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Presented by Pedram Argani, M.D. and prepared by Jeremy Vincent M.D.
Case 3: This is 58 year old female with a renal mass.
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1. Question
Week 509: Case 3
This is 58 year old female with a renal mass.images/1Alex/12-5396 01.jpg
images/1Alex/12-5396 02.jpg
images/1Alex/12-5396 03.jpgCorrect
Answer: Oncocytoma
Histology: The neoplasm is composed of oncocytic cells, and has a nested architecture with a myxoid stroma. The neoplastic cells have generally round nuclei, and finely granular eosinophilic cytoplasm. A small population of smaller cells has a more basophilic appearance, which has been described as “oncoblasts”. These are the typical features of oncocytoma.
Discussion: Chromophobe carcinoma generally has a more sheet like architecture, and the nuclei are convoluted and indented. Clear cell carcinomas become eosinophilic when they are high grade, and would demonstrate a more hypervascular stroma as well as greater nuclear atypia. The t(6;11) renal cell carcinomas can have an oncocytic appearance; however, these lesions typically have a second cell population which is smaller and clusters around basement membrane material, demonstrates immunoreactivity for melanocytic markers Melan A and HMB45, and labels for cathepsin K.
Incorrect
Answer: Oncocytoma
Histology: The neoplasm is composed of oncocytic cells, and has a nested architecture with a myxoid stroma. The neoplastic cells have generally round nuclei, and finely granular eosinophilic cytoplasm. A small population of smaller cells has a more basophilic appearance, which has been described as “oncoblasts”. These are the typical features of oncocytoma.
Discussion: Chromophobe carcinoma generally has a more sheet like architecture, and the nuclei are convoluted and indented. Clear cell carcinomas become eosinophilic when they are high grade, and would demonstrate a more hypervascular stroma as well as greater nuclear atypia. The t(6;11) renal cell carcinomas can have an oncocytic appearance; however, these lesions typically have a second cell population which is smaller and clusters around basement membrane material, demonstrates immunoreactivity for melanocytic markers Melan A and HMB45, and labels for cathepsin K.
