The relative rarity of collecting duct carcinoma (CDC) of the kidney in conjunction with a lack of distinctive cytologic features is a diagnostic challenge for any cytopathologist when dealing with such a tumor on fine needle aspiration cytology. In previous cytologic reports, CDC is not well characterized, and the features overlapped with those of high grade renal cell carcinoma (RCC). Because of the differences in behavior and treatment from conventional RCC, it is important to attempt to diagnose this tumor correctly.
The cytologic findings of CDC in a 56-year-old woman were distinctive and not emphasized previously. Ductal/tubular differentiation, prominent desmoplastic stromal component, neutrophilic infiltration and the presence of numerous tubules ranging from benign to dysplastic and frankly malignant were notable features of this tumor. The expression of high-molecular-weight cytokeratin and Ulex europaeus agglutinin helped to confirm the diagnosis.
The present case highlights several characteristic cytologic features that were useful in suggesting the diagnosis of CDC on fine needle aspiration cytology. Immunohistochemical stains, such as high-molecular-weight cytokeratin and lectin, helped to confirm the diagnosis.
[Show abstract][Hide abstract] ABSTRACT: To review the current usefulness of urinary cytology in the diagnosis of upper urinary tract urothelial tumor in relation to conservative endoscopic treatment.
Bibliographic review of the published articles about urinary cytology of the upper urinary tract urothelial tumor and evaluation of the diagnostic efficacy obtained in various series. Review of the cytological diagnostic criteria for urothelial tumors.
From 1960 to 2003, 26 series collecting results of the cytological diagnosis of urothelial tumors of the ureter and renal pelvis have been published. Results have been variable with a diagnostic accuracy between 23 and 100%. Such an ample variation depends on sampling techniques, preparation techniques, type of tumor, and the urologists and pathologist's experience. The collection of the sample by direct endoscopical visualization significantly proves the diagnostic efficacy of cytology for upper urinary tract urothelial tumors.
Urine cytology selectively obtained from the upper urinary tract with endoscopical techniques is a reliable method in the diagnosis of renal pelvis and ureter neoplasias. Urine cytology has a sensitivity close to 90% and specificity between 98-100% for carcinoma in situ and high-grade urothelial neoplasias, so that it can contribute in the therapeutic decision making process in a very effective manner. Despite its low sensitivity, it may be useful in the diagnosis of low grade urothelial neoplasias when samples are selectively obtained by catheterization, and it has not been excelled by any of the biomarkers molecular tests yet.
Archivos españoles de urología 05/2004; 57(3):227-38. · 0.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: IntroductionThe use more and more extended of tumorectomy, partial nephrectomy and nonsurgical treatments of renal tumors has supposed a renewed interest in the diagnosis use of cytology. Whether during preoperative period, through the puncture aspiration with fine needle (PAAF), or during the intraoperative analysis, the cytology offers the possibility of a specific morphologic diagnosis. In this revision the information concerning the diagnostic value of the cytology in renal tumors is updated.Material and methodsThe references related to renal masses cytological descriptions has been reviewed. For this purpose we have searched both with computer in Medline data base and also manually. In the same way we include authors experience as much in the PAAF of theselesions as in the intraoperative use of the cytology.ResultsBetween neoplasias with more cytological typical presentation are the clear cell renal and papillary carcinomas. The chromophobe and oncocytoma can show similarities, although the accumulated experience in the last years reflects that its differentiation is possible in most of the cases. For the diagnosis of angiomyolipoma, urothelial carcinoma and kidney metastasis, the clinical and image information are of great interest for the pathologist. The integration of these data usually allows a specific diagnosis.Conclusion
Generally, cytology reflects with accuracy the histological characteristics of renal neoplasias, allowing in many cases a specific diagnosis. We consider much appropriated the use of cytology, due to the more and more frequent situation of “incidentaloma”. The PAAF minimum invasive nature and the possibility of performing a fast cytological analysis during intraoperative studies offer important information for the therapeutic management of these patients.
[Show abstract][Hide abstract] ABSTRACT: Introduction:
In the current era of nephron-sparing surgery (NSS) for localized tumors, pretreatment tissue biopsy is being revisited and re-evaluated. Whether a renal biopsy can supplement imaging investigations to change patient management is a subject of current research.
Materials and Methods:
We performed a database search in PubMed for manuscripts from 1988 to 2008 using the appropriate keywords. Manuscripts were selected according to their relevance to the current topic and incorporated into this review.
Preoperative renal biopsy has been utilized to effectively distinguish between benign and malignant tumors localized to the kidney with minimal additional morbidity attributable to the procedure. Tissue diagnosis can also potentially grade renal tumors and uncover unusual malignancies. Although its acceptance remains limited, with fear of false negative results, bleeding and tumor seeding, its ability to influence management decisions has been demonstrated in literature.
The role of preoperative renal biopsy for localized renal tumors is likely to increase rapidly in the coming times. With the expanding scope and utilization of NSS, this diagnostic modality will find increased applicability and acceptance in individualizing management protocols in the future.
Indian Journal of Urology 12/2009; 25(4):494-8. DOI:10.4103/0970-1591.57926
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