562280
research-article2014
IJSXXX10.1177/1066896914562280International Journal of Surgical PathologyParihar et al
Case Reports
Xp11 Translocation Renal Cell Carcinoma Morphologically Mimicking Clear Cell–Papillary Renal Cell Carcinoma in an Adult Patient: Report of a Case Expanding the Morphologic Spectrum of Xp11 Translocation Renal Cell Carcinomas
International Journal of Surgical Pathology 1–4 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1066896914562280 ijs.sagepub.com
Asmita Parihar, MD Pathology1, Satish K. Tickoo, MD Pathology2, Sunil Kumar, MS Surgery1, and Vinod Kumar Arora, MD Pathology1
Abstract Xp11 translocation renal cell carcinoma (RCC) is a relatively rare tumor mainly affecting children and adolescents. It shows significant morphological overlap with the 2 most common adult renal tumors, which are the clear cell (conventional) RCC and papillary RCC. We describe case of a young adult female who presented with right flank pain and abdominal mass. Radiological investigations showed features suggestive of renal cell carcinoma in the right kidney. Histopathological findings while suggestive of Xp11 carcinoma, showed significant overlap with the recently described entity clear cell papillary RCC. TFE3 immunohistochemistry confirmed the tumor to be Xp11 translocation RCC. The patient had an aggressive course with lymph node metastasis. In this report, we discuss differential diagnosis and the diagnostic challenges of Xp11 translocation RCC in adults. Keywords adult, clear cell papillary, renal cell carcinoma, Xp11 translocation
Introduction Xp11 translocation renal cell carcinoma (RCC) was first included as a distinct entity in 2004 World Health Organization classification of renal tumors. It is a rare neoplasm, occurring predominantly in children and adolescents.1 Very few adult cases have been reported till date.2,3 In Xp11 translocation, gene fusion occurs involving the gene transcription factor E3 (TFE3).1,3 The typical microscopic features described for Xp11 RCC are a nested and papillary architecture with tumor cells having abundant clear to eosinophilic cytoplasm, and the presence of psammoma bodies.3 This appearance has a significant overlap with clear cell RCC and papillary RCC, entities that constitute a major fraction of adult renal tumors. TFE3 immunohistochemistry is a highly specific and sensitive marker of tumors with TFE3 gene fusions, and is required for a definite diagnosis.4 More recently, morphologic features beyond that classically described have been reported in some of these tumors.3 We report a case of immunohistochemically confirmed Xp11 translocation RCC in an adult
female that morphologically raised the possibility of the recently described clear cell–papillary RCC, and discuss the morphological differential diagnoses of this rare neoplasm in adults.
Case Report A 34-year-old woman presented with right flank pain for the past 5 months. There was no history of hematuria or previous exposure to chemotherapy. Abdominal examination revealed a palpable mass. Computed tomography scan abdomen showed an enlarged right kidney with an exophytic, hyperdense lesion in the mid kidney. The lesion 1
University College of Medical Sciences, Delhi, India Memorial Sloan-Kettering Cancer, New York, NY, USA
2
Corresponding Author: Vinod Kumar Arora, Department of Pathology, University College of Medical Sciences, Delhi 110095, India. Email: [email protected]
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International Journal of Surgical Pathology
Figure 1. Computed tomography scan abdomen showed a hyperdense lesion in the right kidney.
measured 12.4 × 12.3 × 9 cm and had solid and cystic components. The lesion had well-defined margins and no evident infiltration into the surrounding tissues. The other kidney was normal. A radiologic impression of renal cell carcinoma, right kidney was made (Figure 1). Right-sided radical nephrectomy with lymph node dissection was performed and the specimen was sent for histopathological evaluation. On gross examination, the right kidney measured 16.5 × 11.5 × 6 cm. On bivalving, a large tumor measuring 12.2 × 11.3 × 5.4 cm was identified in the mid kidney. The cut surface showed areas of hemorrhage and necrosis. The tumor was seen involving the renal sinus and renal pelvis (Figure 2). The ureter was grossly unremarkable. Microscopically, the tumor infiltrated the renal capsule, renal sinus, and the renal pelvis. The tumor cells were arranged in papillary and alveolar pattern. The cells had moderate to voluminous clear cytoplasm with Fuhrman nuclear grade 2. The nuclei were predominantly aligned away from the basement membrane in a linear manner. Mitosis was occasional. Psammoma bodies were frequently seen. (Figures 3 and 4) The para-aortic lymph node showed a focus of metastasis. Metastasis was also identified in the para-aortic soft tissue. On immunohistochemistry, tumor cells showed absence of expression of CK7, carbonic anhydrase–IX (CA-IX), and vimentin. However, stain for TFE3 revealed strong and diffuse nuclear reactivity. The melanocytic marker HMB45 was also diffusely positive in the tumor cells. (Figure 5) Based on the morphological features and immunohistochemistry findings, a final diagnosis of Xp11 translocation renal cell carcinoma, right kidney was made.
