Oncocitoma fusocelular hipofisario / Pituitary spindle cell oncocytoma

El oncocitoma fusocelular es una neoplasia selar primaria no endocrina infrecuente, de curso clínico benigno. Debido a su similitud morfológica con los adenomas hipofisarios, considerar al oncocitoma como diagnóstico diferencial lleva a un abordaje quirúrgico cuidadoso, con el objetivo de evitar el sangrado intraquirúrgico y lograr la resección más completa posible, de la que parecería depender la evolución a largo plazo. Se presenta el caso de un hombre de 60 años que consultó por alteración campimétrica. La evaluación bioquímica evidenció panhipopituitarismo y la resonancia magnética (RM) una lesión selar. Se indicó tratamiento quirúrgico por compromiso visual con diagnóstico presuntivo de macroadenoma hipofisario no funcionante. El diagnóstico anatomopatológico fue compatible con oncocitoma fusocelular. En la RM selar, postquirúrgica (a los 5 meses), se observó remanente tumoral y se decidió realizar radiocirugía, constatándose en las subsiguientes RM disminución tumoral sin evidencia de remanente ni recidiva en 4 años de seguimiento. La comunicación de nuevos casos de esta entidad permitirá aumentar la disponibilidad de evidencia y ayudará a determinar la eficacia de los tratamientos disponibles y el pronóstico.

Spindle cell oncocytoma is an infrequent benign non-endocrine sellar neoplasm. Due to its similar morphology to pituitary adenomas, consideration of this differential diagnosis would conduce to a more careful surgical approach in order to avoid intraoperative bleeding and aiming to a complete resection, on which depends long-term outcomes. We present the case of a 60-year-old male who complained about visual abnormalities, with computerized visual field confirmation. On biochemistry, a panhypopituitarism was detected. The brain magnetic resonance images showed a sellar mass. A non-functioning pituitary macroadenoma was presumptively diagnosed and due to the visual impairment, surgical transesphenoidal treatment was indicated. The histological diagnosis was spindle cell oncocytoma. Five months after surgery, the control image demonstrated a lesion that was considered as remnant tumor, hence radiosurgery was performed. During the follow-up, the tumor reduced its size and four years after initial treatment, the sellar resonance imaging showed disappearance of the residual tumor. Communication of new cases of this rare entity will enlarge the existing evidence and will help to determinate the most effective treatment and prognosis.

Imaging Findings of Common Benign Renal Tumors in the Era of Small Renal Masses: Differential Diagnosis from Small Renal Cell Carcinoma: Current Status and Future Perspectives

The prevalence of small renal masses (SRM) has risen, paralleling the increased usage of cross-sectional imaging. A large proportion of these SRMs are not malignant, and do not require invasive treatment such as nephrectomy. Therefore, differentation between early renal cell carcinoma (RCC) and benign SRM is critical to achieve proper management. This article reviews the radiological features of benign SRMs, with focus on two of the most common benign entities, angiomyolipoma and oncocytoma, in terms of their common imaging findings and differential features from RCC. Furthermore, the role of percutaneous biopsy is discussed as imaging is yet imperfect, therefore necessitating biopsy in certain circumstances to confirm the benignity of SRMs.

Computed Tomography and Magnetic Resonance Images of Adrenocortical Oncocytoma Cases

We present two cases of adrenocortical oncocytomas that were well-delineated on multi-detector computed tomography and magnetic resonance imaging. The images showed a well-enhanced large mass with multiple stippled calcifications in a 10-yr-old girl who was consulted due to precocious puberty. A well-enhanced solid mass with necrotic components was incidentally noticed in a 54-yr-old man. These lesions were resected and diagnosed as adrenocortical oncocytomas through immunohistochemical studies and electron microscopy. Adrenocortical oncocytomas are rare disease entities, therefore, we report these interesting, rare adrenocortical oncocytomas here with radiologic findings, and discuss differential diagnosis.

