Clear cell renal cell carcinoma with a syncytial-type multinucleated giant tumor cell component: implications for differential diagnosis

Williamson, Sean R.; Kum, Jennifer B.; Goheen, Michael P.; Liu, Cheng; Grignon, David J.; Idrees, Muhammad T.

doi:10.1016/j.humpath.2013.10.033

Cited by 39 publications

(43 citation statements)

References 34 publications

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“…Emperipolesis also appeared to be more prominent in cases with well‐developed and more extensive ‘squamoid’ cells. Although emperipolesis was found in all cases, this is not a specific phenomenon restricted only to these types of tumour, but has been also documented in some high‐grade clear cell RCCs with syncytial‐type multinucleated cells …”

Section: Discussionmentioning

confidence: 99%

Biphasic papillary renal cell carcinoma is a rare morphological variant with frequent multifocality: a study of 28 cases

et al. 2018

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Aims To further characterise biphasic squamoid renal cell carcinoma (RCC), a recently proposed variant of papillary RCC. Methods and results We identified 28 tumours from multiple institutions. They typically showed two cell populations—larger cells with eosinophilic cytoplasm and higher‐grade nuclei, surrounded by smaller, amphophilic cells with scanty cytoplasm. The dual morphology was variable (median 72.5% of tumour, range 5–100%); emperipolesis was found in all cases. The male/female ratio was 2:1, and the median age was 55 years (range 39–86 years). The median tumour size was 20 mm (range 9–65 mm). Pathological stage pT1a was found in 21 cases, pT1b in three, and pT3a and pT3b in one each (two not available). Multifocality was found in 32%: multifocal biphasic RCC in one case, biphasic + papillary RCC in two cases, biphasic + clear cell RCC in three cases, biphasic + low‐grade urothelial carcinoma of the renal pelvis in one case, and biphasic + Birt–Hogg–Dubé syndrome in one case. Positive immunostains included: PAX8, cytokeratin (CK) 7, α‐methylacyl‐CoA racemase, epithelial membrane antigen, and vimentin. Cyclin D1 was expressed only in the larger cells. The Ki67 index was higher in the larger cells (median 5% versus ≤1%). Negative stains included: carbonic anhydrase 9, CD117, GATA‐3, WT1, CK5/6, and CK20; CD10 and 34βE12 were variably expressed. Gains of chromosomes 7 and 17 were found in two evaluated cases. Follow‐up was available for 23 patients (median 24 months, range 1–244 months): 19 were alive without disease, one was alive with recurrence, and one had died of disease (two had died of other causes). Conclusions Biphasic papillary RCC is a rare variant of papillary RCC, and is often multifocal.

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Section: Discussionmentioning

confidence: 99%

Biphasic papillary renal cell carcinoma is a rare morphological variant with frequent multifocality: a study of 28 cases

et al. 2018

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“…Subsequently, Williamson et al . reported 13 cases with syncytial cells and emperipolesis, and Rotterova et al . contributed a series of 14 identical tumours .…”

Section: Clear Cell Rcc With Giant Cells and Emperipolesismentioning

confidence: 99%

New and emerging renal entities: a perspective post‐WHO 2016 classification

2018

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Renal tumours include a heterogeneous and diverse spectrum of neoplasms. Recent advances in this field have significantly improved our understanding of the morphological, immunohistochemical, molecular, epidemiological and clinical characteristics of renal tumours, which led to the new Vancouver classification of renal neoplasia and the new World Health Organization (WHO) classification of renal cell tumours. This review aims to summarise the new information and evidence on several new and emerging/provisional renal entities, which were mostly generated after the recent classification of renal neoplasia. We include in this review the following new and emerging/provisional renal entities: succinate dehydrogenase‐deficient renal cell carcinoma, thyroid‐like follicular carcinoma of the kidney, anaplastic lymphoma kinase rearrangement‐associated renal cell carcinoma, renal cell carcinomas with prominent smooth muscle stroma, fumarate hydratase‐deficient renal cell carcinoma, biphasic squamoid papillary renal cell carcinoma, eosinophilic solid and cystic renal cell carcinoma, atrophic kidney‐like renal cell carcinoma, clear cell renal cell carcinoma with giant cells and emperipolesis, Warthin‐like papillary renal cell carcinoma, and low‐grade oncocytic renal tumour (CD117‐negative; cytokeratin 7‐positive). Some of these entities, such as succinate dehydrogenase‐deficient renal cell carcinoma, have already been recognised as new entities in the WHO classification, and some have been recognised as provisional/emerging entities. However, we include in this review several additional entities that, on the basis of the published evidence, also warrant this designation. We hope that this review will ease the navigation through this complex and evolving field, and will inform and stimulate new studies and discussions.

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“…The presence of these cells in CCRCC statistically correlated with higher grade and stage [14]. Syncytial cells have been associated with tumour aggressiveness in CCRCC in a very recent study [25], and rhabdoid elements are equivalent to sarcomatoid dedifferentiation in another [26]. Considering the prognostic importance of these histological findings, current sampling protocols in renal carcinomas might not be appropriate.…”

Section: Discussionmentioning

confidence: 95%

Large (>3.8 cm) clear cell renal cell carcinomas are morphologically and immunohistochemically heterogeneous

et al. 2014

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Heterogeneity is an inherent event to tumour development that is lately receiving much attention in oncologic research. The topic is being addressed primarily at the molecular level, and results are promising. However, translation to practical medicine is still pending. Our intention in this study is to approach the problem in a series of clear cell renal cell carcinomas with the tools that pathologists use in routine practice. Three randomly selected areas of 48 clear cell renal cell carcinomas prospectively collected in two different institutions were analysed for intratumour heterogeneity. The evaluated parameters were tumour size, cell type (clear vs. eosinophilic), Fuhrman's grade and immunohistochemical expression of carbonic anhydrase IX, BRCA1-associated protein-1 (BAP-1), cyclooxygenase-2 (COX-2) and Ki67. Intratumour heterogeneity was detected in 26 cases (54 %). Cell type, grade and Ki67 index were the parameters more frequently heterogeneous amounting, respectively, 44, 42 and 38 %. Tumour size was a significantly discriminative factor to predict tumour heterogeneity, with a cut-off of 3.8 cm (p < 0.001). Aside from tumour size, the most relevant parameters related with intratumour heterogeneity were cell type (clear vs. eosinophilic), Fuhrman's grade and Ki67 and COX-2 expression patterns. Carbonic anhydrase 9 and BAP-1 did not show statistical relevance. We conclude that heterogeneity is a common event in clear cell renal cell carcinomas that may be overlooked in cases insufficiently sampled. Tumour size appears as a reliable tool in identifying this situation since clear cell renal cell carcinomas under 3.8 cm in diameter are always homogeneous. This point may help the pathologist to make decisions in tumour sampling.

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Clear cell renal cell carcinoma with a syncytial-type multinucleated giant tumor cell component: implications for differential diagnosis

Cited by 39 publications

References 34 publications

Biphasic papillary renal cell carcinoma is a rare morphological variant with frequent multifocality: a study of 28 cases

Biphasic papillary renal cell carcinoma is a rare morphological variant with frequent multifocality: a study of 28 cases

New and emerging renal entities: a perspective post‐WHO 2016 classification

Large (>3.8 cm) clear cell renal cell carcinomas are morphologically and immunohistochemically heterogeneous

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