-
Archives of Pathology & Laboratory... Dec 2019Eosinophilic cytoplasm is the most common finding of difficult-to-classify kidney tumors. Morphology, cytogenetics, and immunohistochemical stains are discriminatory.... (Review)
Review
CONTEXT.—
Eosinophilic cytoplasm is the most common finding of difficult-to-classify kidney tumors. Morphology, cytogenetics, and immunohistochemical stains are discriminatory. This review compares well-recognized tumors such as granular clear cell carcinoma, papillary variants, chromophobe renal cell carcinoma, and oncocytoma and introduces newly described entities of hybrid oncocytic tumors, carcinomas defined by translocations, and carcinomas with deficiencies in the tricarboxylic acid cycle. The focus is on immunostaining, clinical correlations, and differential diagnoses. Representative examples of some entities are presented with elaboration on their workup.
OBJECTIVE.—
To provide a review of the differential diagnoses for renal neoplasms with eosinophilic cytoplasm and elaborate on methods that may assist with correct identification.
DATA SOURCES.—
Review of current literature on kidney tumors with eosinophilic cytoplasm, as well as the authors' personal experience.
CONCLUSIONS.—
Eosinophilic cytoplasm is a feature shared by many kidney tumors. Understanding the morphologic differences and the role of ancillary studies is key when encountering such a tumor.
Topics: Eosine Yellowish-(YS); Humans; Immunohistochemistry; Kidney Neoplasms; Staining and Labeling
PubMed: 31403331
DOI: 10.5858/arpa.2019-0203-RA -
Advances in Anatomic Pathology Jan 2023Adrenal cortical carcinoma (ACC) is a rare and aggressive malignancy that poses challenging issues regarding the diagnostic workup. Indeed, no presurgical technique or... (Review)
Review
Adrenal cortical carcinoma (ACC) is a rare and aggressive malignancy that poses challenging issues regarding the diagnostic workup. Indeed, no presurgical technique or clinical parameters can reliably distinguish between adrenal cortical adenomas, which are more frequent and have a favorable outcome, and ACC, and the final diagnosis largely relies on histopathologic analysis of the surgical specimen. However, even the pathologic assessment of malignancy in an adrenal cortical lesion is not straightforward and requires a combined evaluation of multiple histopathologic features. Starting from the Weiss score, which was developed in 1984, several histopathologic scoring systems have been designed to tackle the difficulties of ACC diagnosis. Dealing with specific histopathologic variants (eg, Liss-Weiss-Bisceglia scoring system for oncocytic ACC) or patient characteristics (eg, Wieneke index in the pediatric setting), these scores remarkably improved the diagnostic workup of ACC and its subtypes. Nevertheless, cases with misleading features or discordant correlations between pathologic findings and clinical behavior still occur. Owing to multicentric collaborative studies integrating morphologic features with ancillary immunohistochemical markers and molecular analysis, ACC has eventually emerged as a multifaceted, heterogenous malignancy, and, while innovative and promising approaches are currently being tested, the future clinical management of patients with ACC will mainly rely on personalized medicine and target-therapy protocols. At the dawn of the new Fifth World Health Organization classification of endocrine tumors, this review will tackle ACC from the pathologist's perspective, thus focusing on the main available diagnostic, prognostic, and predictive tissue-tethered features and biomarkers and providing relevant clinical and molecular correlates.
Topics: Humans; Child; Adrenocortical Carcinoma; Adrenal Cortex Neoplasms; Prognosis; Adrenal Cortex
PubMed: 36084635
DOI: 10.1097/PAP.0000000000000363 -
Journal of Ultrasound in Medicine :... Oct 2022There has been controversy on how frequently small echogenic masses are angiomyolipomas (AMLs) versus renal cell carcinoma (RCC) and how best to manage these echogenic...
OBJECTIVES
There has been controversy on how frequently small echogenic masses are angiomyolipomas (AMLs) versus renal cell carcinoma (RCC) and how best to manage these echogenic masses. We performed this study to determine the etiologies of echogenic renal masses and compare them with prior publications to reach possible management decisions.
METHODS
This is a retrospective chart review of all consecutive renal ultrasound examinations performed at our institution between January 2015 and December 2016, with an ultrasound report finding containing the wording "echogenic" and "mass." This yielded 6462 total examinations. A total of 107 echogenic lesions met inclusion and exclusion criteria with correlative computed tomography, pathology, or long-term (>5 years) follow-up ultrasound. These lesions were stratified into those that were ≤2 cm and those that were >2 cm.
