Arterielle Hypertonie bei reninsezernierendem retroperitonealem Leiomyosarkom

Summary A case report of an extrarenal retroperitoneal metastatic leiomyosarcoma with associated paraneoplastic renin production is presented. Due to the renin excess syndrome, accelerated hypertension was present combined with the signs of secondary hyperaldosteronism, hypokalemia, and alkalosis. In contrast to other publications of extrarenal malignoma with paraneoplastic renin activity, this case elucidates a histologically close relationship to epitheloid muscle cells of kidney vasa afferentia and derived benign tumors. The retroperitoneal tumor and its brain metastase were morphologically identical. In contrast to histological criteria only the primary tumor exhibited high renin acticity, no activity could be detected in the metastase.

     

Clear cell hidradenoma: a mimic of metastatic clear cell tumors

Clear cell hidradenoma is a benign skin appendage tumor that may mimic conventional-type renal cell carcinoma. Histologically, clear cell hidradenoma contains small ductular lumens, focal apocrine and squamoid change, and a less prominent vascular pattern than renal cell carcinoma. Furthermore, immunohistochemical studies can aid in distinguishing the 2 tumors. Knowing the cytologic features of primary skin adnexal neoplasms helps distinguish them from cutaneous metastases, which are more commonly referred for fine-needle aspiration biopsy evaluation. Detailed clinical history, physical findings, and ancillary studies are essential for correct diagnosis and categorization of these tumors. We report the rare case of a patient with renal cell carcinoma who underwent excision of an axillary clear cell hidradenoma, which was clinically suggestive of cutaneous metastatic disease.     

Utilization of fine-needle aspiration in the diagnosis of metastatic tumors to the kidney.

Renal masses secondary to metastases are not common. Few comprehensive reviews exist, which consist primarily of autopsy and radiologic reports. The purpose of this study was to review the types and incidences of various neoplasms which metastasize to the kidney and to determine the usefulness of fine-needle aspiration (FNA) in diagnosing them. Two hundred and sixty-one radiologically guided FNAs of renal lesions over a 9-yr period were reviewed. The diagnoses of the 261 renal FNAs were as follows: 136 (52%) were malignant, 111 (43%) were benign, and 14 (5%) were unsatisfactory. Of the 136 positive FNAs, 28 (21%) revealed metastatic tumors. The overall incidence of renal FNAs displaying metastatic tumors was 11%. Among the 28 patients with metastases to the kidney, 23 patients were men and 5 were women, with the mean age being 58 yr. Twenty-five patients (89%) had prior history of a primary malignancy, including lung carcinoma (11 cases, 39%), lymphoma (8 cases, 29%), hepatocellular carcinoma (3 cases, 11%), and one case each of breast, pancreatic, and cervical cancer. In the remaining 3 patients (11%), with metastatic adenocarcinoma (2 cases) and squamous-cell carcinoma (1 case), the primary tumor site remained unknown despite an extensive clinical workup. Overall survival after FNA was poor, with a mean of 9.8 mo. FNA is useful in the diagnosis of masses in the kidney secondary to metastatic disease. This information is of clinical importance, principally in the exclusion of a primary malignancy, but also to avoid unnecessary surgery and to plan for subsequent patient care.     

Metastatic ovarian Sertoli-cell tumor: FNA findings with immunohistochemistry

A malignant Sertoli cell tumor of the ovary is a rare sex-cord stromal derived neoplasm. Sertoli cell tumors account for approximately 4% of Sertoli-stromal cell tumors (Hsu et al., J Histochem Cytochem 1981;29:577-580). The diagnosis of this entity by fine-needle aspiration and needle core biopsy can be difficult when the differential also includes a metastatic renal cell carcinoma, due to the overlap of both cytological and histological features. Here, we show that immunohistochemical staining on cytological material including alpha-inhibin can be used to differentiate between these two malignant tumors.     

Fine needle aspiration cytology of liver tumors

Fine needle aspiration cytology has undergone increasing utilization in the evaluation of hepatic neoplasms. Experience with liver aspirates has demonstrated that problems in differential diagnosis require thorough understanding of criteria for distinguishing different tumor types. The present report describes the cytologic presentation of primary and metastatic hepatic tumors with emphasis on characteristic nuclear and cytoplasmic features encountered in fine needle aspiration biopsy specimens.     

