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Collision and composite tumors; radiologic and pathologic correlation

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Abstract

The terms composite and collision tumors have been used interchangeably throughout radiological literature. Both composite and collision tumors involve two morphologically and immunohistochemically distinct neoplasms coexisting within a single organ. However, collision tumors lack the histological cellular intermingling seen in composite tumors. Composite tumors often arise from a common driver mutation that induces a divergent histology from a common neoplastic source while collision tumors may arise from coincidental neoplastic change. The purpose of this review is to provide an overview of abdominal composite and collision tumors by discussing hallmark radiographic and pathological presentations of rare hepatic, renal, and adrenal case studies. A better understanding of the presentation of each lesion is imperative for proper recognition, diagnosis, and management of these unique tumor presentations.

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References

  1. Otal P, et al. (1999) Imaging Features of Uncommon Adrenal Masses with Histopathologic Correlation1. http://dx.doi.org/10.1148/radiographics.19.3.g99ma07569.

  2. Nayyar M, et al. (2014) Composite liver tumors: a radiologic-pathologic correlation. Clin Mol Hepatol 20(4):406–410

    Article  PubMed  PubMed Central  Google Scholar 

  3. Michalinos A, Constantinidou A, Kontos M (2015) Gastric collision tumors: an insight into their origin and clinical significance. Gastroenterol Res Pract 2015:314158

    Article  PubMed  PubMed Central  Google Scholar 

  4. Aggarwal N, et al. (2012) Tumor-to-tumor metastasis: case report of a pulmonary adenocarcinoma metastatic to a clear cell renal cell carcinoma. Pathol Res Pract 208(1):50–52

    Article  PubMed  Google Scholar 

  5. Anani W, et al. (2014) A series of collision tumors in the genitourinary tract with a review of the literature. Pathol Res Pract 210(4):217–223

    Article  PubMed  Google Scholar 

  6. Yao B, et al. (2015) A collision tumor of esophagus. Int J Clin Exp Pathol 8(11):15143–15146

    PubMed  PubMed Central  Google Scholar 

  7. Brandwein-Gensler M, Urken M, Wang B (2004) Collision tumor of the thyroid: a case report of metastatic liposarcoma plus papillary thyroid carcinoma. Head Neck 26(7):637–641

    Article  PubMed  Google Scholar 

  8. Chin S, Kim Z (2014) Sarcomatoid combined hepatocellular-cholangiocarcinoma: a case report and review of literature. Int J Clin Exp Pathol 7(11):8290–8294

    PubMed  PubMed Central  Google Scholar 

  9. Shetty AS, et al. (2014) Combined hepatocellular-cholangiocarcinoma: what the radiologist needs to know about biphenotypic liver carcinoma. Abdom Imaging 39(2):310–322

    Article  PubMed  Google Scholar 

  10. Jarnagin WR, et al. (2002) Combined hepatocellular and cholangiocarcinoma: demographic, clinical, and prognostic factors. Cancer 94(7):2040–2046

    Article  PubMed  Google Scholar 

  11. Lee SD, et al. (2014) Clinicopathological features and prognosis of combined hepatocellular carcinoma and cholangiocarcinoma after surgery. Hepatobiliary Pancreat Dis Int 13(6):594–601

    Article  CAS  PubMed  Google Scholar 

  12. Lee JH, et al. (2011) Long-term prognosis of combined hepatocellular and cholangiocarcinoma after curative resection comparison with hepatocellular carcinoma and cholangiocarcinoma. J Clin Gastroenterol 45(1):69–75

    PubMed  Google Scholar 

  13. Yin X, et al. (2012) Combined hepatocellular carcinoma and cholangiocarcinoma: clinical features, treatment modalities, and prognosis. Ann Surg Oncol 19(9):2869–2876

    Article  PubMed  Google Scholar 

  14. Panjala C, et al. (2010) The diagnostic conundrum and liver transplantation outcome for combined hepatocellular-cholangiocarcinoma. Am J Transplant 10(5):1263–1267

