Difference between revisions of "Renal hybrid oncocytic/chromophobe tumour"

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Hybrid tumour of the kidney -- high mag.jpg
| Width      =
| Caption    = Hybrid oncocytic/chromophobe tumour of the kidney. [[H&E stain]].
| Synonyms  = hybrid tumour
| Micro      = features of [[renal oncocytoma]] and [[chromophobe renal cell carcinoma]] - varies by subtype
| Subtypes  = as per Hes ''et al.'': (1) [[collision tumour]]-type, (2) renal oncocytoma with scattered chromophobe cells-type, (3) large eosinophilic cells with intracytoplasmic vacuoles-type
| LMDDx      = [[renal oncocytoma]], [[chromophobe renal cell carcinoma]], [[renal cell carcinoma, unclassified]], [[SDH-deficient renal cell carcinoma]], other [[renal tumours with eosinophilic cytoplasm]]
| Stains    = Hale's colloidal iron +ve
| IHC        = CD117 +ve, CK7 +ve (variable)
| EM        =
| Molecular  = no features of [[ChRCC]]
| IF        =
| Gross      =
| Grossing  = [[partial nephrectomy grossing]], [[total nephrectomy for tumour grossing]]
| Site      = [[kidney]] - see ''[[kidney tumours]]''
| Assdx      =
| Syndromes  = [[Birt–Hogg–Dubé syndrome]]
| Clinicalhx = renal mass
| Signs      =
| Symptoms  =
| Prevalence = very rare
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = good on very limited data
| Other      =
| ClinDDx    =
| Tx        = surgical excision
}}
'''Renal hybrid oncocytic/chromophobe tumour''', also '''hybrid oncocytic/chromophobe tumour''' (abbreviated '''HOCT''') and '''hybrid tumour''', is a rare [[kidney tumour]] with features of [[chromophobe renal cell carcinoma]] and [[renal oncocytoma]].<ref name=pmid23740406>{{Cite journal  | last1 = Hes | first1 = O. | last2 = Petersson | first2 = F. | last3 = Kuroda | first3 = N. | last4 = Hora | first4 = M. | last5 = Michal | first5 = M. | title = Renal hybrid oncocytic/chromophobe tumors - a review. | journal = Histol Histopathol | volume = 28 | issue = 10 | pages = 1257-64 | month = Oct | year = 2013 | doi =  | PMID = 23740406 }}</ref>
'''Renal hybrid oncocytic/chromophobe tumour''', also '''hybrid oncocytic/chromophobe tumour''' (abbreviated '''HOCT''') and '''hybrid tumour''', is a rare [[kidney tumour]] with features of [[chromophobe renal cell carcinoma]] and [[renal oncocytoma]].<ref name=pmid23740406>{{Cite journal  | last1 = Hes | first1 = O. | last2 = Petersson | first2 = F. | last3 = Kuroda | first3 = N. | last4 = Hora | first4 = M. | last5 = Michal | first5 = M. | title = Renal hybrid oncocytic/chromophobe tumors - a review. | journal = Histol Histopathol | volume = 28 | issue = 10 | pages = 1257-64 | month = Oct | year = 2013 | doi =  | PMID = 23740406 }}</ref>


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*Sporadic.
*Sporadic.
*[[Birt–Hogg–Dubé syndrome]].
*[[Birt–Hogg–Dubé syndrome]].
*Renal oncocytosis.
*[[Renal oncocytosis]].


==Microscopic==
==Microscopic==
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#* Different fields viewed in isolation would be compatible with the different diagnoses. Tumour component do not intermingle.
#* Different fields viewed in isolation would be compatible with the different diagnoses. Tumour component do not intermingle.
# Renal oncocytoma with scattered chromophobe cells.
# Renal oncocytoma with scattered chromophobe cells.
# Large eosinophilic cell with intracytoplasmic vacuoles.
# Large eosinophilic cell with intracytoplasmic vacuoles - this is the evolving entity ''[[eosinophilic vacuolated tumour]]''.
#* Prominent nucleoli ([[ISUP nucleolar grade]] 3).
#* Perinuclear halos (occasional).
#* Nested architecture.


