Diagnostic criteria for oncocytic renal neoplasms: a survey of urologic pathologists.
Renal oncocytoma and chromophobe renal cell carcinoma have been long recognized as distinct tumors; however, it remains unknown if uniform diagnostic criteria are used to distinguish these tumor types in practice. A survey was distributed to urologic pathologists regarding oncocytic tumors. Responses were received from 17 of 26 invitees. Histologically, more than 1 mitotic figure was regarded as most worrisome (n=10) or incompatible (n=6) with oncocytoma diagnosis. Interpretation of focal nuclear wrinkling, focal perinuclear clearing, and multinucleation depended on extent and did not necessarily exclude oncocytoma if minor. Staining techniques most commonly used included the following: cytokeratin 7 (94%), KIT (71%), vimentin (65%), colloidal iron (59%), CD10 (53%), and AMACR (41%). Rare cytokeratin 7-positive cells (≤5%) were regarded as most supportive of oncocytoma, although an extent excluding oncocytoma was not universal. Multiple chromosomal losses were most strongly supportive for chromophobe renal cell carcinoma diagnosis (65%). Less certainty was reported for chromosomal gain or a single loss. For tumors with mixed or inconclusive features, many participants use an intermediate diagnostic category (82%) that does not label the tumor as unequivocally benign or malignant, typically "oncocytic neoplasm" or "tumor" with comment. The term "hybrid tumor" was used variably in several scenarios. A slight majority (65%) report outright diagnosis of oncocytoma in needle biopsies. The morphologic, immunohistochemical, and genetic characteristics that define oncocytic renal tumors remain incompletely understood. Further studies correlating genetics, behavior, and histology are needed to define which tumors truly warrant classification as carcinomas for patient counseling and follow-up strategies.
Department of Pathology and Laboratory Medicine, Detroit, MI, 48202, United States; Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, 48202, United States; Department of Pathology, Wayne State University School of Medicine, Detroit, MI, 48202, United States. Electronic address: seanwill@temple.edu.
Sean R
SR
Williamson
Department of Pathology and Laboratory Medicine, Detroit, MI, 48202, United States.
Ramya
R
Gadde
Department of Pathology and Laboratory Medicine, Calgary Laboratory Service and University of Calgary, Calgary, Alberta, T2V 1P9, Canada.
Kiril
K
Trpkov
Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, United States.
Michelle S
MS
Hirsch
Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, L5M 2N1, Canada.
John R
JR
Srigley
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, United States.
Victor E
VE
Reuter
Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, IN, 46202, United States.
Liang
L
Cheng
Department of Pathology, University of Michigan School of Medicine, Ann Arbor, MI, 48109, United States.
L Priya
LP
Kunju
Vattikutti Urology Institute, Henry Ford Health System, Detroit, MI, 48202, USA.
Ravi
R
Barod
Vattikutti Urology Institute, Henry Ford Health System, Detroit, MI, 48202, USA.
Craig G
CG
Rogers
Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago - Wellington, Wellington, 6242, New Zealand.
Brett
B
Delahunt
Department of Pathology, Charles University in Prague, Faculty of Medicine in Plzeň, Pilsen, 304 60, Czech Republic.
Ondrej
O
Hes
Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, IN, 46202, United States.
John N
JN
Eble
Department of Pathology, New York University Medical Center, New York, NY, 10016, United States.
Ming
M
Zhou
Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
Jesse K
JK
McKenney
Department of Pathology and Diagnostics, University of Verona, Verona, 37134, Italy; Department of Pathology, Pederzoli Hospital, Peschiera del Garda, 37014, Italy.
Guido
G
Martignoni
Department of Cellular and Molecular Pathology, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, United Kingdom.
Stewart
S
Fleming
Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, IN, 46202, United States.
David J
DJ
Grignon
Department of Pathology, University Hospital Zurich, Zurich, CH-8091, Switzerland.
Holger
H
Moch
Department of Pathology and Laboratory Medicine, Detroit, MI, 48202, United States; Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, 48202, United States.
Nilesh S
NS
Gupta
D018249:Adenoma, Oxyphilic / Q000737:chemistry / Q000235:genetics / Q000473:pathology*; D014408:Biomarkers, Tumor / Q000032:analysis / Q000235:genetics; D001706:Biopsy; D002292:Carcinoma, Renal Cell / Q000737:chemistry / Q000235:genetics / Q000473:pathology*; D049109:Cell Proliferation; D003937:Diagnosis, Differential; D019538:Health Care Surveys; D006801:Humans; D007150:Immunohistochemistry; D053552:Keratin-7 / Q000032:analysis; D007680:Kidney Neoplasms / Q000737:chemistry / Q000235:genetics / Q000473:pathology*; D008940:Mitotic Index; D025202:Molecular Diagnostic Techniques; D000072142:Pathologists; D011237:Predictive Value of Tests; D011379:Prognosis; D000072178:Urologists
D014408:Biomarkers, Tumor; C507497:KRT7 protein, human; D053552:Keratin-7
Chromophobe renal cell carcinoma; Diagnostic criteria; Hybrid tumor; Immunohistochemistry; Oncocytoma; Tumor classification