    Article  CAS  PubMed  Google Scholar 

  15. Liu CL, et al. (2003) Hepatic resection for combined hepatocellular and cholangiocarcinoma. Arch Surg 138(1):86–90

    Article  PubMed  Google Scholar 

  16. Wang J, Wang F, Kessinger A (2010) Outcome of combined hepatocellular and cholangiocarcinoma of the liver. J Oncol 2010:7

    Google Scholar 

  17. Chi M, et al. (2012) Management of combined hepatocellular-cholangiocarcinoma: a case report and literature review. Gastrointest Cancer Res 5(6):199–202

    PubMed  PubMed Central  Google Scholar 

  18. Sapisochin G, et al. (2011) Mixed hepatocellular cholangiocarcinoma and intrahepatic cholangiocarcinoma in patients undergoing transplantation for hepatocellular carcinoma. Liver Transpl 17(8):934–942

    Article  PubMed  Google Scholar 

  19. Theise N, et al. (2010) Combined hepatocellular-cholangiocarcinoma. In: Bosman FT, Carneiro F, Hruban RH, Theise ND (eds) Who classification of tumours of the digestive system. Lyon: International Agency for Research on Cancer, pp 225–227

    Google Scholar 

  20. Purysko AS, et al. (2012) LI-RADS: a case-based review of the new categorization of liver findings in patients with end-stage liver disease. Radiographics 32(7):1977–1995

    Article  PubMed  Google Scholar 

  21. Goodman ZD (2007) Neoplasms of the liver. Mod Pathol 20:S49–S60

    Article  PubMed  Google Scholar 

  22. Nakanuma Y, et al. (2010) Pathological classification of intrahepatic cholangiocarcinoma based on a new concept. World J Hepatol 2(12):419–427

    Article  PubMed  PubMed Central  Google Scholar 

  23. Akiba J, et al. (2013) Clinicopathologic analysis of combined hepatocellular-cholangiocarcinoma according to the latest WHO classification. Am J Surg Pathol 37(4):496–505

    Article  PubMed  Google Scholar 

  24. Kassahun WT, Hauss J (2008) Management of combined hepatocellular and cholangiocarcinoma. Int J Clin Pract 62(8):1271–1278

    Article  CAS  PubMed  Google Scholar 

  25. Yang JD, et al. (2011) Factors that affect risk for hepatocellular carcinoma and effects of surveillance. Clin Gastroenterol Hepatol 9(7):617–623

    Article  PubMed  Google Scholar 

  26. Sempoux C, et al. (2011) Intrahepatic cholangiocarcinoma: new insights in pathology. Semin Liver Dis 31(1):49–60

    Article  PubMed  Google Scholar 

  27. de Groen PC, et al. (1999) Biliary tract cancers. N Engl J Med 341(18):1368–1378

    Article  PubMed  Google Scholar 

  28. Xu J, et al. (2016) Combined hepatocellular-cholangiocarcinoma (cholangiolocellular type) with stem-cell features: a clinicopathologic analysis of 26 cases. Zhonghua Bing Li Xue Za Zhi 45(3):175–179

    PubMed  Google Scholar 

  29. Zhang F, et al. (2008) Combined hepatocellular cholangiocarcinoma originating from hepatic progenitor cells: immunohistochemical and double-fluorescence immunostaining evidence. Histopathology 52(2):224–232

    Article  CAS  PubMed  Google Scholar 

  30. Bellissimo F, et al. (2015) Diagnostic and therapeutic management of hepatocellular carcinoma. World J Gastroenterol 21(42):12003–12021

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Allaire GS, et al. (1988) Bile duct adenoma. a study of 152 cases. Am J Surg Pathol 12(9):708–715

    Article  CAS  PubMed  Google Scholar 

  32. Maximin S, et al. (2014) Current update on combined hepatocellular-cholangiocarcinoma. Eur J Radiol Open 1:40–48

    Article  PubMed  PubMed Central  Google Scholar 

  33. Aoki K, et al. (1993) Combined hepatocellular carcinoma and cholangiocarcinoma: clinical features and computed tomographic findings. Hepatology 18(5):1090–1095