S100A1 protein as a potential discriminating marker between chromophobe renal cell carcinoma and renal oncocytoma

The morphological differentiation between chromophobe renal cell carcinoma [RCC] and renal oncocytoma [RO] may be difficult. This study evaluates S100A1 protein as a new marker for the differentiation between these two tumors. We selected twenty cases; fifteen of which were typically diagnosed after routine histopathological staining by hematoxylin and eosin [7 chromophobe RCC and 8 RO] while the remaining five cases showed confusing cytomorphological features and uncertainly diagnosed. Immunoperoxidase technique using atni-S100A1 antibody carried out semiquantitavely in all cases displayed a strong cytoplasmic positive granularity in five typical RO, moderate immunopositivity in two typical RO and weak reactivity in on typical RO while all seven typical chromophobe RCC cases were immunonegative. Regarding uncertainly diagnosed cases, three were immunopositive for S100A1 antibody [one strong, one moderate and one weakly reactive] in the same pattern as typical RO while the remaining two cases were immunonegative like typical chromophobe RCC cases. From our study, we concluded that S100A1 may be a potentially powerful marker to differentiate the chromophobe RCC from RO particularly when these tumors are in doubt about routine histologic diagnosis

Useful markers for differential diagnosis of oncocytoma, chromophobe renal cell carcinoma and conventional renal cell carcinoma.

Renal oncocytoma, conventional RCC (granular cell type) and chromophobe RCC have different prognosis. Sometimes differentiation between them is difficult in HandE slides. In a 5-year study of 128 renal tumors, we selected 76 cases [30 conventional RCC (CRCC), 16 papillary RCC, 21 chromophobe RCC (ChRCC), 8 oncocytoma, 1 collecting duct carcinoma (cdc)] and staining with Hale's colloidal iron, CK7, CK8, CK18, CK19, CK20, Vimentin, EMA, CD10 and RCC marker were done. No significant difference was seen between renal tumor subtypes with CK8, CK18, CK19, CK20 and EMA. The most useful markers were Vimentin, CK7, CD10, RCC marker and Hale's colloidal iron. Hale's colloidal iron staining with diffuse reticular fine cytoplasmic pattern was present in ChRCCs, but was absent in other subtypes and oncocytomas. Vimentin, CK7, CD10, RCC marker and Hale's colloidal iron can be used for the differential diagnosis of problematic epithelial tumors of kidney (CRCC, ChRCC and oncocytoma) - i.e. ChRCC: Vimentin, CD10 and RCC marker - negative, CK7 - positive and positive diffuse fine reticular cytoplasmic pattern of Hale's colloidal iron; oncocytoma: Vimentin, CK7, RCC marker and CD10 - negative and Hale's colloidal iron - negative; CRCC: CK7 - negative, Vimentin, CD10 and RCC marker - positive and Hale's colloidal iron - negative.

Cytology of Hürthle cell neoplasms of thyroid gland.

Hürthle cell neoplasms (HCN) are an uncommon group of tumors of the thyroid gland. Fine needle aspiration cytology (FNAC) is an important diagnostic tool in solitary nodules of the thyroid gland. A 5-year retrospective analysis of all cases diagnosed as HCN on cytology was performed and correlated with the corresponding histopathology wherever available. There were 13 cases diagnosed as HCN out of which 6 cases had subsequent histopathologic examination. Four were adenomas and two were carcinomas. In addition, 3 cases that were adenomas on histopathology were reported on cytology as colloid goiter with cystic degeneration in 2 cases and as follicular adenoma in 1 case. There was extensive cystic degeneration in the former two cases whereas poor cellular preservation led to misdiagnosis in the third case. There were no specific cytomorphological features that distinguished adenoma from carcinoma. FNAC has a high specificity for a diagnosis of HCN, but the sensitivity is not as high because of sampling error.