RESULTS
Almost all masses were benign, with the majority (79/107) being AMLs (73.8%); 64 of the 79 (81%) of the AMLs were in female patients. Two of the 107 masses were RCCs, and 1 mass was an oncocytic neoplasm. There were 77 of the masses that were ≤2 cm and these masses were benign except for one lesion of an oncocytic neoplasm. There were 30 of the 107 masses >2 cm, with 2 of the 30 (6.7%) being RCCs.
CONCLUSIONS
Incidental echogenic renal masses are most commonly AMLs. However, some masses may be RCCs. In comparing our results with the prior literature, we feel that small echogenic renal masses ≤1 cm usually require no further evaluation, while masses greater than that size require other imaging.
Topics: Angiomyolipoma; Carcinoma, Renal Cell; Diagnosis, Differential; Female; Humans; Kidney Neoplasms; Retrospective Studies
PubMed: 35043978
DOI: 10.1002/jum.15946 -
Annals of Diagnostic Pathology Dec 2022Nodular hyperplasia of the thyroid is a process whereby the gland experiences growth by nodular expansion of thyroid parenchyma. We have encountered 45 patients in whom...
Nodular hyperplasia of the thyroid is a process whereby the gland experiences growth by nodular expansion of thyroid parenchyma. We have encountered 45 patients in whom the process was caused by the growth of well-defined and sharply circumscribed but unencapsulated nodules composed of oncocytic thyroid follicular cells. The lesions arose in 39 women and 6 men, aged 25-69 years (mean = 50.3 years). The surrounding thyroid parenchyma showed features of chronic lymphocytic thyroiditis. The nodules varied from microscopic to 5 cm and appeared to compress the surrounding thyroid parenchyma. Most of the lesions lacked a well-defined capsule. In 26 tumors, the nodules displayed a predominantly follicular pattern of growth; in 8 cases there were admixtures of follicular and trabecular patterns with focal solid areas devoid of follicles. Clinical follow-up in 39 patients ranging from 7 to 22 years (median = 16 years) showed no evidence of recurrence, metastasis, or malignant transformation. One patient died of unknown causes 15 years after the diagnosis, and another patient died 4 years after diagnosis from metastatic colonic adenocarcinoma. Oncocytic nodular hyperplasia is a benign process associated with chronic lymphocytic thyroiditis that should be distinguished from benign and malignant oncocytic (Hurthle cell) tumors of the thyroid.
Topics: Male; Humans; Female; Oxyphil Cells; Hashimoto Disease; Thyroid Neoplasms; Hyperplasia; Adenoma, Oxyphilic; Adenocarcinoma; Thyroid Nodule
PubMed: 36162158
DOI: 10.1016/j.anndiagpath.2022.152049 -
Frontiers in Endocrinology 2021In fine-needle aspirations (FNA) of thyroid, Hürthle cells can be found in a broad spectrum of lesions, ranging from non-neoplastic conditions to aggressive malignant... (Review)
Review
In fine-needle aspirations (FNA) of thyroid, Hürthle cells can be found in a broad spectrum of lesions, ranging from non-neoplastic conditions to aggressive malignant tumors. Recognize them morphologically, frequently represents a challenging for an adequately diagnosis and are associated with a significant interobserver variability. Although the limitations of the morphologic diagnosis still exist, the interpretation of the context where the cells appear and the recent advances in the molecular knowledge of Hürthle cells tumors are contributing for a more precise diagnosis. This review aims to describe the cytology aspects of all Hürthle cells neoplastic and non-neoplastic thyroid lesions, focusing on the differential diagnosis and reporting according to The Bethesda System for Reporting Thyroid Cytology (TBSRTC). New entities according to the latest World Health Organization (WHO) classification are included, as well as an update of the current molecular data.
Topics: Biopsy, Fine-Needle; Cytodiagnosis; Diagnosis, Differential; Humans; Oxyphil Cells; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule
PubMed: 34248855
DOI: 10.3389/fendo.2021.701877 -
Archives of Pathology & Laboratory... Mar 2022Although most pancreatic and bile duct neoplasms are solid, mucinous cystic neoplasms and intraductal neoplasms have been increasingly recognized even when clinically... (Review)
Review
CONTEXT.—
Although most pancreatic and bile duct neoplasms are solid, mucinous cystic neoplasms and intraductal neoplasms have been increasingly recognized even when clinically silent, thanks to the increased use of sensitive imaging techniques. Cystic and intraductal neoplasms of the pancreas are often resectable and curable and constitute about 5% of all pancreatic neoplasms. Owing to their preinvasive nature and different biology, recognition of these entities remains a major priority. Mucinous cystic neoplasms are histologically and clinically distinct from other cystic pancreatic neoplasms. Pancreatic intraductal neoplasms encompass 3 major entities: intraductal papillary mucinous neoplasm, intraductal oncocytic papillary neoplasm, and intraductal tubulopapillary neoplasm. Intraductal papillary neoplasms of bile ducts are also preinvasive mass-forming neoplasms with both similarities and differences with their pancreatic counterparts. All of these pancreatobiliary neoplasms have diverse and distinctive clinicopathologic, genetic, and prognostic variations.
