Journal List > Korean J Cytopathol > v.19(2) > 1006528

Korean J Cytopathol. 2008 Sep;19(2):194-199. English.
Published online September 30, 2008.  https://doi.org/10.3338/kjc.2008.19.2.194
Copyright © 2008 The Korean Society for Cytopathology
Mucinous Tubular and Spindle Cell Carcinoma of the Kidney: Touch Imprint Cytologic and Histologic Findings - A Case Report -
Kyu-Yeoun Won, M.D., Gou Young Kim, M.D., Sung-Jig Lim, M.D., Hyun Cheol Kim, M.D.,1 and Seung Hyun Jeon, M.D.2
Department of Pathology, East-West Neo Medical center, School of Medicine, Kyunghee University, Seoul, Korea.
1Department of Radiology, East-West Neo Medical center, School of Medicine, Kyunghee University, Seoul, Korea.
2Department of Urology, East-West Neo Medical center, School of Medicine, Kyunghee University, Seoul, Korea.
Received July 17, 2008; Accepted August 29, 2008.

Abstract

The recent WHO classification has recognized mucinous tubular and spindle cell carcinoma (MTSCC) as a distinct entity of renal cell carcinoma, exhibiting a mixed pattern of tubules and a surrounding spindle cell proliferation within a myxoid stroma, with low-grade nuclear features. A 51-year-old woman had an incidentally discovered renal mass. Radiologic examination revealed a large, well defined mass in the lower pole of the right kidney; a right radical nephrectomy was performed. Imprint cytologic smears from fresh surgical specimens showed cellular, cohesive clusters with thick, broad trabecular arrangements and branching structures. On high power fields, the tumor was composed of round-to-oval low-grade nuclei with vesicular chromatin and small nucleoli. The tumor cells had indistinct borders and pale, eosinophilic cytoplasm. In some areas, round-to-elongated tubular structures and spindle cell patterns were noted. Chronic inflammatory cell infiltration was noted, along with a mucinous background and occasional psammoma bodies. Neither significant cytologic atypia nor mitosis was seen.

Keywords: Kidney neoplasms; Carcinoma; Cytology; Kidney tubules

Figures


Fig. 1
Computed tomography of abdomen shows a well margined, exophytic, heterogenous attenuated mass (arrow) in the lower pole of the right kidney.
Click for larger image


Fig. 2
Cut surface of kidney shows a well-circumscribed gray white to yellow round mass measuring 7.4×6×5.5 cm in size. Foci of hemorrhage are found.
Click for larger image


Fig. 3
Comparison of cytology (A, C, E, G, I) and Histology (B, D, F, H, J). (A) Cytologic smear shows transition from monolayered epithelial sheet to spindle cell pattern. (B) Histologic section shows abrupt transitions between the tubular (left half) and spindled (right half) areas. (C) Cytologic smear shows round to elongated tubule-like structure (arrow). (D) Histologic section shows elongated tubules separated by pale mucinous stroma. the tubules are composed of small bland-looking cuboidal cells with pale eosinophilic cytoplasm. (E) Cytologic smear shows spindle cell pattern with round to oval low nuclear grade. (F) Histologic section shows spindle cell areas with chronic inflammatory cell infiltration. (G) Cytologic smear shows psammoma bodies. (H) Histologic section shows a psammoma body. (I) Cytologic smear shows chronic inflammatory cells including plasma cells, eosinophils, lymphocytes in mucinous background. (A-I ; H&E). (J) Alcian blue staining of histologic section reveals extracellular mucinous materials (Alcian blue).
Click for larger image

References
1. Ferlicot S, Allory Y, Comperat E, et al. Mucinous tubular and spindle cell carcinoma: a report of 15 cases and a review of the literature. Virchows Arch 2005;447:978–983.
2. Parwani AV, Husain AN, Epstein JI, Beckwith JB, Argani P. Low-grade myxoid renal epithelial neoplasms with distal nephron differentiation. Hum Pathol 2001;32:506–512.
3. Sun W, McGregor DK, Ordonez NG, Ayala AG, Caraway NP. Fine needle aspiration cytology of a low grade myxoid renal epithelial neoplasm: a case report. Acta Cytol 2005;49:525–529.
4. Ortega JA, Solano JG, Perez-Guillermo M. Cytologic aspect of mucinous tubular and spindle-cell renal carcinoma in fine-needle aspirates. Diagn Cytopathol 2006;34:660–662.
5. Otani M, Shimizu T, Serizawa H, Nagashima Y. Mucinous tubular and spindle cell carcinoma of the kidney: Report of a case with imprint cytologic features. Acta Cytol 2006;50:680–682.
6. Owens CL, Argani P, Ali SZ. Mucinous tubular and spindle cell carcinoma of the kidney: cytopathologic findings. Diagn Cytopathol 2007;35:593–596.
7. Paner GP, Srigley JR, Radhakrishnan A, et al. Immunohistochemical analysis of mucinous tubular and spindle cell carcinoma and papillary renal cell carcinoma of the kidney: significant immunophenotypic overlap warrants diagnostic caution. Am J Surg Pathol 2006;30:13–19.
8. Shen SS, Ro JY, Tamboli P, et al. Mucinous tubular and spindle cell carcinoma of kidney is probably a variant of papillary renal cell carcinoma with spindle cell features. Ann Diagn Pathol 2007;11:13–21.
9. Delahunt B, Eble JN. Papillary renal cell carcinoma: a clinicopathologic and immunohistochemical study of 105 tumors. Mod Pathol 1997;10:537–544.
10. Park SY, Kang GH, Ro JY, et al. Mucinous tubular and spindle cell carcinoma of kidney occurring in a patient with pulmonary adenocarcinoma. Korean J Pathol 2008;42:54–59.
11. Pillay N, Ramdial PK, Cooper K, Batuule D. Mucinous tubular and spindle cell carcinoma with aggressive histomorphology-a sarcomatoid variant. Hum Pathol 2008;39:966–969.
12. Kuroda N, Toi M, Hiroi M, Shuin T, Enzan H. Review of mucinous tubular and spindle-cell carcinoma of the kidney with a focus on clinical and pathobiological aspects. Histol Histopathol 2005;20:221–224.
13. Layfield LJ. Fine-needle aspiration biopsy of renal collecting duct carcinoma. Diagn Cytopathol 1994;11:74–78.
14. Yi SY, Lee KG. Fine needle aspiration cytology of collecting duct carcinoma of the kidney: a case report. Korean J Cytopathol 1994;5:160–166.