Oncocitoma suprarrenal: a propósito de un caso clínico / Adrenal oncocytoma: a purpose of a case

Presentar las características clínicas, paraclínicas y anatomopatológicas de un tumor retroperitoneal poco frecuente. Estudio descriptivo de caso clínico y revisión de la literatura, de masculino de 45 años quien inició enfermedad de 2 años de evolución caracterizado por la presencia de tumor abdominal en epigastrio de crecimiento progresivo. Concomitantemente pérdida de peso, hiporexia y dolor abdominal. Se práctico ultrasonido que concluye tumor de glándula suprarrenal vs. tumor renal. Tomografía de abdominal de abdomen-pelvis que reporta extensa lesión de apariencia tumoral heterogénea con áreas centrales hipodensas asociadas a calcificaciones distróficas y realce post contraste que parece estar ubicada en la región suprarrenal izquierda condicionando desplazamiento inferior del riñon izquierdo, el cual conserva su morfología y funcionalismo. Se realizó laparotomía y exéresis del mismo con reporte anatomopatológico de tumor retroperitoneal: neoplasia maligna de estirpe epitelial, con necrosis extensa no siendo concluyente, por lo cual se realiza inmunohistoquímica que concluye adenoma, oncocitoma suprarrenal. El paciente evolucionó satisfactoriamente. En 8 meses no se ha evidenciado recidiva. El oncocitoma es una entidad infrecuente diagnóscada con el estudio anatomopatológico de la pieza quirúrgica. Puede tener comportamiento maligno o benigno y su exéresis es el tratamiento de elección.

Nódulos com diagnóstico de padrão folicular: marcadores biológicos são o futuro? / Nodule diagnosed as follicular patterned lesion: are biomarkers the promise?

Com o uso da ultra-sonografia de alta resolução, a prevalência de nódulos tem aumentado e, conseqüentemente, o número de punção aspirativa por agulha fina (PAAF), que é o método de escolha para diagnóstico inicial. Um dos maiores dilemas clínicos para o citologista é o diagnóstico diferencial das lesões foliculares comumente agrupadas na classe padrão folicular. Neste artigo de revisão, discutiremos quais são as lesões que podem ser assim classificadas e os marcadores moleculares, identificados por nós ou por outros grupos, que são capazes de distinguir as lesões benignas das malignas.

There are an increasing number of thyroid nodules found by ultrasound and sampled by fine needle aspiration (FNA). A clinical problem is the accurate distinction between benign and malignant forms of follicular lesion. In this review we discuss the thyroid lesions that are common sources of diagnostic error, and grouped together as follicular patterned lesion, and the molecular markers identified by us and others, and that are able to distinguish the benign from the malignant ones.

Oncocitoma renal: características clínicas y anatomopatológicas: reporte de 7 casos / Renal Oncocytome: Anatomopathological and clinical characteristics

El oncocitoma renal es una neoplasia benigna, constituyendo una lesión rara del riñón. Clínicamente es indistinguible del carcinoma de células renales en donde la radiología muestra un tumor sólido renal cuyo diagnóstico definitivo es sólo mediante el estudio histológico. Objetivo: Conocer las características clínicas y anatomopatológicas de los pacientes con diagnóstico de oncocitoma renal. Material y Método: Se registró el total de pacientes con diagnóstico de tumor renal en el Hospital Clínico de la Universidad de Chile (HCUCH) durante el período comprendido entre enero de 1991 y diciembre de 2005. Se incluyó en el estudio sólo aquellos pacientes que fueron sometidos cirugía. Posteriormente se revisaron los informes histológicos de las biopsias obtenidas seleccionándose sólo los pacientes con diagnóstico de oncocitoma renal. Resultados: El total de pacientes con diagnóstico de tumor renal corresponde a 303 casos, de los cuales 7 casos correspondieron a oncocitomas. La prevalencia del oncocitoma es de 2,3 por ciento. El 71 por ciento (n=5) corresponde a pacientes de sexo masculino y 29 por ciento (n=2) femenino. La edad promedio es de 59.4 años (rango 40-76). El diámetro máximo promedio fue de 4,5 cm (rango 1,8-9). La localización sigue a continuación: 5 casos riñón derecho y 2 casos riñón izquierdo. Ningún caso presentó necrosis ni mitosis. Dos (29 por ciento) y tres (43 por ciento) casos presentaron permeaciones vasculares y extensión extrarrenal, sin embargo todos los pacientes evolucionaron de forma satisfactoria, sin recurrencia ni presencia de metástasis. Conclusión: El oncocitoma renal presenta baja frecuencia, se presenta en el sexo masculino con mayor frecuencia, siendo su diagnóstico principalmente un hallazgo imagenológico, presentándose preferentemente en la edad adulta. El principal diagnóstico diferencial lo constituye el carcinoma de células renales cromófobo, variante eosinófilo.

