Yanxia Jiang

Clinicopathological, genetic, ultrastructural characterizations and prognostic factors of papillary renal cell carcinoma: New diagnostic and prognostic information

Papillary renal cell carcinoma (PRCC) includes two different morphological subtypes. The differences of genetics and ultrastructure of the two subtypes have been rarely reported. Also, new biomarkers related to the diagnosis and prognosis of PRCC have still not been well elucidated. Immunohistochemistry, fluorescence in situ hybridization (FISH) and transmission electron microscopy were used systematically to determine the characteristics of 56 cases of PRCC and to reveal new diagnostic and prognostic information. Type 1 PRCC presented higher expression rates of EMA and CK7, whereas type 2 presented a higher expression rate of CD10. New immunohistochemical markers, including: p504s, PAX-2, PAX-8 and CA-IX showed extensive immunostaining in PRCC. We first revealed a distinct immunostaining pattern of CA-IX, which was located in multiple foci in PRCC. All tumors had at least one chromosomal aberration including loss of Y, gains of 7 or 17. Gain of chromosome 17 was common in type 1; losses of chromosome 18, 11 and 8 appeared in type 2. Ultrastructurally, glycogen granules and secondary lysosomes were seen in type 1, mitochondria and smooth endoplasmic reticulum were scattered in type 2. Tumor subtype, nuclear grade, TNM stage, clear cell renal cell carcinoma (CCRCC) component and sarcomatoid elements, metastasis, CAIX expression, losses of chromosome 18 and 8 were related to poor outcome of PRCC. We conclude that the two subtypes of PRCC originate from different renal cells, and arise from partially common genetic pathways. EMA, CK7, CD10, p504s, PAX-2, PAX-8 and CA-IX are helpful markers in the differential diagnosis of PRCC. CA-IX expression, losses of chromosome 18 and 8 are new prognostic factors of PRCC.

Primary pleomorphic malignant fibrous histiocytoma of the heart.

Primary pleomorphic malignant fibrous histiocytoma of the heart is rare. The present study was performed to study the clinical and pathological features of the disease. We describe two rare cases of primary cardiac malignant fibrous histiocytoma and review the published individual data of the patients. Both patients complained of dyspnea, and underwent palliative tumor resection. However, they died several months after surgery. A thorough literature review with clinical presentations, diagnostic features, treatment, and outcomes was done. We have for the first time analyzed the factors related to the survival of malignant fibrous histiocytoma. It is usually difficult to make an appropriate preoperative diagnosis. Despite complete surgical resection and aggressive chemotherapy and radiotherapy, the prognosis is still poor.

Pulmonary mixed squamous cell and glandular papilloma mimicking adenocarcinoma: a case study and literature review

Mixed squamous cell and glandular papilloma of the lung is an extremely rare benign neoplasm. Here we present another case of mixed squamous cell and glandular papilloma in a 64-year-old female nonsmoker. Histologically, the tumor was composed of mainly papillary structures covered with squamous, glandular and transitional epithelium. Some glandular structures extending into adjacent bronchiolar and alveolar spaces with mucus were similar to adenocarcinoma. Immunohistochemical analysis showed the different kinds of epithelia had similar immunophenotype. The different components were positive for cytokeratin (CK)7, CK19, CAM5.2, CK5/6, CK34βE12, and TTF-1, but negative for CK20. The transitional morphology and immunohistochemistry indicate the different components likely come from a same kind of progenitor in the bronchiolar wall.

Oncocytic papillary renal cell carcinoma: A clinicopathological and genetic analysis and indolent clinical course in 14 cases.

