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Presented by Dr. Pedram Argani and prepared by Dr. Yembur Ahmad.
61 year old male with a renal mass.
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1. Question
This is a 61 year old male with a renal mass. The patient has been on dialysis. What is the diagnosis?
Correct
Answer: B
Histologic Description: This renal neoplasm arises in an end stage kidney. It is associated with extensive cystic change and hemorrhage. The epithelial component of the lesion has a cribriform, sieve-like architecture. The cribriform architecture results from intracellular and intercellular spaces. The neoplastic cells are epithelioid and have abundant pink cytoplasm and round nuclei with occasional prominent nucleoli. Interspersed between the neoplastic cells are calcium oxalate crystals which are refractile and polarizable. These are the characteristic features of acquired cystic disease associated renal cell carcinoma (ACD-RCC).
Differential Diagnosis: Eosinophilic solid and cystic renal cell carcinoma (ESC-RCC) features epithelioid eosinophilic cells, but the cells demonstrate prominent basophilic cytoplasmic precipitates and lack oxalate crystals. Succinate dehydratase deficient renal cell carcinomas characteristically have intracytoplasmic vacuoles and inclusions, and lack oxalate crystals. These neoplasms demonstrate loss of SDHB immunoreactivity. Fumarate hydratase deficient renal cell carcinomas characteristically demonstrate vesicular chromatin with prominent nucleoli, and often have papillary or solid appearance. These neoplasms lack oxalate crystals, and demonstrate loss of fumarate hydratase immunoreactivity.
Incorrect
Answer: B
Histologic Description: This renal neoplasm arises in an end stage kidney. It is associated with extensive cystic change and hemorrhage. The epithelial component of the lesion has a cribriform, sieve-like architecture. The cribriform architecture results from intracellular and intercellular spaces. The neoplastic cells are epithelioid and have abundant pink cytoplasm and round nuclei with occasional prominent nucleoli. Interspersed between the neoplastic cells are calcium oxalate crystals which are refractile and polarizable. These are the characteristic features of acquired cystic disease associated renal cell carcinoma (ACD-RCC).
Differential Diagnosis: Eosinophilic solid and cystic renal cell carcinoma (ESC-RCC) features epithelioid eosinophilic cells, but the cells demonstrate prominent basophilic cytoplasmic precipitates and lack oxalate crystals. Succinate dehydratase deficient renal cell carcinomas characteristically have intracytoplasmic vacuoles and inclusions, and lack oxalate crystals. These neoplasms demonstrate loss of SDHB immunoreactivity. Fumarate hydratase deficient renal cell carcinomas characteristically demonstrate vesicular chromatin with prominent nucleoli, and often have papillary or solid appearance. These neoplasms lack oxalate crystals, and demonstrate loss of fumarate hydratase immunoreactivity.
