Oncocytic renal neoplasms are a major source of diagnostic challenge in genitourinary pathology; however, they are typically nonaggressive in general, raising the question of whether distinguishing different subtypes, including emerging entities, is necessary. Emerging entities recently described include eosinophilic solid and cystic renal cell carcinoma (ESC RCC), low-grade oncocytic tumor (LOT), eosinophilic vacuolated tumor (EVT), and papillary renal neoplasm with reverse polarity (PRNRP). A survey was shared among 65 urologic pathologists using SurveyMonkey.com (Survey Monkey, Santa Clara, CA, USA). De-identified and anonymized respondent data were analyzed. Sixty-three participants completed the survey and contributed to the study. Participants were from Asia (n = 21; 35%), North America (n = 31; 52%), Europe (n = 6; 10%), and Australia (n = 2; 3%). Half encounter oncocytic renal neoplasms that are difficult to classify monthly or more frequently. Most (70%) indicated that there is enough evidence to consider ESC RCC as a distinct entity now, whereas there was less certainty for LOT (27%), EVT (29%), and PRNRP (37%). However, when combining the responses for sufficient evidence currently and likely in the future, LOT and EVT yielded > 70% and > 60% for PRNRP. Most (60%) would not render an outright diagnosis of oncocytoma on needle core biopsy. There was a dichotomy in the routine use of immunohistochemistry (IHC) in the evaluation of oncocytoma (yes = 52%; no = 48%). The most utilized IHC markers included keratin 7 and 20, KIT, AMACR, PAX8, CA9, melan A, succinate dehydrogenase (SDH)B, and fumarate hydratase (FH). Genetic techniques used included TSC1/TSC2/MTOR (67%) or TFE3 (74%) genes and pathways; however, the majority reported using these very rarely. Only 40% have encountered low-grade oncocytic renal neoplasms that are deficient for FH. Increasing experience with the spectrum of oncocytic renal neoplasms will likely yield further insights into the most appropriate work-up, classification, and clinical management for these entities.
Virchows Archiv : an international journal of pathology. 2024 Sep 17 [Epub ahead of print]
Sambit K Mohanty, Anandi Lobo, Shilpy Jha, Ankur R Sangoi, Mahmut Akgul, Kiril Trpkov, Ondrej Hes, Rohit Mehra, Michelle S Hirsch, Holger Moch, Steven C Smith, Rajal B Shah, Liang Cheng, Mahul B Amin, Jonathan I Epstein, Anil V Parwani, Brett Delahunt, Sangeeta Desai, Christopher G Przybycin, Claudia Manini, Daniel J Luthringer, Deepika Sirohi, Deepika Jain, Divya Midha, Ekta Jain, Fiona Maclean, Giovanna A Giannico, Gladell P Paner, Guido Martignoni, Hikmat A Al-Ahmadie, Jesse McKenney, John R Srigley, Jose Ignacio Lopez, L Priya Kunju, Lisa Browning, Manju Aron, Maria M Picken, Maria Tretiakova, Ming Zhou, Mukund Sable, Naoto Kuroda, Niharika Pattnaik, Nilesh S Gupta, Priya Rao, Samson W Fine, Pritinanda Mishra, Amit K Adhya, Bijal N Kulkarni, Mallika Dixit, Manas R Baisakh, Samriti Arora, Sankalp Sancheti, Santosh Menon, Sara E Wobker, Satish K Tickoo, Seema Kaushal, Shailesh Soni, Shivani Kandukuri, Shivani Sharma, Suvradeep Mitra, Victor E Reuter, Vipra Malik, Vishal Rao, Ying-Bei Chen, Sean R Williamson
Department of Pathology, Advanced Medical Research Institute Hospital, Kolkata, India., Department of Pathology, Kapoor Center of Urology and Pathology, Raipur, India., Department of Pathology, El Camino Hospital, Mountain View, USA., Department of Pathology, Albany Medical Centre, Albany, USA., Department of Pathology, University of Calgary, Calgary, Canada., Department of Pathology, Bioptika Laborator S.R.O, Pilsen, Czech Republic., Department of Pathology, University of Michigan, Ann Arbor, USA., Department of Pathology, Brigham and Women's Hospital, Boston, USA., Department of Pathology, University Hospital, Zurich, Switzerland., Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond, USA., Department of Pathology, UT Southwestern Medical Center, Dallas, USA., Department of Pathology, Brown University, Providence, USA., Department of Pathology, The University of Tennessee Health Science Center, Memphis, USA., IMP Pathology, Garden City, USA., Department of Pathology, Ohio State University, Columbus, USA., Department of Pathology, Wellington School/Medicine, Wellington, New Zealand., Department of Pathology, Tata Memorial Hospital, Mumbai, India., Department of Pathology, Cleveland Clinic, Cleveland, USA., Department of Pathology, University of Turin, Turin, Italy., Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, USA., Department of Pathology, University of Utah/ARUP, Salt Lake City, USA., Department of Pathology, Core Diagnostics, Gurgaon, India., Department of Pathology, Tata Medical Center, Kolkata, India., Department of Pathology, Douglass Hanly Moir Pathology, Sydney, Australia., Department of Pathology, Vanderbilt University Medical Center, Nashville, USA., Department of Pathology, University of Chicago, Chicago, USA., Department of Pathology, University of Verona, Verona, Italy., Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA., Department of Pathology, Trillium Health Partners, Credit Valley Hospital, Mississauga, Canada., Department of Pathology, Cruces University Hospital, Barakaldo, Spain., Department of Pathology, Oxford University Hospital NHS Foundation Trust, Oxford, UK., Department of Pathology, Keck School of Medicine of USC, Los Angeles, USA., Department of Pathology, Loyola University Medical Center, Maywood, USA., Department of Pathology, University of Washington, Seattle, USA., Department of Pathology, Tufts University School of Medicine, Boston, USA., Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, India., Department of Pathology, Kochi Red Cross Hospital, Kochi City, Kochi, Japan., Department of Pathology, Henry Ford Health System, Detroit, USA., Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA., Department of Pathology, Kokilaben Ambani Hospital, Mumbai, India., Department of Pathology, Apollo Hospitals Bhubaneshwar, Bhubaneswar, India., Department of Pathology, Homi Bhabha Cancer Center, Visakhapatnam, India., Department of Pathology, The University of North Carolina at Chapel Hill, Chapel Hill, USA., Department of Pathology, All India Institute of Medical Sciences, New Delhi, India., Department of Pathology, Muljibhai Patel Urological Hospital, Nadiad, India., Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India., Department of Pathology, Basavatakaram Indo-American Cancer Hospital and Research Institute, Hyderabad, India., Department of Pathology, Cleveland Clinic, Cleveland, USA. .