Low-grade myxoid renal epithelial neoplasms with distal nephron differentiation

We report 4 distinctive renal epithelial neoplasms that are essentially identical at the morphologic and immunohistochemical levels and do not fit an accepted category in the existing classification of these lesions. The patients were all females, with ages ranging from 32 to 79 years (mean, 50 year...

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Bibliographic Details
Published in:Human pathology 2001-05, Vol.32 (5), p.506-512
Main Authors: Parwani, Anil V., Husain, Aliya N., Epstein, Jonathan I., Beckwith, J.Bruce, Argani, Pedram
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Cell Differentiation
collecting duct carcinoma
Cytoplasm - pathology
Epithelium - pathology
Female
Humans
Immunohistochemistry
Keratins - analysis
Kidney Neoplasms - chemistry
Kidney Neoplasms - pathology
Kidney Tubules, Distal - pathology
Kidneys
Lectins - analysis
loop of Henle
Loop of Henle - pathology
Medical sciences
Microscopy, Electron
Middle Aged
Mucin-1 - analysis
Nephrology. Urinary tract diseases
Nephrons - pathology
Plant Lectins
renal neoplasm
Tumors of the urinary system
Vacuoles - pathology
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Summary:We report 4 distinctive renal epithelial neoplasms that are essentially identical at the morphologic and immunohistochemical levels and do not fit an accepted category in the existing classification of these lesions. The patients were all females, with ages ranging from 32 to 79 years (mean, 50 years). The tumors were well circumscribed and were composed of uniform, predominantly low cuboidal cells with eosinophilic, focally vacuolated cytoplasm. Tumor cells generally formed interconnecting tubules, with smaller areas of cordlike growth and spindling in a bubbly, myxoid stroma. All tumors were confined to the kidney, and all were immunoreactive for high-molecular-weight cytokeratin 34βE12, cytokeratin 7, epithelial membrane antigen, and cytokeratin cocktail AE1/3. Only 1 tumor was focally immunoreactive for Ulex europaeus agglutinin. Ultrastructural study showed tumor cells forming tubular structures reminiscent of the loop of Henle or distal convoluted tubule. Follow-up in all 4 cases was benign. These distinctive tumors may be confused with aggressive sarcomatoid renal cell carcinomas because of their spindled morphology. The morphologic, immunohistochemical, and ultrastructural features of these lesions indicate differentiation toward distal nephron segments. Similar tumors probably have been reported among low-grade collecting duct carcinomas or tumors “possibly related to the loop of Henle.” HUM PATHOL 32:506-512. Copyright © 2001 by W.B. Saunders Company
ISSN:0046-8177
1532-8392
DOI:10.1053/hupa.2001.24320