Figure 2. Gross specimen of the kidney showing a large tumor involving the renal sinus and the renal pelvis.
Figure 3. Microscopy showed tumor cells in papillary and alveolar pattern along with psammoma bodies. The tumor cells had moderate amount of clear cytoplasm and nuclei were aligned away from the basement membrane (hematoxylin and eosin stain, 100×).
Discussion Xp11 translocation RCC result from gene fusions between TFE3 located on chromosome Xp11.2 and various other genes, which include the ASPL at chromosome 17 and PRCC at chromosome 1.5 Other rare fusion partners are PSF and CLTC genes at chromosomes 1 and 17, respectively.6,7
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Figure 4. High-power microscopic view showing alignment of nuclei away from basement membrane (hematoxylin and eosin stain, 400×).
Figure 5. TFE3 immunohistochemistry showed strong and diffuse positivity. Inset shows positivity for HMB-45.
Xp11 RCC is a rare tumor that preferentially affects children and adolescents.1,5 It is relatively uncommon in adults.5 It has been associated with previous exposure to cytotoxic chemotherapy in early childhood.8 However, such a consistent association has not been reported in adults. There is also a difference in the biologic behavior of this tumor between children and adults. In adults, it follows a more aggressive course and presents usually at advanced stage.5 Several morphologic variations have been described in Xp11 RCC, including tumor giant cells and fascicles of spindle cells.3 This case further expands the morphologic
spectrum of Xp11 RCC as the microscopic picture resembled clear cell–papillary RCC. The distinctive morphologic feature of the latter is the linear arrangement of nuclei away from the basement membrane, which was evidently seen in our case, thus adding to the diagnostic dilemma.9 However, clear cell–papillary RCC presents at an early stage, is usually small (mean size, 2.5 cm) and has a very favorable prognosis9 (Table 1). In our case, presence of a large tumor in a young adult with metastasis at presentation favored the consideration of an alternative diagnosis. Other tumors that show morphological similarities with Xp11 RCC are conventional (clear cell) RCC and papillary RCC, the 2 most common renal neoplasms of adults. The gross appearance of Xp11 RCC mimics that of clear cell RCC, being tan-yellow with necrotic and hemorrhagic areas.10 Papillary RCC has variegated appearance and are often multifocal.10 Microscopically Xp11 RCC shows tumor cells arranged in papillary and nested architecture, with cells having abundant clear to eosinophilic granular cytoplasm, vesicular nuclei and prominent nucleoli, and presence of psammoma bodies.6 Clear cell RCC has tumor cells with clear cytoplasm and can have focal pseudopapillary growth pattern.10 Papillary RCC exhibit the characteristic papillary architecture with fibrovascular cores. The tumor cells have amphophilic to eosinophilic cytoplasm and psammoma bodies are frequently seen. It can show focal clear cell areas.10 However, both clear cell RCC and papillary RCC mainly occur in sixth to seventh decade of life, whereas Xp11 RCC is quite uncommon in that age range10 (Table 1). Correct diagnosis of Xp11 generally requires a molecular confirmation. However, immunohistochemisty for TFE3 has been demonstrated to be highly sensitive and specific surrogate molecular testing in tumors bearing TFE3 gene fusions. The stain shows diffuse and strong nuclear positivity,4 as seen in our case. TFE3 is negative in all the other renal cell carcinomas like clear cell, papillary, and clear cell–papillary RCC. Carbonic anhydrase-IX shows strong and diffuse membranous positivity in clear cell RCC but it is mostly negative in translocation associated RCC. CK7 immunoreactivity seen in papillary RCC is absent in Xp11.2 translocation RCC, and other epithelial markers like cytokeratin and epithelial membrane antigen are negative or only focally positive.5 Thus, the most distinctive immunohistochemical feature of translocationassociated RCC is nuclear labeling with TFE3. In Xp11.2 translocation RCC, labeling with melanocytic markers like HMB45 is associated with the rare gene fusions such as PSF-TFE3 and CLTC-TFE3.7,10 Our case showed diffuse reactivity with this marker. However, we were unable to perform molecular analysis as fresh or frozen tissue was not available. In conclusion, Xp11 translocation RCCs can morphologically resemble clear cell–papillary RCC. The presence of a large-sized renal tumor in a young adult, lymph node