Context: kidney oncytoma is thought to be a benign tumor and a rare lesion of the kidney. Its differentiation from renal cell carcinoma is difficult for both showing a solid mass in the x-rays, being this possible only through histopathology. Objetive: To know clinical and histological characteristics of patients with kidney oncocytoma. Methods: The total of patients with kidney tumor diagnosis at the HCUCH during December 1990 and December 2005 where registered. Only surgical patients were included in this study. Histological samples were analyzed and those with kidney oncocytoma diagnosis were selected. Results: The total number of patients with kidney tumor was 303, seven of which had diagnosis of oncocytoma. The prevalence of kidney oncocytoma is 2.3%, 71% of which were men (n=5) and 29% women (n=2). Mean age of presentation was 59.4 years (range 40-76). Maximal mean diameter was 4.5 cms. (range 1.8-9). In terms of localization 5 were in the right kidney and 3 were in the left one. Conclusion: kidney oncocytoma is a rare lesion, presented mostly in men and elderly, being its diagnosis mainly as a founding in images. Its main differential diagnosis is chromophobe variant of renal cell carcinoma.

Claudin-7 is Highly Expressed in Chromophobe Renal Cell Carcinoma and Renal Oncocytoma

Claudin-7 has recently been suggested to be a distal nephron marker. We tested the possibility that expression of claudin-7 could be used as a marker of renal tumors originating from the distal nephron. We examined the immunohistochemical expression of claudin-7 and parvalbumin in 239 renal tumors, including 179 clear cell renal cell carcinoma (RCC)s, 29 papillary RCCs, 20 chromophobe RCCs, and 11 renal oncocytomas. In addition, the methylation specific-PCR (MSP) of claudin-7 was performed. Claudin-7 and parvalbumin immunostains were positive in 3.4%, 7.8% of clear cell RCCs, 34.5%, 31.0% of papillary RCCs, 95.0%, 80.0% of chromophobe RCCs, and 72.7%, 81.8% of renal oncocytomas, respectively. The sensitivity and specificity of claudin-7 in diagnosing chromophobe RCC among subtypes of RCC were 95.0% and 92.3%. Those of parvalbumin were 80.0% and 88.9%. The expression pattern of claudin-7 was mostly diffuse in chromophobe RCC and was either focal or diffuse in oncocytoma. All of the cases examined in the MSP revealed the presence of unmethylated promoter of claudin-7 without regard to claudin-7 immunoreactivity. Hypermethylation of the promoter might not be the underlying mechanism for loss of its expression in RCC. Claudin-7 can be used as a useful diagnostic marker in diagnosing chromophobe RCC and oncocytoma.

Collecting duct carcinoma associated with oncocytoma

Collecting duct carcinoma (CDC) is a rare, highly aggressive malignant neoplasm that arises from the collecting duct epithelium of the kidney. CDC was reported to coexist with renal cell and transitional cell carcinomas. We report a rare case of CDC associated with oncocytoma, confirmed by the characteristic histological appearance and immunohistochemistry. We also review the epidemiological, histological and immunohistochemical criteria for diagnosis, in addition to the genetic and cytogenetic aberrations reported in the literature. Identification and reporting CDC is important for the establishment of treatment strategies and monitoring prognosis.

