Clear cell renal cell carcinoma with a syncytial-type multinucleated giant tumor cell component: Implications for differential diagnosis

Sean R. Williamson, Jennifer B. Kum, Michael P. Goheen, Liang Cheng, David J. Grignon, Muhammad T. Idrees

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

A component of syncytial-type multinucleated tumor giant cells is uncommon in clear cell renal cell carcinoma, and the histogenesis, incidence, and clinical implications of this finding are not well understood. We retrieved 13 such tumors from our pathology archives in patients with a median age of 60 years, comprising 1.5% of clear cell renal cell carcinomas. Stage was typically pT4 or pT3 (each 38%). Microscopically, all tumors included a component of low-grade clear cell renal cell carcinoma with usual features. Syncytial-type giant tumor cells possessed voluminous cytoplasm, usually granular and eosinophilic, and numerous nuclei similar to those of the mononuclear tumor cells. Transition between areas of mononuclear and multinucleated cells was sometimes abrupt. Other findings included necrosis (77%), hyaline globules (46%), emperipolesis (46%), and intranuclear cytoplasmic invaginations (23%). Immunohistochemical staining typically revealed both mononuclear and multinucleated cells to be positive for carbonic anhydrase IX, CD10, epithelial membrane antigen, vimentin, and cytokeratin AE1/AE3 and negative for β human chorionic gonadotropin, TFE3, cathepsin K, cytokeratin 7, cytokeratin 20, HMB45, CD68, smooth muscle actin, and S100. Most patients with available information (7/9) were alive with metastatic disease at the most recent follow-up. Syncytial-type giant cells are an uncommon finding associated with aggressive clear cell renal cell carcinomas. Despite the unusual appearance of this tumor component, its immunoprofile supports an epithelial lineage and argues against trophoblastic, osteoclast-like, or histiocytic differentiation. Reactivity for typical clear cell renal cell carcinoma antigens facilitates discrimination from giant cells of epithelioid angiomyolipoma or other tumors, particularly in a biopsy specimen or a metastatic tumor.

Original languageEnglish (US)
Pages (from-to)735-744
Number of pages10
JournalHuman pathology
Volume45
Issue number4
DOIs
StatePublished - Apr 2014

Fingerprint

Giant Cells
Cellular Structures
Renal Cell Carcinoma
Differential Diagnosis
Neoplasms
Emperipolesis
Keratin-20
Cathepsin K
Keratin-7
Angiomyolipoma
Giant Cell Tumors
Mucin-1
Hyalin
Vimentin
Osteoclasts
Chorionic Gonadotropin
Keratins
Smooth Muscle
Actins
Cytoplasm

Keywords

  • Emperipolesis
  • Hyaline globules
  • Immunohistochemistry
  • Renal cell carcinoma
  • Syncytial giant cells

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Clear cell renal cell carcinoma with a syncytial-type multinucleated giant tumor cell component : Implications for differential diagnosis. / Williamson, Sean R.; Kum, Jennifer B.; Goheen, Michael P.; Cheng, Liang; Grignon, David J.; Idrees, Muhammad T.

In: Human pathology, Vol. 45, No. 4, 04.2014, p. 735-744.

Research output: Contribution to journalArticle

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abstract = "A component of syncytial-type multinucleated tumor giant cells is uncommon in clear cell renal cell carcinoma, and the histogenesis, incidence, and clinical implications of this finding are not well understood. We retrieved 13 such tumors from our pathology archives in patients with a median age of 60 years, comprising 1.5{\%} of clear cell renal cell carcinomas. Stage was typically pT4 or pT3 (each 38{\%}). Microscopically, all tumors included a component of low-grade clear cell renal cell carcinoma with usual features. Syncytial-type giant tumor cells possessed voluminous cytoplasm, usually granular and eosinophilic, and numerous nuclei similar to those of the mononuclear tumor cells. Transition between areas of mononuclear and multinucleated cells was sometimes abrupt. Other findings included necrosis (77{\%}), hyaline globules (46{\%}), emperipolesis (46{\%}), and intranuclear cytoplasmic invaginations (23{\%}). Immunohistochemical staining typically revealed both mononuclear and multinucleated cells to be positive for carbonic anhydrase IX, CD10, epithelial membrane antigen, vimentin, and cytokeratin AE1/AE3 and negative for β human chorionic gonadotropin, TFE3, cathepsin K, cytokeratin 7, cytokeratin 20, HMB45, CD68, smooth muscle actin, and S100. Most patients with available information (7/9) were alive with metastatic disease at the most recent follow-up. Syncytial-type giant cells are an uncommon finding associated with aggressive clear cell renal cell carcinomas. Despite the unusual appearance of this tumor component, its immunoprofile supports an epithelial lineage and argues against trophoblastic, osteoclast-like, or histiocytic differentiation. Reactivity for typical clear cell renal cell carcinoma antigens facilitates discrimination from giant cells of epithelioid angiomyolipoma or other tumors, particularly in a biopsy specimen or a metastatic tumor.",
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