J Pathol Transl Med.  2015 Sep;49(5):413-417. 10.4132/jptm.2015.07.01.

Oncocytic Renal Cell Carcinoma with Tubulopapillary Growth Having a Fat Component

• Kim NR
• Cho HY

• KMID: 2381398
• DOI: http://doi.org/10.4132/jptm.2015.07.01

Abstract

We report a rare case of oncocytic renal cell carcinoma (RCC) with tubulopapillary growth in the background of tuberculous end-stage kidney disease. Histology of the renal mass consisted of oncocytic cells forming solid, thin tubules and rare papillae. The tumor had abundant eosinophilic oncocytic cells containing occasional cytoplasmic Mallory body-like hyaline globules and a tiny focus of clear cells with intervening mature fat. Both the oncocytic cells and clear cells were immunoreactive for a-methylacyl-CoA racemase, vimentin, pancytokeratin, and CD10, and negative for transcription factor E3, CD15, human melanoma black 45, and c-kit. Mallory body-like hyaline globules were positive for CAM 5.2 and periodic acid-Schiff with or without diastase. Ultrastructurally, the tumor cells had abundant cytoplasmic mitochondria. The present case is a rare case of oncocytic RCC with tubulopapillary growth pattern. The case is unique in that the tumor was mixed with fat component, which is not common in RCC and thus can lead to misdiagnosis.

Keyword

Oxyphil cells; Carcinoma, renal cell; Adipocytes; Mycobacterium tuberculosis

MeSH Terms

Adipocytes
Amylases
Carcinoma, Renal Cell*
Cytoplasm
Diagnostic Errors
Eosinophils
Humans
Hyalin
Kidney Failure, Chronic
Melanoma
Mitochondria
Mycobacterium tuberculosis
Oxyphil Cells
Transcription Factors
Vimentin
Amylases
Transcription Factors
Vimentin

Figure

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  Fig. 1. Coronal view of abdominopelvic computed tomography reveals severe hydronephrosis of bilateral kidneys. Note a round lesion in the left kidney (arrow).

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  Fig. 2. (A) Tumor cells with abundant eosinophilic cytoplasm are arranged in solid papillae and tubules, intermingled with mature fat component. (B) The tumor is composed of a compact arrangement of small thin tubules. (C) At the solid area, lobules separated by thin capillaries consist of eosinophilic and granular tumor cells. Note fat vacuoles. (D) Eosinophilic tumor cells are lining the tubules with focal surface decapitation. (E) Oncocytic cells occasionally form papillary architecture (left). The tubules of clear tumor cells have the appearance of clear-type renal cell carcinoma (right). (F) The oncocytic cells have eosinophilic cytoplasmic globules (arrows, left) that are stained with periodic acid-Schiff (right).

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  Fig. 3. Electron microscopy reveals oval-shaped tumor cells with abundant mitochondria and shelf-like cristae (× 3,000).

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