Cases reported "Carcinoma, Renal Cell"

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1/24. Bellini duct (collecting duct) carcinoma of the kidney.

    carcinoma of the collecting ducts, or Bellini carcinoma, is a rare renal tumour and, unlike most renal cell carcinomas, it derives from distal tubules. It displays highly aggressive behaviour and has a poor prognosis. In this study, the authors present three cases which they observed over the past three years.
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2/24. Aspiration cytology of mesoblastic nephroma in an adult: diagnostic dilemma.

    A case of adult mesoblastic nephroma (MN) was erroneously interpreted as a benign mesenchymal tumor on fine-needle aspiration (FNA) cytology. MN is a rare tumor in infants and is extremely uncommon in adults. A 50-yr-old female presented with a renal lump with the clinicoradiological possibility of renal-cell carcinoma. Giemsa-stained smears were highly cellular and showed cohesive interlacing fragments of spindle cells embedded in abundant pink fibrillary stromal matrix. Epithelial component was seen in the form of tubules. Pleomorphism, mitosis, and necrosis were absent. Cytologic features in both adult and infantile MN are similar, but in an adult can be mistaken for benign or malignant mesenchymal tumor and the sarcomatoid variant of renal-cell carcinoma. FNA in such a rare yet cytomorphologically characteristic lesion can be helpful in guiding the management. awareness on the part of both the clinician and the cytopathologist is necessary to resolve the diagnostic dilemma.
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3/24. Collecting duct carcinoma.

    Collecting duct carcinoma of the kidney is a rare variant of renal cell carcinoma. hematuria is the most common presenting symptom. This tubulopapillary tumor arises from or differentiates forward to medullary collecting tubules. It is typically centered on the medulla of the kidney and extends into the cortex with a desmoplastic reaction. There are few reports documenting the clinical presentation and long-term prognosis. We describe a case of this uncommon tumor with clinical, histological and immunohistochemical features and review the literature.
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4/24. Clear cell carcinoid tumor of the gallbladder: another distinctive manifestation of von hippel-lindau disease.

    We describe a morphologically distinctive carcinoid tumor of the gallbladder that occurred in a 38-year-old man with von Hippel-Lindau (VHL) disease. The carcinoid tumor was composed predominantly of lipid-containing clear cells arranged in nests and tubules with pagetoid spread into the biliary epithelium and was interpreted as metastatic renal cell carcinoma. The neoplastic cells showed diffuse immunoreactivity for chromogranin, synaptophysin, cytokeratins (cytokeratin 7 and AE1/AE3) and, unexpectedly, for inhibin, but were negative for monoclonal carcinoembryonic antigen, serotonin and a variety of peptide hormones. This clear cell carcinoid tumor of the gallbladder was histologically similar to the recently described clear cell endocrine pancreatic tumor associated with VHL. Four cases of the latter tumor, which were also inhibin positive showed, in addition, focal and variable reactivity for the pancreatic hormones. Two classical carcinoid tumors of the gallbladder, two renal cell carcinomas associated with VHL and 11 of 13 sporadic endocrine pancreatic tumors (not associated with VHL) did not show immunoreactivity for inhibin. Inhibin appears to be an immunohistochemical marker for gallbladder clear cell carcinoid and clear cell endocrine pancreatic tumors associated with VHL and is a useful tool to distinguish these tumors from metastatic renal cell carcinoma. However, the basis for the inhibin positivity in these endocrine tumors is unknown.
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5/24. Low-grade renal cell carcinoma arising from the lower nephron: a case report with immunohistochemical, histochemical and ultrastructural studies.

    Most renal cell carcinomas (RCC) are composed of clear cells with sinusoid-like vasculatures and originate from the proximal tubule. On the other hand, collecting duct carcinoma (CDC) and chromophobe RCC are thought to originate from the lower nephron. In the present study, we present a case of unusual RCC. The patient was a 68-year-old Japanese woman who had developed general fatigue with hematuria. Computed tomography revealed a left renal tumor suggesting sarcoma. The resected tumor was located in the renal parenchyma, measuring 12 x 10 x 8 cm in size. Histologically, the tumor consisted principally of cuboidal cells forming parallel or radiating arrays, continuous with the spindle-shaped cells. Most parts of the tumor showed hemorrhagic necrosis. Immunohistochemically, tumor cells were positive for high molecular weight cytokeratins, vinculin, vimentin, CD15 and epithelial membrane antigen, and showed affinities with some kinds of lectins. N- and E-cadherins and beta-catenin were diffusely positive in tumor cells. Nuclear positivity for Ki-67 and p53 protein were approximately 2.0 and 1.7%, respectively. Considering its morphological and histochemical natures, this tumor is considered to have originated from the lower nephron, which is unique for a tumor of low-grade malignancy.
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6/24. Renal cell carcinoma, chromophobe type, with collecting duct carcinoma and sarcomatoid components.

