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Presented by Dr. Pedram Argani and prepared by Dr. Harsimar Kaur.
This is a 51 year old male with a renal neoplasm.
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1. Question
This is a 51 year old male with a renal neoplasm.
Correct
Answer: D
Histologic Description: The neoplasm has both solid and cystic architecture, and is composed of cells that have variably clear to eosinophilic cytoplasm. There is a second population of smaller cells within the acini formed by the neoplasm. These focally surround hyaline basement membrane material. The neoplasm is diffusely immunoreactivity for cathepsin K and Melan A, focally immunoreactivity for HMB45, and demonstrated TFEB rearrangement by FISH.
Differential Diagnosis: The clear cell areas of this neoplasm closely resemble clear cell RCC; however, the latter would not have these small cell component and diffuse immunoreactivity for cathepsin K and Melan A. Low grade oncocytic tumor closely resembles eosinophilic chromophobe RCC, and labels for cytokeratin 7 but not CD117. It also would not label for diffusely for Melan A or HMB45. Eosinophilic solid and cystic renal cell carcinoma may have the solid cystic architecture of the current lesion; however, it features large polygonal cells with eosinophilic cytoplasm and basophilic cytoplasmic stippling, and focal immunoreactivity for cytokeratin 20. Both ESC RCC and low grade oncocytic tumors are associated with TSC gene mutations.
TFEB rearranged renal cell carcinomas typical harbor a t(6;11) (p21;q12) translocation resulting from a MALAT1-TFEB gene fusion. These tumors are more indolent than the Xp11 translocation RCC.Incorrect
Answer: D
Histologic Description: The neoplasm has both solid and cystic architecture, and is composed of cells that have variably clear to eosinophilic cytoplasm. There is a second population of smaller cells within the acini formed by the neoplasm. These focally surround hyaline basement membrane material. The neoplasm is diffusely immunoreactivity for cathepsin K and Melan A, focally immunoreactivity for HMB45, and demonstrated TFEB rearrangement by FISH.
Differential Diagnosis: The clear cell areas of this neoplasm closely resemble clear cell RCC; however, the latter would not have these small cell component and diffuse immunoreactivity for cathepsin K and Melan A. Low grade oncocytic tumor closely resembles eosinophilic chromophobe RCC, and labels for cytokeratin 7 but not CD117. It also would not label for diffusely for Melan A or HMB45. Eosinophilic solid and cystic renal cell carcinoma may have the solid cystic architecture of the current lesion; however, it features large polygonal cells with eosinophilic cytoplasm and basophilic cytoplasmic stippling, and focal immunoreactivity for cytokeratin 20. Both ESC RCC and low grade oncocytic tumors are associated with TSC gene mutations.
TFEB rearranged renal cell carcinomas typical harbor a t(6;11) (p21;q12) translocation resulting from a MALAT1-TFEB gene fusion. These tumors are more indolent than the Xp11 translocation RCC.
