Showing papers on "Mucinous tubular and spindle cell carcinoma published in 2009"
TL;DR: It behooves the surgical pathologist to not only be capable of diagnosing the common forms of renal cancer, but also to be aware of the rare types of renal carcinoma, many of which have emerged in recent years.
202 citations
TL;DR: Helpful features in distinguishing spindle cells of sarcomatoid component versus that of the native tumor include the presence of high-grade cytology, expansile growth with loss of typical imperceptible blending with the tubulo-papillary component and loss of expression of α-methylacyl-CoA racemase that contrasted the classic areas.
Abstract: Sarcomatoid change has been well documented in the various subtypes of renal cell carcinoma (RCC) and its presence is known to portend a worse prognosis in RCC. Mucinous tubular and spindle cell carcinoma is a RCC subtype, which is defined as polymorphous histology wherein the spindled epithelial ce
100 citations
TL;DR: A case of MTSCC is reported in a 71-year-old woman with a rare, low-grade renal epithelial neoplasm representing a newly established subtype in the World Health Organization (WHO) 2004 classification, which has a lower malignant potential than other subtypes of RCC.
Abstract: Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare, low-grade renal epithelial neoplasm representing a newly established subtype in the World Health Organization (WHO) 2004 classification. Shen et al. reported 12 cases (0.67%) of MTSCC in approximately 1800 cases of renal cell carcinoma (RCC). Here we report a case of MTSCC in a 71-year-old woman.Abdominal dynamic computed tomography (CT) demonstrated that the tumor had well-defined margins (56 ¥ 52 mm), and was not enhanced on the early phase but slightly enhanced on the late phase (Fig. 1a,b). Asymptomatic microscopic hematuria and anemia were detected. Power-doppler ultrasound sonography (US) showed no arterial bloodstream in the tumor. Abdominal magnetic resonance imaging (MRI) demonstrated an isointensity tumor in both T1 and T2-weighted images, and revealed a regional lymph node swelling 7 mm in size. There was no finding of distant metastasis. From these results, this tumor was clinically diagnosed as hypovascular RCC, and staged as clinical T1bN1M0, and retroperitoneoscopic radical left nephrectomy was carried out. The histological findings showed that the tumor was 58 ¥ 57 ¥ 47 mm in size, and was well circumscribed but unencapsulated (Fig. 1c). The tumor was diagnosed as MTSCC of the kidney. The pathological staging was diagnosed as T1bN0M0, INFa, without vascular invasion and lymph node metastasis. The patient recovered uneventfully after surgery. She had no documented recurrence or metastasis at her most recent follow up 7 months after surgery. Most MTSCC tumors were solitary, and were incidentally discovered by US or CT examinations. The radiological finding was generally hypovascular, well-defined tumor. In many cases, radical nephrectomy was carried out under the diagnosis of hypovascular RCC. Distant metastasis and death related to MTSCC has not been reported. The histological staining is characterized by eosinophilic cytoplasm, elongated and anastomosing tubules, myxomatous stroma and lowgrade nuclear cytology with hematoxylin and eosin (H&E) staining. Immunohistochemical staining showed that MTSCC tumor was positive for the markers of epithelial cells and distal nephron, and negative for proximal nephron. Our case corresponded with these findings (Fig. 1d). The histogenetic origin and differentiation of MTSCC remains unclear. Hes et al. reported immunohistochemical and ultrastructural differentiation toward the distal nephron. Some cases with MTSCC show similar histological findings to low-grade collectingduct carcinoma. More recently, the reports showed immunohistochemical overlap with papillary RCC, suggesting differentiation toward the proximal nephron. Indeed , pathologists formerly classified MTSCC as a variant of papillary RCC, sarcomatoid carcinoma or collecting-duct carcinoma before the establishment of the WHO MTSCC definition. Only seven MTSCC cases have been previously reported in Japan to our knowledge. MTSCC has a lower malignant potential than other subtypes of RCC, and therefore it is important to distinguish it from other subtypes of RCC to avoid unnecessary adjuvant immunotherapy with interferon-a, interleukin-2 or others. While the prognosis of MTSCC is generally good , two cases with lymph node metastasis and a few cases with local recurrence were reported. Further investigation will be needed to elucidate the clinical and pathological characteristics of MTSCC with a longer follow-up period. References
38 citations
TL;DR: A novel antibody cocktail for detection of high-grade squamous intraepithelial lesions on cervical cytology specimens and a sensitive and specific marker of HPV-associated squamous lesions of the cervix is presented.
37 citations
TL;DR: To avoid administration of excessive adjuvant treatment to patients, pathologists and urologists should consider this newly recognized low‐grade malignancy when diagnosing renal tumors.