Renal adenocarcinoma presenting with bilateral metastases to Bartholin's glands: primary diagnosis by aspiration cytology

The first recorded case of renal adenocarcinoma presenting with bilateral metastases to the Bartholin's glands is presented. Primary diagnosis of the metastatic deposits was made by fine-needle aspiration cytology with subsequent localization of the unsuspected renal primary. The value of fine-needle aspiration in the identification of inapparent primary tumors is discussed and cytological findings are described in detail.     

Interpretation of needle biopsies of the kidney for investigation of renal masses

The development of new therapeutic options for renal tumors has lead to the need of a pretherapeutic diagnosis for an increasing proportion of patients presenting with a renal mass. This need is particularly important for a small, incidentally discovered renal mass (less than 4 cm) as it can be a benign lesion in a significant percentage of cases. Recent studies have shown that needle biopsy is an accurate and safe method allowing for a precise histopathological diagnosis of the mass in most cases. The aims of the biopsy are (1) to assess the benign or malignant nature of the lesion, (2) to assess the primary or secondary nature of the lesion, and (3), in case of a primary malignancy, to determine histological prognostic factors, such as the tumor type. This review, based on the most recent literature and our own experience, is intended to provide a practical approach to the diagnosis, relying on appropriate morphologic assessment and the use of immunohistochemistry.     

Renal and extrarenal rhabdoid tumors in children: a clinicopathologic study of 14 patients

The clinical and pathologic features of 14 children with rhabdoid tumors are presented. Eight patients had primary renal neoplasms and six had extrarenal tumors. The eight renal rhabdoid tumors were identified among 514 primary renal neoplasms collected at four pediatric institutions. Six patients were under 1 year of age; five children died of tumor-related causes, four of them within 4 months of diagnosis and one 17 months postnephrectomy. Another patient died of sepsis 12 days postnephrectomy. One is alive 13 months postnephrectomy, and one was lost to follow-up evaluation. The most common sites of metastasis were the lymph nodes (seven children) and the lungs (three patients). Three infants with renal rhabdoid tumors had, in addition, intracranial masses, two of which manifested clinically before the detection of the renal tumors, in one confirmed to be a primitive neuroectodermal tumor. Five of the 6 extrarenal tumors were identified among 155,926 surgical pathology specimens examined in the same children's hospitals over the same period of time; the remaining extrarenal rhabdoid tumor was received in consultation from a community hospital. The extrarenal rhabdoid tumors occurred in the dorsum of the right foot, liver, soft tissue of the right chest wall, left temporal lobe, left leg, and left thoracic paraspinal region. The ages ranged from 6 weeks to 15 years and two months. Three patients died of tumor-related causes within 4 months of diagnosis; one was a term stillborn. Two are alive, 1 month and 70 months postdiagnosis. Common sites for metastases included the lungs (three patients), and liver and lymph nodes (two children each). Patients with renal and extrarenal rhabdoid tumors are of similar age, have a similar clinical course, with early metastases and poor response to therapy. Primitive neuroectodermal intracranial tumors have been identified in several reported patients with renal rhabdoid tumors; similar brain tumors have not been documented in patients with extrarenal rhabdoid tumors. The histogenesis of this tumor remains unknown.     

Heavily pigmented renal cell carcinoma: a case report, with review of the literature and differential diagnosis

Clear cell carcinoma is the most common histotype among renal cell tumors. The prominent vascular network of sinusoidal vessels lined by delicate endothelial cells may often lead to hemorrhagic areas with secondary deposition of chunky birefringent hemosiderin granules. The finding of pigmentation other than iron, and in particular melanin deposits, in renal tumors is a rare occurrence that should lead to differential diagnosis with other primary and metastatic tumors of the kidney.     