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International Journal of Surgical Pathology
Table 1. The Clinical, Pathological, and Genetic Features of Xp11.2 Translocation Renal Cell Carcinoma (RCC) and Other Adult Renal Tumors. Xp11.2 RCC Age Gender preference Clinical features Genetics Gross features Microscopic findings
Immunohistochemistry Prognosis
Clear Cell RCC
Common in children and adolescents; rarely in adults Females In children, associated with chemotherapy exposure t(X;17) t(X;1) Tan-yellow with hemorrhagic and necrotic areas Papillary or nested architecture, clear to eosinophilic cytoplasm, psammoma bodies TFE3+, CA IX−, CK 7− Aggressive
Papillary RCC
Clear Cell–Papillary RCC
6th to 7th decade
6th to 7th decade
6th to 7th decade
Males Hematuria, abdominal pain, palpable mass
Males Can be bilateral and multifocal
Males Occurs in end-stage renal disease
VHL gene mutation, loss Trisomy 7/17, of chromosome 3 chromosome Y loss Tan-yellow with Multifocal, variegated hemorrhagic and necrotic areas Acinar architecture, Papillary architecture, clear cytoplasm psammoma bodies CA IX+, CK 7−, TFE3− Aggressive
or distant metastasis at presentation, and microscopic presence of psammoma bodies should raise a high degree of suspicion for translocation-associated RCCs. In these cases, TFE3 immunohistochemistry should be performed to render an accurate diagnosis. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
References 1. Argani P, Ladanyi M. Recent advances in pediatric renal neoplasia. Adv Anat Pathol. 2003;10:243-260. 2. Meyer PN, Clark JI, Flanigan RC, Picken MM. Xp11.2 translocation renal cell carcinoma with very aggressive course in five adults. Am J Clin Pathol. 2007;128:70-79. 3. Argani P, Olgac S, Tickoo SK, et al. Xp11 translocation renal cell carcinoma in adults: expanded clinical, pathologic, and genetic spectrum. Am J Surg Pathol. 2007;31:1149-1160.
No 3p loss, no trisomy 7/17 Well circumscribed, small size
Papillary architecture, clear cytoplasm, nuclei aligned away from basement membrane CK 7+, CA IX−, TFE3− CA IX+, CK 7+ Better than clear cell Favorable RCC
4. Gaillot-Durand L, Chevallier M, Colombel M, et al. Diagnosis of Xp11 translocation renal cell carcinomas in adult patients under 50 years: interest and pitfalls of automated immunohistochemical detection of TFE3 protein. Pathol Res Pract. 2013;209:83-89. 5. Zou H, Kang X, Pang LJ, et al. Xp11 translocation renal cell carcinoma in adults: a clinicopathological and comparative genomic hybridization study. Int J Clin Exp Pathol. 2013;7:236-245. 6. Zhong M, Weisman P, Zhu B, et al. Xp11.2 translocation renal cell carcinoma with PSF-TFE3 rearrangement. Diagn Mol Pathol. 2013;22:107-111. 7. Argani P, Lui MY, Couturier J, Bouvier R, Fournet JC, Ladanyi M. Cloning of a novel CLTC-TFE3 gene fusion in pediatric renal adenocarcinoma with t(X;17)(p11.2;q23). Oncogene. 2003;22:5374-5378. 8. Argani P, Laé M, Ballard ET, et al. Translocation carcinomas of the kidney following chemotherapy in childhood. J Clin Oncol. 2006;24:1529-1534. 9. Srigley JR, Delahunt B, Eble JN, et al; ISUP Renal Tumor Panel. The International Society of Urological Pathology (ISUP) Vancouver Classification of Renal Neoplasia. Am J Surg Pathol. 2013;37:1469-1489. 10. Reuter VE, Tickoo SK. Adult renal tumors. In: Mills SE, ed. Sternberg’s Diagnostic Surgical Pathology. Philadelphia, PA: Lippincott Williams & Wilkins; 2010:1757-1798.
