Contributed by Craig Horbinski, MD, PhD and Federico Monzon-Bordonaba, MD
Published on line in August 2006
Contributed by Craig Horbinski, MD, PhD and Federico Monzon-Bordonaba, MD
Published on line in August 2006
CLINICAL HISTORY:
)
)
)
)
)
The patient was a 60 year-old woman who had inflammatory ductal carcinoma of the left breast diagnosed on a core biopsy in January 2005. An axillary lymph node was positive for metastatic disease on a concurrent FNA. The tumor was found to be ER-positive, PR-negative, and Her2-Neu weakly positive. Workup for further metastatic disease found multiple lesions in the liver and spine [images 1 and 2] as well as a 5 cm mass in the upper pole of the left kidney [image 3].
She received neoadjuvant chemotherapy and then underwent a modified radical mastectomy in October 2005 that found extensive primary tumor [image 4] as well as metastases in 14 of 14 axillary lymph nodes [image 5]. Two months later she had a left nephrectomy:
GROSS DESCRIPTION:
)
)
The specimen was a 280-gram nephrectomy measuring 12 cm superior to inferior, 6.0 cm anterior to posterior, and 7.0 cm medial to lateral. There was a 4.5 x 3 x 3 cm well circumscribed heterogeneous soft orange-yellow tumor protruding out of the superior pole with cystic changes and hemorrhage [image 6]. There was also a 0.2 cm well-defined white nodule near the renal papillae in the inferior pole [image 7].
MICROSCOPIC DESCRIPTION:
)
)
)
)
)
)
)
)
)
)
Sections of the tumor showed tubules and solid nests containing large clear cells with sharp cytoplasmic borders, dark pleomorphic nuclei, and occasionally prominent nucleoli [images 8, 9 and 10]. Further examination of the tumor showed a large focus of cells arranged in solid nests that had eosinophilic cytoplasm, larger nuclei, open chromatin, and prominent nucleoli [images 11, 12 and 13]. Occasional glandular/ductular structures were seen [image 14]. Similar-appearing cells were seen in the inferior pole nodule [images 15 and 16].
The immunohistochemical profile of these cells is summarized in Table 1 and image 17.
Table 1:
|
Marker |
Clear cell component |
Eosinophilic cell component |
|
RCC |
negative |
negative |
|
CK7 |
focally positive |
positive |
|
CK20 |
negative |
negative |
|
GCDFP |
negative |
negative |
|
Vimentin |
positive |
negative |
|
CD10 |
positive |
positive |
|
BerEp4 |
weakly positive |
positive |
|
C-kit |
negative |
negative |
|
Inhibin |
negative |
negative |
|
E-cadherin |
weakly positive |
strongly positive |
|
ER |
negative |
positive |
|
Ki67 index |
~20% |
~40% |
