosinophilic cytoplasm. Recently, apart from these two types, oncocytic PRCC and clear-cell PRCC have been described. To the best of our knowledge, lipocyte-like cells have not yet been reported to accompany any subtypes of renal cell carcinoma. Herein, we report a case of PRCC with lipocyte-like cells and sarcomatoid features. Lipocyte-like cells might represent a special type of PRCC or this feature may be an indication of poor prognosis regarding its association with sarcomatoid change.

UP-2.083: Clinical Characteristic of Oncocytic Papillary Renal Cell Carcinoma

Two variants (type 1, 2 by Delahunt) of papillary renal cell carcinoma (PRCC) are differentiated. There was described recently oncocytic variant of PRCC (O-PRCC). We compared clinical data of O-PRCC and other types of PRCC.

Uncommon and recently described renal carcinomas

Major consensus conferences held over a decade ago laid the foundations for the current (2004) WHO classification of renal carcinoma. Clear cell, papillary and chromophobe carcinomas account for 85–90% carcinomas seen in routine practice. The remaining 10–15% of carcinomas consist of rare sporadic and hereditary tumors, some of which had been long recognized, but many of which only emerged as distinct entities in the decade leading up to the WHO publication. Collecting-duct carcinoma is a rare, often lethal form of carcinoma. Medullary carcinoma associated with sickle cell trait, has emerged as a distinctive tumor showing some overlapping features with upper tract urothelial carcinoma. Mucinous tubular and spindle-cell carcinoma and tubulocystic carcinoma were earlier considered as patterns of low-grade collecting-duct carcinoma, but are now recognized as separate tumor entities. Carcinomas associated with somatic translocations of TFE3 and TFEB comprise a significant proportion of pediatric renal carcinomas. Oncocytoid renal carcinomas in neuroblastoma survivors was recognized as a unique tumor category in the WHO classification. Renal carcinoma associated with end-stage renal disease is now recognized as having distinct morphological patterns and behavior. In addition there is a group of rare recently described carcinomas, including clear cell papillary carcinoma, oncocytic papillary renal cell carcinoma, follicular renal carcinoma and leiomyomatous renal cell carcinoma. It behooves the surgical pathologist to not only be capable of diagnosing the common forms of renal cancer, but also to be aware of the rare types of renal carcinoma, many of which have emerged in recent years.