Metastatic medulloblastoma to the breast

We present a case of metastatic medulloblastoma to the breast in a 33-year-old woman who had a cerebellar medulloblastoma excised 2 years previously. Upon presentation, she had a bilateral breast tumor, which was diagnosed as a malignant small cell tumor by means of fine needle aspiration biopsy. An excisional biopsy of the tumor was performed, showing metastatic medulloblastoma, morphologically identical with a cerebellar primary. Eighteen months following breast surgery, the patient developed unilateral ovarian and peritoneal metastases and died of the disease 57 months after the cerebellar tumor was excised. Metastatic medulloblastoma to the breast is an extremely rare form of a secondary breast tumor, which may be easily diagnosed when both primary and secondary tumors are cytologically or histologically compared. If this is not possible, considerable problems may be encountered to get to the correct diagnosis.     

Fine-needle aspiration cytology of metastatic breast tumor originating from leukemia.

Two cases of metastatic breast tumor originating from leukemia are reported. Fine-needle aspiration (FNA) specimens showed a large number of isolated small-to-medium-sized atypical lymphocytic cells. It is difficult to distinguish metastatic breast tumors and primary breast cancers by physical findings alone. FNA cytology is an effective method for qualitative diagnosis. When atypical lymphocytic cells are obtained in aspiration materials of the breast, past history and general examination are necessary for diagnosis. In some cases of leukemia with breast involvement, good outcomes are obtained. Therefore, earlier detection is necessary in order to begin suitable therapy earlier and to avoid unnecessary excisional biopsy in patients with leukemia and breast tumors. To achieve this it is also necessary to first take into consideration the possibility of metastasis or infiltration of leukemia, and second to prepare two types of specimen for Papanicolaou stain and Giemsa stain before operation.     

Diagnostic accuracy of core biopsies of renal masses: Experience in a real-life setting from a tertiary center

ObjectiveTo document and analyze diagnostic accuracy of renal core biopsy (RCB), its diagnostic correlation with resection specimens, and to question the need for immunohistochemistry (IHC) in the preoperative diagnosis of renal masses.Material and methodRCBs performed at a reference center between 2007 and 2017 were included. Pathological, clinical, and radiological data were obtained from medical records.ResultsAmong 302 biopsies included in this study, 274 (90.7%) were diagnostic. Two hundred sixty-six were neoplastic and 179 were of primary renal origin. The most common secondary neoplasms were hematolymphoid (n = 35) and metastatic (n = 17). Sixty-nine tumors were classified as small renal masses (SRMs) (≤4 cm in diameter) and 53 of them were malignant. Nephrectomy was performed in 58 patients. Overall diagnostic accuracy between resections and RCBs was 88.7%. IHC was performed in 160 (53%) cases. In 15 of those, a definite diagnosis could not be rendered. Renal cell origin and subtype were determined by histomorphology alone in 81 and 75 cases, respectively. Sixty primary neoplasms of renal cell origin required IHC for diagnosis.ConclusionRCB is a safe and highly accurate method for the diagnosis of both primary and secondary renal neoplasms. IHC is mostly required for the diagnosis of secondary tumors. Histomorphology is still the primary diagnostic tool, highly dependent on the experience of the surgical pathologist.     

Benign metastasizing pleomorphic adenoma of salivary gland: diagnosis of bone lesions by fine-needle aspiration biopsy.

Two cases of benign salivary gland pleomorphic adenomas metastatic to bone (benign-metastasizing pleomorphic adenomas) diagnosed by fine-needle aspiration biopsy are presented. Both primary tumors were slightly atypical cytologically but neither case demonstrated features of carcinoma. The metastatic lesions contained benign epithelial, myoepithelial, and stromal components. In both cases the clinical history was either not known by the radiologist or not communicated to the cytopathologist interpreting the case, and a primary tumor of bone was the leading clinical diagnosis. Obtaining pertinent clinical history and comparing the cytomorphology of the bone aspirate with the primary parotid tumor allowed for an accurate diagnosis in both cases. The differential diagnosis with primary bone tumors is discussed and the importance of clinical history is emphasized.     

