Department of Pathology, Health Science Center, Peking University, Beijing, China.
Department of Pathology and Laboratory Medicine, Calgary Laboratory Services and University of Calgary, Calgary, AB, Canada.
Virchows Arch. 2018 Dec;473(6):725-738. doi: 10.1007/s00428-018-2456-4. Epub 2018 Sep 19.
The spectrum of the renal oncocytic tumors has been expanded in recent years to include several novel and emerging entities. We describe a cohort of novel, hitherto unrecognized and morphologically distinct high-grade oncocytic tumors (HOT), currently diagnosed as "unclassified" in the WHO classification. We identified 14 HOT by searching multiple institutional archives. Morphologic, immunohistochemical (IHC), molecular genetic, and molecular karyotyping studies were performed to investigate these tumors. The patients included 3 men and 11 women, with age range from 25 to 73 years (median 50, mean 49 years). Tumor size ranged from 1.5 to 7.0 cm in the greatest dimension (median 3, mean 3.4 cm). The tumors were all pT1 stage. Microscopically, they showed nested to solid growth, and focal tubulocystic architecture. The neoplastic cells were uniform with voluminous oncocytic cytoplasm. Prominent intracytoplasmic vacuoles were frequently seen, but no irregular (raisinoid) nuclei or perinuclear halos were present. All tumors demonstrated prominent nucleoli (WHO/ISUP grade 3 equivalent). Nine of 14 cases were positive for CD117 and cytokeratin (CK) 7 was either negative or only focally positive in of 6/14 cases. All tumors were positive for AE1-AE3, CK18, PAX 8, antimitochondrial antigen, and SDHB. Cathepsin K was positive in 13/14 cases and CD10 was positive in 12/13 cases. All cases were negative for TFE3, HMB45, Melan-A. No TFEB and TFE3 genes rearrangement was found in analyzable cases. By array CGH, complete chromosomal losses or gains were not found in any of the cases, and 3/9 cases showed absence of any abnormalities. Chromosomal losses were detected on chromosome 19 (4/9), 3 with losses of the short arm (p) and 1 with losses of both arms (p and q). Loss of chromosome 1 was found in 3/9 cases; gain of 5q was found in 1/9 cases. On molecular karyotyping, 3/3 evaluated cases showed loss of heterozygosity (LOH) on 16p11.2-11.1 and 2/3 cases showed LOH at 7q31.31. Copy number (CN) losses were found at 7q11.21 (3/3), Xp11.21 (3/3), Xp11.22-11.21 (3/3), and Xq24-25 (2/3). CN gains were found at 13q34 (2/3). Ten patients with available follow up information were alive and without disease progression, after a mean follow-up of 28 months (1 to 112 months). HOT is a tumor with unique morphology and its IHC profile appears mostly consistent. HOT should be considered as an emerging renal entity because it does not meet the diagnostic criteria for other recognized eosinophilic renal tumors, such as oncocytoma, chromophobe renal cell carcinoma (RCC), TFE3 and TFEB RCC, SDH-deficient RCC, and eosinophilic solid and cystic RCC.
近年来,肾嗜酸细胞瘤的范围已经扩大,包括几种新出现的实体瘤。我们描述了一组新的、迄今为止尚未被认识到的形态独特的高级嗜酸细胞瘤(HOT),目前在世界卫生组织(WHO)分类中被诊断为“未分类”。我们通过搜索多个机构的档案,确定了 14 例 HOT。对这些肿瘤进行了形态学、免疫组织化学(IHC)、分子遗传学和分子核型分析研究。患者包括 3 名男性和 11 名女性,年龄范围为 25 岁至 73 岁(中位数 50 岁,平均 49 岁)。肿瘤最大径为 1.5 至 7.0 厘米(中位数 3 厘米,平均 3.4 厘米)。所有肿瘤均为 pT1 期。显微镜下,它们表现为巢状至实性生长,并有局灶性管状囊性结构。肿瘤细胞均匀一致,胞质丰富嗜酸。经常可见明显的细胞内空泡,但无不规则(葡萄干样)核或核周晕。所有肿瘤均有明显的核仁(WHO/ISUP 分级 3 级等效)。14 例中有 9 例 CD117 阳性,6/14 例 CK7 阴性或仅局灶性阳性。所有肿瘤均表达 AE1-AE3、CK18、PAX8、抗线粒体抗体和 SDHB。组织蛋白酶 K 在 13/14 例中阳性,CD10 在 12/13 例中阳性。所有病例均为 TFE3、HMB45、Melan-A 阴性。可分析病例均未发现 TFEB 和 TFE3 基因重排。通过 array CGH,未发现任何病例存在染色体完全缺失或获得,3/9 例存在无异常。在 9/9 例中检测到染色体 19 的缺失(4/9),3 例缺失短臂(p),1 例缺失两条臂(p 和 q)。在 9/9 例中发现染色体 1 的缺失,在 1/9 例中发现 5q 的增益。在分子核型分析中,3/3 例评估病例显示 16p11.2-11.1 缺失杂合性(LOH),2/3 例显示 7q31.31 的 LOH。发现 7q11.21(3/3)、Xp11.21(3/3)、Xp11.22-11.21(3/3)和 Xq24-25(2/3)存在拷贝数(CN)丢失。发现 13q34 存在 CN 增益(2/3)。在有可用随访信息的 10 名患者中,在平均随访 28 个月(1 至 112 个月)后,均存活且无疾病进展。HOT 是一种具有独特形态的肿瘤,其 IHC 特征似乎大多一致。由于 HOT 不符合其他公认的嗜酸肾肿瘤(如嗜酸细胞瘤、嫌色性肾细胞癌(RCC)、TFE3 和 TFEB RCC、SDH 缺陷型 RCC 和嗜酸细胞实性和囊性 RCC)的诊断标准,因此应将其视为一种新出现的肾实体瘤。