Presented by Dr. Pedram Argani and prepared by Dr. Yembur Ahmad
This case talks about an adult patient with a renal mass.
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1. Question
This is an adult patient with a 6 cm renal mass. What is the diagnosis?
Correct
Answer: A
Histologic Description: This is a cellular neoplasm composed of spindle and epithelioid cells. There are strands of collagen throughout the lesion that have a ropy quality. The neoplasm was diffusely immunoreactive for CD34 and demonstrated STAT6 nuclear labeling, supporting the diagnosis of cellular solitary fibrous tumor.
Differential Diagnosis: Synovial sarcoma will not label for CD34 and STAT6, and typically demonstrates focal cytokeratin immunoreactivity. Like the current lesion, clear cell sarcoma of the kidney could label for BCOR, but would have much more open chromatin and would be extremely uncommon in a patient of this age. Sarcomatoid renal cell carcinoma would be defined by seeing a well-defined epithelioid renal cell carcinoma component in addition to malignant spindle cells.
Incorrect
Answer: A
Histologic Description: This is a cellular neoplasm composed of spindle and epithelioid cells. There are strands of collagen throughout the lesion that have a ropy quality. The neoplasm was diffusely immunoreactive for CD34 and demonstrated STAT6 nuclear labeling, supporting the diagnosis of cellular solitary fibrous tumor.
Differential Diagnosis: Synovial sarcoma will not label for CD34 and STAT6, and typically demonstrates focal cytokeratin immunoreactivity. Like the current lesion, clear cell sarcoma of the kidney could label for BCOR, but would have much more open chromatin and would be extremely uncommon in a patient of this age. Sarcomatoid renal cell carcinoma would be defined by seeing a well-defined epithelioid renal cell carcinoma component in addition to malignant spindle cells.
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