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Presented by Pedram Argani, M.D. and prepared by Jeremy Vincent M.D.
Case 3: This is a 58 year old female with a renal mass.
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1. Question
Week 538: Case 3
This is a 58 year old female with a renal mass.images/vincent/5576_1.jpg
images/vincent/5576_2.jpg
images/vincent/5576_3.jpgCorrect
Answer: Papillary renal cell carcinoma
Histology: This is an extensively papillary neoplasm which is composed of cells with cytologic features of oncocytoma, in that they have round nuclei and finely granular cytoplasm. The distinctive feature of the current lesion is the location of the nuclei opposite the base of the fibrovascular cores. These are the typical features of oncocytic papillary renal cell carcinoma. At this time, it is not clear to all experts that this is distinctive entity, and hence these lesions are typically characterized under the category of papillary renal cell carcinoma, eosinophilic (type II) type.
Discussion: Oncocytoma should not show the papillary architecture of the current lesion. Clear cell carcinomas may have pseudopapillary areas when they are high Fuhrman grade; however, those cases show greater cytologic atypia, more angulated nuclei, and more highly vascularized septa. Chromophobe carcinomas demonstrate raisinoid nuclei and demonstrate perinuclear halos not evident in the current lesion.
Incorrect
Answer: Papillary renal cell carcinoma
Histology: This is an extensively papillary neoplasm which is composed of cells with cytologic features of oncocytoma, in that they have round nuclei and finely granular cytoplasm. The distinctive feature of the current lesion is the location of the nuclei opposite the base of the fibrovascular cores. These are the typical features of oncocytic papillary renal cell carcinoma. At this time, it is not clear to all experts that this is distinctive entity, and hence these lesions are typically characterized under the category of papillary renal cell carcinoma, eosinophilic (type II) type.
Discussion: Oncocytoma should not show the papillary architecture of the current lesion. Clear cell carcinomas may have pseudopapillary areas when they are high Fuhrman grade; however, those cases show greater cytologic atypia, more angulated nuclei, and more highly vascularized septa. Chromophobe carcinomas demonstrate raisinoid nuclei and demonstrate perinuclear halos not evident in the current lesion.
