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Presented by Dr. Andres Matoso and prepared by Dr. Yembur Ahmad
This case talks about an adult female with a kidney mass.
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Correct: D
Histology: The tumor is composed of compressed and elongated tubules, spindle cells and extracellular mucin. There are areas of hemorrhage and foci of necrosis. Tumor cells have nuclei with large nucleoli, visible at 10X.
Discussion: MTSC is most commonly a low-grade carcinoma presenting in older individuals as a well circumscribed small mass and patients have a favorable prognosis. A small proportion of cases can show more aggressive histologic features including high nuclear grade, necrosis, and sarcomatoid transformation. The main differential diagnosis is papillary RCC, and the distinction is often difficult in cases with not very well-developed morphology. The immunohistochemistry profile is similar to papillary RCC including positive staining for CK7 and AMACR.
Expression of VSTM2A, detected by mRNA in situ hybridization, has been recently proposed as a diagnostic marker of MTSC.Reference:
Hatayama T, et al. IJU Case Rep. 2019. PMID: 32743410
Bulimbasic S, et al. Hum Pathol. 2009. PMID: 19442792
Miura K, et al. J Surg Case Rep. 2020. PMID: 32104563
Kwon R, et al. Am J Surg Pathol. 2021. PMID: 33239504Incorrect
Correct: D
Histology: The tumor is composed of compressed and elongated tubules, spindle cells and extracellular mucin. There are areas of hemorrhage and foci of necrosis. Tumor cells have nuclei with large nucleoli, visible at 10X.
Discussion: MTSC is most commonly a low-grade carcinoma presenting in older individuals as a well circumscribed small mass and patients have a favorable prognosis. A small proportion of cases can show more aggressive histologic features including high nuclear grade, necrosis, and sarcomatoid transformation. The main differential diagnosis is papillary RCC, and the distinction is often difficult in cases with not very well-developed morphology. The immunohistochemistry profile is similar to papillary RCC including positive staining for CK7 and AMACR.
Expression of VSTM2A, detected by mRNA in situ hybridization, has been recently proposed as a diagnostic marker of MTSC.Reference:
Hatayama T, et al. IJU Case Rep. 2019. PMID: 32743410
Bulimbasic S, et al. Hum Pathol. 2009. PMID: 19442792
Miura K, et al. J Surg Case Rep. 2020. PMID: 32104563
Kwon R, et al. Am J Surg Pathol. 2021. PMID: 33239504