    Article  CAS  PubMed  Google Scholar 

  34. Chen LD, et al. (2010) Intrahepatic cholangiocarcinoma and hepatocellular carcinoma: differential diagnosis with contrast-enhanced ultrasound. Eur Radiol 20(3):743–753

    Article  CAS  PubMed  Google Scholar 

  35. Leoni S, et al. (2010) The impact of vascular and nonvascular findings on the noninvasive diagnosis of small hepatocellular carcinoma based on the EASL and AASLD criteria. Am J Gastroenterol 105(3):599–609

    Article  PubMed  Google Scholar 

  36. Sherman M (2010) The radiological diagnosis of hepatocellular carcinoma. In: Am J Gastroenterol. United States. p 610–612.

  37. Ros PR, et al. (1986) Mesenchymal hamartoma of the liver: radiologic-pathologic correlation. Radiology 158(3):619–624

    Article  CAS  PubMed  Google Scholar 

  38. Kim KA, et al. (2006) Unusual mesenchymal liver tumors in adults: radiologic-pathologic correlation. AJR Am J Roentgenol 187(5):W481–W489

    Article  PubMed  Google Scholar 

  39. Lai FM, et al. (1996) Hepatic mesenchymal hamartoma: a case report and radiological findings. Singap Med J 37(2):226–228

    CAS  Google Scholar 

  40. Horton KM, et al. (1999) CT and MR imaging of benign hepatic and biliary tumors. Radiographics. doi:10.1148/radiographics.19.2.g99mr04431

    Google Scholar 

  41. Ros PR, et al. (1986) Mesenchymal hamartoma of the liver: radiologic-pathologic correlation. Radiology. doi:10.1148/radiology.158.3.3511498

    Google Scholar 

  42. Kim SH, et al. (2007) Radiological spectrum of hepatic mesenchymal hamartoma in children. Korean J Radiol 8(6):498–505

    Article  PubMed  PubMed Central  Google Scholar 

  43. Cornette J, et al. (2009) Mesenchymal hamartoma of the liver: a benign tumor with deceptive prognosis in the perinatal period. Case report and review of the literature. Fetal Diagn Ther 25(2):196–202

    Article  CAS  PubMed  Google Scholar 

  44. Anil G, Fortier M, Low Y (1001) Cystic hepatic mesenchymal hamartoma: the role of radiology in diagnosis and perioperative management. Br J Radiol 2011(84):e91–e94

    Google Scholar 

  45. Isaacs H Jr (2007) Fetal and neonatal hepatic tumors. J Pediatr Surg 42(11):1797–1803

    Article  PubMed  Google Scholar 

  46. Lall C, et al. (2015) Renal collision and composite tumors: imaging and pathophysiology. Urology 86(6):1159–1164

    Article  PubMed  Google Scholar 

  47. Lopez-Beltran A, et al. (2006) 2004 WHO classification of the renal tumors of the adults. Eur Urol 49(5):798–805

    Article  PubMed  Google Scholar 

  48. Waldert M, et al. (2010) Hybrid renal cell carcinomas containing histopathologic features of chromophobe renal cell carcinomas and oncocytomas have excellent oncologic outcomes. Eur Urol 57(4):661–665

    Article  PubMed  Google Scholar 

  49. Su D, Singer EA, Srinivasan R (2015) Molecular pathways in renal cell carcinoma: recent advances in genetics and molecular biology. Curr Opin Oncol 27(3):217–223

    Article  CAS  PubMed  Google Scholar 

  50. Mucciardi G, et al. (2015) Transitional cell carcinoma of the renal pelvis with synchronous ipsilateral papillary renal cell carcinoma: case report and review. Urol Case Rep 3(4):93–95

    Article  PubMed  PubMed Central  Google Scholar 

  51. Upton MP, et al. (2005) Histologic predictors of renal cell carcinoma response to interleukin-2-based therapy. J Immunother 28(5):488–495

