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Presented by Pedram Argani, M.D. and prepared by Priya Banerjee, M.D.
Case 6: 58 year old female a renal mass.
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1. Question
Week 360: Case 6
58 year old female a renal massimages/8_4_08 6a.jpg
images/8_4_08 6b.jpg
images/8_4_08 6c.jpg
images/8_4_08 6d.jpgCorrect
Answer: Oncocytoma
Histology: This region has typical architecture of an oncocytoma. The lesion consists of oncocytic epithelioid cells with densely granular eosinophilic cytoplasm in a nested pattern, set in a myxoid stroma. A central area of scarring is evident. The usual features of this lesion are the presence of degenerative atypia, and smaller eosinophilic cells (oncoblasts). These are accepted features of oncocytoma.
Discussion: Clear cell renal cell carcinoma has a more highly vascularized stroma and would lack the typical round nuclei and prominent nucleoli of oncocytoma. Epithelioid angiomyolipoma would label HMB45 but not for cytokeratin, and might feature dysplastic blood vessels or foci of fat. Chromophobe renal cell carcinoma features sheets of cells with perinuclear halos and irregular, convoluted nuclear membranes.
In addition to degenerative atypia oncocytomas may involve the perirenal fat and rarely may show vascular invasion. Extensive papillary areas, clear cells, or necrosis are features not typical of oncocytoma.
Incorrect
Answer: Oncocytoma
Histology: This region has typical architecture of an oncocytoma. The lesion consists of oncocytic epithelioid cells with densely granular eosinophilic cytoplasm in a nested pattern, set in a myxoid stroma. A central area of scarring is evident. The usual features of this lesion are the presence of degenerative atypia, and smaller eosinophilic cells (oncoblasts). These are accepted features of oncocytoma.
Discussion: Clear cell renal cell carcinoma has a more highly vascularized stroma and would lack the typical round nuclei and prominent nucleoli of oncocytoma. Epithelioid angiomyolipoma would label HMB45 but not for cytokeratin, and might feature dysplastic blood vessels or foci of fat. Chromophobe renal cell carcinoma features sheets of cells with perinuclear halos and irregular, convoluted nuclear membranes.
In addition to degenerative atypia oncocytomas may involve the perirenal fat and rarely may show vascular invasion. Extensive papillary areas, clear cells, or necrosis are features not typical of oncocytoma.
