Chromophobe renal cell carcinoma showing oncocytoma-like hyalinized and edematous stroma: A case report and review of the literature

doi:10.1016/j.urolonc.2004.03.015

Urologic Oncology: Seminars and Original Investigations

Volume 22, Issue 6, November–December 2004, Pages 461-464

https://doi.org/10.1016/j.urolonc.2004.03.015 Get rights and content

Abstract

A case of chromophobe renal cell carcinoma (CRCC) with abundant hyalinized and edematous stroma mimicking oncocytoma is presented. This stromal architecture in the current case has not been reported on CRCC to our knowledge. A further interesting finding is entrapped non-neoplastic tubules in the hyalinized and edematous stroma composing the tumor. These histological features, such as abundant hyalinized and edematous stroma containing non-neoplastic tubules, may be analogous to oncocytoma. We reported a unique case of CRCC and studied with light microscopy and immunohistochemistry.

Introduction

Chromophobe renal cell carcinoma (CRCC) is an uncommon subtype of renal cell carcinoma first described by Thoenes et al. in 1985 [1]. Although CRCC was initially considered to be rare, its frequency has been reported to range between 2% and 11% of all renal epithelial neoplasms [1], [2], [3], [4]. Although Hale’s colloidal iron stain positivity is considered to be characteristic for CRCC [1], [2], [4], [5], several investigators have shown that other renal tumors also display positive reactions for Hale’s colloidal iron stain with variable intensities [6], [7]. Although CRCC has been reported to have a more favorable prognosis than conventional renal cell carcinoma [1], [3], [4], [5], sarcomatoid transformation has been reported [8], [9]. On the basis of previously described findings, CRCC has been considered as a distinct entity in clinicopathological aspect. However, CRCC may resemble oncocytoma on routine stains, and investigators have encountered difficulty in distinguishing CRCC from oncocytoma histologically. The importance of distinguishing CRCC from oncocytoma is because of the different prognosis. The presence of hyalinized stroma in CRCC has been briefly mentioned [3], [9], however, myxoid areas in CRCC have been uncommon [7], [10]. We describe here a case of CRCC with abundant hyalinized and edematous stroma mimicking oncocytoma.

Section snippets

Case reports

An 86-yr-old Japanese woman was admitted to our hospital with a complaint of rectal bleeding. Colonic endoscopy showed a centrally ulcerated tumor of the transverse colon. Preoperative examination for colonic tumor incidentally demonstrated a right renal mass on a computerized tomography (CT) scan. Angiography revealed a hypovascular tumor in the right kidney. Colectomy and right radical nephrectomy were performed, and the colectomy specimen showed primary colonic adenocarcinoma.

The surgically

Discussion

The cellular morphology of CRCC, such as nuclear and cytoplasmic findings, has been well described. Detailed study of the histological architecture, especially tumor stroma, has not been performed, although stromal calcification in CRCC has been reported [2], [4], [11]. Myxoid and fibrotic areas in CRCC have been uncommon [7], [10], although hypocellular hyalinized stroma partially showing an oncocytoma-like proliferation pattern in CRCC has been reported [9]. Billis et al. [3] mentioned that 5

