Answer: Acquired cystic disease associated renal cell carcinoma

Histology: none provided

Discussion: The current patient has a long history of dialysis for end stage renal disease (ESRD). In addition to the usual types of RCC seen in sporadic settings, two additional subtypes of RCC unique to ESRD patients are emerging.

The first and more common type, designated as “acquired cystic disease-associated RCC” by Tickoo et al. is characterized by a typical microcystic architecture with abundant intratumoral oxalate crystal deposits. The tumor cells have eosinophilic to focally clear cytoplasm, Fuhrman grade 3 nuclei and are focally arranged in papillary architecture. As indicated in their designation, these tumors occurred exclusively in kidneys with ACDK.

The second unique type of ESRD associated renal carcinomas is designated “clear-cell papillary RCC of the end-stage kidney”. They have a prominent cystic and papillary architecture. The papillae are lined almost purely with clear cells.

Biologically, the ACDK associated RCC type appear to be the more aggressive subtype of two unique subtypes of ESDR associated tumors.

Reference(s):
– Tickoo SK, dePeralta-Venturina MN, Harik LR, Worcester HD, Salama ME, Young AN,Moch H, Amin MB. Spectrum of epithelial neoplasms in end-stage renal disease: an experience from 66 tumor-bearing kidneys with emphasis on histologic patterns distinct from those in sporadic adult renal neoplasia. Am J Surg Pathol. 2006 Feb;30(2):141-53.