    We report a case of a 72-year-old man with a chromophobe renal cell carcinoma that had both sarcomatoid and collecting duct carcinoma components. The 7-cm tumor occupied the entire lower pole of the kidney and infiltrated the renal parenchyma and the pelvic-calyceal system. Histologically, it had an area of classic chromophobe renal cell carcinoma that merged into a sarcomatoid component. Closely intermixed with the sarcomatoid component was a collecting duct carcinoma component characterized by highly pleomorphic, epithelioid cells arranged in cords, nests, and tubulomicrocystic structures. The cords, nests, and tubules were associated with a florid desmoplastic stromal response and numerous inflammatory cells. In addition, dysplastic changes were noted in adjacent nonneoplastic collecting duct epithelium. Immunohistochemical studies confirmed the presence of 3 distinct components in this patient's tumor. To the best of our knowledge, this is the first reported case of a chromophobe renal cell carcinoma with sarcomatoid and collecting duct carcinoma components.
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7/24. Metanephric adenoma and papillary carcinoma with sarcomatoid dedifferentiation of kidney. A case report.

    We present the case of a 74-year-old Caucasian male with an expansive process of the left kidney. No clinical and laboratory signs of polycytemia or hypertension were present. Microscopically, the spherical main tumor mass was composed of small basophilic cells arranged in longitudinal branching tubules typical of metanephric adenoma (MA). Another component, different from MA, was formed by a tumor in a papillary and tubopapillary arrangement. This component was diagnostic of grade 3 papillary renal cell carcinoma. The third component, which was merging with the papillary one, was composed of sarcomatoid, spindle cell carcinoma with prominent nuclear polymorphism and a high number of mitotic figures, including atypical mitoses. The sarcomatoid component filled the entire cortico-medullary space and infiltrated the surrounding non-neoplastic renal tissue, including the renal pelvis. Areas of necroses, hemorrhages, and mitotic figures were frequent. No structures of Wilm's tumor were seen in our case. One year after the excision, the patient is without recurrence and metastasis. The existence of the above mentioned tumor supports the hypothesis that metanephric adenomas and papillary renal cell carcinomas are interrelated lesions.
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8/24. The genetics of renal oncocytosis: a possible model for neoplastic progression.

    Renal oncocytosis is a rare condition characterized by the presence of numerous oncocytomas and oncocytic changes in the renal tubules. Other than oncocytomas associated with the Birt-Hogg-Dube (BDH) syndrome, the genetics of oncocytosis is not known. Whether oncocytomas and oncocytosis are similar to BDH syndrome, in which the tumors diploid (as most oncocytomas are), or show chromosomal losses may be significant regarding the observation that in oncocytosis, there frequently is morphological evidence of progression to chromophobe carcinoma. Here we report on the case of a 69-year old male who underwent a staged procedure of partial nephrectomy on the left side and right radical nephrectomy for multiple renal tumors. The tumors were studied by routine hematoxylin and eosin morphology, immunohistochemistry, cytogenetics, and loss of heterozygosity analysis. Both kidneys had numerous oncocytic neoplasms morphologically progressing from oncocytomas to hybrid tumors with chromophobe carcinoma. Genetic studies demonstrated progression from normal cytogenetics to chromosomal losses similar to those in some oncocytomas and in chromophobe carcinomas. The genetics of this apparently nonfamilial oncocytoma differs from that of BDH syndrome and is characterized by losses involving chromosomes 1, 14, 21, and Y. To our knowledge, this is the first report of the genetic and cytogenetic findings in oncocytosis not related to BDH syndrome and may suggest a possible model of progression from oncocytoma to chromophobe renal cell carcinoma.
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9/24. Fine needle aspiration cytology of collecting duct carcinoma of the kidney: report of a case with distinctive features and differential diagnosis.

    BACKGROUND: 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. CASE: 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. CONCLUSION: 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.
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10/24. Chromophobe renal cell carcinoma showing oncocytoma-like hyalinized and edematous stroma: A case report and review of the literature.

    A case of chromophobe renal cell carcinoma (CRCC) with abundant hyalinized and edematous stroma mimicking oncocytoma is presented. This stromal architecture in the current case has not been reported on CRCC to our knowledge. A further interesting finding is entrapped non-neoplastic tubules in the hyalinized and edematous stroma composing the tumor. These histological features, such as abundant hyalinized and edematous stroma containing non-neoplastic tubules, may be analogous to oncocytoma. We reported a unique case of CRCC and studied with light microscopy and immunohistochemistry.
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