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Presented by Jonathan Epstein, M.D. and prepared by Sarah Karram, M.D.
A 65 year old man with a history of a renal tumor underwent a bone biopsy for a presumed metastatic lesion.
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Question 1 of 1
1. Question
Week (612): Case 2
A 65 year old man with a history of a renal tumor underwent a bone biopsy for a presumed metastatic lesion.
Correct
Answer: Metastatic tubulocystic carcinoma
Histology: The needle biopsy contains dilated glands lined by cells with eosinophilic cytoplasm with enlarge nuclei with prominent nucleoli.
Discussion: This patient had a history of tubulocystic carcinoma of the kidney. This is an uncommon variant of renal cell carcinoma composed of variably sized cysts, some dilated, giving it a “swiss cheese” appearance. The cytology seen in this case is typical of this entity. Although initially considered a low grade collecting duct carcinoma, it is currently considered a distinct entity. In contrast to collecting duct carcinoma, tubulocystic carcinoma is circumscribed and lacks a desmoplastic stroma. Whereas collecting duct carcinoma is an aggressive tumor with frequent metastases, tubulocystic carcinoma has in general an excellent prognosis. However as seen in this case, metastases can rarely occur. One does not typically grade tubulocystic carcinomas as what would be considered grade 3 nuclei does not typically correlate with their indolent behavior.
Incorrect
Answer: Metastatic tubulocystic carcinoma
Histology: The needle biopsy contains dilated glands lined by cells with eosinophilic cytoplasm with enlarge nuclei with prominent nucleoli.
Discussion: This patient had a history of tubulocystic carcinoma of the kidney. This is an uncommon variant of renal cell carcinoma composed of variably sized cysts, some dilated, giving it a “swiss cheese” appearance. The cytology seen in this case is typical of this entity. Although initially considered a low grade collecting duct carcinoma, it is currently considered a distinct entity. In contrast to collecting duct carcinoma, tubulocystic carcinoma is circumscribed and lacks a desmoplastic stroma. Whereas collecting duct carcinoma is an aggressive tumor with frequent metastases, tubulocystic carcinoma has in general an excellent prognosis. However as seen in this case, metastases can rarely occur. One does not typically grade tubulocystic carcinomas as what would be considered grade 3 nuclei does not typically correlate with their indolent behavior.