DDx:
DDx:
*[[Renal oncocytoma]] - may have limited chromophobe-like areas (<=5% of tumour).<ref name=pmid21166703>{{Cite journal  | last1 = Trpkov | first1 = K. | last2 = Yilmaz | first2 = A. | last3 = Uzer | first3 = D. | last4 = Dishongh | first4 = KM. | last5 = Quick | first5 = CM. | last6 = Bismar | first6 = TA. | last7 = Gokden | first7 = N. | title = Renal oncocytoma revisited: a clinicopathological study of 109 cases with emphasis on problematic diagnostic features. | journal = Histopathology | volume = 57 | issue = 6 | pages = 893-906 | month = Dec | year = 2010 | doi = 10.1111/j.1365-2559.2010.03726.x | PMID = 21166703 }}</ref>
*[[Renal oncocytoma]] - may have limited chromophobe-like areas (<=5% of tumour).<ref name=pmid21166703>{{Cite journal  | last1 = Trpkov | first1 = K. | last2 = Yilmaz | first2 = A. | last3 = Uzer | first3 = D. | last4 = Dishongh | first4 = KM. | last5 = Quick | first5 = CM. | last6 = Bismar | first6 = TA. | last7 = Gokden | first7 = N. | title = Renal oncocytoma revisited: a clinicopathological study of 109 cases with emphasis on problematic diagnostic features. | journal = Histopathology | volume = 57 | issue = 6 | pages = 893-906 | month = Dec | year = 2010 | doi = 10.1111/j.1365-2559.2010.03726.x | PMID = 21166703 }}</ref>
*[[Chromophobe renal cell carcinoma]], eosinophilic variant.
*[[Chromophobe renal cell carcinoma]], eosinophilic variant.
*[[SDH-deficient renal cell carcinoma]] - lower nuclear grade, not nested.
*[[Eosinophilic vacuolated tumour]] - evolving entity.
*Other [[renal tumours with eosinophilic cytoplasm]].
*Other [[renal tumours with eosinophilic cytoplasm]].
*[[Renal cell carcinoma, unclassified]].
*[[Renal cell carcinoma, unclassified]].
===Images===
====Case 1====
<gallery>
Image: Hybrid tumour of the kidney -- low mag.jpg | HOCT - low mag. (WC)
Image: Hybrid tumour of the kidney -- intermed mag.jpg | HOCT - intermed. mag. (WC)
Image: Hybrid tumour of the kidney -- high mag.jpg | HOCT - high mag. (WC)
</gallery>
====Case 2====
<gallery>
Image: Renal hybrid tumour - 2 -- intermed mag.jpg | HOCT - intermed. mag. (WC)
Image: Renal hybrid tumour - 2 -- high mag.jpg | HOCT - high mag. (WC)
Image: Renal hybrid tumour - 2 -- very high mag.jpg | HOCT - very high mag. (WC)
Image: Renal hybrid tumour - nests - 2 -- intermed mag.jpg | HOCT - intermed. mag. (WC)
Image: Renal hybrid tumour - nests - 2 -- high mag.jpg | HOCT - high mag. (WC)
Image: Renal hybrid tumour - nests - 2 -- very high mag.jpg | HOCT - very high mag. (WC)
</gallery>


==Stains==
==Stains==
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Features:
Features:
*CD117 +ve (practically definitional<ref name=pmid23740406/>).
*CD117 +ve (practically definitional<ref name=pmid23740406/>).
*CK7 +ve - may be variable.<ref name=pmid23708994/>
*CK7 +ve - often variable/patchy (oncocytoma-like).<ref name=pmid23708994/>
 
Others:
*Vimentin -ve.
*EMA +ve.
*CD10 +ve.
*PAX8 +ve.


==Molecular==
==Molecular==
*No features characteristic of [[chromophobe RCC]] on array-CGH analysis.<ref name=pmid23708994/>
*No features characteristic of [[chromophobe RCC]] on array-CGH analysis.<ref name=pmid23708994/>
==Sign out==
<pre>
Left Kidney, Partial Nephrectomy:
- Renal tumour with eosinophilic cytoplasm of undetermined malignant potential
  in keeping with the so called "hybrid oncocytic/chromophobe tumour", see comment.
-- Resection margins clear.
-- Tumour limited to kidney.
Comment:
The tumour may be seen in the context of Birt–Hogg–Dubé syndrome.
</pre>


==See also==
==See also==
*[[Renal tumours with eosinophilic cytoplasm]].
*[[Renal tumours with eosinophilic cytoplasm]].
*[[Renal oncocytoma]].
*[[Renal oncocytoma]].
*[[High-grade oncocytic renal tumour]].


