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Presented by Dr. Andres Matoso and prepared by Dr. Harsimar Kaur.
Renal mass in a 70-year-old female.
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1. Question
Renal mass in a 70-year-old female.
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Histology: This is a predominantly cystic mass with areas of small solid tumor nests composed with clear cells. There are occasional papillary structures and psammomatous calcifications.
Discussion: The combination of papillary structures, lined by clear cells and associated psammomatous calcifications is a morphologic clue to translocation RCC. While translocation RCC are more predominant in children and adults under the age of 35 year, they can occur at any age. Translocation Xp11.2 RCC are usually negative or focally positive for cytokeratin stains and for CAIX while they exhibit nuclear expression of TFE3 and can be confirmed by FISH.
References:
1. Argani P, Zhong M, Reuter VE, et al. TFE3-Fusion Variant Analysis Defines Specific Clinicopathologic Associations Among Xp11 Translocation Cancers. Am J Surg Pathol. 2016;40:723-737.
2. Argani P, Lal P, Hutchinson B, et al. Aberrant nuclear immunoreactivity for TFE3 in neoplasms with TFE3 gene fusions: a sensitive and specific immunohistochemical assay. Am J Surg Pathol. 2003;27:750-761.Incorrect
Histology: This is a predominantly cystic mass with areas of small solid tumor nests composed with clear cells. There are occasional papillary structures and psammomatous calcifications.
Discussion: The combination of papillary structures, lined by clear cells and associated psammomatous calcifications is a morphologic clue to translocation RCC. While translocation RCC are more predominant in children and adults under the age of 35 year, they can occur at any age. Translocation Xp11.2 RCC are usually negative or focally positive for cytokeratin stains and for CAIX while they exhibit nuclear expression of TFE3 and can be confirmed by FISH.
References:
1. Argani P, Zhong M, Reuter VE, et al. TFE3-Fusion Variant Analysis Defines Specific Clinicopathologic Associations Among Xp11 Translocation Cancers. Am J Surg Pathol. 2016;40:723-737.
2. Argani P, Lal P, Hutchinson B, et al. Aberrant nuclear immunoreactivity for TFE3 in neoplasms with TFE3 gene fusions: a sensitive and specific immunohistochemical assay. Am J Surg Pathol. 2003;27:750-761.
