Oncocytic papillary renal cell carcinoma: A clinicopathological and genetic analysis and indolent clinical course in 14 cases

Han, Guiyan; Yu, Wenjuan; Chu, Jing; Liu, Yan; Jiang, Yu; Li, Yujun; Zhang, Wei

doi:10.1016/j.prp.2016.04.009

Cited by 33 publications

(15 citation statements)

References 15 publications

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“…Similarly, oncocytic PRCC characterised by voluminously fine granular eosinophilic cytoplasm (Type II feature) and usually low‐ISUP‐grade and linearly arranged nuclei (Type I feature) is also unable to meet the morphological criteria for either type of PRCC 3 . Nevertheless, oncocytic PRCC is not yet fully characterised because of the limited number of cases, and inconsistent conclusions owing to divergent inclusion criteria for this tumour type in previous studies 4–6 …”

Section: Introductionmentioning

confidence: 99%

Frequent KRAS mutations in oncocytic papillary renal neoplasm with inverted nuclei

Tong

Zhu

et al. 2020

Histopathology

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Aims: Papillary renal neoplasm with reverse polarity (PRNRP) is a newly documented rare tumour type. Its molecular pathological features have thus far been very little studied. Methods and results: There were 13 PRNRP cases including 3 The Cancer Genome Atlas (TCGA) cases and our 10 cases in this study. The 3 TCGA cases were found by a combined analysis of GATA3 mRNA expression levels and digital slides from the TCGA papillary renal cell carcinoma project. KRAS codon 12 mutations were identified in the three PRNRPs from TCGA. Of our 10 PRNRP cases, the mutations were also discovered using Sanger sequencing in seven (77.8%) of nine cases with available DNA, where KRAS p.G12V (n = 3), p.G12D (n = 2), p.G12R (n = 1) and p.G12C (n = 1) alterations were found. PRNRP shared similar gene expression profiles with renal distal tubules via an interprofile correlation analysis. Gene set enrichment analysis revealed that genes involved in 'KEGG aldosterone regulated sodium reabsorption' or 'hallmark apical surface' were enriched in PRNRP. Moreover, polarised immunostaining patterns for L1CAM and EMA in the distal tubule were maintained in PRNRP. Conclusions: These results imply that the tumour potentially originates from the distal tubule, especially from the cortical collecting duct, and probably retains its cell polarity, except for nuclear inversion. We therefore propose that oncocytic papillary renal neoplasm with inverted nuclei (OPR-NIN) is a better name for this tumour type. OPRNIN is a kidney site-specific KRAS mutation neoplasm different from conventional papillary renal cell carcinoma.

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Section: Introductionmentioning

confidence: 99%

Frequent KRAS mutations in oncocytic papillary renal neoplasm with inverted nuclei

Tong

Zhu

et al. 2020

Histopathology

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“…The tumor is uncommon and there is a lack of understanding of its immunohistochemical features that makes the classification controversial (10). In 2016, Han et al (11) characterized ORPCC as having a papillary structure with a single layer of cells with round or polygonal nuclei and eosinophilic granular cytoplasm. On immunohistochemistry, above 90% of the cells were positive for AMACR, whereas a few showed positivity for CD10 and vimentin (11).…”

Section: Discussionmentioning

confidence: 99%

Solitary Metachronous Drop Metastasis of a Rare Variant of Renal Cell Carcinoma to Ipsilateral Ureteric Stump - A Case Report