    Article  CAS  PubMed  Google Scholar 

  52. Escudier B, et al. (2007) Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med 356(2):125–134

    Article  CAS  PubMed  Google Scholar 

  53. Polascik TJ, Bostwick DG, Cairns P (2002) Molecular genetics and histopathologic features of adult distal nephron tumors. Urology 60(6):941–946

    Article  PubMed  Google Scholar 

  54. Sukosd F, et al. (2003) Deletion of chromosome 3p14.2-p25 involving the VHL and FHIT genes in conventional renal cell carcinoma. Cancer Res 63(2):455–457

    PubMed  Google Scholar 

  55. Gurel S, et al. (2013) Subtypes of renal cell carcinoma: MRI and pathological features. Diagn Interv Radiol 19(4):304–311

    PubMed  Google Scholar 

  56. Sun MR, et al. (2009) Renal cell carcinoma: dynamic contrast-enhanced MR imaging for differentiation of tumor subtypes–correlation with pathologic findings. Radiology 250(3):793–802

    Article  PubMed  Google Scholar 

  57. Vargas HA, et al. (2012) Renal cortical tumors: use of multiphasic contrast-enhanced MR imaging to differentiate benign and malignant histologic subtypes. Radiology 264(3):779–788

    Article  PubMed  Google Scholar 

  58. Gordetsky J, Zarzour J (2016) Correlating preoperative imaging with histologic subtypes of renal cell carcinoma and common mimickers. Curr Urol Rep 17(7):52

    Article  PubMed  Google Scholar 

  59. Campbell N, Rosenkrantz AB, Pedrosa I (2014) MRI phenotype in renal cancer: is it clinically relevant? Top Magn Reson Imaging 23(2):95–115

    Article  PubMed  PubMed Central  Google Scholar 

  60. Davidson AJ, et al. (1993) Renal oncocytoma and carcinoma: failure of differentiation with CT. Radiology 186(3):693–696

    Article  CAS  PubMed  Google Scholar 

  61. Rosenkrantz AB, et al. (2010) MRI features of renal oncocytoma and chromophobe renal cell carcinoma. AJR Am J Roentgenol 195(6):W421–W427

    Article  PubMed  Google Scholar 

  62. Perez-Ordonez B, et al. (1997) Renal oncocytoma: a clinicopathologic study of 70 cases. Am J Surg Pathol 21(8):871–883

    Article  CAS  PubMed  Google Scholar 

  63. Harmon WJ, King BF, Lieber MM (1996) Renal oncocytoma: magnetic resonance imaging characteristics. J Urol 155(3):863–867

    Article  CAS  PubMed  Google Scholar 

  64. Rosenkrantz AB, et al. (2010) Utility of the apparent diffusion coefficient for distinguishing clear cell renal cell carcinoma of low and high nuclear grade. AJR Am J Roentgenol 195(5):W344–W351

    Article  PubMed  Google Scholar 

  65. Taouli B, et al. (2009) Renal lesions: characterization with diffusion-weighted imaging versus contrast-enhanced MR imaging. Radiology 251(2):398–407

    Article  PubMed  Google Scholar 

  66. Mugiya S, et al. (2004) Ultrasonographic features of chromophobe cell renal carcinoma. Hinyokika Kiyo 50(12):865–868

    PubMed  Google Scholar 

  67. Kondo T, et al. (2004) Spoke-wheel-like enhancement as an important imaging finding of chromophobe cell renal carcinoma: a retrospective analysis on computed tomography and magnetic resonance imaging studies. Int J Urol 11(10):817–824

    Article  PubMed  Google Scholar 

  68. Shuch B, et al. (2012) Sarcomatoid renal cell carcinoma: a comprehensive review of the biology and current treatment strategies. Oncologist 17(1):46–54

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. de Peralta-Venturina M, et al. (2001) Sarcomatoid differentiation in renal cell carcinoma: a study of 101 cases. Am J Surg Pathol 25(3):275–284