Abstract: A 33-year-old man was hospitalized for treatment of a left renal tumor. The radiological findings were consistent with those of a left renal cell carcinoma (RCC). Subsequently, a radical nephrectomy was carried out. Macroscopic examination showed that a well-demarcated tumor measuring 2.9 x 2.6 x 2.5 cm was present in the middle portion of the resected kidney. The cut surface of the tumor was grayish-white in color. Pathological examination of the resected specimen showed a mucinous tubular and spindle cell carcinoma of the kidney (MTSCC-K). MTSCC-K is a low-grade renal epithelial neoplasm that has recently been recognized as a specific entity in the World Health Organization 2004 classification of RCC. To our knowledge, 17 cases of MTSCC-K in Japan have been reported by Japanese investigators. To avoid administration of excessive adjuvant treatment to patients, pathologists and urologists should consider this newly recognized low-grade malignancy when diagnosing renal tumors.
13 citations
TL;DR: Several chromosomal losses involving chromosomes 1, 2, 17 and likely chromosome 7 were revealed by fluorescence in situ hybridization (FISH) and were helpful for including this entity in the differential diagnosis of renal cell carcinomas.
Abstract: Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare renal tumor. Here we report two cases of MTSCC which were initially evaluated by fine needle aspiration biopsy (FNAB) and followed by surgical resection of the tumors. The cytomorphologic features of MTSCC were characterized by aggregates of relatively uniform, predominantly oval to spindle cells intermixed with abundant metachromatic myxoid matrix. Only rare epithelioid tumor cells with vacuolated cytoplasm were present. Immunohistochemically, the tumor cells were positive for CK7, CK19, CD10, vimentin, E-cadherin, alpha-methyl CoA racemase, and negative for CK903 and CK20. EMA and carbonic anhydrase IX immunoreactivity was seen in one of the two cases. Multiple chromosomal losses involving chromosomes 1, 2, 17 and likely chromosome 7 were revealed by fluorescence in situ hybridization (FISH). These cytomorphologic, immunophenotypic, and cytogenetic features were helpful for including this entity in the differential diagnosis of renal cell carcinomas.
12 citations
TL;DR: A case of mucinous tubular and spindle cell carcinoma in a 63-year-old male presented with right flank pain which was diagnosed after nephrectomy is reported, and pathologists should consider this diagnosis and its spectrum of histopathologic features in mind.
Abstract: Low grade mucinous tubular and spindle cell carcinoma of kidney was newly established as a distinct renal cell carcinoma in the World Health Organization (WHO) classification of 2004. Until now, less than 60 cases have been reported and the largest series represented approximately 15 patients with this type of tumor. Herein, we report a case of mucinous tubular and spindle cell carcinoma in a 63-year-old male presented with right flank pain which was diagnosed after nephrectomy. Pathologists should consider this diagnosis and its spectrum of histopathologic features in mind to ensure an accurate diagnosis.
6 citations
TL;DR: A rare case of renal cell carcinoma (RCC) with clear cell change sharing both characteristics of MTSCC and papillary RCC is reported in a 61-year-old Japanese man found to have a tumor in the left kidney.
Abstract: To the Editor: The concept of mucinous tubular and spindle cell carcinoma (MTSCC) has been recently integrated into the World Health Organization (WHO) classification. In the present article we report a rare case of renal cell carcinoma (RCC) with clear cell change sharing both characteristics of MTSCC and papillary RCC. A 61-year-old Japanese man was found to have a tumor in the left kidney. Laparoscopic nephrectomy was performed. Macroscopically, the cut surface of the tumor measuring 5.1 ¥ 4.8 ¥ 3.7 cm was soft and yellowish (Fig. 1). Microscopically, the tumor consisted of papillary or tubular growth pattern of neoplastic cells with extensively clear to slightly eosinophilic cytoplasm (Fig. 2a). Foci of spindle cells were identified (Fig. 2b). The nuclear atypia corresponded to Fuhrman grade 2. Myxoid stroma was focally observed and this material was positive for Alcian blue stain (Fig. 2c). Immunohistochemically, neoplastic cells were diffusely positive for alpha-Methylacyl-CoA racemase (AMACR; P504S, 13H4, 1:100; DakoCytomation, Glostrup, Denmark). Genetic analysis was performed after obtaining informed consent from this patient. The G-band karyotype was 49, -X, -Y, +add(3)(q11.1), +7, +7, add(11)(11.2), +12, +17[16]/46, XY[4]. On fluorescence in situ hybridization (FISH), we found monosomy of chromosome 15 (D15Z1; Fig. 3) and disomy of chromosome 22 (LSI TUPLE(22q11.2)/ARSA(22q13.3) probe; authors thank Cytogenetic Testing Group, Molecular Genetic Testing Department, Clinical Testing Center, Mitsubishi Chemical Medience, Kyoto, Japan). No mutations of the
5 citations
TL;DR: A 65-year-old male who presented with flank pain, hematuria and a well-defined renal mass that was diagnosed as mucinous tubular and spindle cell tumor is reported.
Abstract: Mucinous tubular and spindle cell carcinoma is a rare variant of renal cell carcinoma, which has recently been described. It has a low malignant potential and is usually confined to the kidney. These are thought to be of the loop of Henle or distal nephron origin. We report a 65-year-old male who presented with flank pain, hematuria and a well-defined renal mass that was diagnosed as mucinous tubular and spindle cell tumor.
3 citations