Spectrum of Epithelial Neoplasms in End-Stage Renal Disease

Abstract

Most (up to 71%) of renal cell neoplasms occurring in patients with end-stage renal disease (ESRD), particularly with acquired cystic disease of the kidney (ACDK), have been reported to be papillary renal cell carcinoma (RCC). Our initial experience with tumors in such a setting indicated that many tumors were histologically difficult to classify into the known subtypes of RCC or had features that were different from those in sporadically occurring RCCs. In this study on 66 ESRD kidneys (52 of which showed features of ACDK) removed because tumors were detected in them, we found two major groups of RCC. Overall, there were 261 grossly identified tumors in these kidneys, and many additional tumors were observed on microscopic evaluation in some. Of the two major groups of RCCs, one consisted of tumors similar to those seen in sporadic settings (ie, clear-cell, papillary, and chromophobe RCC), and these formed the dominant mass in 12 (18%), 10 (15%), and 5 (8%) of the 66 kidneys, respectively. The other group consisted of two subtypes of RCC that appear quite unique to ESRD. The more common tumor that we have designated as "acquired cystic disease-associated RCC" was seen as the dominant mass in 24 (36%) of 66 of the kidneys, and it formed the most common tumor type among the smaller nondominant masses, as well. It was characterized by a typical microcystic architecture, eosinophilic cytoplasm with Fuhrman's grade 3 nuclei, and frequent association with intratumoral oxalate crystals. Additionally, these tumors frequently, but usually focally, exhibited papillary architecture, and clear cytoplasm. These tumors occurred only in kidneys with ACDK, and not in noncystic ESRD. The other category was "clear-cell papillary RCC of the end-stage kidneys," present as the dominant mass in 15 (23%) of the 66 kidneys and occurring in both the ACDK and noncystic ESRD. These predominantly cystic tumors showed prominent papillary architecture with purely clear-cell cytology. Immunohistochemical studies in tumors with histology similar to the known subtypes of sporadic RCC showed immunoprofiles similar to that reported in sporadically occurring tumors. The two subtypes of RCC unique to ESRD had distinctive immunoprofiles supporting their separate morphologic subcategorization. Only the acquired cystic disease-associated RCC showed lymph node metastases in 2 cases and sarcomatoid features in 2 more cases. One of the latter 2 died with widespread metastatic disease within 34 months of nephrectomy. Thus, a broad spectrum of renal cell tumors exist in ESRD, only some of which resemble the sporadic RCCs. Acquired cystic disease-associated RCC is the commonest tumor subtype in ESRD, and biologically it appears to be more aggressive than the other tumor subtypes in ESRD.

TFE3-Fusion Variant Analysis Defines Specific Clinicopathologic Associations Among Xp11 Translocation Cancers

“…Four of five cases demonstrated psammomatous calcifications. Four of the five cases demonstrated nuclear palisading with sub-nuclear vacuoles, a pattern which mimics clear cell papillary RCC (34,35) (Figures 2,3). This pattern was focal (present in <50% of the tumor) in two cases and diffuse (present in >50% of the tumor) in the other two.…”

Clear cell papillary renal cell carcinoma: micro-RNA expression profiling and comparison with clear cell renal cell carcinoma and papillary renal cell carcinoma

“…All available hematoxylin and eosin slides were reviewed, and diagnosis was confirmed based on the presence of morphological and immunohistochemical features previously reported by others [9–11]. These included morphological features as the presence of papillary architecture, diffuse cytoplasmic clarity, and typical arrangement of nuclei away from the basement membrane.…”

“…CCPRCC is a renal epithelial neoplasm originally described in kidneys with end-stage renal disease and subsequently found outside this setting [9,10]. CCPRCC is a low-grade renal neoplasm with morphological characteristics mimicking both CCRCC and PRCC.…”

No Tumor-Free Waiting Period after Treatment of Multilocular Cystic Renal Cell Carcinoma: A New Case and Review of the Literature

“…One prospective study demonstrated that the prevalence of RCC from screening renal ultrasound during pre-kidney transplant evaluation was up to 3.4% with the positive predictive value of a solid lesion on ultrasound of 100% [6]. In one series, the most common histopathology of these tumors was acquired cystic kidney disease-associated RCC followed by clear cell RCC and papillary RCC [7]. The 2001 American Society of Transplantation guidelines suggest that high-risk patients for RCC should be screened with both radiographic imaging and urine cytology [8].…”