A sort of PRCC with distinct eosinophilic cytoplasm named Oncocytic Papillary Renal Cell Carcinoma (OPRCC) has been increasingly attracting the attention of researchers recently. However, owing to the rarity of OPRCC, the clinicopathological and genetic features of the tumor have still not been well elucidated and whether it should be regarded as an independent subtype of PRCC remains controversial. Herein, a cohort of 14 OPRCCs was studied with the aim of revealing the distinct clinicopathological features, facilitating the classification and correct diagnosis of OPRCC. Men and women each accounted for a half of the cohort with the median age of 64 years old. The majority of patients (9/14) were identified by medical examination and the remaining presented with macroscopic haematuria or lumbar pain. Grossly, tumors were well demarcated and varied from 1.5 to 9cm in diameter. Microscopically, typical OPRCC possessed fine papillary structures with delicate fibrovascular cores, lined with a single layer cell with large, deeply eosinophilic granular cytoplasm and round or polygonal-shaped nucleus exhibiting low nuclear grade in 10 cases (WHO/ISUP grade I-II). Most cases (12/14) possessed hemosiderin-laden and foam-like cells. Focal necrosis presented in 5 cases. Furthermore, solid oncocytoma-like areas appeared in 5 cases and focal sarcomatoid differentiation was identified in 1 case. Immunohistochemically, the majority of tumors presented high expression rates of alpha-methylacylCoA racemase (AMACR), CD10 and vimentin, which were similar to type 2 PRCC. The immune markers including cytokeratin-7 (CK7), KSP-cadherin and EMA exhibited variable positive immunostaining. Genetically, FISH analysis demonstrated trisomy of chromosome 7 in 7 OPRCCs and trisomy of chromosome 17 in 6 OPRCCs. Among 7 male cases, loss of chromosome Y was revealed in 2 cases. Follow-up data was available in 13 patients and only 1 patient died of bone metastasis of the tumor. The other 12 patients were all alive uneventfully at a mean follow-up time of 37 months, indicating that OPRCC is a unique subtype of PRCC with indolent clinical behavior. In conclusion, OPRCCs show a single layer tumor cell of low nuclear grade similar to type 1 PRCC, and abundant eosinophilic cytoplasm resembling type 2 PRCC. Furthermore, the tumor presents the same immunophynotype as type 2 PRCC but the same genetic features and prognosis as type 1 PRCC. OPRCC should be classified as an independent subtype of PRCC with different features from both type 1 and type 2 PRCC.

Genetic analysis and clinicopathological features of ALK-rearranged renal cell carcinoma in a large series of resected Chinese renal cell carcinoma patients and literature review.

Anaplastic lymphoma kinase (ALK)‐rearranged renal cell carcinoma (RCC) is a rare subtype of RCC reported in recent years, with eight cases so far. The aims of the present study were to screen ALK‐rearranged cases from a large cohort of RCCs in China to determine the frequency of ALK rearrangement and investigate the clinicopathological features and outcomes.

The clinicopathological, ultrastructural, genetic features and diagnosis of small cell variant renal oncocytoma

The small cell variant renal oncocytoma is until now a rarely described and easily misdiagnosed subtype of renal oncocytoma. The tissue morphology, immunohistochemical profile, ultrastructural and molecular characteristics of four cases of small cell variant renal oncocytoma were analyzed and the literature was reviewed. The patients were three women and one man with ages ranging from 51 to 76 years. The size of the tumors ranged from 3 to 8.5 cm in diameter. The follow-up duration ranged from 6 to 58 months. All patients lived uneventfully without tumor recurrence or metastasis. The tumors were grayish yellow to brown, well demarcated, with a central scar or cystic change. Microscopically, the tumor was arranged in lobular structure containing dense small acini or tubular structures, with small cells featuring weak eosinophilic and scant cytoplasm, small round nuclei and inconspicuous nucleoli. No mitotic figures or necrosis were discerned. The immunohistochemical profile of small cell variant of renal oncocytoma is partially consistent with classic oncocytoma, expressing EMA, CK18, CD117 and E-cad. However, MITO and S-100A1 were intensively expressed in classic RO, but neither of them was expressed in small cell variant RO. Ultrastructurally, a small number of organelles was revealed in the tumor cell, including a few mitochondria, lysosomes and microvilli, less than those in the classic oncocytoma. No genetic aberrations were found in all cases regardless of clinicopathological characteristics and tissue types. Small cell variant renal oncocytoma of the kidney is frequently difficult to be differentiated from other benign and malignant small cell tumors with eosinophilic cytoplasm. The immunohistochemical profile, ultrastructural and genetic features of the tumor are integrally presented here for the first time. Acquaintance with the special characteristics of the tumor could facilitate the correct diagnosis of the tumor.

Primary intravascular large B cell lymphoma of the endometrium.

Primary intravascular large B cell lymphoma (IVLBCL) of the endometrium is extremely rare. So far, only 5 cases have been reported in the English literature. We now report a new case of endometrial IVLBCL which exhibited distinct clinicopathological characteristics and meaningful laboratory tests, and also review the literature. A 66-year-old woman showed symptoms of chronic cough and choking sensation for 4 months. Following three days of vaginal bleeding she presented for examination and diagnosis. The percentage of monocytes in the blood was double that of normal levels. There was a polyp in the endometrium, which showed a number of medium-large lymphoid cells in dilated capillaries. Immunohistochemically, the lymphoid cells were immunoreactive to CD20, CD79a, Mum-1 and Foxp-1 with 85% cells immunoreactive to Ki-67. IVLBCL of the endometrium is rare and the clinical diagnosis is very difficult. Unexplained fever of old people and abnormal laboratory tests such as obvious abnormal monocyte distribution in the blood should alert the clinical doctor to the possibility of IVLBCL. A correct diagnosis mainly depends on pathological tests and immunohistochemical labeling. The prognosis of IVLBCL is poor and few patients survive longer than one year.