Paratesticular congenital malignant rhabdoid tumor diagnosed by fine-needle aspiration cytology. a case report

We report the FNA features of a congenital malignant extrarenal rhabdoid tumor (MERT) located in the right paratesticular area of a newborn full-term boy (39 wk gestation), with disseminated metastases in the liver and right parietal region. The diagnosis was suggested two days after birth by fine-needle aspiration biopsy (FNAB) of the parietal mass, which demonstrated an atypical large cell proliferation with vesicular nuclei, prominent nucleoli, and abundant cytoplasm exhibiting paranuclear dense inclusions. The diagnosis was confirmed by histopathologic and immunohistochemical examination of the primary paratesticular tumor. To the best of our knowledge, this is the third MERT reported in the paratesticular region, one of the few congenital extrarenal non-central nervous system cases, and the third congenital case (renal or extrarenal) primarily diagnosed by FNAB. We emphasize the characteristic cytologic features of a congenital rhabdoid tumor, which must be known by pathologists because of the clinical and prognostic implications. Diagn. Cytopathol. 2004;30:46-50.     

Renal cell carcinoma metastatic to Hurthle cell adenoma of thyroid

Metastases to the thyroid gland are a common finding at autopsy in patients who died of malignancy and are often misdiagnosed as primary thyroid neoplasms clinically. We present a patient with a rare, unusual case of renal cell carcinoma (RCC) metastatic to a Hurthle cell adenoma of the thyroid. A 53-year-old woman was admitted to a University of Texas Medical Branch Hospital (Galveston, TX) for a large right thyroid mass that was present for 3 months. A fine needle aspiration of the thyroid mass was performed and interpreted as suggestive of a Hurthle cell neoplasm. A total thyroidectomy revealed Hurthle cell adenoma containing clusters of cytologically atypical cells with clear cytoplasm. Subsequent patient evaluation and computed tomography revealed a renal mass. Left radical nephrectomy was performed at a later date for left renal mass and the microscopic examination confirmed the diagnosis of primary clear cell carcinoma of the kidney. Further studies confirmed that the thyroid mass was metastases from RCC. Although carcinoma of the kidney is responsible in most instances of metastatic disease to the thyroid, metastatic RCC to a thyroid neoplasm is extremely rare, with only two reports found in the English literature. The possibility of metastatic RCC should always be taken under consideration, especially when nests of clear cells are seen infiltrating into the thyroid parenchyma or neoplasm.     

Feasibility of differential diagnosis of kidney tumors by comparative genomic hybridization of fine needle aspiration biopsies

The association of a genetic analysis that could improve the diagnostic accuracy of renal cell tumors in biopsy samples would allow better‐informed therapeutic decisions. We performed comparative genomic hybridization (CGH) on an ex vivo fine‐needle aspiration (FNA) biopsy and a tumor fragment obtained from 75 patients consecutively diagnosed with renal tumors and subjected to radical nephrectomy. The pattern of genomic changes by CGH was used blindly to classify the renal tumors and the genetic findings were subsequently compared with the histopathologic diagnosis. In particular cases, including in two carcinomas with morphologically distinct tumor areas, we performed FISH with several locus‐specific probes, and looked for VHL point mutations, exonic rearrangements, or promoter methylation. CGH was successful in 82.7% FNA biopsies and in 96% tumor fragments, with the former allowing genetic diagnosis in 75% of renal cell tumors. The genetic and the initial histological classification differed in two renal neoplasias, but the genetic diagnosis was confirmed after review. The genetic pattern correctly diagnosed 93.5% of clear cell renal cell carcinomas (RCC), 61.5% of chromophobe RCC, 100% of papillary RCC, and 14.3% of oncocytomas, with the negative predictive value being 93.9, 90.7, 100, and 90.2%, respectively. The positive predictive value and specificity of copy number profiles was 100%. We demonstrate that genetic diagnosis by CGH on FNA biopsies can improve differential diagnosis in patients with kidney tumors. © 2010 Wiley‐Liss, Inc.     