==References==
==References==

Latest revision as of 15:12, 20 March 2024

Renal hybrid oncocytic/chromophobe tumour
Diagnosis in short

Hybrid oncocytic/chromophobe tumour of the kidney. H&E stain.
Synonyms hybrid tumour
LM features of renal oncocytoma and chromophobe renal cell carcinoma - varies by subtype
Subtypes as per Hes et al.: (1) collision tumour-type, (2) renal oncocytoma with scattered chromophobe cells-type, (3) large eosinophilic cells with intracytoplasmic vacuoles-type
LM DDx renal oncocytoma, chromophobe renal cell carcinoma, renal cell carcinoma, unclassified, SDH-deficient renal cell carcinoma, other renal tumours with eosinophilic cytoplasm
Stains Hale's colloidal iron +ve
IHC CD117 +ve, CK7 +ve (variable)
Molecular no features of ChRCC
Grossing notes partial nephrectomy grossing, total nephrectomy for tumour grossing
Site kidney - see kidney tumours
Syndromes Birt–Hogg–Dubé syndrome
Clinical history renal mass
Prevalence very rare
Prognosis good on very limited data
Treatment surgical excision

Renal hybrid oncocytic/chromophobe tumour, also hybrid oncocytic/chromophobe tumour (abbreviated HOCT) and hybrid tumour, is a rare kidney tumour with features of chromophobe renal cell carcinoma and renal oncocytoma.[1]

General

  • Rare.
  • Molecular heterogeneous group[1] - may represent several different entities.
  • Prognosis good - based on one series of 11 cases.[2]

May be seen in several contexts:[1]

Microscopic

Three morphologic patterns as per Hes et al.:[1]

  1. Renal oncocytoma and chromophobe renal cell carcinoma collision tumour.
    • Different fields viewed in isolation would be compatible with the different diagnoses. Tumour component do not intermingle.
  2. Renal oncocytoma with scattered chromophobe cells.
  3. Large eosinophilic cell with intracytoplasmic vacuoles - this is the evolving entity eosinophilic vacuolated tumour.

DDx:

Images

Case 1

  • HOCT - low mag. (WC)

  • HOCT - intermed. mag. (WC)

  • HOCT - high mag. (WC)

Case 2

  • HOCT - intermed. mag. (WC)

  • HOCT - high mag. (WC)

  • HOCT - very high mag. (WC)

  • HOCT - intermed. mag. (WC)

  • HOCT - high mag. (WC)

  • HOCT - very high mag. (WC)

Stains

Features:[2]

IHC

Features:

  • CD117 +ve (practically definitional[1]).
  • CK7 +ve - often variable/patchy (oncocytoma-like).[2]

Others:

  • Vimentin -ve.
  • EMA +ve.
  • CD10 +ve.
  • PAX8 +ve.

Molecular

Sign out

Left Kidney, Partial Nephrectomy:
- Renal tumour with eosinophilic cytoplasm of undetermined malignant potential 
  in keeping with the so called "hybrid oncocytic/chromophobe tumour", see comment. 
-- Resection margins clear.
-- Tumour limited to kidney.

Comment:
The tumour may be seen in the context of Birt–Hogg–Dubé syndrome.

See also

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Hes, O.; Petersson, F.; Kuroda, N.; Hora, M.; Michal, M. (Oct 2013). "Renal hybrid oncocytic/chromophobe tumors - a review.". Histol Histopathol 28 (10): 1257-64. PMID 23740406.
  2. ↑ 2.0 2.1 2.2 2.3 Poté, N.; Vieillefond, A.; Couturier, J.; Arrufat, S.; Metzger, I.; Delongchamps, NB.; Camparo, P.; Mège-Lechevallier, F. et al. (Jun 2013). "Hybrid oncocytic/chromophobe renal cell tumours do not display genomic features of chromophobe renal cell carcinomas.". Virchows Arch 462 (6): 633-8. doi:10.1007/s00428-013-1422-4. PMID 23708994.
  3. ↑ Trpkov, K.; Yilmaz, A.; Uzer, D.; Dishongh, KM.; Quick, CM.; Bismar, TA.; Gokden, N. (Dec 2010). "Renal oncocytoma revisited: a clinicopathological study of 109 cases with emphasis on problematic diagnostic features.". Histopathology 57 (6): 893-906. doi:10.1111/j.1365-2559.2010.03726.x. PMID 21166703.
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