Expanding the histologic spectrum of mucinous tubular and spindle cell carcinoma of the kidney Journal Article
| Authors: | Fine, S. W.; Argani, P.; DeMarzo, A. M.; Delahunt, B.; Sebo, T. J.; Reuter, V. E.; Epstein, J. I. |
| Article Title: | Expanding the histologic spectrum of mucinous tubular and spindle cell carcinoma of the kidney |
| Abstract: | Mucinous tubular and spindle cell carcinomas (MTSCs) are polymorphic neoplasms characterized by small, elongated tubules lined by cuboidal cells and/or cords of spindled cells separated by pale mucinous stroma. Nonclassic morphologic variants and features of MTSC have not been well studied. We identified 17 previously unreported MTSCs from Surgical Pathology and consultative files of the authors and their respective institutions and studied their morphologic features. A total of 10/17 cases were considered "classic," as described above, with 5/10 showing at least focal (20% to 50%) tubular predominance without apparent mucinous matrix. Alcian blue staining revealed abundant (>50%) mucin in all classic cases. Seven of 17 MTSCs were classified as "mucin-poor," with little to no extracellular mucin appreciable by hematoxylin and eosin. Four of these cases showed equal tubular and spindled morphology, 2 cases showed spindle cell predominance (70%; 95%), and 1 case showed tubular predominance (90%). In 5/7 mucin-poor cases, staining for Alcian blue revealed scant (<10%) mucin in cellular areas with the other 2 cases having 30% mucin. Unusual histologic features identified in the 17 cases were: foamy macrophages (n=8), papillations/well formed papillae (n=6/n=1), focal clear cells in tubules (n=3), necrosis (n=3), oncocytic tubules (n=2; 40%, 5%), numerous small vacuoles (n=2), heterotopic bone (n=1), psammomatous calcification (n=1), and nodular growth with lymphocytic cuffing (n=1). An exceptional case contained a well-circumscribed, HMB45-positive angiomyolipoma within the MTSC. MTSCs may be "mucin-poor" and show a marked predominance of either of its principal morphologic components, which coupled with the presence of other unusual features such as clear cells, papillations, foamy macrophages, and necrosis, may mimic other forms of renal cell carcinoma. Pathologists must be aware of the spectrum of histologic findings within MTSCs to ensure their accurate diagnosis. © 2006 Lippincott Williams & Wilkins, Inc. |
| Keywords: | immunohistochemistry; adolescent; adult; clinical article; human tissue; aged; aged, 80 and over; middle aged; histopathology; diagnostic accuracy; adenocarcinoma; cell structure; diagnosis, differential; adenocarcinoma, mucinous; tumor markers, biological; necrosis; kidney carcinoma; kidney neoplasms; kidney; kidney calcification; carcinoma, renal cell; angiomyolipoma; cancer cell; staining; carcinoma; eosin; hematoxylin; clear cell carcinoma; cell shape; cancer classification; macrophage; spindle cell carcinoma; cytopathology; mucinous carcinoma; mucin; mucinous tubular and spindle cell carcinoma; mucins; cell vacuole; kidney tubule; papillary renal cell carcinoma; heterotopic ossification; coloring agents; alcian blue; foam cell; kidney papilla |
| Journal Title: | American Journal of Surgical Pathology |
| Volume: | 30 |
| Issue: | 12 |
| ISSN: | 0147-5185 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2006-12-01 |
| Start Page: | 1554 |
| End Page: | 1560 |
| Language: | English |
| DOI: | 10.1097/01.pas.0000213271.15221.e3 |
| PUBMED: | 17122511 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 40" - "Export Date: 4 June 2012" - "CODEN: AJSPD" - "Source: Scopus" |
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