PubMed · 14852008
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M ZARA, E MERCIER. 1951. [Hematic thyroid cysts].. https://pubmed.ncbi.nlm.nih.gov/14852008/
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That chromophobe renal cell carcinoma has an uncommon eosinophilic variant has been recognized for more than a decade. In sections stained with hematoxylin and eosin, the eosinophilic variant of chromophobe renal cell carcinoma and renal oncocytoma are similar in appearance. While it is well established that chromophobe renal cell carcinoma and renal oncocytoma have different patterns of genetic anomalies, little is known of the genetics of the eosinophilic variant of chromophobe renal cell carcinoma. This study was undertaken to elucidate the genetic lesions of eosinophilic chromophobe renal cell carcinoma and to compare them with those found in classic chromophobe renal cell carcinoma and in renal oncocytoma. A total of 29 renal neoplasms--nine eosinophilic chromophobe renal cell carcinomas, 10 classic chromophobe renal cell carcinomas, and 10 oncocytomas--were investigated by fluorescence in situ hybridization on 5 microm paraffin-embedded tissue sections with centromeric probes for chromosomes 1, 2, 6, 10, and 17. Signals were counted in 100-200 neoplastic nuclei from each tumor. Chromophobe renal cell carcinomas frequently showed loss of chromosomes 1 (70% of classic, 67% of eosinophilic), 2 (90% classic, 56% eosinophilic), 6 (80% classic, 56% eosinophilic), 10 (60% classic, 44% eosinophilic), and 17 (90% classic, 78% eosinophilic); Among the classic chromophobe renal cell carcinomas, only one had no loss of any of the chromosomes, while 50% had loss of all five chromosomes. Among the eosinophilic chromophobe renal cell carcinomas, one of nine had no loss and 44% had loss of all five chromosomes. One oncocytoma had loss of chromosome 1. No other chromosomal loss was detected in the oncocytomas. In conclusion, losses of chromosomes 1, 2, 6, 10, and 17 are frequent in both eosinophilic and classic chromophobe renal cell carcinomas. Loss of chromosome 1 occurs occasionally in oncocytoma but losses of chromosomes 2, 6, 10, and 17 are not found in oncocytomas. When the differential diagnostic problem is oncocytoma vs eosinophilic chromophobe renal cell carcinoma, detection of losses of chromosomes 2, 6, 10, or 17 effectively excludes the diagnosis of oncocytoma and supports the diagnosis of chromophobe renal cell carcinoma.
Controversy still exists about the ability to differentiate between malignant and benign Hürthle cell tumors (HCTs) before and during surgery. Diagnostic difficulties make surgical decisions debatable. The aim of this study was to evaluate factors predicting the malignancy of HCT and to plan its appropriate management. From January 1998 to May 2003 a series of 41 patients underwent thyroidectomy in our surgical department because of HCT. A cross-sectional study of 23 patients with carcinoma and 18 patients with adenoma was carried out: demographic data, tumor characteristics, diagnostic results of fine-needle aspiration cytology (FNAC), frozen section (FS), MIBI scan scintigraphy, surgical indications, and treatment were evaluated. The mean tumor size was significantly greater for carcinomas than adenomas (3.1 vs. 1.9 cm; p = 0.006). Threshold sizes of more than 3.0 cm and 4.0 cm, respectively, were significant for predicting malignancy ( p = 0.025 and p = 0.012). Conversely, 47.8% of carcinomas had a diameter smaller than 3.0 cm. FNAC and FS sensitivities for carcinoma detection were 23.8% and 33.3%, respectively. The positive uptake on MIBI scan imaging was likely to be similarly malignant or benign. Because of the lack of accuracy of all diagnostic studies for predicting malignancy, all oxyphilic cell nodules should be referred to surgery. Different tumor sizes cannot be the only factor on which to base a surgical decision. Therefore, because of diagnostic uncertainties, we believe that an experienced surgeon can safely perform total thyroidectomy in all patients with an HCT.
Renal oncocytosis is a rare condition characterized by the presence of numerous oncocytomas and oncocytic changes in the renal tubules. Other than oncocytomas associated with the Birt-Hogg-Dube (BDH) syndrome, the genetics of oncocytosis is not known. Whether oncocytomas and oncocytosis are similar to BDH syndrome, in which the tumors diploid (as most oncocytomas are), or show chromosomal losses may be significant regarding the observation that in oncocytosis, there frequently is morphological evidence of progression to chromophobe carcinoma. Here we report on the case of a 69-year old male who underwent a staged procedure of partial nephrectomy on the left side and right radical nephrectomy for multiple renal tumors. The tumors were studied by routine hematoxylin and eosin morphology, immunohistochemistry, cytogenetics, and loss of heterozygosity analysis. Both kidneys had numerous oncocytic neoplasms morphologically progressing from oncocytomas to hybrid tumors with chromophobe carcinoma. Genetic studies demonstrated progression from normal cytogenetics to chromosomal losses similar to those in some oncocytomas and in chromophobe carcinomas. The genetics of this apparently nonfamilial oncocytoma differs from that of BDH syndrome and is characterized by losses involving chromosomes 1, 14, 21, and Y. To our knowledge, this is the first report of the genetic and cytogenetic findings in oncocytosis not related to BDH syndrome and may suggest a possible model of progression from oncocytoma to chromophobe renal cell carcinoma.