OBJECTIVE.—
To review the clinical, pathologic, and molecular features of mucinous cystic and intraductal neoplasms of the pancreatobiliary tract.
DATA SOURCES.—
Literature review, diagnostic manuals, and guidelines.
CONCLUSIONS.—
This review will briefly describe well-known clinical and pathologic features and will focus on selected recently described aspects of morphology, grading, classification, and genomic alterations of cystic and intraductal neoplasms of the pancreatobiliary tract.
Topics: Bile Duct Neoplasms; Carcinoma, Pancreatic Ductal; Humans; Pancreas; Pancreatic Intraductal Neoplasms; Pancreatic Neoplasms; Prognosis
PubMed: 35192699
DOI: 10.5858/arpa.2021-0399-RA -
Der Pathologe Nov 2021Recent developments in differential diagnosis have led to new knowledge about oncocytic renal neoplasms. (Review)
Review
BACKGROUND
Recent developments in differential diagnosis have led to new knowledge about oncocytic renal neoplasms.
OBJECTIVES
Overview of differential diagnosis of oncocytic tumours.
MATERIALS AND METHODS
We performed a literature search on oncocytic renal tumours and mapped known tumour types. Possible differential diagnoses are discussed.
RESULTS
Besides the tumour types already acknowledged by the 2016 WHO classification, there is new evidence regarding the group of hard-to-classify oncocytic neoplasms. Findings point to immunohistochemical and molecular characteristics that may lead to the establishment of new entities in the future. In addition, important differential diagnosis can now be identified, facilitating specific therapies for oncocytic renal tumours.
CONCLUSION
A correct diagnosis of oncocytic renal tumours not only improves prognostic assessment (and, if necessary, specific therapies) but is also clinically relevant regarding a possible association with hereditary tumour syndromes.
Topics: Adenoma, Oxyphilic; Carcinoma, Renal Cell; Diagnosis, Differential; Humans; Immunohistochemistry; Kidney Neoplasms
PubMed: 34468818
DOI: 10.1007/s00292-021-00979-w -
Abdominal Radiology (New York) Aug 2023This study aimed to characterize the clinical and imaging findings of intraductal oncocytic papillary neoplasm of the pancreas (IOPN-P) compared to those of intraductal...
PURPOSE
This study aimed to characterize the clinical and imaging findings of intraductal oncocytic papillary neoplasm of the pancreas (IOPN-P) compared to those of intraductal papillary mucinous adenoma/carcinoma (IPMA/IPMC).
METHODS
This multi-institutional retrospective study reviewed the clinical, imaging, and pathological findings of 21 patients with pathologically proven IOPN-P. Twenty-one computed tomography (CT) and magnetic resonance imaging, and seven F-fluorodeoxyglucose (FDG)-positron emission tomography were performed before surgery. The following findings were evaluated: preoperative blood test results, lesion size and location, pancreatic duct diameter, contrast-enhancement effect, bile duct and peripancreatic invasion, maximum standardized uptake (SUVmax) value, and pathological stromal invasion.
RESULTS
Serum carcinoembryonic antigen (CEA) and cancer antigen 19-9 (CA19-9) levels were significantly higher in the IPMN/IPMC group than in the IOPN-P group. Except in one patient, IOPN-P showed multifocal cystic lesions with solid components or a tumor in the main pancreatic duct (MPD) with dilatation. IOPN-P had a higher frequency of solid parts and a lower frequency of downstream MPD dilatation than IPMA. IPMC showed smaller overall cyst size, more radiological peripancreatic invasion, and worse recurrence-free and overall survival than IOPN-P. The average SUVmax value of IOPN-P was 7.5. Pathologically, 17 of the 21 IOPN-Ps had a malignant component, and six showed stromal invasion.
CONCLUSION
IOPN-P shows cystic-solid lesions similar to IPMC but has lower serum CEA and CA19-9 levels, larger overall cyst size, lower frequency of peripancreatic invasion, and more favorable prognosis than IPMC. Moreover, the high FDG uptake by IOPN-Ps may be a characteristic finding of this study.
