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Presented by Dr. Jonathan Epstein and prepared by Austin McCuiston.
A 67 year old man underwent a nephrectomy for a renal mass.
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1. Question
A 67 year old man underwent a nephrectomy for a renal mass.
Correct
Answer: Carcinoid tumor
Histology: The tumor has a relatively uniform growth pattern consisting of cords and trabeculae. The tumor appears very vascular with numerous fine capillaries interspersed throughout. Cytologically, the cells are not very pleomorphic and lack prominent nucleoli with a fine speckled chromatin. In areas of the tumor there are dense fibrous bands. Mitotic figures are difficult to identify.
Discussion. The morphology of this tumor is classic for a carcinoid tumor. It is only difficult in that carcinoid tumors of the kidney are rare, and consequently pathologists do not think of it in the differential diagnosis of a renal tumor. Carcinoid tumors of the kidney are aggressive tumors with approximately 50% of them developing metastatic disease regardless of their mitotic count and even if necrosis is absent. Consequently, terminology used for these tumors in the kidney do not parallel that used in other organs where neuroendocrine tumors are divided into well-differentiated NE tumors and high grade NE carcinomas. Given that in the kidney, mitotic figures and necrosis do not correlate with prognosis, they are merely referred to as “carcinoid tumor” of the kidney where their prognosis is unpredictable but fairly aggressive.
Incorrect
Answer: Carcinoid tumor
Histology: The tumor has a relatively uniform growth pattern consisting of cords and trabeculae. The tumor appears very vascular with numerous fine capillaries interspersed throughout. Cytologically, the cells are not very pleomorphic and lack prominent nucleoli with a fine speckled chromatin. In areas of the tumor there are dense fibrous bands. Mitotic figures are difficult to identify.
Discussion. The morphology of this tumor is classic for a carcinoid tumor. It is only difficult in that carcinoid tumors of the kidney are rare, and consequently pathologists do not think of it in the differential diagnosis of a renal tumor. Carcinoid tumors of the kidney are aggressive tumors with approximately 50% of them developing metastatic disease regardless of their mitotic count and even if necrosis is absent. Consequently, terminology used for these tumors in the kidney do not parallel that used in other organs where neuroendocrine tumors are divided into well-differentiated NE tumors and high grade NE carcinomas. Given that in the kidney, mitotic figures and necrosis do not correlate with prognosis, they are merely referred to as “carcinoid tumor” of the kidney where their prognosis is unpredictable but fairly aggressive.
