Cytopathologic features of clear cell papillary renal cell carcinoma: A recently described variant to be considered in the differential diagnosis of clear cell renal epithelial neoplasms.
一个需要与肾脏透明细胞癌鉴别的新亚型—乳头状透明细胞肾癌的细胞病理学特征
Abstract
Clear cell papillary renal cell carcinoma (CCPRCC) is a distinctive variant of renal cell carcinoma that has been formally adopted by the new Word Health Organization classification. An emerging consensus has documented its particularly indolent course and emphasized its separation from conventional clear cell renal cell carcinoma (CCRCC) for treatment planning. CCPRCC features in cytologic preparations have not been studied.
This study retrospectively identified a series of CCPRCCs that had cytology samples before the histopathologic diagnosis and reviewed corresponding cytologic materials, including aspirate smears, cell block materials, touch preparations, and core biopsy samples. The identified clinicopathologic and cytologic features were tabulated.
Five cases of CCPRCC with cytopathologic materials were identified from 4 women and 1 man aged 34 to 70 years (2 with end-stage renal disease), and the sampled lesions were 1.8 to 11.0 cm. The original cytopathologic diagnostic considerations ranged from atypical cyst-lining cells to angiomyolipoma to CCRCC and CCPRCC. The aspirate and touch preparation samples showed scant cellularity with scattered sheets and clusters of small, bland epithelial cells (much smaller than admixed renal tubular cells) with optically clear cytoplasm (lacking conspicuous cytoplasmic vacuolization) and small, grade 1 nuclei. The cell block materials and the core biopsy samples showed cyst walls with prominent myomatous stroma lined by low-grade epithelium with optically clear cytoplasm, inverse nuclear polarization, and a characteristic cytokeratin 7-positive/carbonic anhydrase IX-positive phenotype. Three cases were treated with resection, 1 case was treated with ablation, and 1 case was under surveillance.
CCPRCC demonstrates recognizable cytomorphologic features and merits consideration in the cytologic differential diagnosis for kidney lesions. With increasing experience, more conservative management may be contemplated. Cancer Cytopathol 2016;124:565-72. © 2016 American Cancer Society.
This study retrospectively identified a series of CCPRCCs that had cytology samples before the histopathologic diagnosis and reviewed corresponding cytologic materials, including aspirate smears, cell block materials, touch preparations, and core biopsy samples. The identified clinicopathologic and cytologic features were tabulated.
Five cases of CCPRCC with cytopathologic materials were identified from 4 women and 1 man aged 34 to 70 years (2 with end-stage renal disease), and the sampled lesions were 1.8 to 11.0 cm. The original cytopathologic diagnostic considerations ranged from atypical cyst-lining cells to angiomyolipoma to CCRCC and CCPRCC. The aspirate and touch preparation samples showed scant cellularity with scattered sheets and clusters of small, bland epithelial cells (much smaller than admixed renal tubular cells) with optically clear cytoplasm (lacking conspicuous cytoplasmic vacuolization) and small, grade 1 nuclei. The cell block materials and the core biopsy samples showed cyst walls with prominent myomatous stroma lined by low-grade epithelium with optically clear cytoplasm, inverse nuclear polarization, and a characteristic cytokeratin 7-positive/carbonic anhydrase IX-positive phenotype. Three cases were treated with resection, 1 case was treated with ablation, and 1 case was under surveillance.
CCPRCC demonstrates recognizable cytomorphologic features and merits consideration in the cytologic differential diagnosis for kidney lesions. With increasing experience, more conservative management may be contemplated. Cancer Cytopathol 2016;124:565-72. © 2016 American Cancer Society.
摘要
乳头状透明细胞肾癌(CCPRCC)是肾细胞癌的一个独特亚型，已被WHO新分类采纳。现在形成的共识是：已证实CCPRCC呈现极为惰性的过程，并强调其治疗方案有别于经典的肾脏透明细胞癌。CCPRCC细胞学制片的特点尚未研究过。
本研究回顾性地对一系列在组织学诊断之前获取细胞学标本的CCPRCC进行研究，包括穿刺涂片、细胞块、细胞印片和芯针活检标本，将临床病理诊断和相应的细胞学特征制表。5例CCPRCC细胞病理学标本，女性4例，男性1例，年龄34岁到70岁（2例伴有终末期肾病）,病变样本长度为1.8-11.0厘米。原细胞病理诊断考虑的范围包括非典型囊壁内衬细胞、血管平滑肌脂肪瘤、CCRCC 和CCPRCC。穿刺组织及细胞印片显示少量细胞散在分布和簇状的小而温和的上皮细胞(远小于混入其中的肾小管细胞)，胞浆透亮(缺乏明显的胞浆空泡)和，核小、1级。细胞块标本和芯针活检样本可见囊肿壁间质呈显著的肌性特征，囊壁内衬低级别的上皮细胞，其胞浆透明,核极性倒置,呈特有的细胞角蛋白7 /碳酸酐酶IX阳性表型。3例做了切除术,1例消融治疗,1例在随访中。
CCPRCC具有可识别的细胞形态特征，在肾脏疾病的细胞学鉴别诊断中值得考虑。随着经验的增加,对其会采取更为保守的处理。
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