RESUMO
BACKGROUND: Partial nephrectomy (PN) has become the dominant treatment modality for cT1 renal tumor lesions. Tumors suspected of malignant potential are indicated for surgery, but some are histologically classified as benign lesions after surgery. This study aims to analyze the number of benign findings after PN according to definitive histology and to evaluate whether there is an association between malignant tumor findings and individual factors. METHODS: The retrospective study included 555 patients who underwent open or robotic-assisted PN for a tumor in our clinic from January 2013 to December 2020. The cohort was divided into groups according to definitive tumor histology (malignant tumors vs. benign lesions). The association of factors (age, sex, tumor size, R.E.N.A.L.) with the malignant potential of the tumor was further evaluated. RESULTS: In total, 462 tumors were malignant (83%) and 93 benign (17%). Of the malignant tumors, 66% were clear-cell RCC (renal cell carcinoma), 12% papillary RCC, and 6% chromophobe RCC. The most common benign tumor was oncocytoma in 10% of patients, angiomyolipoma in 2%, and papillary adenoma in 1%. In univariate analysis, there was a higher risk of malignant tumor in males (OR 2.13, 95% CI 1.36-3.36, p = 0.001), a higher risk of malignancy in tumors larger than 20 mm (OR 2.32, 95% CI 1.43-3.74, p < 0.001), and a higher risk of malignancy in tumors evaluated by R.E.N.A.L. as tumors of intermediate or high complexity (OR 2.8, 95% CI 1.76-4.47, p < 0.001). In contrast, there was no association between older age and the risk of malignant renal tumor (p = 0.878). CONCLUSIONS: In this group, 17% of tumors had benign histology. Male sex, tumor size greater than 20 mm, and intermediate or high R.E.N.A.L. complexity were statistically significant predictors of malignant tumor findings.
Assuntos
Neoplasias Renais , Nefrectomia , Humanos , Masculino , Neoplasias Renais/cirurgia , Neoplasias Renais/patologia , Feminino , Nefrectomia/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Idoso , Carcinoma de Células Renais/cirurgia , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/epidemiologia , Angiomiolipoma/patologia , Angiomiolipoma/cirurgia , Adulto , Período Pré-Operatório , Adenoma Oxífilo/patologia , Adenoma Oxífilo/cirurgiaRESUMO
Oncocytic lesions represent a group of benign and potentially precancerous tumors characterized by the accumulation of oncocytes, which are large, granular, and eosinophilic cells. Diagnosing oncocytic lesions in the parotid gland typically involves a combination of imaging techniques, such as ultrasound, Computed Tomography (CT) scans, and Magnetic Resonance Imaging (MRI). Fine-needle aspiration (FNA) biopsy with histopathological examination remains the primary diagnostic tool for these lesions. Accurate diagnosis is crucial for appropriate management decisions. Treatment options for oncocytic lesions in the parotid gland include surgery, conservative management, and radiation therapy (RT). However, in the head and neck region, radiation doses can be a double-edged sword. While RT is a treatment modality, low radiation doses can promote the development of oncocytic lesions in the parotid gland. The prognosis for patients with oncocytic lesions is generally favorable, especially when the lesions are benign and appropriately managed. Current research focuses on the molecular mechanisms underlying oncocytic lesions in response to low-dose radiation exposure. The development of these lesions following low radiation doses represents a significant clinical concern. This manuscript provides a comprehensive overview of the current knowledge regarding oncocytic lesions in the parotid gland, including risk factors, diagnosis, treatment options, and ongoing research, offering valuable insights for clinicians and researchers.
