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Item Diagnostic Criteria for Oncocytic Renal Neoplasms: A Survey of Urologic Pathologists(Elsevier, 2017-05) Williamson, Sean R.; Gadde, Ramya; Trpkov, Kiril; Hirsch, Michelle S.; Srigley, John R.; Reuter, Victor E.; Cheng, Liang; Kunju, L. Priya; Barod, Ravi; Rogers, Craig G.; Delahunt, Brett; Hes, Ondrej; Eble, John N.; Zhou, Ming; McKenney, Jesse K.; Martignoni, Guido; Fleming, Stewart; Grignon, David J.; Moch, Holger; Gupta, Nilesh S.; Department of Pathology and Laboratory Medicine, IU School of MedicineRenal oncocytoma and chromophobe renal cell carcinoma have been long recognized as distinct tumors; however, it remains unknown if uniform diagnostic criteria are used to distinguish these tumor types in practice. A survey was distributed to urologic pathologists regarding oncocytic tumors. Responses were received from 17 of 26 invitees. Histologically, more than 1 mitotic figure was regarded as most worrisome (n = 10) or incompatible (n = 6) with oncocytoma diagnosis. Interpretation of focal nuclear wrinkling, focal perinuclear clearing, and multinucleation depended on extent and did not necessarily exclude oncocytoma if minor. Staining techniques most commonly used included the following: cytokeratin 7 (94%), KIT (71%), vimentin (65%), colloidal iron (59%), CD10 (53%), and AMACR (41%). Rare cytokeratin 7–positive cells (≤5%) were regarded as most supportive of oncocytoma, although an extent excluding oncocytoma was not universal. Multiple chromosomal losses were most strongly supportive for chromophobe renal cell carcinoma diagnosis (65%). Less certainty was reported for chromosomal gain or a single loss. For tumors with mixed or inconclusive features, many participants use an intermediate diagnostic category (82%) that does not label the tumor as unequivocally benign or malignant, typically “oncocytic neoplasm” or “tumor” with comment. The term “hybrid tumor” was used variably in several scenarios. A slight majority (65%) report outright diagnosis of oncocytoma in needle biopsies. The morphologic, immunohistochemical, and genetic characteristics that define oncocytic renal tumors remain incompletely understood. Further studies correlating genetics, behavior, and histology are needed to define which tumors truly warrant classification as carcinomas for patient counseling and follow-up strategies.Item Low-grade Oncocytic Tumor of Kidney (CD117 Negative, Cytokeratin 7 Positive): A Distinct Entity?(Wiley, 2019) Trpkov, Kiril; Williamson, Sean R.; Gao, Yuan; Martinek, Petr; Cheng, Liang; Sangoi, Ankur R.; Yilmaz, Asli; Wang, Cheng; Fraile, Pilar San Miguel; Montiel, Delia M. Perez; Bulimbasić, Stela; Rogala, Joanna; Hes, Ondrej; Pathology and Laboratory Medicine, School of MedicineAim To describe a group of distinct low‐grade oncocytic renal tumors that demonstrate CD117 negative/Cytokeratin (CK) 7 positive immunoprofile. Methods and results We identified 28 such tumors from 4 large renal tumor archives. We performed immunohistochemistry for: CK7, CD117, PAX8, CD10, AMACR, e‐cadherin, CK20, CA9, AE1/AE3, vimentin, BerEP4, MOC31, CK5/6, p63, HMB45, melan A, CD15 and FH. In 14 cases we performed array CGH; in 9 cases with successful result. Median patient age was 66 years (range 49‐78 years) with a male‐to‐female ratio of 1:1.8. Median tumor size was 3 cm (range 1.1‐13.5 cm). All were single tumors, solid and tan‐brown, without a syndromic association. On microscopy, all cases showed solid and compact nested growth. There were frequent areas of edematous stroma with loosely arranged cells. The tumor cells had oncocytic cytoplasm with uniformly round to oval nuclei, but without significant irregularities, and showed only focal perinuclear halos. Negative CD117 and positive CK7 reactivity were present in all cases (in 2 cases there was focal and very weak CD117 reactivity). Uniform reactivity was found for: PAX8, AE1/AE3, e‐cadherin, BerEP4 and MOC31. Negative stains included: CA9, CK20, vimentin, CK5/6, p63, HMB45, Melan A and CD15. CD10 and AMACR were either negative or focally positive; FH was retained. On array CGH, there were frequent deletions at 19p13.3 (7/9), 1p36.33 (5/9) and 19q13.11 (4/9); disomic status was found in 2/9 cases. On follow‐up (mean 31.8 months, range 1‐118), all patients were alive with no disease progression. Conclusion Low‐grade oncocytic tumors that are CD117 negative/CK7positive demonstrate consistent and readily recognizable morphology, immunoprofile, and indolent behavior.