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Hyalinized stroma is a characteristic feature of pancreatic intraductal oncocytic papillary neoplasm: An immunohistochemical study
2020, Annals of Diagnostic Pathology
Citation Excerpt :
Hyalinized stroma (HS), which is a dense, eosinophilic, and amorphous material, is occasionally observed in the stroma of the papillary structure of IOPN [6]. HS has been observed not only in IOPN, but also in other tumors such as basaloid squamous carcinoma of the upper aerodigestive tract, endometrioid carcinomas of the uterine corpus, myoepithelial tumors of soft tissue, renal oncocytoma, ovarian clear cell carcinoma, and chromophobe renal cell carcinoma [6,8-21]. However, the histopathological features of HS in IPMN and IOPN have not been well documented.
Hyalinized stroma (HS) is a dense, eosinophilic, and amorphous extracellular material in the stroma. HS is observed in several tumors; however, it has not been comprehensively studied in pancreatic intraductal papillary mucinous neoplasm (IPMN) or intraductal oncocytic papillary neoplasm (IOPN). Here, we aimed to evaluate the immunohistochemical and microscopic characteristics of HS in IPMN and IOPN. The prevalence of HS was determined in 168 cases of IPMN, including intestinal type (IPMN-I), gastric type (IPMN-G), and pancreatobiliary type (IPMN-PB), as well as in 11 cases of IOPN. Immunohistochemical staining for laminin and collagen (types I, II, III, IV, and V), as well as Congo red staining were performed in IPMN and IOPN cases containing HS. The prevalence of HS among the IPMN and IOPN specimens was 1.2% (2/168 cases) and 45.5% (5/11 cases), respectively. The prevalence rates of HS in each IPMN subtype were as follows: 2.2% (2/91 cases) in IPMN-G, and 0% in IPMN-PB and IPMN-I. All seven HS cases were positive for collagen I, III, IV, and V but were negative for Congo red staining. Most cases showed negative, focal, or weak expression of laminin and type II collagen. These findings indicate that HS is associated with IOPN and is primarily composed of collagen fibers.
Oncocytic renal cell carcinoma with immunohistochemical properties of renal oncocytoma
2009, Pathology Research and Practice
Renal oncocytoma (RO) is a characteristic benign renal tumor. The existence of malignant RO is controversial and anecdotal, partly due to a lack of specific markers for RO. With recent advances in immunohistochemistry, RO can be distinguished from other renal neoplasms with routine stains and with the aid of immunostaining. We report two cases of renal neoplasms with similar histopathological appearances. They were characterized by oncocytic cytoplasm, numerous intra-cytoplasmic vacuoles, uniform round to oval hyperchromatic nuclei with remarkably thick nuclear membranes and prominent nucleoli. The tumor cells were closely packed and disposed in an alveolar pattern. The neoplastic cells were diffusely reactive for CD117 and progesterone receptor, and diffusely or focally reactive for cytokeratin AE1/AE3, and focally reactive for cytokeratin 7, CD10, and racemase. The cells were non-reactive for renal cell carcinoma (RCC) antigen, vimentin, S100, and neuroendocrine markers. One tumor showed lymph node metastasis. Due to the remarkable cytological atypia, lymph node metastasis, and similar immunological features of RO, these two tumors likely represent a distinct subtype of RCC related to RO.
Claudin-7 and claudin-8: immunohistochemical markers for the differential diagnosis of chromophobe renal cell carcinoma and renal oncocytoma
2009, Human Pathology
Citation Excerpt :
Chromophobe RCC, in contrast, is a malignant renal epithelial neoplasm that may undergo tumor necrosis, sarcomatoid differentiation, and metastasis like other more common renal cancers [11-15]. However, chromophobe RCC and oncocytoma often show overlapping features, with some cases of chromophobe RCC showing areas with oncocytoma-like hyalinized and edematous stroma or eosinophilic changes [16,17]. The relatively recent description of so-called hybrid tumors, which can be associated with the Birt-Hogg-Dubé syndrome and are composed of both chromophobe RCC, oncocytomas, and/or other renal tumors, complicates the issue of differential diagnosis even more [18-21].
Claudin-7 and claudin-8 code for tight junction proteins expressed in distal nephron epithelium. In a recent oligonucleotide microarray study, we identified claudin-7 and claudin-8 as candidate markers to distinguish chromophobe renal cell carcinoma from other renal tumors, including oncocytoma. Distinction of these lesions can be difficult by light microscopy but is clinically important because chromophobe renal cell carcinoma has malignant biological potential, whereas renal oncocytoma is benign. Claudin-7 and claudin-8 expression was studied by immunohistochemistry in 11 chromophobe renal cell carcinomas and 17 oncocytomas using formalin-fixed paraffin-embedded tissue sections of tumor with adjacent nonneoplastic kidney. Steam antigen retrieval was performed before immunohistochemistry. Specificity was verified by negative control reactions without primary antibody and appropriate membranous staining patterns in positive control tissues (colon carcinoma and adjacent nonneoplastic kidney). Claudin-7 protein was expressed in a membranous pattern in 10 of 11 chromophobe renal cell carcinomas and 4 of 17 oncocytomas (P < .01). Claudin-8 was expressed in multiple patterns: In oncocytoma, 11 of 