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Neoplasias Parotídeas , Humanos , Neoplasias Parotídeas/radioterapia , Neoplasias Parotídeas/patologia , Neoplasias Parotídeas/diagnóstico por imagem , Células Oxífilas/patologia , Dosagem Radioterapêutica , Adenoma Oxífilo/patologia , Adenoma Oxífilo/radioterapia , Adenoma Oxífilo/diagnóstico por imagem , Glândula Parótida/patologia , Glândula Parótida/diagnóstico por imagem , Doses de Radiação , Neoplasias Induzidas por Radiação/patologia , Neoplasias Induzidas por Radiação/etiologiaRESUMO
Hepatocellular carcinoma typically metastasizes within the liver and may involve extrahepatic sites such as the lungs, adrenal glands, and bones at advanced stages. However, hepatocellular carcinoma metastasis to the thyroid is very uncommon and tumor-to-tumor metastasis from a hepatocellular cancer to a thyroid neoplasm is extremely rare. In this report, we present a case of a 70-year-old man with a hepatocellular carcinoma metastasizing to oncocytic thyroid carcinoma, emphasizing the importance of clinical history and of a multidisciplinary approach, as well as the usefulness of site-specific immunohistochemical markers, in diagnosing and managing cases of Rosai's metastasis, especially when donor and recipient neoplasms share similar histologic features.
Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Neoplasias da Glândula Tireoide , Humanos , Carcinoma Hepatocelular/secundário , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/diagnóstico , Masculino , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/secundário , Idoso , Biomarcadores Tumorais/análise , Imuno-Histoquímica , Adenoma Oxífilo/patologia , Adenoma Oxífilo/secundárioRESUMO
Objective: To explore the association between obesity/overweight and the risk of malignancy in Hürthle cell neoplasms of the thyroid. Methods: The data of patients with complete data who were diagnosed with Hürthle cell neoplasms of the thyroid at the Third Hospital of Peking University from September 2016 to September 2023 were retrospectively collected. Based on postoperative pathological diagnosis, tumors were classified into thyroid Hürthle cell adenoma group and Hürthle cell carcinoma group. Multivariate logistic regression analysis was employed to explore the association between overweight/obesity and the risk of malignancy in Hürthle cell neoplasms of the thyroid. Results: A total of 102 patients (13 males and 89 females) were included, aged (48.7±13.1) years. There were 22 cases of thyroid Hürthle cell carcinoma and 80 cases of thyroid Hürthle cell adenoma. Univariate analysis showed that the rate of overweight/obesity in the Hürthle cell carcinoma group was higher than that in the adenoma group [73% (16/22) vs 46% (37/80), P=0.050]. Multivariate logistic regression analysis indicated that the overweight/obese patients had a higher risk of malignancy in Hürthle cell neoplasms of the thyroid compared with the non-overweight/obese patients (OR=3.170, 95%CI: 1.126-9.955, P=0.035). Sensitivity analysis excluding individuals with multiple tumors was consistent with the main study results (OR=2.878, 95%CI: 0.922-10.228, P=0.080). Conclusion: Overweight/obesity may be associated with a higher risk of malignancy in patients with Hürthle cell neoplasms of the thyroid.
Assuntos
Adenoma Oxífilo , Obesidade , Sobrepeso , Neoplasias da Glândula Tireoide , Humanos , Masculino , Feminino , Adenoma Oxífilo/patologia , Pessoa de Meia-Idade , Neoplasias da Glândula Tireoide/etiologia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/epidemiologia , Estudos Retrospectivos , Obesidade/complicações , Fatores de Risco , Sobrepeso/complicações , Adulto , Modelos Logísticos , Adenoma/patologia , Adenoma/epidemiologiaRESUMO
Comprehensive molecular characterization and effective therapy in a rare case of metastatic renal oncocytoma.
