Renal oncocytoma
Epidemiology
Oncocytomas constituted 3-5% of all renal tumours.
Macroscopic appearances
The tumour is the colour of the adjacent renal cortex. There may be a central scar. There is a diffuse form of renal oncocytosis3.
Histopathology
The architecture consists of small nests and tubules without broad trabeculae. The cells have granular cytoplasm. The nuclei lack atypia but there are small distinct nucleoli. The colloidal iron stain is negative or shows focal membrane positivity.
Immunohistochemistry
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Pancytokeratin KL-1
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6/7 (diffuse positivity of more than 80% of tumour cells; 5, strong positivity of 50-80% of tumour cells; 1: study by tissue microarray)5
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34bE12
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0/7 (study by tissue microarray)5
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Cam5.2
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6/7 (diffuse positivity of more than 80% of tumour cells; 5, strong positivity of 50-80% of tumour cells; 1: study by tissue microarray)5
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CK7
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3/62,
1/7 (heterologous positivity of less than 50% of tumour cells in one case : study by tissue microarray)5,
4/21(four positive, seven focally positive)6,
10/10(patchy weak to moderate cytoplasmic staining wihtout membrane staining)7,
3/11(weak staining of less than 5% of tumour cells)8, 3/69, 2/3116
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CK20
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0/216
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EMA
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4/62,
6/7 (diffuse positivity of more than 80% of tumour cells; 2, strong positivity of 50-80% of tumour cells; 1, heterologous positivity of less than 50% of tumour cells; 3: study by tissue microarray)5, 4/69, 16/3116
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MOC31
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0/7 (study by tissue microarray)5
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BerEP4
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2/7 (diffuse positivity of more than 80% of tumour cells; 1, heterologous positivity of less than 50% of tumour cells; 1: study by tissue microarray)5
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RCC Ma
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1/7 (strong positivity of 50-80% of tumour cells; study by tissue microarray)5, 0/910,
0/12(granular [eosinophilic] variants)14, 0/2017
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CD10
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4/62,
0/7 (study by tissue microarray)53/910, 4/69,
7/12(granular [eosinophilic] variants: 3 cases diffuse strong membrane or granular cytoplasmic positivity, 4 cases focal)14
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E-cadherin
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5/7 (strong positivity of 50-80% of tumour cells; 5: study by tissue microarray)5
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CD15
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4/7 (diffuse positivity of more than 80% of tumour cells; 1, strong positivity of 50-80% of tumour cells; 1, heterologous positivity of less than 50% of tumour cells; 2: study by tissue microarray)5
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CD117
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12/12(granular [eosinophilic] variants: diffuse strong membrane or granular cytoplasmic positivity)14
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RON
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12/12(granular [eosinophilic] variants: 9 cases diffuse strong membrane or granular cytoplasmic positivity, focal in 3 cases)14
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Vimentin
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5/62,
0/7 (study by tissue microarray)5, 0/811, 0/812,1/69, 3/3116
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Parvalbumin
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11/164, 8/811
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Antimitochondrial antibody
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5/69
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b defensin-1
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8/811
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Epcam
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1/15 strongly membrane positive13
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kidney-specific cadherin
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15/20(staining is predominently membranous)15,
2/31(this study used tissue microarrays, which may account for the lower rate of staining in oncocytomas, where others have found the staining to be patchy. A more dilute primary antibody was used than in other studies)16, 19/2017, 31/4118
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Colloidal iron
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5/12(granular [eosinophilic] variants: focal faint apical and perinuclear cytoplasmic positivity)14,
2/31(the two positive cases were also positive for kidney-specific cadherin and CK7)16
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P504S
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3/2019
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Differential diagnosis
Management
Observation or local resection.
Prognosis
There is a single case of metastasis to the liver2.
References
1 Renshaw, A. A. (2002). "Subclassification of renal cell neoplasms: an update for the practising pathologist." Histopathology 41(4): 283-300.
2 Perez-Ordonez, B., G. Hamed, et al. (1997). "Renal oncocytoma: a clinicopathologic study of 70 cases." Am J Surg Pathol 21(8): 871-83.
