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Presented by Pedram Argani, M.D. and prepared by Safia Salaria, M.B.B.S.
Case 1: This is a 43 year old female with a renal mass.
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1. Question
Week 493: Case 1
This is a 43 year old female with a renal mass.images/1Alex/082211case1image1.jpg
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images/1Alex/082211case1image4.jpgCorrect
Answer: Papillary renal cell carcinoma, solid variant
Histology: The neoplasm consists of tightly packed clusters of tubules with small abortive papillae.The cells lining the tubules have scant, finely granular to clear cytoplasm, while the micropapilla feature cells with more prominent eosinophilic cytoplasm and higher nuclear grade.This arrangement gives the neoplasm a somewhat “glomeruloid” architecture.By immunohistochemistry, the neoplasm was diffusely immunoreactive for cytokeratin 7 and negative for WT-1, supporting the diagnosis of papillary renal cell carcinoma.
Discussion: Metanephric adenoma would be composed of more basophilic cells, and would label for WT-1. Mucinous tubular and spindle cell carcinoma may have papillary areas, but it should also have mucinous stroma and spindle cell areas.Clear cell carcinoma is suggested by the paleness of the cytoplasm of some the cells; however, it would feature hypervascular septa, and the cells would have water-clear cytoplasm.
Incorrect
Answer: Papillary renal cell carcinoma, solid variant
Histology: The neoplasm consists of tightly packed clusters of tubules with small abortive papillae.The cells lining the tubules have scant, finely granular to clear cytoplasm, while the micropapilla feature cells with more prominent eosinophilic cytoplasm and higher nuclear grade.This arrangement gives the neoplasm a somewhat “glomeruloid” architecture.By immunohistochemistry, the neoplasm was diffusely immunoreactive for cytokeratin 7 and negative for WT-1, supporting the diagnosis of papillary renal cell carcinoma.
Discussion: Metanephric adenoma would be composed of more basophilic cells, and would label for WT-1. Mucinous tubular and spindle cell carcinoma may have papillary areas, but it should also have mucinous stroma and spindle cell areas.Clear cell carcinoma is suggested by the paleness of the cytoplasm of some the cells; however, it would feature hypervascular septa, and the cells would have water-clear cytoplasm.
