Warthin-like papillary renal cell carcinoma: Clinicopathologic,morphologic, immunohistochemical and molecular genetic analysis of 11 cases |
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| Institution: | 1. Department of Pathology, University of Sarajevo Clinical Center, Sarajevo, Bosnia and Herzegovina;2. “Ljudevit Jurak” Pathology Department, Clinical Hospital Center “Sestre milosrdnice”, Zagreb, Croatia;3. Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic;4. Department of Pathology, University of British Columbia, Royal Columbian Hospital, Vancouver, BC, Canada;5. Department of Pathology, Bellvitge University Hospital, Barcelona, Spain;6. Department of Pathology, Masaryk''s Oncologic Institute, University Hospital Brno, Czech Republic;7. Department of Pathology, Instituto Nacional de Cancerologia, Mexico City, Mexico;8. Department of Pathology, Centro Medico, Mexico City, Mexico;9. Department of Radiation Oncology, Oncology Institute, Kosice, Slovakia;10. Department Pathology, Regional Hospital Jindrichuv Hradec, Czech Republic;11. Department Pathology, Regional Hospital Most, Czech Republic;12. Department of Urology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic;13. Biopticka Laboratory, Pilsen, Czech Republic;1. Department of Pathology, University of Szeged, 6720 Szeged, Hungary;2. Department of Pathology, Clinical Center of the University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina;3. School of Medicine, University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina;4. Department of Medical Sciences, University of Turin, Pathology Unit, 10126 Turin, Italy;5. Candiolo Cancer Institute - Fondazione del Piemonte per l''Oncologia (FPO), IRCCS, 10060, Candiolo (To), Italy;6. Department of Pathology, Bács-Kiskun County Teaching Hospital, 6000 Kecskemét, Hungary;1. Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia;2. Department of Biology, School of Medicine, University of Zagreb, Zagreb, Croatia;3. Department of Pathology, School of Medicine, University of Zagreb, Croatia;4. Department of Pathology, Clinical Center, University of Sarajevo, Sarajevo, Bosnia and Herzegovina;5. School of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina;1. Caris Life Sciences, Phoenix, AZ, USA;2. College of Medicine, Qatar University, Doha, Qatar;1. Department of Pathology, University of Alabama at Birmingham, Birmingham, AL;2. Department of Radiology, University of Alabama at Birmingham, Birmingham, AL;3. Department of Urology, University of Alabama at Birmingham, Birmingham, AL;1. Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109, USA;2. School of Public Health, University of Michigan Medical School, Ann Arbor, MI 48109, USA;3. Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI 48109, USA;4. Department of Urology, University of Michigan Medical School, Ann Arbor, MI 48109, USA;5. Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI 48109, USA;6. Howard Hughes Medical Institute, University of Michigan Medical School, Ann Arbor, MI 48109, USA;7. Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, USA |
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| Abstract: | 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 59 years (range 14–76), and a mean tumor size of 7 cm (range 1–22 cm). 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 47.6 months, 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. |
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