The role of fine-needle aspiration cytology in the evaluation of metastatic clear cell tumors

Abstract

BACKGROUND Clear cell tumors (CCTs) occur as primary neoplasms in a number of anatomic sites. Due to their overlapping morphologic features, these tumors can be challenging for the cytologist, particularly when they present as metastatic lesions. METHODS Forty‐nine fine‐needle aspirations (FNA) of metastatic CCTs from 46 patients (age range, 29–87 years; mean, 64 years) were reviewed retrospectively. In addition to the routine smears and cell block preparations, ancillary studies were performed in selected cases. Clinical and/or histologic follow‐up was obtained for all patients. RESULTS The sites of the 49 FNAs were the lung (12 cases), lymph nodes (9 cases), liver (7 cases), bone (7 cases), soft tissue (4 cases), pelvis (2 cases), adrenal gland (2 cases), pancreas (1 case), thyroid (2 cases), peritoneum (2 cases), and vagina (1 case). Twenty‐seven patients had a previous history of a CCT and the FNA material in these cases was consistent with a metastasis. The primary anatomic sites in these cases were the kidney (20 cases), ovary (2 cases), salivary gland (1 case), and cervix (1 case). On light microscopy, these tumors had a similar appearance and often were indistinguishable. Nineteen patients did not have a prior history of malignancy; 12 of these patients had a concurrent renal mass and the diagnosis of metastatic renal cell carcinoma was made. The anatomic site of origin of seven of the ten remaining tumors (kidney [2 cases], lung [2 cases], ovary [1 case], germ cell [1 case], and endometrium [1 case]) was established through immunocytochemical studies of cytologic material and clinical follow‐up. CONCLUSIONS FNA plays an important role in the diagnosis of metastatic CCT. Cytologic examination, ancillary studies, and clinical information can establish the anatomic site of origin in the majority (95%) of cases, precluding the necessity of obtaining additional tissue. Cancer (Cancer Cytopathol) 1999;87:380–9. © 1999 American Cancer Society.

Solitary Metachronous Metastasis to the Thyroid from Renal Clear Cell Carcinoma 19 Years After Nephrectomy: Report of a Case

“…H&E stain (ϫ40, ϫ100); B Tg stain (ϫ40, ϫ100); C TTF-1 stain (ϫ40, ϫ100); D PAS stain (ϫ40, ϫ200) Thyroglobulin staining is the most sensitive immunohistochemical tool for distinguishing between primary thyroid carcinomas and metastases from carcinomas arising in other organs. 7,9,13,15,18,22 Interestingly, Shimizu et al 7 and Carcangiu et al 14 suggested that Tg staining might be weak or unclear, even in tumors derived from thyroid follicular cells, although they noted that such findings were uncommon. Shimizu et al 7 correlated the results of Tg staining with those of periodic acid-Schiff (PAS) staining and concluded that these combinations identify primary clear cell tumors of the thyroid more sensitively.…”

“…22 Subsequent immunohistochemical staining with thyroglobulin (Tg) is helpful for distinguishing between primary and metastatic thyroid carcinomas. 7,9,13,15,18,22 We used both Tg and thyroid transcription factor-1 (TTF-1) stains to confirm the RCC metastasis. TTF-1, a homeodomain containing the nuclear protein originally identified in thyroid follicular cells, has been evaluated as an immunohistochemical marker for the identification of thyroid or lung tissue.…”

Metastatic hepatocellular carcinoma to the heart

“…6 However, in the case of an unknown primary, differentiation of renal cell carcinoma from hepatocellular carcinoma can be difficult and rarely indistinguishable by light microscopy alone, especially with clear cell and granular cell variants. 7 In this case, the smears demonstrate classic features of hepatocellular carcinoma, including the trabecular arrangements with prominent endothelial cells, resemblance to normal hepatocytes, but with marked increased nuclear to cytoplasmic ratios and large nucleoli. The yellow granules (bile) and monolayers transgressed by capillaries greatly aid in the diagnosis.…”

Diagnosis of Bony Metastasis of Renal Cell Carcioma at a Rare Site on Fine Needle Aspiration Cytology: A Rare Case Report

“…[11] Fuhrman nuclear grade used in histology can be applied in cytology smears. [14] Cells of RCC contain intra cytoplasmic fat, hence Oil Red O staining of air dried smears can be used to distinguish RCC from other clear cell tumors. [15] While metastasis are associated with poor outcome, solitary bone lesions have increased associated survival when compared to multiple bony lesions or a combination of bone and other organs.…”