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Chromophobe renal cell carcinoma with liposarcomatous dedifferentiation - report of a unique case.
[pleomorphic liposarcoma]
Sarcomatous
transformation
of
chromophobe
renal
cell
carcinoma
(
CRCC
)
is
a
well
recognized
phenomenon
.
Of
the
published
cases
with
sarcomatous
transformation
of
CRCC
,
none
have
shown
liposarcomatous
differentiation
.
Out
of
a
cohort
of
250
cases
of
CRCC
,
19
(
7
.
6
%
)
showed
sarcomatous
differentiation
.
In
one
case
(
female
,
age
46
years
)
,
the
sarcomatous
component
of
the
tumor
displayed
histological
features
of
a
pleomorphic
liposar-
coma
.
Light
microscopic
examination
revealed
a
biphasic
pattern
with
a
chromophobe
renal
cell
carcinoma
(
CRCC
)
and
a
high
-grade
sarcomatous
component
containing
large
pleomorphic
lipoblasts
.
In
several
areas
both
components
were
intermingled
.
The
conventional
CRCC
component
showed
classic
histological
features
with
calcifications
,
medium-sized
polygonal
cells
arranged
in
solid-
alveolar
structures
with
raisinoid
nuclei
,
pale-eosinophilic
flocculent
cytoplasm
with
perinuclear
haloes
.
In
addition
,
a
microcystic-adenomatous
component
had
luminal
spaces
filled
with
erythrocytes
.
The
CRCC
was
positive
with
Hale
's
colloidal
iron
-stain
whereas
the
sarcomatous
component
was
negative
.
The
CRCC
component
was
diffusely
positive
for
cytokeratin
7
,
parvalbumin
and
racemase
but
negative
for
cy
-tokeratin
20
,
vimentin
,
CD
10
,
carboanhydrase
IX
and
S
100
-
protein
.
The
pleomorphic
liposarcomatous
component
displayed
immunereactivity
for
CD
10
,
vimentin
,
racemase
and
focally
for
carboanhydrase
IX
.
The
proliferative
activity
(
Mib-
1
/
Ki-
67
)
was
5
%
in
the
CRCC
and
30
%
in
the
pleomorphic
liposarcomatous
component
.
No
immunereactivity
for
MDM
2
or
CDK
4
was
detected
.
This
is
the
first
reported
case
of
a
sarcomatoid
CRCC
where
the
sarcomatous
component
displayed
features
of
a
pleomorphic
liposarcoma
.
The
patient
died
from
widespread
metastatic
disease
12
months
after
nephrectomy
.
Diseases
Validation
Diseases presenting
"renal cell carcinoma"
symptom
cowden syndrome
dedifferentiated liposarcoma
esophageal adenocarcinoma
esophageal squamous cell carcinoma
liposarcoma
pleomorphic liposarcoma
severe combined immunodeficiency
systemic capillary leak syndrome
von hippel-lindau disease
This symptom has already been validated