Mucinous tubular and spindle cell carcinoma with Fuhrman nuclear grade 3: A histological, immunohistochemical, ultrastructural and FISH study
N. Kuroda1, O. Hes2, M. Michal2, J. Nemcova2, V. Gal3, T. Yamaguchi4, T. Kawada5, Y. Imamura6, Y. Hayashi7 and G.H. Lee7
1Department of Diagnostic Pathology, Kochi Red Cross Hospital, Kochi, Japan, 2Department of Pathology, Charles University Hospital Plzen, Czech Republic, 3Department of Pathology, Alpha Medical Pathology, l.t.d., Bratislava, Slovak Republic, 4Department of Pathology, Ayabe City Hospital, Kyoto, Japan, 5Department of Pathology, Maizuru Kyosai Hospital, 6Division of Surgical Pathology, University of Fukui Hospital, Fukui, Japan, 7Department of Pathology, Kochi Medical School, Kochi University, Kochi, Japan.
Offprint requests to: Naoto Kuroda, Department of Diagnostic Pathology, Kochi Red Cross Hospital, Shin-honamchi 2-chome 13-51, Kochi City, Kochi 780-8562, Japan. e-mail: firstname.lastname@example.org
Summary. Mucinous tubular and spindle cell carcinoma (MTSCC) of the kidney generally shows low nuclear grade. MTSCC with high nuclear grade is relatively rare. In this article, we report two cases of MTSCC with Fuhrman grade 3. One case occurred in a 57-year-old Japanese female and the second case in a 49-year-old Caucasian female. Histologically, the tumors were composed of neoplastic cells with cuboidal or columnar and spindle morphology, and Fuhrman nuclear grade 3. The myxoid stroma was also observed. This stroma was positive for Alcian blue stain. Immunohistochemically, neoplastic cells of both cases were positive for AMACR, but negative for CD10 and RCC Ma. Ultrastructurally, tumorous cells of one case contained numerous mitochondria. In FISH analysis, many neoplastic cells of both cases demonstrated monosomy of chromosomes 15 and 22 and disomy of chromosomes 7 and 17. One of the two patients died of respiratory failure due to pleuritis carcinomatosa 48 months postoperatively. Finally, the pathologist should recognize that high grade MTSCC exists despite its rare frequency. FISH analysis may be helpful in establishing the diagnosis of this entity. Furthermore, we present the first report of a patient with MTSCC dying of distant metastasis. Histol Histopathol 23, 1517-1523 (2008)
Key words: Kidney, High grade, Mucinous tubular and spindle cell carcinoma, Renal cell carcinoma, FISH, Chromosome 15, Chromosome 22