Topics: Humans; Carcinoma, Pancreatic Ductal; Retrospective Studies; Fluorodeoxyglucose F18; Carcinoembryonic Antigen; CA-19-9 Antigen; Pancreatic Neoplasms; Pancreas; Cysts; Neoplasm Invasiveness
PubMed: 37358603
DOI: 10.1007/s00261-023-03985-z -
Endocrine-related Cancer Nov 2023Molecular testing contributes to improving the diagnosis of indeterminate thyroid nodules (ITNs). ThyroidPrint® is a ten-gene classifier aimed to rule out malignancy in...
Molecular testing contributes to improving the diagnosis of indeterminate thyroid nodules (ITNs). ThyroidPrint® is a ten-gene classifier aimed to rule out malignancy in ITN. Post-validation studies are necessary to determine the real-world clinical benefit of ThyroidPrint® in patients with ITN. A single-center, prospective, noninterventional clinical utility study was performed, analyzing the impact of ThyroidPrint® in the physicians' clinical decisions for ITN. Demographics, nodule characteristics, benign call rates (BCRs), and surgical outcomes were measured. Histopathological data were collected from surgical biopsies of resected nodules. Of 1272 fine-needle aspirations, 109 (8.6%) were Bethesda III and 135 (10.6%) were Bethesda IV. Molecular testing was performed in 155 of 244 ITN (63.5%), of which 104 were classified as benign (BCR of 67.1%). After a median follow-up of 15 months, 103 of 104 (99.0%) patients with a benign ThyroidPrint® remained under surveillance and one patient underwent surgery which was a follicular adenoma. Surgery was performed in all 51 patients with a suspicious for malignancy as per ThyroidPrint® result and in 56 patients who did not undergo testing, with a rate of malignancy of 70.6% and 32.1%, respectively. A higher BCR was observed in follicular lesion of undetermined significance (87%) compared to atypia of undetermined significance (58%) (P < 0.05). False-positive cases included four benign follicular nodules and six follicular and four oncocytic adenomas. Our results show that, physicians chose active surveillance instead of diagnostic surgery in all patients with a benign ThyroidPrint® result, reducing the need for diagnostic surgery in 67% of patients with preoperative diagnosis of ITN.
Topics: Humans; Prospective Studies; Gene Expression Profiling; Retrospective Studies; Thyroid Neoplasms; Thyroid Nodule; Biopsy, Fine-Needle
PubMed: 37671897
DOI: 10.1530/ERC-22-0409 -
Journal of Hepato-biliary-pancreatic... Jul 2023To clarify the pathological significance of two precursors (high-grade biliary intraepithelial neoplasm [BilIN] and intraductal papillary neoplasm of bile duct [IPNB])...
BACKGROUND
To clarify the pathological significance of two precursors (high-grade biliary intraepithelial neoplasm [BilIN] and intraductal papillary neoplasm of bile duct [IPNB]) in cholangiocarcinomas (CCAs).
METHODS
Ninety-one cases of CCA (47 distal CCAs [dCCAs], 31 perihilar CCAs [pCCAs] and 13 intrahepatic CCAs of large duct type [LD-iCCAs]) were examined for their association with precursors. Neoplastic intraepithelial lesions without underlying infiltrating carcinoma in the surrounding mucosa of CCAs were considered to reflect high-grade BilIN. High-grade BilIN and IPNB were subdivided into gastric, biliary, intestinal and oncocytic subtypes, while CCAs were subdivided into gastrobiliary, intestinal and oncocytic subtypes. The postoperative overall survival (OS) was examined.
RESULTS
Fifty-four and 8 of 91 CCAs were associated with high-grade BilIN and IPNB, respectively, while these precursors were unidentifiable in the remaining CCAs. A majority of CCAs were of the gastrobiliary subtype, while the intestinal subtype was occasionally detected, and the oncocytic subtype was rare. CCAs with high-grade BilIN showed a similar postoperative OS to CCAs without precursors, while CCAs with IPNB showed a favorable postoperative OS compared to CCAs without precursors.
CONCLUSIONS
CCAs were frequently associated with precursors; high-grade BilIN may be a major precursor and IPNB a minor one. CCAs with IPNB showed a favorable postoperative OS compared to CCAs with high-grade BilIN.
Topics: Humans; Bile Ducts, Intrahepatic; Bile Duct Neoplasms; Cholangiocarcinoma; Bile Ducts; Carcinoma in Situ; Bile Pigments
PubMed: 36707055
DOI: 10.1002/jhbp.1308