Assuntos
Adenoma Oxífilo , Neoplasias Renais , Humanos , Pessoa de Meia-Idade , Adenoma Oxífilo/secundário , Adenoma Oxífilo/patologia , Adenoma Oxífilo/genética , Neoplasias Renais/genética , Neoplasias Renais/patologia , Neoplasias Renais/tratamento farmacológico , Metástase NeoplásicaRESUMO
Adrenocortical tumours are rare in children and account for only 0.3%-0.4% of all neoplasms in childhood. They present with variable signs and symptoms, depending on the type of hormonal hypersecretion. The majority of the adrenocortical tumours in children are functional (90%) and malignant (88%). Here, we describe a functional plurihormonal oncocytic adrenal cortical adenoma in a young girl, that mimicked a malignant adrenal lesion, clinically as well as on imaging and biochemical features. This report bears the objective of being aware of the atypical biochemical as well as imaging characteristics of oncocytic adrenal tumours.
Assuntos
Neoplasias do Córtex Suprarrenal , Adenoma Adrenocortical , Feminino , Humanos , Adenoma Oxífilo/patologia , Adenoma Oxífilo/diagnóstico , Adenoma Oxífilo/diagnóstico por imagem , Adenoma Oxífilo/cirurgia , Neoplasias do Córtex Suprarrenal/diagnóstico , Neoplasias do Córtex Suprarrenal/cirurgia , Neoplasias do Córtex Suprarrenal/diagnóstico por imagem , Neoplasias do Córtex Suprarrenal/patologia , Adenoma Adrenocortical/diagnóstico , Adenoma Adrenocortical/cirurgia , Adenoma Adrenocortical/diagnóstico por imagem , Adenoma Adrenocortical/patologia , Diagnóstico Diferencial , Tomografia Computadorizada por Raios X , AdolescenteRESUMO
BACKGROUND: Spindle cell oncocytomas (SCO) and granular cell tumors (GCT) are rare primary pituitary neoplasms; the optimal treatment paradigms for these lesions are unknown and largely unexplored. Thus, using national registries, we analyze the epidemiology, management patterns, and surgical outcomes of SCOs and GCTs. METHODS: The National Cancer Database (NCDB; years 2003-2017) and the Surveillance, Epidemiology, and End Results Program (SEER; years 2004-2018) were queried for patients with pituitary SCOs or GCTs. Incidence, extent of surgical resection, and rate of postoperative radiation use for subtotally resected lesions comprised the primary outcomes of interest. All-cause mortality was also analyzed via time-to-event Kaplan-Meier curves. RESULTS: SCOs and GCTs have an annual incidence of 0.017 and 0.023 per 1,000,000, respectively. They comprise 0.1% of the benign pituitary tumors registered in NCDB. A total of 112,241 benign pituitary tumors were identified in NCDB during the study period, of which 83 (0.07%) were SCOs and 59 (0.05%) were GCTs. Median age at diagnosis was 55 years, 44% were females, and median maximal tumor diameter at presentation was 2.1 cm. Gross total resection was achieved in 54% patients. Ten patients (7%) had postoperative radiation. Comparing patients with GCTs versus SCOs, the former were more likely to be younger at diagnosis (48.0 vs. 59.0, respectively; p < 0.01) and female (59% vs. 34%, p = 0.01). GCTs and SCOs did not differ in terms of size at diagnoses (median maximal diameter: 1.9 cm vs. 2.2 cm, respectively; p = 0.59) or gross total resection rates (62% vs. 49%, p = 0.32). After matching SCOs and GCTs with pituitary adenomas on age, sex, and tumor size, the former were less likely to undergo gross total resection (53% vs. 72%; p = 0.03). Patients with SCOs and GCTs had a shorter overall survival when compared to patients with pituitary adenomas (p < 0.01) and a higher rate of thirty-day mortality (3.1% vs 0.0%; p = 0.013). CONCLUSION: SCOs and GCTs are rare pituitary tumors, and their management entails particular challenges. Gross total resection is often not possible, and adjuvant radiation might be employed following subtotal resection.
