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Presented by Dr. Pedram Argani and prepared by Dr. Jennifer Bynum
This is a 68 year old female with a kidney tumor.
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1. Question
Week 629: Case 1
This is a 68 year old female with a kidney tumor.
Correct
Answer: B
Histologic Description: This is a high grade adenocarcinoma involving the kidney. The tumor is associated with acutely inflamed desmoplastic stroma. The neoplastic cells form tubules and cribriform structures, and are characterized by vesicular chromatin with prominent nucleoli and occasional intracytoplasmic inclusions (rhabdoid features). The neoplastic cells label for PAX8 and show loss of labeling for INI-1, supporting the diagnosis of renal medullary carcinoma. Hemoglobin electrophoresis later showed evidence of sickle cell trait.
Differential Diagnosis: Urothelial carcinoma would feature transitional type stratified epithelium, and may involve the renal pelvis. Urothelial carcinoma would label for high molecular cytokeratin and generally has intact INI-1 protein. SDHB-RCC is typically an oncocytic tumor with intra cytoplasmic vacuoles and inclusions, dissimilar to the current case. HLRCC-associated RCC characteristically features cells with vesicular chromatin and extremely prominent nucleoli. These neoplasms often but not always demonstrate papillary architecture.
This patient is of more advanced age than the typical renal medullary carcinoma, but the typical morphologic features in this unusual age group led to subsequent hemoglobin electrophoresis, which demonstrated sickle cell trait.
Incorrect
Answer: B
Histologic Description: This is a high grade adenocarcinoma involving the kidney. The tumor is associated with acutely inflamed desmoplastic stroma. The neoplastic cells form tubules and cribriform structures, and are characterized by vesicular chromatin with prominent nucleoli and occasional intracytoplasmic inclusions (rhabdoid features). The neoplastic cells label for PAX8 and show loss of labeling for INI-1, supporting the diagnosis of renal medullary carcinoma. Hemoglobin electrophoresis later showed evidence of sickle cell trait.
Differential Diagnosis: Urothelial carcinoma would feature transitional type stratified epithelium, and may involve the renal pelvis. Urothelial carcinoma would label for high molecular cytokeratin and generally has intact INI-1 protein. SDHB-RCC is typically an oncocytic tumor with intra cytoplasmic vacuoles and inclusions, dissimilar to the current case. HLRCC-associated RCC characteristically features cells with vesicular chromatin and extremely prominent nucleoli. These neoplasms often but not always demonstrate papillary architecture.
This patient is of more advanced age than the typical renal medullary carcinoma, but the typical morphologic features in this unusual age group led to subsequent hemoglobin electrophoresis, which demonstrated sickle cell trait.
