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Renal cell tumors with an entrapped papillary component: a collision with predilection for oncocytic tumors

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Abstract

Renal cell tumors with mixed morphology resembling multiple renal cell carcinoma (RCC) subtypes are generally regarded as unclassified RCC. However, occasionally, papillary adenoma or RCC appears admixed with a larger, different tumor histology. We retrieved 17 renal tumors containing a papillary adenoma or papillary RCC component admixed with another tumor histology and studied them with immunohistochemistry and fluorescence in situ hybridization (FISH). Larger tumors were oncocytomas (n = 10), chromophobe RCCs (n = 5), borderline oncocytic tumor (n = 1), and clear cell RCC (n = 1). The size of papillary component ranged from 1 to 34 mm. One tumor was an oncocytoma encircled by a cyst (2.0 cm) with papillary hyperplasia of the lining. The papillary lesions were diffusely cytokeratin 7 positive (17/17), in contrast to “host” tumors. Alpha-methylacyl-coA-racemase labeling was usually stronger in the papillary lesions (13/15). KIT was negative in all papillary lesions and the clear cell RCC and positive in 16/16 oncocytic or chromophobe tumors. Eight of 15 (53%) collision tumors had differing FISH results in the two components. A papillary renal cell proliferation within another tumor is an uncommon phenomenon with predilection for oncocytoma and chromophobe RCC, possibly related to their common entrapment of benign tubules. When supported by distinct morphology and immunohistochemistry in these two components, this phenomenon should be diagnosed as a collision of two processes. A diagnosis of unclassified RCC should be avoided, due to potential misrepresentation as an aggressive renal cancer.

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Author information

Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine and Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, USA

    Sean R. Williamson, Ramya Gadde & Nilesh S. Gupta

  2. Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA

    Sean R. Williamson

  3. Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

    Liang Cheng & David J. Grignon

  4. Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA

    Giovanna A. Giannico

  5. Department of Pathology, St. Joseph Mercy Hospital, Ann Arbor, MI, USA

    Matthew J. Wasco

  6. Departments of Pathology and Laboratory Medicine and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA

    Paul J. Taylor Smith, Merce Jorda & Oleksandr N. Kryvenko

  7. Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA

    Merce Jorda & Oleksandr N. Kryvenko

Authors
  1. Sean R. Williamson
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  2. Liang Cheng
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  3. Ramya Gadde
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  4. Giovanna A. Giannico
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  5. Matthew J. Wasco
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  6. Paul J. Taylor Smith
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  7. Nilesh S. Gupta
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  8. David J. Grignon
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  9. Merce Jorda
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  10. Oleksandr N. Kryvenko
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Contributions

SRW and ONK conceived and designed the study, researched and analyzed the data, and wrote, edited, and reviewed the manuscript. LC, RG, GAG, MJW, PJTS, NSG, DJG, and MJ researched and analyzed the data and edited and reviewed the manuscript. All the authors gave final approval for publication. SRW takes full responsibility for the work as a whole, including the study design, access to data, and the decision to submit and publish the manuscript.

Corresponding author

Correspondence to Sean R. Williamson.

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This study was approved by the Institutional Review Boards of the participating institutions. The need for written informed consent was waived.

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The authors declare that they have no conflict of interest.

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Williamson, S.R., Cheng, L., Gadde, R. et al. Renal cell tumors with an entrapped papillary component: a collision with predilection for oncocytic tumors. Virchows Arch 476, 399–407 (2020). https://doi.org/10.1007/s00428-019-02648-z

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  • DOI: https://doi.org/10.1007/s00428-019-02648-z

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