Assuntos
Adenoma Oxífilo , Adenoma , Craniofaringioma , Tumor de Células Granulares , Neoplasias Hipofisárias , Humanos , Feminino , Masculino , Neoplasias Hipofisárias/epidemiologia , Neoplasias Hipofisárias/cirurgia , Neoplasias Hipofisárias/diagnóstico , Adenoma Oxífilo/cirurgia , Tumor de Células Granulares/diagnóstico , Hipófise/patologia , Adenoma/epidemiologia , Adenoma/cirurgiaRESUMO
OBJECTIVE: Quantitative comparison of the diagnostic efficacy of conventional diffusion-weighted imaging (DWI) and intravoxel incoherent motion (IVIM) in differentiating between chromophobe renal cell carcinoma (ChRCC) from renal oncocytoma (RO). METHODS: A total of 48 patients with renal tumours who had undergone DWI and IVIM were divided into two groups-ChRCC (n = 28) and RO (n = 20) groups, and the apparent diffusion coefficient (ADC), true diffusivity (D), pseudo-diffusion coefficient (D*), perfusion fraction (f) and their diagnostic efficacy were compared between the two groups. RESULTS: The D* values were higher in the ChRCCs group compared to the RO groups (0.019 ± 0.003 mm2/s vs 0.008 ± 0.002 mm2/s, P < .05). Moreover, the ADC, D and f values were higher in ROs compared to ChRCCs (0.61 ± 0.08 × 10-3 mm2/s vs 0.51 ± 0.06 × 10-3 mm2/s, 1.02 ± 0.15 × 10-3 mm2/s vs 0.86 ± 0.07 × 10-3 mm2/s, 0.41 ± 0.05 vs 0.28 ± 0.02, P < .05). The areas of the ADC, D, D* and f values under the ROC curves in differentiating ChRCCs from ROs were 0.713, 0.839, 0.856 and 0.906, respectively. The cut-off values of ADC, D, D* and f were 0.54, 0.91, 0.013 and 0.31, respectively. The AUC, sensitivity, specificity and accuracy of the f values were 0.906, 89.3%, 80.0% and 89.6%, respectively. For pairwise comparisons of ROC curves and diagnostic efficacy, IVIM parameters, that is, D, D* and f offered better diagnostic accuracy than ADC in differentiating ChRCCs from ROs (P = .013, .016, and .008) with f having the highest diagnostic accuracy. CONCLUSION: IVIM parameters presented better performance than ADC in differentiating ChRCCs from ROs. ADVANCES IN KNOWLEDGE: (1) D* values of ChRCCs were higher, while ADC, D and f values were lower than those of RO tumours. (2) f values had the highest diagnostic efficacy in differentiating ChRCC from RO. (3) IVIM parameters, that is, D, D* and f offered better diagnostic accuracy than ADC in differentiating ChRCC from RO (P=.013, .016, and .008).
Assuntos
Adenoma Oxífilo , Carcinoma de Células Renais , Imagem de Difusão por Ressonância Magnética , Neoplasias Renais , Humanos , Neoplasias Renais/diagnóstico por imagem , Carcinoma de Células Renais/diagnóstico por imagem , Adenoma Oxífilo/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Diagnóstico Diferencial , Feminino , Pessoa de Meia-Idade , Masculino , Idoso , Adulto , Sensibilidade e Especificidade , Estudos RetrospectivosRESUMO
Not required for Clinical Vignettes.