Downloaded from ijs.sagepub.com at VITERBO UNIV on January 26, 2015
research-article2014
IJSXXX10.1177/1066896914562280International Journal of Surgical PathologyParihar et al
Case Reports
Xp11 Translocation Renal Cell Carcinoma Morphologically Mimicking Clear Cell–Papillary Renal Cell Carcinoma in an Adult Patient: Report of a Case Expanding the Morphologic Spectrum of Xp11 Translocation Renal Cell Carcinomas
International Journal of Surgical Pathology 1–4 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1066896914562280 ijs.sagepub.com
Asmita Parihar, MD Pathology1, Satish K. Tickoo, MD Pathology2, Sunil Kumar, MS Surgery1, and Vinod Kumar Arora, MD Pathology1
Abstract Xp11 translocation renal cell carcinoma (RCC) is a relatively rare tumor mainly affecting children and adolescents. It shows significant morphological overlap with the 2 most common adult renal tumors, which are the clear cell (conventional) RCC and papillary RCC. We describe case of a young adult female who presented with right flank pain and abdominal mass. Radiological investigations showed features suggestive of renal cell carcinoma in the right kidney. Histopathological findings while suggestive of Xp11 carcinoma, showed significant overlap with the recently described entity clear cell papillary RCC. TFE3 immunohistochemistry confirmed the tumor to be Xp11 translocation RCC. The patient had an aggressive course with lymph node metastasis. In this report, we discuss differential diagnosis and the diagnostic challenges of Xp11 translocation RCC in adults. Keywords adult, clear cell papillary, renal cell carcinoma, Xp11 translocation
Introduction Xp11 translocation renal cell carcinoma (RCC) was first included as a distinct entity in 2004 World Health Organization classification of renal tumors. It is a rare neoplasm, occurring predominantly in children and adolescents.1 Very few adult cases have been reported till date.2,3 In Xp11 translocation, gene fusion occurs involving the gene transcription factor E3 (TFE3).1,3 The typical microscopic features described for Xp11 RCC are a nested and papillary architecture with tumor cells having abundant clear to eosinophilic cytoplasm, and the presence of psammoma bodies.3 This appearance has a significant overlap with clear cell RCC and papillary RCC, entities that constitute a major fraction of adult renal tumors. TFE3 immunohistochemistry is a highly specific and sensitive marker of tumors with TFE3 gene fusions, and is required for a definite diagnosis.4 More recently, morphologic features beyond that classically described have been reported in some of these tumors.3 We report a case of immunohistochemically confirmed Xp11 translocation RCC in an adult
female that morphologically raised the possibility of the recently described clear cell–papillary RCC, and discuss the morphological differential diagnoses of this rare neoplasm in adults.
Case Report A 34-year-old woman presented with right flank pain for the past 5 months. There was no history of hematuria or previous exposure to chemotherapy. Abdominal examination revealed a palpable mass. Computed tomography scan abdomen showed an enlarged right kidney with an exophytic, hyperdense lesion in the mid kidney. The lesion 1
University College of Medical Sciences, Delhi, India Memorial Sloan-Kettering Cancer, New York, NY, USA
2
Corresponding Author: Vinod Kumar Arora, Department of Pathology, University College of Medical Sciences, Delhi 110095, India. Email: [email protected]
Downloaded from ijs.sagepub.com at VITERBO UNIV on January 26, 2015
2
International Journal of Surgical Pathology
Figure 1. Computed tomography scan abdomen showed a hyperdense lesion in the right kidney.
measured 12.4 × 12.3 × 9 cm and had solid and cystic components. The lesion had well-defined margins and no evident infiltration into the surrounding tissues. The other kidney was normal. A radiologic impression of renal cell carcinoma, right kidney was made (Figure 1). Right-sided radical nephrectomy with lymph node dissection was performed and the specimen was sent for histopathological evaluation. On gross examination, the right kidney measured 16.5 × 11.5 × 6 cm. On bivalving, a large tumor measuring 12.2 × 11.3 × 5.4 cm was identified in the mid kidney. The cut surface showed areas of hemorrhage and necrosis. The tumor was seen involving the renal sinus and renal pelvis (Figure 2). The ureter was grossly unremarkable. Microscopically, the tumor infiltrated the renal capsule, renal sinus, and the renal pelvis. The tumor cells were arranged in papillary and alveolar pattern. The cells had moderate to voluminous clear cytoplasm with Fuhrman nuclear grade 2. The nuclei were predominantly aligned away from the basement membrane in a linear manner. Mitosis was occasional. Psammoma bodies were frequently seen. (Figures 3 and 4) The para-aortic lymph node showed a focus of metastasis. Metastasis was also identified in the para-aortic soft tissue. On immunohistochemistry, tumor cells showed absence of expression of CK7, carbonic anhydrase–IX (CA-IX), and vimentin. However, stain for TFE3 revealed strong and diffuse nuclear reactivity. The melanocytic marker HMB45 was also diffusely positive in the tumor cells. (Figure 5) Based on the morphological features and immunohistochemistry findings, a final diagnosis of Xp11 translocation renal cell carcinoma, right kidney was made.
