Mucinous tubular and spindle cell carcinoma of the kidney with neuroendocrine differentiation: report of two cases.

Department of Pathology, Inje University College of Medicine, Pusan Paik Hospital, Busan 614-725, Korea.
American Journal of Clinical Pathology (Impact Factor: 3.01). 02/2006; 125(1):99-104.
Source: PubMed

ABSTRACT We encountered 2 cases of mucinous tubular and spindle cell carcinoma (MTSCC) during a short time. In a 61-year-old man who had macroscopic hematuria for 1 month, the 14.5 x 14.0 x 12.0-cm resected tumor involved the right middle aspect of the renal parenchyma and compressed the renal pelvis. In an asymptomatic 47-year-old man, a renal tumor was found during an annual physical examination. The 3.5 x 3.0 x 2.0-cm tumor was located at the upper pole of the right kidney. The histologic findings in both cases were similar Tumors consisted of tightly packed, small, elongated tubules separated by pale mucinous stroma. The tumor cells were cuboidal to spindled with eosinophilic cytoplasm and low nuclear grade. Mitoses were few or nonexistent and without abnormal figures. Both tumors were immunoreactive for cytokeratin (CK) cocktail (AE1/AE3), high-molecular-weight CK (34betaE12), low-molecular-weight CK (35betaH11), CK7, epithelial membrane antigen, E-cadherin, and vimentin. The tumor cells also were reactive for neuron-specific enolase, chromogranin, and synaptophysin. The ultrastructure of the tumor cells contained abundant mitochondria, junctional complex, and dense-core neurosecretory granules. We present 2 additional cases of MTSCC showing typical morphologic features with neuroendocrine differentiation.

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    ABSTRACT: Mucinous tubular and spindle cell carcinoma of the kidney (MTSCC-K) is an unusual renal tumor. It is important to increase the recognition of MTSCC-K and improve the level of clinical diagnosis. The current study presents a case of MTSCC-K with clinical, imaging and pathological examination. A 60-year-old female presented to the First Hospital of Jilin University suffering from lumbodorsalgia on the right side for approximately one month, without gross hematuria and fever. Imaging examination by abdominal computed tomography scan revealed a ~6.5×5.0-cm solid mass in the inferior pole of the right kidney. The patient underwent laparoscopic radical resection of the right kidney. Pathological examination showed that the tumor was composed of small, elongated cords or tubules, in a tightly packed arrangement. Myxoid stroma was shown to be interspersed among the tubular cells, and appeared to exhibit slender tubular spindle cell-like structures. Tumor cells were smaller and cube-shaped or oval, with single small eosinophilic nucleoli and low-grade nuclei. Occasionally, necrosis and foam cell infiltration were observed. Myxoid stroma was stained by acidic mucus. Immunohistochemical markers, including CK7, CK19, EMA, Vimentin and P504S (AMACR) showed positive expression in tumoral cells, but the tumoral cells were CD10-negative. The MTSCC-K is a low-grade polymorphic renal epithelial neoplasm, which may be diagnosed by immunohistochemistry. The patients are likely to have an improved prognosis following surgery compared with patients with other renal cell carcinomas.
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    ABSTRACT: Mucinous tubular and spindle cell carcinoma (MTSC) was first recognized as a specific entity in the World Health Organization 2004 classification. The ¿classic¿ tumor presentation includes an extracellular blue-gray mucinous/myxoid matrix accompanying the typical tubular and spindle cell epithelial components. Tubules are lined by cuboidal to columnar cells with bland nuclei, central small to medium sized nucleoli, and few to no mitoses. By expanding the histologic spectrum, a number of studies highlighted the distinction between MTSC and solid variant of papillary renal cell carcinoma (sPRCC), although controversy still exists. Here, we evaluated two cases of MTSC and compared two cases of sPRCC by light microscopy, special staining, immunohistochemical staining and fluorescence in situ hybridization (FISH). We found that morphologic and immunophenotyping features showed more overlap between MTSC and sPRCC. In addition, gains of chromosomes 7 and 17 and loss of Y, which are characteristic of PRCC, were observed in two cases of sPRCC and one case of MTSC, suggesting that MTSC is similar to sPRCC or may be a subtype of PRCC.Virtual SlidesThe virtual slide(s) for this article can be found here:
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    ABSTRACT: Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare and recently recognized subtype of renal cell carcinoma (RCC). Apart from the classic morphology comprising conventional three components, there exist a large number of non-classic morphological variants of MTSCC, which make it necessity to differentiate from other RCC. Herein, we report two non-classic morphological variants of MTSCC. Case 1, a 85 years old man, showed numerous vacuoles among inherent components and cytoplasmic pallor/clearing within tubules mimicking conventional clear cell RCC with a 8.5 years follow-up, while Case 2 indicated a "mucin-poor" MTSCC associated with simultaneous conventional clear cell RCC at her age of 73 years. Until now Case 1 carries the longest disease-free survival reported in literature since MTSCC was defined and ranks the oldest since reported in literature, while Case 2 is the first report of "mucin-poor" MTSCC associated with simultaneous conventional clear cell RCC. Now, since no biomarkers or imagining tools but pathological examination can confirm the diagnosis of MTSCC, the management is always following the guideline of RCC in clinical practice. Generally, most reports consider it as a good prognosis disease, but sarcomatoid variant, even classic subtype can progress rapidly to life-threatening disease.


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