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

  • Sean R. WilliamsonEmail author
  • Liang Cheng
  • Ramya Gadde
  • Giovanna A. Giannico
  • Matthew J. Wasco
  • Paul J. Taylor Smith
  • Nilesh S. Gupta
  • David J. Grignon
  • Merce Jorda
  • Oleksandr N. Kryvenko
Original Article


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.


Oncocytoma Renal cell carcinoma Papillary adenoma Collision tumor 


Authors’ 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.

Compliance with ethical standards

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

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Pathology and Laboratory Medicine and Henry Ford Cancer InstituteHenry Ford Health SystemDetroitUSA
  2. 2.Department of PathologyWayne State University School of MedicineDetroitUSA
  3. 3.Department of Pathology and Laboratory MedicineIndiana University School of MedicineIndianapolisUSA
  4. 4.Department of Pathology, Microbiology, and ImmunologyVanderbilt University Medical CenterNashvilleUSA
  5. 5.Department of PathologySt. Joseph Mercy HospitalAnn ArborUSA
  6. 6.Departments of Pathology and Laboratory Medicine and Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiUSA
  7. 7.Department of UrologyUniversity of Miami Miller School of MedicineMiamiUSA

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