Figure 2. Gross specimen of the kidney showing a large tumor involving the renal sinus and the renal pelvis.
Figure 3. Microscopy showed tumor cells in papillary and alveolar pattern along with psammoma bodies. The tumor cells had moderate amount of clear cytoplasm and nuclei were aligned away from the basement membrane (hematoxylin and eosin stain, 100×).
Discussion Xp11 translocation RCC result from gene fusions between TFE3 located on chromosome Xp11.2 and various other genes, which include the ASPL at chromosome 17 and PRCC at chromosome 1.5 Other rare fusion partners are PSF and CLTC genes at chromosomes 1 and 17, respectively.6,7
Downloaded from ijs.sagepub.com at VITERBO UNIV on January 26, 2015
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Parihar et al
Figure 4. High-power microscopic view showing alignment of nuclei away from basement membrane (hematoxylin and eosin stain, 400×).
Figure 5. TFE3 immunohistochemistry showed strong and diffuse positivity. Inset shows positivity for HMB-45.
Xp11 RCC is a rare tumor that preferentially affects children and adolescents.1,5 It is relatively uncommon in adults.5 It has been associated with previous exposure to cytotoxic chemotherapy in early childhood.8 However, such a consistent association has not been reported in adults. There is also a difference in the biologic behavior of this tumor between children and adults. In adults, it follows a more aggressive course and presents usually at advanced stage.5 Several morphologic variations have been described in Xp11 RCC, including tumor giant cells and fascicles of spindle cells.3 This case further expands the morphologic
spectrum of Xp11 RCC as the microscopic picture resembled clear cell–papillary RCC. The distinctive morphologic feature of the latter is the linear arrangement of nuclei away from the basement membrane, which was evidently seen in our case, thus adding to the diagnostic dilemma.9 However, clear cell–papillary RCC presents at an early stage, is usually small (mean size, 2.5 cm) and has a very favorable prognosis9 (Table 1). In our case, presence of a large tumor in a young adult with metastasis at presentation favored the consideration of an alternative diagnosis. Other tumors that show morphological similarities with Xp11 RCC are conventional (clear cell) RCC and papillary RCC, the 2 most common renal neoplasms of adults. The gross appearance of Xp11 RCC mimics that of clear cell RCC, being tan-yellow with necrotic and hemorrhagic areas.10 Papillary RCC has variegated appearance and are often multifocal.10 Microscopically Xp11 RCC shows tumor cells arranged in papillary and nested architecture, with cells having abundant clear to eosinophilic granular cytoplasm, vesicular nuclei and prominent nucleoli, and presence of psammoma bodies.6 Clear cell RCC has tumor cells with clear cytoplasm and can have focal pseudopapillary growth pattern.10 Papillary RCC exhibit the characteristic papillary architecture with fibrovascular cores. The tumor cells have amphophilic to eosinophilic cytoplasm and psammoma bodies are frequently seen. It can show focal clear cell areas.10 However, both clear cell RCC and papillary RCC mainly occur in sixth to seventh decade of life, whereas Xp11 RCC is quite uncommon in that age range10 (Table 1). Correct diagnosis of Xp11 generally requires a molecular confirmation. However, immunohistochemisty for TFE3 has been demonstrated to be highly sensitive and specific surrogate molecular testing in tumors bearing TFE3 gene fusions. The stain shows diffuse and strong nuclear positivity,4 as seen in our case. TFE3 is negative in all the other renal cell carcinomas like clear cell, papillary, and clear cell–papillary RCC. Carbonic anhydrase-IX shows strong and diffuse membranous positivity in clear cell RCC but it is mostly negative in translocation associated RCC. CK7 immunoreactivity seen in papillary RCC is absent in Xp11.2 translocation RCC, and other epithelial markers like cytokeratin and epithelial membrane antigen are negative or only focally positive.5 Thus, the most distinctive immunohistochemical feature of translocationassociated RCC is nuclear labeling with TFE3. In Xp11.2 translocation RCC, labeling with melanocytic markers like HMB45 is associated with the rare gene fusions such as PSF-TFE3 and CLTC-TFE3.7,10 Our case showed diffuse reactivity with this marker. However, we were unable to perform molecular analysis as fresh or frozen tissue was not available. In conclusion, Xp11 translocation RCCs can morphologically resemble clear cell–papillary RCC. The presence of a large-sized renal tumor in a young adult, lymph node