Agarwal¹,

Yuvaraja²,

Waigankar³

et al. 2023

uob

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Metachronous metastasis of renal cell carcinoma (RCC) to its ureter has been scarcely reported. All such reports have involved clear cell RCC. We report the first ever case of an oncocytic variant of papillary RCC (OPRCC) -an extremely rare variant that spreads to the ipsilateral ureter. A sixty-five-year-old man, diagnosed to have non-metastatic left RCC with renal vein thrombus, underwent radical nephrectomy. Histopathology revealed large cells in papillary and tubular arrangements with abundant granular cytoplasm. On immunohistochemistry, cells strongly expressed Alpha-methylacyl-CoA racemase and were negative for CD10, C-kit, TFE3, and Melan A, hence a diagnosis of OPRCC, type 2 was given. During follow-up six months, he had a fluorodeoxyglucose avid lesion of size 2.8 cm in the proximal aspect of the left ureteric stump. Therefore, we performed robotic excision of the left ureteric stump and bladder cuff with pelvic node dissection. Pathological examination showed a ureteric mass infiltrating the muscularis propria and periureteric adipose tissue with features of OPRCC, similar to the nephrectomy specimen. It was Pax 8 positive with negativity for the urothelial markers Gata 3, uroplakin and p63, consistent with drop metastasis in a known case. Thus, clinicians must bear in mind that ureteric masses are not always of transitional cell variety and non-clear cell RCC can also metastasize to the ureter. This should be considered by pathologists while evaluating kidney specimens showing oncocytic features. This is the first case report of non-clear cell variety of drop metastasis of a rare histological variant of RCC to the ipsilateral ureter.

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“…In addition, one of the tumours in our series demonstrated abundant oncocytic cytoplasm with variably prominent nucleoli. The appropriate classification of oncocytic PRCC has yet to be determined; however, there is evidence that they generally follow an indolent clinical course more akin to PRCC type 1 22–24…”

Section: Discussionmentioning

confidence: 99%

Accuracy of renal tumour biopsy for the diagnosis and subtyping of papillary renal cell carcinoma: analysis of paired biopsy and nephrectomy specimens with focus on discordant cases

et al. 2019

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AimsRenal tumour biopsy (RTB) is increasingly recognised as a useful diagnostic tool in the management of small renal masses, particularly those that are incidentally found. Intratumoural heterogeneity with respect to morphology, grade and molecular features represents a frequently identified limitation to the use of RTB. While previous studies have evaluated pathological correlation between RTB and nephrectomy, no studies to date have focused specifically on the role of RTB for the diagnosis of papillary renal cell carcinoma (PRCC) and its further subclassification into clinically relevant subtypes.MethodsThis single-institution study evaluated 60 cases of PRCC for concordance between RTB and nephrectomy with respect to diagnosis, grading and subtyping (type 1/type 2).ResultsWe observed 93% concordance (55 of 59 evaluable cases) between RTB and nephrectomy for the diagnosis of PRCC, although seven tumours (12%) were undergraded on RTB. Subtyping of PRCC on RTB was concordant with nephrectomy in 89% of cases reported as type 1 PRCC on RTB (31/35), but only 40% of cases reported as type 2 PRCC on RTB (4/10). Morphological misclassification of PRCC on RTB was most likely to occur in tumours showing a solid growth pattern. Discordant PRCC subtyping most often occurred in tumours with eosinophilia/oncocytic change.ConclusionThere was good concordance between RTB and nephrectomy for the primary diagnosis of PRCC. Although further subtyping of PRCC can aid therapeutic stratification, this can be challenging on RTB and tumours with overlapping or ambiguous features are best reported as PRCC not otherwise specified pending development of more robust methods to facilitate definitive subclassification.

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Oncocytic papillary renal cell carcinoma: A clinicopathological and genetic analysis and indolent clinical course in 14 cases

Cited by 33 publications

References 15 publications

Frequent KRAS mutations in oncocytic papillary renal neoplasm with inverted nuclei

Frequent KRAS mutations in oncocytic papillary renal neoplasm with inverted nuclei

Solitary Metachronous Drop Metastasis of a Rare Variant of Renal Cell Carcinoma to Ipsilateral Ureteric Stump - A Case Report

Accuracy of renal tumour biopsy for the diagnosis and subtyping of papillary renal cell carcinoma: analysis of paired biopsy and nephrectomy specimens with focus on discordant cases

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