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Presented by Dr. Pedram Argani and prepared by Austin McCuiston
This is a 68 year old male with a cystic renal mass.
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1. Question
This is a 68 year old male with a cystic renal mass.
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Answer: Multilocular cystic renal neoplasm of low malignant potential
Histologic Description: This is a purely cystic renal lesion, and the cysts mold the septa. The septa are thin and without nodules. While most of the septa are characterized by fibrous tissue with foci of ossification, one can appreciate bland clear cells within the septa, frequently associated with prominent capillary vasculature. These cells label for EMA and carbonic anhydrase 9, and have the phenotype of clear cell carcinoma. Because they fail to form nodules, this lesion is regarded as a multilocular cystic renal neoplasm of low malignant potential. Such cases have not demonstrated metastatic behavior in clinical follow-up.
Discussion: Differential Diagnosis: Renal cell carcinomas of clear cell type frequently become cystic; however, in these cases, the septa are thickened and nodular and mold the cysts. Cystic nephroma/mixed epithelial stromal tumor tends to have a wavier, “ovarian-like” stroma that frequently labels for inhibin, and only infrequently has clear cells lining the cysts. Clear cells are typically not present in the septa of cystic nephroma/MEST. The latter occurs far more frequently in adult women. Clear cell papillary renal cell carcinoma is frequently cystic; however, the clear cells line the cysts, and are characterized by prominent subnuclear vacuoles not seen in the current case.
Incorrect
Answer: Multilocular cystic renal neoplasm of low malignant potential
Histologic Description: This is a purely cystic renal lesion, and the cysts mold the septa. The septa are thin and without nodules. While most of the septa are characterized by fibrous tissue with foci of ossification, one can appreciate bland clear cells within the septa, frequently associated with prominent capillary vasculature. These cells label for EMA and carbonic anhydrase 9, and have the phenotype of clear cell carcinoma. Because they fail to form nodules, this lesion is regarded as a multilocular cystic renal neoplasm of low malignant potential. Such cases have not demonstrated metastatic behavior in clinical follow-up.
Discussion: Differential Diagnosis: Renal cell carcinomas of clear cell type frequently become cystic; however, in these cases, the septa are thickened and nodular and mold the cysts. Cystic nephroma/mixed epithelial stromal tumor tends to have a wavier, “ovarian-like” stroma that frequently labels for inhibin, and only infrequently has clear cells lining the cysts. Clear cells are typically not present in the septa of cystic nephroma/MEST. The latter occurs far more frequently in adult women. Clear cell papillary renal cell carcinoma is frequently cystic; however, the clear cells line the cysts, and are characterized by prominent subnuclear vacuoles not seen in the current case.
