Warthin-like papillary renal cell carcinoma: Clinicopathologic, morphologic, immunohistochemical and molecular genetic analysis of 11 cases.
Oncocytic papillary renal cell carcinoma (PRCC) is a distinct subtype of PRCC, listed as a possible new variant of PRCC in the 2016 WHO classification. It is composed of papillae aligned by large single-layered eosinophilic cells showing linearly arranged oncocytoma-like nuclei. We analyzed clinicopathologic, morphologic, immunohistochemical and molecular-genetic characteristics of 11 oncocytic PRCCs with prominent tumor lymphocytic infiltrate, morphologically resembling Warthin's tumor. The patients were predominantly males (8/11, 73%), with an average age of 59years (range 14-76), and a mean tumor size of 7cm (range 1-22cm). Tumors had the features of oncocytic PRCCs with focal pseudostratification in 8/11 cases and showed dense stromal inflammatory infiltration in all cases. Papillary growth pattern was predominant, comprising more than 60% of tumor volume. Tubular and solid components were present in 5 and 3 cases, respectively. Uniform immunohistochemical positivity was found for AMACR, PAX-8, MIA, vimentin, and OSCAR. Tumors were mostly negative for carboanhydrase 9, CD117, CK20, and TTF-1. Immunohistochemical stains for DNA mismatch repair proteins MLH1 and PMS2 were retained in all cases, while MSH2 and MSH6 were negative in 1 case. Tumor infiltrating lymphocytes (TILs) consisted of both B and T cells. Chromosomal copy number variation analysis showed great variability in 5 cases, ranging from a loss of one single chromosome to complex genome rearrangements. Only one case showed gains of chromosomes 7 and 17, among other aberrations. In 4 cases no numerical imbalance was found. Follow up data was available for 9 patients (median 47.6months, range 1-132). In 6 patients no lethal progression was noted, while 3 died of disease. In conclusion, Warthin-like PRCC is morphologically very close to oncocytic PRCC, from which it differs by the presence of dense lymphoid stroma. Chromosomal numerical aberration pattern of these tumors is variable; only one case showed gains of chromosomes 7 and 17. Warthin-like PRCC is a potentially aggressive tumor since a lethal outcome was recorded in 3/9 cases.
Department of Pathology, University of Sarajevo Clinical Center, Sarajevo, Bosnia and Herzegovina.
Faruk
F
Skenderi
"Ljudevit Jurak" Pathology Department, Clinical Hospital Center "Sestre milosrdnice", Zagreb, Croatia.
Monika
M
Ulamec
Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic.
Tomas
T
Vanecek
Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic.
Petr
P
Martinek
Department of Pathology, University of British Columbia, Royal Columbian Hospital, Vancouver, BC, Canada.
Reza
R
Alaghehbandan
Department of Pathology, Bellvitge University Hospital, Barcelona, Spain.
Maria Pane
MP
Foix
Department of Pathology, Masaryk's Oncologic Institute, University Hospital Brno, Czech Republic.
Iva
I
Babankova
Department of Pathology, Instituto Nacional de Cancerologia, Mexico City, Mexico.
Delia Perez
DP
Montiel
Department of Pathology, Centro Medico, Mexico City, Mexico.
Isabel
I
Alvarado-Cabrero
Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic.
Marian
M
Svajdler
Department of Radiation Oncology, Oncology Institute, Kosice, Slovakia.
Pavol
P
Dubinský
Department Pathology, Regional Hospital Jindrichuv Hradec, Czech Republic.
Dana
D
Cempirkova
Department Pathology, Regional Hospital Most, Czech Republic.
Michal
M
Pavlovsky
Department of Pathology, University of Sarajevo Clinical Center, Sarajevo, Bosnia and Herzegovina.
Semir
S
Vranic
Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic.
Ondrej
O
Daum
Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic.
Ondrej
O
Ondic
Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic.
Kristyna
K
Pivovarcikova
Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic.
Kvetoslava
K
Michalova
Department of Urology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic.
Milan
M
Hora
Biopticka Laboratory, Pilsen, Czech Republic.
Pavla
P
Rotterova
Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic.
Adela
A
Stehlikova
Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic.
Martin
M
Dusek
Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic.
Michal
M
Michal
Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic. Electronic address: hes@medima.cz.
Ondrej
O
Hes
D018249:Adenoma, Oxyphilic / Q000235:genetics / Q000473:pathology; D000293:Adolescent; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D002291:Carcinoma, Papillary / Q000235:genetics / Q000473:pathology*; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000235:genetics* / Q000473:pathology*; D056915:DNA Copy Number Variations / Q000235:genetics; D005260:Female; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing / Q000379:methods; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D017404:In Situ Hybridization, Fluorescence / Q000379:methods; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000235:genetics* / Q000473:pathology*; D008297:Male; D008875:Middle Aged
D014408:Biomarkers, Tumor
Chromosomal aberration pattern; Immunohistochemistry; Kidney; Lymphoid stroma; Oncocytic papillary renal cell carcinoma; Warthin's tumor; Warthin-like