Low-Grade Clear Cell Renal Cell Carcinoma Mimicking Hemangioma of the Kidney A Series of 4 Cases
From the Department of Pathology, Henry Ford Hospital, Detroit, Michigan (Drs Kryvenko, Roquero, Gupta, and Lee)Archives of pathology & laboratory medicine (Impact Factor: 2.84). 02/2013; 137(2):251-254. DOI: 10.5858/arpa.2011-0615-OA
Context.- Clear cell renal cell carcinoma (CCRCC) has a rich, sinusoid-like vascularity frequently used as a diagnostic criterion. CCRCC with predominantly vascular architecture has not been described. Objective.- To describe 4 unusual CCRCC cases, primarily presenting with hemangioma-like morphologic pattern. Design.- Clinicopathologic and selected immunohistochemical analysis of 4 cases of CCRCC mimicking hemangioma. Results.- Cases were seen in 1 woman and 3 men (average age, 48.8 years; range, 40-66 years). Grossly, tumors were red-brown (3 of 4) with scant bright-yellow foci in 1. The average tumor size was 4 cm (range, 2.5-5.5 cm). Microscopically, all were composed of varying proportions of a rich, arborizing, sinusoid-like vasculature with focal hobnail appearance of endothelial cells. Entrapment of renal tubules between blood vessels was seen at the periphery of the tumors. This morphology was reminiscent of anastomosing hemangioma. Isolated tumor cells resembling lymphocytes with clear halos were sparsely interspersed between vessels. Cytokeratin immunostain confirmed the diagnosis of CCRCC. Conclusion.- Extensive sampling and immunohistochemical workup of what is deemed to be a benign vascular neoplasm of the kidney is needed to rule out the presence of individual carcinoma cells or small viable carcinoma cell clusters.
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ABSTRACT: To study clear cell renal cell carcinomas with predominant cystic and sclerotic components, in which a solid epithelial component precluded a diagnosis of multilocular cystic renal cell carcinoma. We designated these tumours 'cystic partially regressed clear cell renal cell carcinoma.' METHODS AND RESULTS: Twenty-seven tumours were studied, from patients with a median age of 58 years; the stage was most often pT1 (89%). The Fuhrman grade was 2 (48%), 1 (33%), or 3 (19%). The solid epithelial component constituted up to 30% of the tumour volume (median, 10%), whereas the cystic component constituted 15-80% (median, 65%), and the sclerotic component 10-70% (median, 20%). Thin fibrovascular septa lined by cells with clear cytoplasm were almost always present, resembling multilocular cystic renal cell carcinoma. Both zones of sclerosis and fibrovascular septa often contained inconspicuous epithelial cells. Sclerotic areas ranged in appearance from a cellular fibroblastic reaction to scar-like with a residual network of capillaries resembling haemangioma. No patient developed recurrence or metastasis. Cystic partially regressed clear cell renal cell carcinoma is an uncommon pattern of clear cell renal cell carcinoma, being composed of cysts with solid epithelial and sclerotic components that differentiate it from multilocular cystic renal cell carcinoma.Histopathology 07/2013; 63(6). DOI:10.1111/his.12239 · 3.45 Impact Factor
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ABSTRACT: Study hemangiomas in end-stage renal disease (ESRD). Twenty ESRD nephrectomies from 16 patients (9 months to 68 years old) were due to hypertension (4), focal segmental glomerulosclerosis (4), lupus nephritis (3), diabetes (1), IgA nephropathy (1), hereditary nephritis (1), congenital nephrotic syndrome (1), and unknown cause (1). Tumors measured 0.2 to 3.5 cm. Hemangiomas appeared as a single mass (15), 2 masses (1), 3 masses (1), 4 masses (2), and 8 masses (1) per kidney. Four patients had bilateral hemangiomas. All tumors were in the medulla and often abutted renal sinus fat. All except one of the tumors were anastomosing hemangioma showing isolated or interconnected sinusoidal capillary-sized vascular channels lined by a single layer of benign cuboidal CD34+, CD31+, D2-40- endothelial cells, separated by loose stroma with spindle cells. One tumor was cellular capillary hemangioma. Intravascular growth was seen in 9 specimens. All hemangiomas had extramedullary hematopoiesis. Acquired cystic kidney disease (ACKD) was seen in 11 kidneys (9 patients), renal cell carcinoma (RCC) in 5, ACKD-associated RCC precursors in 3, Wilms' tumor in 1, and papillary adenomas in 6. Anastomosing hemangioma appears as a distinctive clinicopathologic entity which develops in kidneys with ESRD, with or without ACKD. This article is protected by copyright. All rights reserved.Histopathology 02/2014; 65(3). DOI:10.1111/his.12394 · 3.45 Impact Factor
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ABSTRACT: Clear cell papillary renal cell carcinoma (CCPRCC) is a novel tumor entity that was recently recognized as a new distinct epithelial tumor within the current classification system. Nonclassic morphologic variants have rarely been reported. We present six challenging cases of CCPRCC with prominent (>75 %) tubular, acinar, and/or solid component and angioleiomyomatous stroma. The tumors lacked well-organized papillary architecture. All tumors had a variously thick capsule formed by a layer of bands of smooth muscle. The leiomyomatous tissue often entirely encased patches of tubular structures, or it formed only small leiomyomatous islands within the epithelial component. There was a remarkable relationship between the vascular network and the epithelial component in the sense that every single tubule or acinus was associated with a fine capillary network, with the capillaries intimately surrounding the tubular or acinar circumference. CCPRCC with variant morphology expressed carbonic anhydrase IX (CA-IX) in cup-shaped distribution. In addition, the tumor cells stained positive for cytokeratin 34betaE12, CK7, and vimentin. Renal cell carcinoma (RCC), P504s/AMACR, Melan A, and HMB45 were negative in tumor cells in all cases examined. Fluorescence in situ hybridization studies showed the presence of a normal copy number for chromosomes 7, 17, 3q, and 3p. CCPRCC with variant morphology seems to have a favorable prognosis. In the current series, tumor stage was low at presentation, and none of the patients had local recurrence or metastatic disease. The distinction between CCPRCC with variant morphology and clear cell RCC is critical because no case of CCPRCC has behaved aggressively.Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 04/2014; 464(6). DOI:10.1007/s00428-014-1581-y · 2.65 Impact Factor
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