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Presented by Dr. Jonathan Epstein and prepared by Austin McCuiston.
A 65 year old male was incidentally found to have a 5 cm renal mass on imaging.
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Question 1 of 1
1. Question
A 65 year old male was incidentally found to have a 5 cm renal mass on imaging.
Correct
Answer: Papillary renal cell carcinoma
Histological Description: The tumor is composed of large, round to polygonal cells with abundant eosinophilic cytoplasm. Architecturally, there are numerous papillary fronds lined by multilayered columnar granular eosinophilic/oncocytic cells. The nuclei are relatively round with prominent nucleoli. Numerous foamy histiocytes occupy the papillary fibrovascular cores. Hemosiderin deposition is present in some of the histiocytes as well in some of the epithelium.
Discussion: Certain features are not allowed in oncocytomas. They are: 1) papillary fronds; 2) necrosis; 3) clear cells (except for the degenerative cells in central scars); and 4) non-degenerative nuclear atypia consisting of irregular, notched, crinkly, folded nuclei. The one clarification about papillary features is that papillary projections may be seen into dilated cysts of oncocytomas composed of dilated tubules. Immunohistochemically, papillary renal cell carcinomas are typically diffusely positive for CK7. Oncocytomas can show patchy focal staining but never diffuse staining. Foamy histiocytes are a good clue in a renal tumor that it is papillary renal cell carcinoma and is not seen in oncocytomas. However, foamy histiocytes may be seen in other renal tumors so is not entirely specific. Another feature typical of papillary renal cell carcinoma is the presence of hemosiderin in tumor cells, also not seen in oncocytomas.
Incorrect
Answer: Papillary renal cell carcinoma
Histological Description: The tumor is composed of large, round to polygonal cells with abundant eosinophilic cytoplasm. Architecturally, there are numerous papillary fronds lined by multilayered columnar granular eosinophilic/oncocytic cells. The nuclei are relatively round with prominent nucleoli. Numerous foamy histiocytes occupy the papillary fibrovascular cores. Hemosiderin deposition is present in some of the histiocytes as well in some of the epithelium.
Discussion: Certain features are not allowed in oncocytomas. They are: 1) papillary fronds; 2) necrosis; 3) clear cells (except for the degenerative cells in central scars); and 4) non-degenerative nuclear atypia consisting of irregular, notched, crinkly, folded nuclei. The one clarification about papillary features is that papillary projections may be seen into dilated cysts of oncocytomas composed of dilated tubules. Immunohistochemically, papillary renal cell carcinomas are typically diffusely positive for CK7. Oncocytomas can show patchy focal staining but never diffuse staining. Foamy histiocytes are a good clue in a renal tumor that it is papillary renal cell carcinoma and is not seen in oncocytomas. However, foamy histiocytes may be seen in other renal tumors so is not entirely specific. Another feature typical of papillary renal cell carcinoma is the presence of hemosiderin in tumor cells, also not seen in oncocytomas.