Assuntos
Adenoma Oxífilo , Neoplasias das Glândulas Suprarrenais , Humanos , Adenoma Oxífilo/patologia , Glândulas Suprarrenais/patologiaAssuntos
Adenoma Oxífilo , Neoplasias do Córtex Suprarrenal , Humanos , Adenoma Oxífilo/patologia , Adenoma Oxífilo/diagnóstico , Adenoma Oxífilo/diagnóstico por imagem , Neoplasias do Córtex Suprarrenal/diagnóstico , Neoplasias do Córtex Suprarrenal/patologia , Neoplasias do Córtex Suprarrenal/complicações , Feminino , Pessoa de Meia-Idade , Masculino , Idoso , AdultoRESUMO
Renal low-grade oncocytic tumor (LOT) is a recently recognized renal cell neoplasm designated within the "other oncocytic tumors" category in the 2022 World Health Organization classification system. Although the clinicopathologic, immunohistochemical, and molecular features reported for LOT have been largely consistent, the data are relatively limited. The morphologic overlap between LOT and other low-grade oncocytic neoplasms, particularly eosinophilic chromophobe renal cell carcinoma (E-chRCC), remains a controversial area in renal tumor classification. To address this uncertainty, we characterized and compared large cohorts of LOT (n = 67) and E-chRCC (n = 69) and revealed notable differences between the 2 entities. Clinically, LOT predominantly affected women, whereas E-chRCC showed a male predilection. Histologically, although almost all LOTs were dominated by a small-nested pattern, E-chRCC mainly showed solid and tubular architectures. Molecular analysis revealed that 87% of LOT cases harbored mutations in the tuberous sclerosis complex (TSC)-mTOR complex 1 (mTORC1) pathway, most frequently in MTOR and RHEB genes; a subset of LOT cases had chromosomal 7 and 19q gains. In contrast, E-chRCC lacked mTORC1 mutations, and 60% of cases displayed chromosomal losses characteristic of chRCC. We also explored the cell of origin for LOT and identified L1 cell adhesion molecule (L1CAM), a collecting duct and connecting tubule principal cell marker, as a highly sensitive and specific ancillary test for differentiating LOT from E-chRCC. This distinctive L1CAM immunohistochemical labeling suggests the principal cells as the cell of origin for LOT, unlike the intercalated cell origin of E-chRCC and oncocytoma. The ultrastructural analysis of LOT showed normal-appearing mitochondria and intracytoplasmic lumina with microvilli, different from what has been described for chRCC. Our study further supports LOT as a unique entity with a benign clinical course. Based on the likely cell of origin and its clinicopathologic characteristics, we propose that changing the nomenclature of LOT to "Oncocytic Principal Cell Adenoma of the Kidney" may be a better way to define and describe this entity.
Assuntos
Adenoma Oxífilo , Biomarcadores Tumorais , Carcinoma de Células Renais , Neoplasias Renais , Molécula L1 de Adesão de Célula Nervosa , Humanos , Neoplasias Renais/patologia , Neoplasias Renais/genética , Neoplasias Renais/química , Carcinoma de Células Renais/genética , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/química , Feminino , Masculino , Pessoa de Meia-Idade , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/genética , Molécula L1 de Adesão de Célula Nervosa/genética , Molécula L1 de Adesão de Célula Nervosa/análise , Molécula L1 de Adesão de Célula Nervosa/metabolismo , Idoso , Adulto , Adenoma Oxífilo/patologia , Adenoma Oxífilo/genética , Diagnóstico Diferencial , Idoso de 80 Anos ou mais , Imuno-Histoquímica , Gradação de Tumores , MutaçãoRESUMO
BACKGROUND: Oncocytoid salivary tumors include several entities such as oncocytoma, Warthin tumor, secretory carcinoma (SC), salivary duct carcinoma (SDC), acinic cell carcinoma (AciCC), oncocytic mucoepidermoid carcinoma (OMEC), intraductal carcinoma, and epithelial myoepithelial carcinoma (EMC). This review investigates the differential diagnosis of oncocytoid salivary tumors and explore the role of newly described immunostains as valuable tools for their diagnosing and potentially guiding treatment options. METHODS: We assess the utility of incorporating new immunohistochemical markers in routine practice to aid in diagnosing oncocytoid salivary tumors and potentially provide treatment options. RESULTS: In SDC, AR and Her2 immunostains are utilized as diagnostic tools and biomarkers for selecting patients who might benefit from Androgen-deprivation therapy (ADT) and HER2-targeted therapy. Furthermore, nuclear Pan-Trk immunostaining can aid in diagnosing SC. Additionally, NR4A3 immunostaining has been shown high sensitivity and specificity in identifying AciCC in both surgical and cytologic specimens. Similarly, RAS Q61R mutant-specific immunostaining, detected in EMC, may offer a cost-effective diagnostic marker for this tumor. Although further studies are required to evaluate the role of BSND, this marker has been reported to be positive in Warthin tumor and oncocytoma, aiding in differentiating them from other oncocytoid tumors, particularly OMEC. In addition, BRAFV600E mutant-specific immunostaining can serve as a diagnostic and potentially therapeutic marker for oncocytic intraductal carcinoma in mutation positive cases. CONCLUSION: Oncocytoid salivary tumors may have overlapping morphologies, posing diagnostic challenges for pathologists. Recently described immunohistochemical markers may offer valuable tools for diagnosing and potentially guiding treatment options for these tumors.
