Sayeed Sadia, Lindsey Kathryn G, Baras Alexander S, Jackson Christopher, Powers Celeste N, Uram-Tuculescu Cora, Smith Steven C
Department of Pathology, Virginia Commonwealth University Health System, Richmond, Virginia.
Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina.
Cancer Cytopathol. 2016 Aug;124(8):565-72. doi: 10.1002/cncy.21721. Epub 2016 Apr 7.
Clear cell papillary renal cell carcinoma (CCPRCC) is a distinctive variant of renal cell carcinoma that has been formally adopted by the new Word Health Organization classification. An emerging consensus has documented its particularly indolent course and emphasized its separation from conventional clear cell renal cell carcinoma (CCRCC) for treatment planning. CCPRCC features in cytologic preparations have not been studied.
This study retrospectively identified a series of CCPRCCs that had cytology samples before the histopathologic diagnosis and reviewed corresponding cytologic materials, including aspirate smears, cell block materials, touch preparations, and core biopsy samples. The identified clinicopathologic and cytologic features were tabulated.
Five cases of CCPRCC with cytopathologic materials were identified from 4 women and 1 man aged 34 to 70 years (2 with end-stage renal disease), and the sampled lesions were 1.8 to 11.0 cm. The original cytopathologic diagnostic considerations ranged from atypical cyst-lining cells to angiomyolipoma to CCRCC and CCPRCC. The aspirate and touch preparation samples showed scant cellularity with scattered sheets and clusters of small, bland epithelial cells (much smaller than admixed renal tubular cells) with optically clear cytoplasm (lacking conspicuous cytoplasmic vacuolization) and small, grade 1 nuclei. The cell block materials and the core biopsy samples showed cyst walls with prominent myomatous stroma lined by low-grade epithelium with optically clear cytoplasm, inverse nuclear polarization, and a characteristic cytokeratin 7-positive/carbonic anhydrase IX-positive phenotype. Three cases were treated with resection, 1 case was treated with ablation, and 1 case was under surveillance.
CCPRCC demonstrates recognizable cytomorphologic features and merits consideration in the cytologic differential diagnosis for kidney lesions. With increasing experience, more conservative management may be contemplated. Cancer Cytopathol 2016;124:565-72. © 2016 American Cancer Society.
透明细胞乳头状肾细胞癌（CCPRCC）是肾细胞癌的一种独特变体，已被世界卫生组织新分类正式采用。新的共识记录了其特别惰性的病程，并强调在治疗规划中将其与传统透明细胞肾细胞癌（CCRCC）区分开来。CCPRCC在细胞学制片中的特征尚未得到研究。
本研究回顾性地确定了一系列在组织病理学诊断之前有细胞学样本的CCPRCC病例，并复查了相应的细胞学材料，包括抽吸涂片、细胞块材料、触摸涂片和芯针活检样本。将所确定的临床病理和细胞学特征制成表格。
从4名女性和1名年龄在34至70岁（2例患有终末期肾病）的男性中确定了5例有细胞病理学材料的CCPRCC病例，所取样的病变大小为1.8至11.0厘米。最初的细胞病理学诊断考虑范围从非典型囊肿衬里细胞到血管平滑肌脂肪瘤，再到CCRCC和CCPRCC。抽吸和触摸涂片样本显示细胞数量稀少，有散在的小片状和小簇状温和的上皮细胞（比混合存在的肾小管细胞小得多），胞质透明（无明显的胞质空泡化），细胞核小，为1级。细胞块材料和芯针活检样本显示囊肿壁有突出的肌瘤样间质，内衬低级别上皮，胞质透明，核极性倒置，具有特征性的细胞角蛋白7阳性/碳酸酐酶IX阳性表型。3例接受了切除术，l例接受了消融治疗，1例在观察中。
CCPRCC表现出可识别的细胞形态学特征，在肾脏病变的细胞学鉴别诊断中值得考虑。随着经验的增加，可能会考虑更保守的治疗方法。《癌症细胞病理学》2016年；124：565 - 572。©2016美国癌症协会
