Difference between revisions of "Chromophobe renal cell carcinoma"

From Libre Pathology
Jump to navigation Jump to search
Line 103: Line 103:
*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 }}
*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>
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>
**ChRCC 10 of 11 -ve versus Oncocytoma 3 of 23 -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>


==Molecular==
==Molecular==

Revision as of 14:31, 12 December 2013

Chromophobe renal cell carcinoma
Diagnosis in short

Eosinophilic variant of chromophobe renal cell carcinoma. H&E stain.

LM pale 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
LM DDx clear cell renal cell carcinoma (classic), renal oncocytoma, clear cell renal cell carcinoma eosinophilic variant
Stains Hale's colloidal iron +ve
IHC CK7 +ve cell membrane, CD117 +ve, vimentin -ve
Site kidney - see renal tumours

Syndromes Birt–Hogg–Dubé syndrome

Prevalence relatively common

Chromophobe renal cell carcinoma, abbreviated ChRCC, is a relatively common form of renal cell carcinoma.

General

There are two subtypes:[3]

  • Classic.
  • Eosinophilic variant.

Gross

  • Tan, light-brown.
  • Solitary.
  • Well-circumscribed.

Image:

Microscopic

Classic

Features - classic type (3 P's mnemonic):[4][3]

  • Pale cytoplasm, with wisps of eosinophilic material; the cells are not completely clear, they have "cobwebs".
  • Perinuclear clearing, i.e. a pale halo surrounds the nucleus - key feature.
  • Periphery of cell distinct, i.e. cell membrane is easy to discern.

Notes:

  • May have psammoma bodies.
  • May be described as "plant-like"; plant cells have (thick) cell walls.
  • The perinuclear clearing is often somewhat patchy, i.e. it is usually not present in very tumour cell.

DDx:

  • Clear cell RCC (classic).
    • Perinuclear clearing is not seen in clear cell RCC.
    • ChRCC has wisps in the cytoplasm.

Eosinophilic variant

Features - eosinophilic variant:[3]

  • Eosinophilic (finely granular) cytoplasm.
  • Perinuclear clearing - key feature.
  • Periphery of cell distinct.
  • Smaller cells than classic subtype.

Notes:

  1. May have psammoma bodies.

DDx:

  1. Oncocytoma - particularly the eosinophilic variant.
    • IHC may be useful to differentiate (CK7: oncocytoma = cytoplasm +ve, chromophobe = cell membrane +ve).
    • A comparison based on histomorphology: Tabular comparison between ChRCC & oncocytoma.
      • Oncocytoma typically has: no perinuclear clearing, no raisinoid nuclei, no binucleation.
  2. Clear cell RCC, eosinophilic variant.
    • Perinuclear clearing is not seen in clear cell RCC.
    • ChRCC has wisps in the cytoplasm.

Image

www:

Stains

Images:

IHC

  • CK7 +ve cell membrane.[3]
  • CD117 +ve.
  • Vimentin -ve.[6]

ChRCC versus oncocytoma

  • PAX2 -ve .[7]
    • ChRCC 10 of 11 -ve versus Oncocytoma 3 of 23 -ve.
  • Amylase α-1A -ve.[8]

Molecular

  • Extensive aneusomy (monosomy?):[9]
    • Loss of chromosomes: 1, 2, 6, 10, 13, 17, 21.

Sign out

KIDNEY, RIGHT UPPER POLE, PARTIAL NEPHRECTOMY:
- CHROMOPHOBE RENAL CELL CARCINOMA.

COMMENT:
The sections show a mix of clear cells with wispy cytoplasm, and cells with eosinophilic
cytoplasm and perinuclear halos. There are no true papillae. 

Stains and immunostains:
Positive: CK7, CAM5.2, EMA, pankeratin, CD117, colloidal iron.
Negative: AMACR, CD10, CD68, RCC, vimentin.

See also

References

  1. Delahunt, B.; Sika-Paotonu, D.; Bethwaite, PB.; McCredie, MR.; Martignoni, G.; Eble, JN.; Jordan, TW. (Jun 2007). "Fuhrman grading is not appropriate for chromophobe renal cell carcinoma.". Am J Surg Pathol 31 (6): 957-60. doi:10.1097/01.pas.0000249446.28713.53. PMID 17527087.
  2. Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 290. ISBN 978-0781765275.
  3. 3.0 3.1 3.2 3.3 Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 293. ISBN 978-0443066771.
  4. Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1016-7. ISBN 0-7216-0187-1.
  5. URL: http://www.ultrapath.org/oldsite/cases99/sep99/cotm9-2.html. Accessed on: 9 October 2011.
  6. Zhang, W.; Yu, WJ.; Jiang, YX.; Li, YJ.; Han, F.; Liu, Y.; Han, ZL. (Feb 2012). "[Chromophobe renal cell carcinoma: a clinicopathologic study and immunophenotypes of 42 cases].". Zhonghua Bing Li Xue Za Zhi 41 (2): 76-80. PMID 22455881.
  7. Memeo L, Jhang J, Assaad AM, et al. (February 2007). "Immunohistochemical analysis for cytokeratin 7, KIT, and PAX2: value in the differential diagnosis of chromophobe cell carcinoma". Am. J. Clin. Pathol. 127 (2): 225–9. doi:10.1309/9KWEA4W9Y94D1AEE. PMID 17210525. http://ajcp.ascpjournals.org/cgi/pmidlookup?view=long&pmid=17210525.
  8. Jain, S.; Roy, S.; Amin, M.; Acquafondata, M.; Yin, M.; Laframboise, W.; Bastacky, S.; Pantanowitz, L. et al. (Dec 2013). "Amylase α-1A (AMY1A): A Novel Immunohistochemical Marker to Differentiate Chromophobe Renal Cell Carcinoma From Benign Oncocytoma.". Am J Surg Pathol 37 (12): 1824-30. doi:10.1097/PAS.0000000000000108. PMID 24225843.
  9. Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 292. ISBN 978-0781765275.