27
Kidneys, Adrenals, and Retroperitoneum
Fig. 27.22 (A) Papillary renal cell carcinoma, type 2, demonstrating higher grade, larger nuclei with prominent nucleoli (arrow). (B and C) Sheets of
type 2 cells with pink intercellular basement membrane material (Papanicolaou stain x LP). (D) Fluorescence in situ hybridization (FISH) shows trisomy of
chromosomes 3 (red), 7 (green), and 17 (aqua) (Uro Vysion Vysis) (FISH x OI).
Key features of mucinous tubular and spindle cell
carcinoma of the kidney
• Rare b u t d is tin c t sub typ e o f R C C w ith a b e tte r p rog n o sis
th a n o th e r types o f RCC;
• C o m p o se d o f c u b o id a l a nd sp in d le cells arranged as
tu b u le s and sheets set in a m y x o id o r m u c in o u s
b a ckg rou nd ; and
• P o sitive fo r C K -7, C K -19, v im e n tin , C D 10 , R C C M a,
A M A C R , and C D 1 5 .
Sarcomatoid Renal Cell Carcinoma
Sarcom atoid RCC is a rare, h ig h ly aggressive, and h ig h ly p ro-
life ra tive neoplasm ,92 counting fo r s lig h tly m ore th a n 1% o f
renal parenchym al tu m o rs. To q u a lify fo r in c lu sio n in this
category, b y h isto lo g y a recognizable RCC c om p onent as w e ll
as a d efinite sarcom atoid c om p onent m ust be present. The tw o
com ponents m ay abut d irectly o n each o th e r o r blend together.
Three m orp h olog ic appearances o f the sarcom atoid com po-
n e n t are described: m a lig n a n t fib rous h istio c yto m a (M F H ),
fibrosarcom a, and unclassified sarcoma. In the 42 patients
reported b y Ro and coworkers,93 clinicop atholog ic stage was a
Fig. 27.23 (A) Papillary renal cell carcinoma, type 2, showing large
irregular nuclei, prominent nucleoli, and coarse chromatin (Papanicolaou x MP).
(C) Fluorescence in situ hybridization demonstrates monosomy 17, shown by a
single blue signal (arrows) in two cells (UroVysion x OI).
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