Lymphocyte-rich renal cell carcinoma: an unusual histomorphologic manifestation of a tumor that is not part of lynch syndrome

Lynch syndrome (LS) is characterized by familial clustering of early cancer development in various organs. One of the histologic characteristics of carcinomas associated with LS is prominent intratumoral and peritumoral lymphocytes. The relationship between LS and the rare lymphocyte-rich clear cell renal cell carcinoma (CRCC) has been not been studied. We compared lymphocyte-rich CRCC (N=15) with CRCC with no or minimal lymphoid infiltration, occurring in young (40 y of age) patients (N=15) and in a control group of older (62 y of age) patients (N=5) with CRCC having conventional histologic features. All cases were analyzed histologically and immunohistochemically using antibodies against the mismatch repair (MMR) proteins MLH1, MSH2, MSH6, and PMS2. The mutational status of the Von Hippel-Lindau (VHL) gene was analyzed successfully in 25 cases. We found no case with complete absence of immunoreactivity for the MMR proteins/ enzymes studied in any of the groups. Hence, none of the RCCs with heavy lymphocytic infiltration displayed complete absence of protein expression of any of the MMR enzymes. We found mutation of the VHL gene in 2 of 8 tumors from group A, in 4 of 12 tumors from group B, and no mutation in the control group C. We conclude that this rare subset of renal neoplasms is not part of the spectrum of tumors seen in LS. The results of the VHL gene analysis are in concordance with published data on sporadic CRCCs.