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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (2): 276-282. doi: 10.19723/j.issn.1671-167X.2023.02.011

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Mucinous tubular and spindle cell carcinoma of kidney: Clinicopathology and prognosis

Qi SHEN*(),Yi-xiao LIU,Qun HE   

  1. Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
  • Received:2022-10-10 Online:2023-04-18 Published:2023-04-12
  • Contact: Qi SHEN E-mail:13522300373@163.com

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Abstract:

Objective: To investigate and summarize the clinicopathological features, immunophenotype, differential diagnosis and prognosis analysis of mucinous tubular and spindle cell carcinoma (MTSCC). Methods: The data of thirteen cases of MTSCC were retrospectively analyzed, the clinical and pathological characteristics and immunohistochemical expression were summarized, and fluorescence in situ hybridization was detected. Results: Among the thirteen patients, four were males and nine females, with a male-to-female ratio of 1 ∶2.25. The average age was 57.1 years, ranging from 39 to 78 years. The maximum diameter of the tumor was 2-12 cm. All cases had no symptoms, and were accidentally discovered, 3 cases underwent partial renal resection, 10 cases underwent radical renal resection, 9 cases were located in the left kidney, and 4 cases were located in the right kidney. Most of the cases showed the classical morphological changes, with 11 cases of nuclear grading [World Health Organization (WHO)/International Society of Urological Pathology (ISUP) grading system] being G2 and 2 cases being G3. There were 6 cases of stage PT1a, 3 cases of PT1b, 2 cases of PT2a, and 1 case of PT2b and 1 case of PT3a. The positive rates of immunohistochemical staining were: vimentin, AE1/AE3, α-methylacyl-CoA racemase (αMACR) and cytokeratin (CK) 8/18, 100% (13/13); CK7, 92.3% (12/13); epithelial membrane antigen (EMA), 92.3% (12/13); CK20, 46.2% (6/13); CD10, 30.8% (4/13); synaptophysin (Syn), 7.7% (1/13); chromogranin A (CgA), CD57, WT1 and Ki-67, 0 (0/13), and fluorescence in situ hybridization showed that no trisomy of chromosomes 7 and 17 were observed in any of the cases. The follow-up period was 6 months to 7 years and 6 months, 2 cases died after lung metastasis (one with ISUP/WHO grade G3, one with necrosis), and the remaining 11 cases had no recurrence and metastasis. Conclusion: MTSCC is a unique type of low-grade malignancy kidney tumor, occurs predominantly in females, widely distributed in age, the current treatment method is surgical resection, and cases with necrosis and high-grade morphology are prone to recurrence and metastasis, although most cases have a good prognosis, but they still need close follow-up after surgery.

Key words: Renal cell carcinoma, Mucinous adenocarcinoma, Clinical pathology, Immunohistoche-mistry, Prognosis

CLC Number: 

  • R737.11

Table 1

Clinicopathological features of the MTSCC cases"

Case no. Gender Age/years Location Nephrectomy Tumor size/cm WHO/ISUP nuclear grade Necorsis T stage Follow-up/months Status
1 F 51 Right Total 7.6 2 No 2a 90 NED
2 F 77 Left Total 2.0 2 Yes 1a 15 Dead (lung metastasis)
3 F 56 Left Partial 2.5 2 No 1a 70 NED
4 M 69 Left Total 5.5 3 No 3a 6 Dead (lung metastasis)
5 M 50 Left Total 6.0 2 No 1b 54 NED
6 F 56 Right Total 7.3 2 No 2a 50 NED
7 F 51 Left Total 6.8 2 No 1b 38 NED
8 M 54 Left Partial 3.5 2 No 1a 27 NED
9 F 78 Left Total 2.5 3 No 1a 20 NED
10 F 50 Right Total 12.0 2 No 2b 14 NED
11 M 67 Left Total 3.6 2 No 1a 8 NED
12 F 39 Right Partial 2.2 2 No 1a 8 NED
13 F 44 Left Total 6.0 2 No 1b 6 NED

Figure 1

Histopathology of MTSCC (×100) A-E, hematoxylin-eosin staining. A, the typical features of MTSCC; B, the blue pools of mucin; C, the lymphocytic infiltration; D, the high grade MTSCC with WHO/ISUP nucleolar grade 3; E, the foam cells; F, immunohistochemical staining of CK7 showed the necrosis. MTSCC, mucinous tubular and spindle cell carcinoma. WHO/ISUP, World Health Organization/International Society of Urological Pathology."

Table 2

The results of immunohischemical stains for MTSCC"

Markers +++ ++ + -
CK7 1 7 4 1
αMACR 7 6 0 0
EMA 0 3 9 1
AE1/AE3 5 5 3 0
Vimentin 3 2 8 0
CK8/18 6 5 2 0
CD10 0 0 4 9
CK20 0 0 6 7
Syn 0 0 1 12
CgA 0 0 0 13
CD57 0 0 0 13
WT1 0 0 0 13
Ki-67 0 0 0 13

Figure 2

Immunohistochemical staining of MTSCC (×100) A, CK7; B, αMACR; C, EMA; D, AE1/AE3; E, vimentin; F, CD10; G, CgA; H, Ki-67. Abbreviations as in Table 2."

Figure 3

Fluorescence in situ hybridization analysis in MTSCC A, the FISH with centromeric probe for chromosome 7 displaying nuclei with two hybridization signals in MTSCC; B, the FISH with centromeric probe for chromosome 7 displaying nuclei with three hybridization signals in PRCC. FISH, fluorescence in situ hybridization; MTSCC, mucinous tubular and spindle cell carcinoma; PRCC, papillary renal cell carcinoma."

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