Assuntos
Adenolinfoma , Adenoma Oxífilo , Neoplasias da Mama , Carcinoma de Células Acinares , Carcinoma Ductal , Carcinoma Intraductal não Infiltrante , Carcinoma , Neoplasias da Próstata , Neoplasias das Glândulas Salivares , Masculino , Humanos , Adenoma Oxífilo/patologia , Adenolinfoma/patologia , Imuno-Histoquímica , Diagnóstico Diferencial , Antagonistas de Androgênios , Biomarcadores Tumorais/genética , Neoplasias da Próstata/diagnóstico , Neoplasias das Glândulas Salivares/patologia , Carcinoma de Células Acinares/patologia , Carcinoma Ductal/diagnósticoRESUMO
Recurrent gene fusions are common in salivary gland tumors including benign tumors, such as pleomorphic adenoma (PA) and myoepithelioma (ME). In cases where chromosomal rearrangement is identified in the pleomorphic adenoma gene 1 (PLAG1) gene, different gene partners are found. Oncocytic metaplasia, characterized by oncocytes with abundant eosinophilic granular cytoplasm and hyperchromatic nuclei, is a well-known phenomenon in salivary gland neoplasms. However, the pure oncocytic variant of PA/ME showed PLAG1 gene rearrangements involving various gene partners at the molecular level, without any recurrent fusion being found. Our study includes 20 cases of PA/ME, with 11 females and 9 males. The age of patients ranged from 37 to 96 years, with a median age of 62.8 years. Most tumors originate from the parotid gland. The median size of the tumor was 26.5 mm (range: 13 to 60 mm). Among the 20 cases, 14 were a pure oncocytic variant of PA/ME, whereas 6 cases showed focal oncocytic or oncocytic-like aspects. Molecular studies on 20 cases of PA/ME were conducted. A novel recurrent ZBTB47-AS1::PLAG1 fusion was identified in 6 of 12 cases with pure oncocytic metaplasia, whereas the other cases had PLAG1 gene fusion with different gene partners. The transcriptomic analysis of the cases harboring ZBTB47-AS1::PLAG1 fusion demonstrated that these tumors have a distinct molecular profile from conventional PA/ME. This study reveals a unique subset in the oncocytic PA/ME spectrum characterized by pure oncocytic morphology with larger oncocytic cells and recurrent ZBTB47-AS1::PLAG1 fusion. It also highlights the transcriptomic distinctness of salivary gland adenomas with pure oncocytic metaplasia in the spectrum of salivary gland neoplasms. Further studies are needed to better understand the oncocytic variant of PA/ME and to determine the true nature of oncocytic cells in PA/ME.