3 Tickoo, S. K., V. E. Reuter, et al. (1999). "Renal oncocytosis: a morphologic study of fourteen cases." Am J Surg Pathol 23(9): 1094-101.
4 Martignoni, G., M. Pea, et al. (2001). "Parvalbumin is constantly expressed in chromophobe renal carcinoma." Mod Pathol 14(8): 760-7.
5 Pan CC, Chen PC,Ho DM. The diagnostic utility of MOC31, BerEP4, RCC marker and CD10 in the classification of renal cell carcinoma and renal oncocytoma: an immunohistochemical analysis of 328 cases. Histopathology 2004; 45:452-9
6 Wu SL, Kothari P, Wheeler TM, et al. Cytokeratins 7 and 20 immunoreactivity in chromophobe renal cell carcinomas and renal oncocytomas. Mod Pathol 2002; 15:712-7
7 Mathers ME, Pollock AM, Marsh C, et al. Cytokeratin 7: a useful adjunct in the diagnosis of chromophobe renal cell carcinoma. Histopathology 2002; 40:563-7
8 Leroy, X., Moukassa, D., Copin, M.C., Saint, F., Mazeman, E. and Gosselin, B. Utility of cytokeratin 7 for distinguishing chromophobe renal cell carcinoma from renal oncocytoma. Eur Urol 2000;37:484-7.
9 Abrahams, N. A., G. T. Maclennan, et al. (2004). "Chromophobe renal cell carcinoma: a comparative study of histological, immunohistochemical and ultrastructural features using high throughput tissue microarray." Histopathology 45(6): 593-602.
10 Avery, A.K., Beckstead, J., Renshaw, A.A. and Corless, C.L. Use of antibodies to RCC and CD10 in the differential diagnosis of renal neoplasms. Am J Surg Pathol 2000;24:203-10.
11 Young, A.N., de Oliveira Salles, P.G., Lim, S.D., Cohen, C., Petros, J.A., Marshall, F.F., Neish, A.S. and Amin, M.B. Beta defensin-1, parvalbumin, and vimentin: a panel of diagnostic immunohistochemical markers for renal tumors derived from gene expression profiling studies using cDNA microarrays. Am J Surg Pathol 2003;27:199-205.
12 Morgan B et al. Immunohistochemical subtyping of renal cortical tumours. J Pathol July 2004, abstract 21.
13 Went P, Dirnhofer S, Salvisberg T, et al. Expression of epithelial cell adhesion molecule (EpCam) in renal epithelial tumors. Am J Surg Pathol 2005; 29:83-8
14 Wang HY,Mills SE. KIT and RCC are useful in distinguishing chromophobe renal cell carcinoma from the granular variant of clear cell renal cell carcinoma. Am J Surg Pathol 2005; 29:640-6
15 Kuehn A, Paner GP, Skinnider BF, et al. Expression analysis of kidney-specific cadherin in a wide spectrum of traditional and newly recognized renal epithelial neoplasms: diagnostic and histogenetic implications. Am J Surg Pathol 2007; 31:1528-33
16 Mazal PR, Exner M, Haitel A, et al. Expression of kidney-specific cadherin distinguishes chromophobe renal cell carcinoma from renal oncocytoma. Hum Pathol 2005; 36:22-8
17 Shen SS, Krishna B, Chirala R, et al. Kidney-specific cadherin, a specific marker for the distal portion of the nephron and related renal neoplasms. Mod Pathol 2005; 18:933-40 FULL TEXT
18 Adley BP, Gupta A, Lin F, et al. Expression of kidney-specific cadherin in chromophobe renal cell carcinoma and renal oncocytoma. Am J Clin Pathol 2006; 126:79-85
19 Tretiakova MS, Sahoo S, Takahashi M, et al. Expression of alpha-methylacyl-CoA racemase in papillary renal cell carcinoma. Am J Surg Pathol 2004; 28:69-76
This page last revised 2.2.2008.
©SMUHT/PW Bishop