Renal oncocytoma with hyaline globules: cytologic diagnosis by guided fine needle aspiration, a case report.

Renal oncocytomas are rare renal parenchymal neoplasms which have a good prognosis. An accurate pre-operative diagnosis by guided fine needle aspiration cytology helps to plan a more conservative surgery. Cytologic findings in a case of renal oncocytoma are presented. Smears showed polygonal or rounded cells in groups and acinar pattern having a well-defined, granular, eosinophilic cytoplasm, and round regular nuclei displaying very little pleomorphism. Intra and extracellular hyaline material staining pink with May Grunwald Giemsa stain were seen. The resected specimen showed the characteristic findings of oncocytoma. Renal oncocytoma has to be distinguished from granular renal cell carcinoma (RCC) and chromophobe cell carcinoma, because of the markedly different prognosis.

Carcinoma de células de Hürthle tiroideo. Caso clínico / Hürthle cell carcinoma of the thyroid

El carcinoma de células de Hürthle tiroideo es un neoplasma raro, comprende alrededor del 0.4 a 10 por ciento de todos los cánceres diferenciados del tiroides. La terminología es a menudo confusa, y la discriminación entre carcinoma de célula de Hürthle y tumor benigno de células de Hürthle puede ser incierta. La Tiroidectomía total con disección central de los ganglios linfáticos cervicales es la terapia de elección para los pacientes con carcinoma de células de Hürthle.

Oncocitoma renal: Presentación de un caso y revisión de la literatura: Una visión clínico-patológica / Renal on oncocitoma. Preserntation of acse and revision of literature. A clinical - pathological vision

Se presenta un caso de oncocitoma renal desde el punto de vista clínico y anatomopatológico, haciendo énfasis en las características clínicas e histológicas concernientes a diferenciación celular, comportamiento clínico, pronóstico y tratamiento. Los oncocitomas en general son neoplasias raras que suelen presentarse en diferentes órganos como lesiones benignas y/o malignas; sin embargo en el riñón se siguen considerando de naturaleza benigna a pesar de la dificultad en la diferenciación histopatológica con el carcinoma de células renales. Afortunadamente en la actualidad se cuenta con estrategias clínicas y ayudas diagnósticas refinadas que permiten caracterizar la histología de estas neoplasias lo cual permite garantizar un buen pronóstico para el paciente

Ateneo radiológico / Radiology conference

Presentamos un paciente varón de 56 años con hematuria y masa palpable renal derecha. Se confirma por TC de abdomen que muestra tumor sólido, que se tiñe con el contraste, con límite neto y una imagen hipodensa central de aspecto radiado que hace sospechar un tipo particular de tumor renal (oncocitoma). El diagnóstico fue confirmado por cirugía y anatomía patológica

Carcinoma medular y carcinoma de células de Hürthle del tiroides sincrónicos: una rara asociación lesional. Presentación de un caso clínico y revisión de la bibliografía / Synchronic medullary carcinoma and Hurtle cell carcinoma of the thyroid: a rare lesional association

Los autores presentan un caso de asociación lesionalsincrónica e independiente de carcinoma medular del tiroides con metástasis ganglionares, y carcinoma de células de Hürthle del lóbulo tiroideo contralateral. Se destaca la falta de referencia en la literatura revisada de casos similares. Se describen detalladamente los pasos diagnósticos y terapéuticos seguidos con este paciente. La bibliografía consultada permitió realizar una puesta al día de los aspectos diagnósticos terapéuticos y pronósticos de ambos tipos de cánceres tiroideos. A diez meses de la intervención quirúrgica el paciente se encuentra libre de enfermedad y en buenas condiciones, debiendo continuar con un estricto control evolutivo