Assuntos
Adenoma Oxífilo , Adenoma Pleomorfo , Mioepitelioma , Neoplasias das Glândulas Salivares , Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Adulto , Idoso , Idoso de 80 Anos ou mais , Adenoma Pleomorfo/genética , Adenoma Pleomorfo/patologia , Mioepitelioma/genética , Mioepitelioma/patologia , Proteínas de Ligação a DNA/genética , Neoplasias das Glândulas Salivares/genética , Neoplasias das Glândulas Salivares/patologia , Fusão Gênica , MetaplasiaRESUMO
Oncocytoma is a benign tumor of the salivary gland. Its incidence is very low and very seldom documen-ted in literature. Clear-cell dominant oncocytoma is even less common. The tumor's clinical symptoms and imaging results are nonspecific, so distinguishing other salivary gland tumors (such as oncocytic carcinoma) from clear-cell renal carcinoma is difficult, possibly leading to misdiagnosis and maltreatment. Here, a case of clear-cell dominant oncocytoma was presented, and the relevant literature was evaluated to investigate the diagnosis and management of clear-cell dominant oncocytoma.
Assuntos
Adenoma Oxífilo , Neoplasias das Glândulas Salivares , Humanos , Glândula Parótida/patologia , Adenoma Oxífilo/diagnóstico , Adenoma Oxífilo/patologia , Neoplasias das Glândulas Salivares/diagnóstico , Diagnóstico DiferencialAssuntos
Adenoma Oxífilo , Neoplasias Renais , Humanos , Feminino , Neoplasias Renais/cirurgia , Neoplasias Renais/patologia , Neoplasias Renais/diagnóstico por imagem , Adenoma Oxífilo/cirurgia , Adenoma Oxífilo/patologia , Adenoma Oxífilo/diagnóstico por imagem , Adulto , Carcinoma de Células Renais/cirurgia , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/diagnóstico por imagem , Nefrectomia/métodos , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: The 2022 World Health Organization classification of renal neoplasia expanded the spectrum of oncocytic neoplasms to encompass newly established and emerging entities; one of the latter is the low-grade oncocytic tumor (LOT). This study reports the radiologic appearance and clinical behavior of LOT. METHODS: In this IRB-approved, HIPPA-compliant retrospective study, our institution's pathology database was searched for low-grade oncocytic tumors or neoplasms. Patient age, gender, and comorbidities were obtained from a review of electronic medical records, and imaging characteristics of the tumors were assessed through an imaging platform. RESULTS: The pathology database search yielded 14 tumors in 14 patients. Four patients were excluded, as radiologic images were not available in three, and one did not fulfill diagnostic criteria after pathology re-review. The resulting cohort consisted of 10 tumors (median diameter 2.3 cm, range 0.7-5.1) in 10 patients (median age 68 years, range 53-91, six women). All tumors presented as a solitary, well-circumscribed, mass with solid components. All enhanced as much or almost as much as adjacent renal parenchyma; all but one enhanced heterogeneously. None had lymphadenopathy, venous invasion, or metastatic disease at presentation or at clinical follow-up (median, 22.2 months, range 3.4-71.6). Among five tumors undergoing active surveillance, mean increase in size was 0.4 cm/year at imaging follow-up (median 16.7 months, range 8.9-25.4). CONCLUSION: LOT, a recently described pathologic entity in the kidney, can be considered in the differential diagnosis of an avidly and typically heterogeneously enhancing solid renal mass in an adult patient.