    Article  PubMed  Google Scholar 

  70. Cheville JC, et al. (2004) Sarcomatoid renal cell carcinoma: an examination of underlying histologic subtype and an analysis of associations with patient outcome. Am J Surg Pathol 28(4):435–441

    Article  PubMed  Google Scholar 

  71. Shuch B, et al. (2009) Cytoreductive nephrectomy for kidney cancer with sarcomatoid histology–is up-front resection indicated and if not, is it avoidable? J Urol 182(5):2164–2171

    Article  PubMed  PubMed Central  Google Scholar 

  72. Schieda N, et al. (2015) Diagnosis of sarcomatoid renal cell carcinoma with CT: evaluation by qualitative imaging features and texture analysis. AJR Am J Roentgenol 204(5):1013–1023

    Article  PubMed  Google Scholar 

  73. Sant GR, et al. (1984) Computed tomographic findings in renal angiomyolipoma: an histologic correlation. Urology 24(3):293–296

    Article  CAS  PubMed  Google Scholar 

  74. Kloos RT, et al. (1995) Incidentally discovered adrenal masses. Endocr Rev 16(4):460–484

    CAS  PubMed  Google Scholar 

  75. Katabathina VS, et al. (2013) Adrenal collision tumors and their mimics: multimodality imaging findings. Cancer Imaging 13(4):602–610

    Article  PubMed  PubMed Central  Google Scholar 

  76. Ctvrtlik F, et al. (2009) Differential diagnosis of incidentally detected adrenal masses revealed on routine abdominal CT. Eur J Radiol 69(2):243–252

    Article  PubMed  Google Scholar 

  77. Johnson PT, Horton KM, Fishman EK (2009) Adrenal mass imaging with multidetector CT: pathologic conditions, pearls, and pitfalls. Radiographics 29(5):1333–1351

    Article  PubMed  Google Scholar 

  78. Otal P, et al. (1999) Imaging features of uncommon adrenal masses with histopathologic correlation. Radiographics 19(3):569–581

    Article  CAS  PubMed  Google Scholar 

  79. Johnson PT, Horton KM, Fishman EK (2009) Adrenal imaging with multidetector CT: evidence-based protocol optimization and interpretative practice. Radiographics 29(5):1319–1331

    Article  PubMed  Google Scholar 

  80. Piotrowski Z, et al. (2015) Renal cell carcinoma and an incidental adrenal lesion: adrenal collision tumors. Urology 85(3):e17–e18

    Article  PubMed  Google Scholar 

  81. Reznek RH, Armstrong P (1994) The adrenal gland. Clin Endocrinol 40(5):561–576

    Article  CAS  Google Scholar 

  82. Szolar DH, Kammerhuber F (1997) Quantitative CT evaluation of adrenal gland masses: a step forward in the differentiation between adenomas and nonadenomas? Radiology 202(2):517–521

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiological Sciences, Irvine School of Medicine, University of California, 101 The City Drive South, Suite #1105, Orange, CA, 92868, USA

    Calvin T. Sung, Roozbeh Houshyar, Shreya Chatterjee, Thomas K. Lee, Paul Tung, Mohammed Helmy & Chandana Lall

  2. School of Medicine, University of California Riverside, 900 University Ave., Riverside, CA, 92521, USA

    Calvin T. Sung

  3. Department of Radiology, Washington University School of Medicine in St. Louis, 510 South Kingshighway Boulevard, St. Louis, MO, 63110, USA

    Anup Shetty

  4. Department of Radiology, Mayo Clinic, Phoenix, AZ, 85054, USA

    Christine O. Menias

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  1. Calvin T. Sung
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  2. Anup Shetty
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Correspondence to Chandana Lall.

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Sung, C.T., Shetty, A., Menias, C.O. et al. Collision and composite tumors; radiologic and pathologic correlation. Abdom Radiol 42, 2909–2926 (2017). https://doi.org/10.1007/s00261-017-1200-x

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