17 cases showed cytoplasmic, 4 of 17 membranous, and 2 of 17 negative reactions. In chromophobe renal cell carcinoma, 0 of 11 cases showed cytoplasmic, 3 of 11 membranous, and 8 of 11 negative reactions (P < .01). The immunohistochemical pattern of membranous claudin-7 and negative claudin-8 was seen in 7 of 11 chromophobe renal cell carcinomas and 1 of 17 oncocytomas (63% sensitivity, 84% specificity, 88% positive predictive value for chromophobe renal cell carcinoma). Negative claudin-7 and cytoplasmic claudin-8 were observed in 10 of 17 oncocytomas and 0 of 11 chromophobe renal cell carcinomas (59% sensitivity, 100% specificity and positive predictive value for oncocytoma). The distal nephron proteins claudin-7 and claudin-8 have potential use as immunohistochemical biomarkers in the differential diagnosis of chromophobe renal cell carcinoma and oncocytoma. Expression of claudin-7 and claudin-8 may reflect the relationship of chromophobe renal cell carcinoma and oncocytoma to intercalated cells of the cortical collecting duct. It may be necessary to identify additional biomarkers to include with claudin-7 and claudin-8 in a larger immunohistochemical panel to improve diagnostic sensitivity and specificity.
Pathobiology and prognosis of chromophobe renal cell carcinoma
2008, Urologic Oncology: Seminars and Original Investigations
Citation Excerpt :
Recent studies revealed new immunohistochemical markers such as c-kit [9] and cytokeratin 7 [10] as useful tools. As previously stated, another distinguishing feature includes diffuse cytoplasmic reactivity with Hale's colloidal staining, which stains acid mucopolysaccharides within the cytoplasmic microvesicles of the tumor [6,8,18]. However, studies have shown that other sub-types also display positive reactions with variable intensities [6,8,19].
To analyze pathobiology and prognosis of chromophobe renal cell carcinoma (CRCC).
We studied 124 patients with CRCC who underwent nephrectomy from 1989 to 2006 at two institutions. Clinicopathological characteristics and survival were compared with 1,693 consecutive patients with clear-cell RCC.
Compared with clear cell RCC, patients with CRCC presented with less advanced tumors, but had a higher prevalence of concomitant sarcomatoid features (15% vs. 6%, P < 0.001). Metastatic CRCC showed a high incidence of sarcomatoid features (50%) and a predilection for liver metastases. The 5-year DSS rate for all patients with CRCC was 78% compared with 60% for patients with clear-cell RCC (P = 0.008). When adjusted for metastatic status, this survival difference disappeared. Nonmetastatic RCCs had similar prognosis (P = 0.157), whereas survival of metastatic CRCC was inferior to that of patients with metastatic clear-cell tumors (median: 6 vs. 19 months, P = 0.0095). In multivariate analysis, ECOG PS, symptomatic presentation, T stage, N stage, M stage, nuclear grade, and presence of sarcomatoid features, but not histological sub-type, were independent prognostic factors of DSS. Ten patients received immunotherapy, none of whom were responders.
Compared with clear-cell RCC, patients with CRCC present with less advanced tumors, which lead to better survival rates on the whole. However, adjustment for metastatic status negates this difference. Patients with metastatic CRCC show a high prevalence of sarcomatoid features, predilection for liver metastases, no response to immunotherapy, and exhibit poor prognosis.
Subtypes of renal cell carcinoma: A chromophobe cell carcinoma
2005, Feuillets de Radiologie
Les auteurs rapportent un cas de carcinome rénal chromophobe sous la forme d’une corrélation anatomo-pathologique. Le carcinome chromophobe est le troisième carcinome rénal (5 %) après le carcinome à cellules claires et le carcinome tubulo-papillaire. La lésion illustrée ici présente un aspect polylobé, composé de masses confluentes dont certaines ont un caractère stellaire ou en rayon de roue.
We report a case of chromophobe cell renal carcinoma demonstrating the pathological correlation. The chromophobe tumor is an uncommon type of renal cell carcinoma, the third after the clear cell a and the tubulopapillary carcinoma. This tumor is lobulated, and some parts have a spoke-wheel-like enhancement with a central scar.
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Original articlesChromophobe renal cell carcinoma showing oncocytoma-like hyalinized and edematous stroma: A case report and review of the literature

Abstract

Introduction

Section snippets

Case reports

Discussion

J Urol

Human chromophobe cell renal carcinoma

Virchows Arch B Cell Pathol

Chromophobe cell carcinoma of the kidney. A clinicopathologic study of 21 cases

Am J Surg Pathol

Chromophobe renal cell carcinomaclinicopathological study of 7 cases

Ultrastructural Pathol

Chromophobe cell carcinomaanalysis of five cases

Am J Surg Pathol

Chromophobe renal cell carcinoma. A comparative histochemical and immunohistochemical study

J Urol Pathol

Renal chromophobe cell carcinoma and oncocytoma. A comparative morphologic, histochemical, and immunohistochemical study of 124 cases

Arch Pathol Lab Med

Chromophobe renal cell carcinoma with osteosarcoma-like differentiation

Am J Surg Pathol

A case of chromophobe renal cell carcinoma with sarcomatoid foci and a small daughter lesion

Pathol Int

Original articles
Chromophobe renal cell carcinoma showing oncocytoma-like hyalinized and edematous stroma: A case report and review of the literature