Assuntos
Adenoma Oxífilo , Neoplasias Renais , Humanos , Feminino , Masculino , Idoso , Pessoa de Meia-Idade , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Estudos Retrospectivos , Idoso de 80 Anos ou mais , Adenoma Oxífilo/diagnóstico por imagem , Adenoma Oxífilo/patologia , Gradação de Tumores , Meios de Contraste , Tomografia Computadorizada por Raios X/métodos , Imageamento por Ressonância Magnética/métodos , Diagnóstico DiferencialRESUMO
BACKGROUND: Oncocytic carcinoma (OCA) was recently reclassified as a distinct differentiated thyroid carcinoma (DTC). Given its rarity, OCA studies are limited. This study describes the characteristics of OCA in a 20-year cohort. METHODS: Retrospective analysis of patients with OCA at a single tertiary care hospital from 2000 to 2021. RESULTS: Fifty-one OCA patients (22M:29F) were identified. The mean age at diagnosis was 60.3 years; 90% presented as palpable mass; 24% had a family history of thyroid cancer. None had vocal fold paresis. On ultrasound, most tumors were solid and hypoechoic. FNA (n = 14) showed Bethesda-4 lesions in 93%. All were treated surgically. Histologically, 63% demonstrated angioinvasion, 35% had lymphovascular invasion, and 15% had extrathyroidal extension. Radioactive iodine was used as adjunct therapy in 77%. CONCLUSION: OCA has distinct features that distinguish it from other DTCs, and additional focused studies will help clarify the aggressive nature, treatment options, and prognosis of the disease.
Assuntos
Adenoma Oxífilo , Neoplasias da Glândula Tireoide , Humanos , Masculino , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/terapia , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Adenoma Oxífilo/patologia , Adenoma Oxífilo/terapia , Estudos de Coortes , Adulto , Tireoidectomia , Biópsia por Agulha FinaRESUMO
OBJECTIVE: The classification of renal tumors is expanding with the addition of new molecular entities in the 5th World Health Organization classification. Apart from this, the major updates in the definition of papillary renal cell carcinoma are that these tumors are no longer subtyped into type 1 and type 2. In oncocytic tumors, the new molecularly defined renal tumors, emerging and novel entities need to be considered in the diagnosis of oncocytic and chromophobe renal tumors. MATERIAL AND METHODS: This is a retrospective study to review and reclassify papillary, oncocytic, and chromophobe renal tumors based on the new WHO classification and correlate with clinical data, gross, microscopic features, and immunohistochemistry markers. RESULTS: A total of thirteen cases were reviewed and the tumor grade was changed for three out of four cases of papillary renal cell carcinoma and a single case was recategorized and graded. In nine cases of oncocytic and chromophobe renal tumors, the diagnoses were modified in 3 cases. CONCLUSION: Newly defined molecular renal tumors require advanced immunohistochemistry markers and molecular tests. This poses diagnostic challenges to pathologists practicing in low resource settings where molecular tests are not available.
Assuntos
Biomarcadores Tumorais , Carcinoma de Células Renais , Imuno-Histoquímica , Neoplasias Renais , Organização Mundial da Saúde , Humanos , Neoplasias Renais/patologia , Neoplasias Renais/classificação , Neoplasias Renais/química , Estudos Retrospectivos , Masculino , Feminino , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/classificação , Carcinoma de Células Renais/química , Pessoa de Meia-Idade , Idoso , Biomarcadores Tumorais/análise , Adulto , Adenoma Oxífilo/patologia , Adenoma Oxífilo/classificação , Adenoma Oxífilo/química , Gradação de TumoresRESUMO
Altered metabolism is a hallmark of cancer; however, it has been difficult to specifically target metabolism in cancer for therapeutic benefit. Cancers with genetically defined defects in metabolic enzymes constitute a subset of cancers where targeting metabolism is potentially accessible. Hürthle cell carcinoma of the thyroid (HTC) tumors frequently harbor deleterious mitochondrial DNA (mtDNA) mutations in subunits of complex I of the mitochondrial electron transport chain (ETC). Previous work has shown that HTC models with deleterious mtDNA mutations exhibit mitochondrial ETC defects that expose lactate dehydrogenase (LDH) as a therapeutic vulnerability. Here, we performed forward genetic screens to identify mechanisms of resistance to small-molecule LDH inhibitors. We identified two distinct mechanisms of resistance: upregulation of an LDH isoform and a compound-specific resistance mutation. Using these tools, we demonstrate that the anticancer activity of LDH inhibitors in cell line and xenograft models of complex I mutant HTC is through on-target LDH inhibition.