Mucinous tubular and spindle cell carcinoma of kidney is probably a variant of papillary renal cell carcinoma with spindle cell features

Shen, Steven S.; Ro, Jae Y.; Tamboli, Pheroze; Truong, Luan D.; Zhai, Qihui; Jung, Soo-Jin; Tibbs, Rita G.; Ordonez, Nelson G.; Ayala, Alberto G.

doi:10.1016/j.anndiagpath.2006.09.005

« Previous Next »Annals of Diagnostic Pathology
Volume 11, Issue 1 , Pages 13-21, February 2007

Mucinous tubular and spindle cell carcinoma of kidney is probably a variant of papillary renal cell carcinoma with spindle cell features

Steven S. Shen, MD, PhD
- Department of Pathology, The Methodist Hospital and Research Institute, Houston, TX 77030, USA
- Department of Pathology, Weill Medical College of Cornell University, Houston, TX 77030, USA
- Corresponding author. Department of Pathology, The Methodist Hospital and Research Institute, and Weill Medical College of Cornell University, Houston, TX 77030, USA. Tel.: +1 713 441 6987; fax: +1 713 793 1603.
Jae Y. Ro, MD, PhD
- Department of Pathology, The Methodist Hospital and Research Institute, Houston, TX 77030, USA
- Department of Pathology, Weill Medical College of Cornell University, Houston, TX 77030, USA
Pheroze Tamboli, MD
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
Luan D. Truong, MD
- Department of Pathology, The Methodist Hospital and Research Institute, Houston, TX 77030, USA
- Department of Pathology, Weill Medical College of Cornell University, Houston, TX 77030, USA
Qihui Zhai, MD
- Department of Pathology, The Methodist Hospital and Research Institute, Houston, TX 77030, USA
- Department of Pathology, Weill Medical College of Cornell University, Houston, TX 77030, USA
Soo-Jin Jung, MD
- Department of Pathology, Inje University College of Medicine, Busan, Korea
Rita G. Tibbs, MD
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
Nelson G. Ordonez, MD
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
Alberto G. Ayala, MD
- Department of Pathology, The Methodist Hospital and Research Institute, Houston, TX 77030, USA
- Department of Pathology, Weill Medical College of Cornell University, Houston, TX 77030, USA

Abstract

Mucinous tubular and spindle cell carcinoma is a rare and newly described type of renal cell carcinoma (RCC) with a relatively indolent behavior. However, its histogenetic origin or line of differentiation remains unclear. Twelve cases of mucinous tubular and spindle cell carcinoma were identified and retrieved from the files of 3 institutions. Detailed morphological features, as well as their immunohistochemical profile established with markers of proximal renal tubules (RCC marker antigen, CD15, and α-methylacyl-CoA racemase) and of distal renal tubules (kidney-specific cadherin and cytokeratin 7), were studied. The age range of the patients was 35 to 73 years with a median of 56 years. The male to female ratio was 1:3. All of the patients were alive with follow-up between 4 and 38 months. All the tumors were confined to the kidney with a mean tumor size of 6.9 cm (range, 1.8-17 cm). The tumors were composed of variable proportions of tubular and spindle cell areas with focal to prominent mucinous or myxoid stroma. Foamy macrophages were seen in 10 cases and were prominent in 4 cases. A focal compressed tubulopapillary growth pattern was seen in 10 cases. The tumor cells were uniformly cuboidal with ovoid to round nuclei and inconspicuous nucleoli (Furhman nuclear grade 3 in 6 cases). Focal necrosis was seen in 3 cases. Immunostains showed that tumors were positive for RCC marker antigen (11/12), α-methylacyl-CoA racemase (11/12), CD15 (8/12), CD10 (2/12), kidney-specific cadherin (1/12), and cytokeratin 7 (11/12). Its morphological features as well as a strong preferential expression of proximal tubule markers suggest that this tumor is a type of RCC with proximal tubular differentiation, which appears closely related to or represents a morphological variant of papillary RCC.

Keywords: Renal cell carcinoma, Mucinous tubular and spindle cell carcinoma, Papillary renal cell carcinoma, Immunohistochemical markers