The Current State of Emerging Renal Oncocytic Neoplasms: A Survey of Urologic Pathologists
Recommended Citation
Mohanty S, Lobo A, Parwani A, Adhya A, Sangoi A, Kulkarni B, Delahunt B, Przybycin C, Manini C, Luthringer D, Sirohi D, Midha D, Jain E, Maclean F, Giannico G, Paner G, Martignoni G, Al-Ahmadie H, Moch H, McKenney J, Epstein J, Lopez J, Trpkov K, Cheng L, Browning L, Akgul M, Amin M, Baisakh M, Aron M, Picken M, Tretiakova M, Hirsch M, Zhou M, Kuroda N, Pattnaik N, Gupta NS, Hes O, Rao P, Shah R, Mehra R, Fine S, Desai S, Sancheti S, Menon S, Wobker S, Tickoo S, Kaushal S, Jha S, Kandukuri S, Sharma S, Smith S, Mitra S, Reuter V, Rao B, Chen Y, Williamson SR. The Current State of Emerging Renal Oncocytic Neoplasms: A Survey of Urologic Pathologists. Mod Pathol 2022; 35(SUPPL 2):638.
Document Type
Conference Proceeding
Publication Date
3-19-2022
Publication Title
Mod Pathol
Abstract
Background: Oncocytic renal neoplasms are diagnostically challenging but usually nonaggressive. Several newer entities have been recently described, including 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), the acceptance and clinical significance of which are still emerging. Design: A survey instrument was shared among 65 urologic pathologists using SurveyMonkey.com (SurveyMonkey, Santa Clara, CA, USA). De-identified and anonymized respondent data were analyzed. Results: Sixty 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%). Practice experience was (27%), 10-20 years (44%), or >20 years (29%). Half encounter oncocytic renal neoplasms that are difficult to classify at least monthly. Most (70%) indicated that there is enough evidence to consider ESC as a distinct entity now, whereas there was less certainty for LOT (27%), EVT (29%), and PRNRP (37%). However, >50% reported that eventually (if not already) these would likely be regarded as distinct entities. Most (60%) would not render an outright diagnosis of oncocytoma in a needle core biopsy and would provide a comment rather than erring toward one diagnosis. There was a dichotomy in the routine use of immunohistochemistry (IHC) in the evaluation of oncocytoma (yes=52%; no=48%). Most used IHC markers included keratin 7 and 20, KIT, AMACR, PAX8, CA9, melan A, SDHB, and FH. When prompted with a scenario of a tumor with ESC-like features but papillary growth noted, there was a mixture of response between interpreting as ESC (48%) vs unclassified RCC (35%). Genetic techniques used included TSC1/TSC2/MTOR (67%) or TFE3 (74%); however, the majority reported using these very rarely. Only 40% have encountered low-grade oncocytic renal neoplasms that are deficient for fumarate hydratase. Conclusions: ESC is the most strongly accepted as a distinct entity (70%), although most (>50%) felt that LOT, EVT, and PRNRP would likely be distinct entities eventually (if not already). Genetic techniques are currently being used rarely, but most used markers include the TSC/MTOR pathway and translocations.
PubMed ID
Not assigned.
Volume
35
Issue
SUPPL 2
First Page
638
