1. Reappraisal of Morphological Differences between Renal Medullary Carcinoma, Collecting Duct Carcinoma, and Fumarate Hydratase-Deficient Renal Cell Carcinoma
- Author
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Gabriella Nesi, Lakshmi P. Kunju, Gladell P. Paner, Fiona Maclean, Scott A. Tomlins, Steven C. Smith, Deepika Sirohi, Mahul B. Amin, Jonathan I. Epstein, Jesse K. McKenney, Anthony J. Gill, Adeboye O. Osunkoya, Pedram Argani, Mitual Amin, Kiril Trpkov, Ying-Bei Chen, Chisato Ohe, Abbas Agaimy, Victor E. Reuter, Michelle S. Hirsch, Eva Comperat, Priya Rao, Maurizio Colecchia, Maria M. Picken, Mariza de Peralta-Venturina, Mukul K. Divatia, Wolfram Jochum, Rohit Mehra, Isabela Werneck da Cunha, Liang Cheng, Ondřej Hes, Cristina Magi-Galluzzi, Luciana Schultz, Satish K. Tickoo, Paulo Guilherme de Oliveira Salles, Ohe, C, Smith, Sc, Sirohi, D, Divatia, M, de Peralta-Venturina, M, Paner, Gp, Agaimy, A, Amin, Mb, Argani, P, Chen, Yb, Cheng, L, Colecchia, M, Comperat, E, da Cunha, Iw, Epstein, Ji, Gill, Aj, Hes, O, Hirsch, M, Jochum, W, Kunju, Lp, Maclean, F, Magi-Galluzzi, C, Mckenney, Jk, Mehra, R, Nesi, G, Osunkoya, Ao, Picken, Mm, Rao, P, Reuter, Ve, Salles, Pgd, Schultz, L, Tickoo, Sk, Tomlins, Sa, and Trpkov, K
- Subjects
0301 basic medicine ,Male ,Pathology ,Biopsy ,DNA Mutational Analysis ,urologic and male genital diseases ,Fumarate Hydratase ,Collecting duct carcinoma ,0302 clinical medicine ,Renal cell carcinoma ,SMARCB1 ,Child ,Aged, 80 and over ,Kidney ,Kidney Medulla ,medicine.diagnostic_test ,Middle Aged ,Immunohistochemistry ,Kidney Neoplasms ,Europe ,medicine.anatomical_structure ,Phenotype ,030220 oncology & carcinogenesis ,Female ,Anatomy ,Brazil ,Adult ,medicine.medical_specialty ,Canada ,Adolescent ,Article ,Pathology and Forensic Medicine ,Renal medullary carcinoma ,Diagnosis, Differential ,03 medical and health sciences ,Young Adult ,Predictive Value of Tests ,medicine ,Carcinoma ,Biomarkers, Tumor ,Humans ,Genetic Predisposition to Disease ,Kidney Tubules, Collecting ,Carcinoma, Renal Cell ,Aged ,Retrospective Studies ,business.industry ,Australia ,medicine.disease ,United States ,030104 developmental biology ,Mutation ,Surgery ,Hereditary leiomyomatosis and renal cell carcinoma ,Neoplasm Grading ,business - Abstract
Renal Medullary Carcinomas (RMCs) and Collecting Duct Carcinomas (CDCs) are rare subsets of lethal high-stage, high-grade distal nephron-related adenocarcinomas with a predilection for the renal medullary region. Recent findings have established an emerging group of fumarate hydratase (FH)-deficient tumors related to hereditary leiomyomatosis and renal cell carcinoma syndrome (HLRCC-RCCs) within this morphologic spectrum. Recently-developed, reliable ancillary testing has enabled consistent separation between these tumor types. Here, we present the clinicopathologic features and differences in the morphological patterns between RMCs, CDCs and FH-deficient RCCs in consequence of these recent developments. This study included a total of 100 cases classified using contemporary criteria and ancillary tests. Thirty-three RMCs (SMARCB1/INI1-deficient, hemoglobinopathy), 38 CDCs (SMARCB1/INI1-retained) and 29 RCCs defined by the FH-deficient phenotype (FH-/2SC+ or FH±/2SC+ with FH mutation, regardless of HLRCC syndromic stigmata/ history) were selected. The spectrum of morphologic patterns was critically evaluated and the differences between the morphological patterns present in the three groups were analyzed statistically. Twenty five percent of cases initially diagnosed as CDC were reclassified as FH-deficient RCC based on our contemporary diagnostic approach. Among the different overlapping morphologic patterns, sieve-like/cribriform and reticular/yolk sac tumor-like patterns favored RMCs, whereas intracystic papillary and tubulocystic patterns favored FH-deficient RCC. Tubulopapillary pattern favored both CDCs and FH-deficient RCCs, and multinodular infiltrating papillary pattern favored CDCs. Infiltrating glandular and solid sheets/cords/nested patterns were not statistically different among the three groups. Viral inclusion-like large nucleoli considered as a hallmark of HLRCC-RCCs were observed significantly more frequently in FH-deficient RCCs. Despite the overlapping morphology found among these clinically aggressive infiltrating high-grade adenocarcinomas of the kidney, reproducible differences in morphology emerged between these categories after rigorous characterization. Finally, we recommend that definitive diagnosis of CDC should only be made if RMC and FH-deficient RCC are excluded.
- Published
- 2018