Aneurysmal bone cyst: fine-needle aspiration findings in 23 patients with clinical and radiologic correlation

Aneurysmal bone cyst (ABC) is an osseous mass lesion that accounts for 1% of primary bone tumors. We describe 23 cases of ABC initially evaluated by fine-needle aspiration biopsy (FNAB). In 4 cases, the ABC was secondary to another primary tumor. Aspirates from 6 cases (26%) were insufficient. Twelve aspirates diagnosed as ABC by FNAB were confirmed as ABC by histologic examination. The accuracy of FNAB was 82% when cases insufficient for evaluation were excluded. One case diagnosed as ABC cytologically was subsequently found to be metastatic carcinoma. In another, the specimen was interpreted as ABC vs giant cell tumor. In the remainder, a diagnosis of ABC was favored cytologically. Owing to the nonspecific findings, ABC cannot be definitively diagnosed by FNAB. However, the presence of typical clinical and radiographic features in conjunction with a blood-rich, mesenchymal cell containing aspirate devoid of overtly malignant cells strongly suggests the diagnosis of ABC.     

Case report: metastatic renal carcinoid to the thyroid diagnosed by fine needle aspiration biopsy

We report a case of primary renal carcinoid arising in a horseshoe kidney. To the best of our knowledge this is the first case to be reported in the cytology literature, which has been diagnosed by fine needle aspiration (FNA). A 32-year-old male, presented to the Emory University Hospital, with a renal mass arising in a horseshoe kidney; along with a thyroid mass. FNA of the renal mass resulted in an initial diagnosis of renal cell carcinoma, unclassified. A thyroid aspiration was attempted later, and revealed a neuroendocrine morphology. This was compared with the renal aspiration and both of them were found to have similar morphology. With the help of immunostains, a diagnosis of renal carcinoid tumor metastatic to the thyroid was made. Thus, we demonstrate that renal carcinoid, being a rare entity, can pose a diagnostic challenge.     

Secondary tumors of the pancreas diagnosed by endoscopic ultrasound‐guided fine‐needle aspiration: A 10‐year experience

Determining whether a pancreatic mass is a primary or secondary neoplasm is necessary for appropriate treatment. We reviewed our experience using endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA) for diagnosis of pancreatic tumors to identify clinical and cytopathologic characteristics of metastatic disease. We reviewed all cases of tumors metastatic to the pancreas evaluated at The University of Texas MD Anderson Cancer Center and The Methodist Hospital in Houston, Texas during the period from 2002 to 2012. The review included cytologic specimens, clinical history, radiologic findings, primary tumor type, and clinical follow‐up. We identified 66 patients with disease metastatic to the pancreas for which cytologic material was available: 38 (58%) men and 28 (42%) women, with an average age of 63 years (range, 40–89 years). Most metastases (98%) were single lesions, and nearly half were located in the head of the pancreas (30/66). The most common site of origin for these metastases was kidney (27 [41%] cases). Follow‐up information was available for 65 (98%) patients, and duration of follow‐up ranged from <1 to 10 years (mean, 2.3 years). Thirty‐three patients (50%) were alive at the time of the most recent follow‐up contact. Of the 25 patients with metastatic renal cell carcinoma, clear cell type, 19 (76%) were alive at the time of the most recent follow‐up. It was concluded that metastases may mimic primary pancreatic carcinomas both clinically and cytologically. Ancillary studies in conjunction with clinical history are necessary for the accurate diagnosis of FNAs of secondary pancreatic tumors. Diagn. Cytopathol. 2014;42:738–743. © 2014 Wiley Periodicals, Inc.     

Malignant rhabdoid tumor: Cyto-histologic correlation and immunohistochemical characterization of a rare pediatric malignancy and its differential diagnoses

Malignant rhabdoid tumor of the kidney (MRTK) is a rare aggressive pediatric renal tumor which can be diagnosed via fine-needle aspiration (FNA) cytology and core biopsy. The diagnosis of MRTK is challenging, and requires morphologic, immunohistochemical and clinical correlation to distinguish it from other entities. The differential diagnosis includes Wilms tumor, desmoplastic small round cell tumor, rhabdomyosarcoma, synovial sarcoma, renal medullary carcinoma, and epithelioid sarcoma. Here we describe a case of MRTK diagnosed on renal cytology and core biopsy with immunohistochemistry and follow by nephrectomy with gross and morphologic findings.