Renal cell tumors with an entrapped papillary component: a collision with predilection for oncocytic tumors
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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.
KeywordsOncocytoma Renal cell carcinoma Papillary adenoma Collision tumor
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.
- 1.Moch H, Amin MB, Argani P et al. Renal cell tumours. In: Moch H, Humphrey PA, Ulbright TM, Reuter VE, eds. WHO Classification of Tumours of the Urinary System and Male Genital Organs. 4th ed. Lyon: International Agency for Research on Cancer; 2016:14–17. World Health Organization Classification of Tumours; vol 8Google Scholar
- 5.Williamson SR, Gadde R, Trpkov K, Hirsch MS, Srigley JR, Reuter VE, Cheng L, Kunju LP, Barod R, Rogers CG, Delahunt B, Hes O, Eble JN, Zhou M, McKenney JK, Martignoni G, Fleming S, Grignon DJ, Moch H, Gupta NS (2017) Diagnostic criteria for oncocytic renal neoplasms: a survey of urologic pathologists. Hum Pathol 63:149–156CrossRefGoogle Scholar
- 7.Karakiewicz PI, Hutterer GC, Trinh QD, Pantuck AJ, Klatte T, Lam JS, Guille F, de la Taille A, Novara G, Tostain J, Cindolo L, Ficarra V, Schips L, Zigeuner R, Mulders PF, Chautard D, Lechevallier E, Valeri A, Descotes JL, Lang H, Soulie M, Ferriere JM, Pfister C, Mejean A, Belldegrun AS, Patard JJ (2007) Unclassified renal cell carcinoma: an analysis of 85 cases. BJU Int 100(4):802–808CrossRefGoogle Scholar
- 8.Eble JN, Moch H, Amin MB et al. Papillary adenoma. In: Moch H, Humphrey PA, Ulbright T.M., Reuter VE, eds. WHO Classification of Tumours of the Urinary System and Male Genital Organs. 4th ed. Lyon: International Agency for Research on Cancer; 2016:42–43. World Health Organization Classification of Tumours; vol 8Google Scholar
- 9.Williamson SR, Gupta NS, Eble JN, Rogers CG, Michalowski S, Zhang S, Wang M, Grignon DJ, Cheng L (2015) Clear cell renal cell carcinoma with borderline features of clear cell papillary renal cell carcinoma: combined morphologic, immunohistochemical, and cytogenetic analysis. Am J Surg Pathol 39(11):1502–1510CrossRefGoogle Scholar
- 13.Matoso A, Chen YB, Rao V, Wang L, Cheng L, Epstein JI (2016) Atypical renal cysts: a morphologic, immunohistochemical, and molecular study. Am J Surg Pathol 40(2):202–211Google Scholar
- 20.Mudaliar KM, Mehta V, Gupta GN, Picken MM (2014) Expanding the morphologic spectrum of adult biphasic renal tumors--mixed epithelial and stromal tumor of the kidney with focal papillary renal cell carcinoma: case report and review of the literature. Int J Surg Pathol 22(3):266–271CrossRefGoogle Scholar
- 30.Tomaszewski JJ, Uzzo RG, Smaldone MC (2014) Heterogeneity and renal mass biopsy: a review of its role and reliability. Cancer Biol Med 11(3):162–172Google Scholar