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Presented by Justin A. Bishop, M.D. and prepared by Whitney Green, M.D.
Case 1: 50 year old man with a sinonasal mass.
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1. Question
Week 560: Case 1
50 year old man with a sinonasal massimages/JB071813Case1_1.jpg
images/JB07182013Case 1_Image2.jpg
images/JB07182013Case1_Figure3.jpgCorrect
Answer: Surface-type sinonasal carcinoma
Histology: The specimen consisted of fragments of sinonasal mucosa and a proliferation of cells arranged in nests and follicles with intraluminal eosinophilic secretions. There is abundant hemorrhage in the background. The tumor cells have “water-clear” cytoplasm and uniform round, bland nuclei. Occasional mitotic figures were identified. The findings are entirely consistent with renal cell carcinoma, but the tumor was negative for the renal cell markers PAX8, RCC, and CD10, and the patient had no history of renal cell carcinoma. Other considerations include metastatic thyroid carcinoma with clear cell change and primary myoepithelial carcinoma, but the tumor was negative for TTF-1, thyroglobulin, p63, actin, and calponin.
Discussion: The tumor is most consistent with a primary sinonasal, surface-type adenocarcinoma, and has many features of the rare “renal cell carcinoma like” variant of sinonasal adenocarcinoma. In the rare reports of this tumor, no cases exhibited aggressive behavior or were found to have renal cell carcinoma.
Reference(s):
– Storck K, et al. Sinonasal renal cell-like adenocarcinoma: a report on four patients. Head Neck Pathol. 2008;2(2):75-80.
– Zur KB, et al. Primary description of a new entity, renal cell-like variant of the nasal cavity: van Meegren in the house of Vermeer. Arch Otolaryngol Head Neck Surg. 128(4):441-7.Incorrect
Answer: Surface-type sinonasal carcinoma
Histology: The specimen consisted of fragments of sinonasal mucosa and a proliferation of cells arranged in nests and follicles with intraluminal eosinophilic secretions. There is abundant hemorrhage in the background. The tumor cells have “water-clear” cytoplasm and uniform round, bland nuclei. Occasional mitotic figures were identified. The findings are entirely consistent with renal cell carcinoma, but the tumor was negative for the renal cell markers PAX8, RCC, and CD10, and the patient had no history of renal cell carcinoma. Other considerations include metastatic thyroid carcinoma with clear cell change and primary myoepithelial carcinoma, but the tumor was negative for TTF-1, thyroglobulin, p63, actin, and calponin.
Discussion: The tumor is most consistent with a primary sinonasal, surface-type adenocarcinoma, and has many features of the rare “renal cell carcinoma like” variant of sinonasal adenocarcinoma. In the rare reports of this tumor, no cases exhibited aggressive behavior or were found to have renal cell carcinoma.
Reference(s):
– Storck K, et al. Sinonasal renal cell-like adenocarcinoma: a report on four patients. Head Neck Pathol. 2008;2(2):75-80.
– Zur KB, et al. Primary description of a new entity, renal cell-like variant of the nasal cavity: van Meegren in the house of Vermeer. Arch Otolaryngol Head Neck Surg. 128(4):441-7.