Downloaded from ijs.sagepub.com at VITERBO UNIV on January 26, 2015
4
International Journal of Surgical Pathology
Table 1. The Clinical, Pathological, and Genetic Features of Xp11.2 Translocation Renal Cell Carcinoma (RCC) and Other Adult Renal Tumors. Xp11.2 RCC Age Gender preference Clinical features Genetics Gross features Microscopic findings
Immunohistochemistry Prognosis
Clear Cell RCC
Common in children and adolescents; rarely in adults Females In children, associated with chemotherapy exposure t(X;17) t(X;1) Tan-yellow with hemorrhagic and necrotic areas Papillary or nested architecture, clear to eosinophilic cytoplasm, psammoma bodies TFE3+, CA IX−, CK 7− Aggressive
Papillary RCC
Clear Cell–Papillary RCC
6th to 7th decade
6th to 7th decade
6th to 7th decade
Males Hematuria, abdominal pain, palpable mass
Males Can be bilateral and multifocal
Males Occurs in end-stage renal disease
VHL gene mutation, loss Trisomy 7/17, of chromosome 3 chromosome Y loss Tan-yellow with Multifocal, variegated hemorrhagic and necrotic areas Acinar architecture, Papillary architecture, clear cytoplasm psammoma bodies CA IX+, CK 7−, TFE3− Aggressive
or distant metastasis at presentation, and microscopic presence of psammoma bodies should raise a high degree of suspicion for translocation-associated RCCs. In these cases, TFE3 immunohistochemistry should be performed to render an accurate diagnosis. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
References 1. Argani P, Ladanyi M. Recent advances in pediatric renal neoplasia. Adv Anat Pathol. 2003;10:243-260. 2. Meyer PN, Clark JI, Flanigan RC, Picken MM. Xp11.2 translocation renal cell carcinoma with very aggressive course in five adults. Am J Clin Pathol. 2007;128:70-79. 3. Argani P, Olgac S, Tickoo SK, et al. Xp11 translocation renal cell carcinoma in adults: expanded clinical, pathologic, and genetic spectrum. Am J Surg Pathol. 2007;31:1149-1160.
No 3p loss, no trisomy 7/17 Well circumscribed, small size
Papillary architecture, clear cytoplasm, nuclei aligned away from basement membrane CK 7+, CA IX−, TFE3− CA IX+, CK 7+ Better than clear cell Favorable RCC
4. Gaillot-Durand L, Chevallier M, Colombel M, et al. Diagnosis of Xp11 translocation renal cell carcinomas in adult patients under 50 years: interest and pitfalls of automated immunohistochemical detection of TFE3 protein. Pathol Res Pract. 2013;209:83-89. 5. Zou H, Kang X, Pang LJ, et al. Xp11 translocation renal cell carcinoma in adults: a clinicopathological and comparative genomic hybridization study. Int J Clin Exp Pathol. 2013;7:236-245. 6. Zhong M, Weisman P, Zhu B, et al. Xp11.2 translocation renal cell carcinoma with PSF-TFE3 rearrangement. Diagn Mol Pathol. 2013;22:107-111. 7. Argani P, Lui MY, Couturier J, Bouvier R, Fournet JC, Ladanyi M. Cloning of a novel CLTC-TFE3 gene fusion in pediatric renal adenocarcinoma with t(X;17)(p11.2;q23). Oncogene. 2003;22:5374-5378. 8. Argani P, Laé M, Ballard ET, et al. Translocation carcinomas of the kidney following chemotherapy in childhood. J Clin Oncol. 2006;24:1529-1534. 9. Srigley JR, Delahunt B, Eble JN, et al; ISUP Renal Tumor Panel. The International Society of Urological Pathology (ISUP) Vancouver Classification of Renal Neoplasia. Am J Surg Pathol. 2013;37:1469-1489. 10. Reuter VE, Tickoo SK. Adult renal tumors. In: Mills SE, ed. Sternberg’s Diagnostic Surgical Pathology. Philadelphia, PA: Lippincott Williams & Wilkins; 2010:1757-1798.
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