Loading

Journal of Urology and Research

Mucinous Tubular and Spindle Cell Renal Cell Carcinoma: About an Observation and Review of the Literature

Case Report | Open Access

  • 1. Department of Urology B, Mohamed V University, Morocco
+ Show More - Show Less
Corresponding Authors
Yassir Himmi, Department of Urology B, CHU Ibn Sina, Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco, Email: benani.urologie@gmail.com
Abstract

Mucinous tubular and spindle cell carcinoma is a rare tumor described in the 2004 WHO classification as a new entity with a relatively indolent behavior. We report a case of 60 year old man with a large left upper pole tumor. The patient was treated by left radical nephrectomy. The histologic findings confirmed that it was a tubulo-mucinous carcinoma and spindle cell grade I Furhman contours with non-infiltrating hilar invasion. Because of the favorable prognosis with this type of tumor, mucinous tubular and spindle cell carcinoma must be differentiated from papillary renal cell carcinoma, especially the variant with sarcomatoid dedifferentiation. Our case report of this rare entity ain to draw the attention of pathologists and clinicians to the importance of its diagnosis.

Keywords

Renal carcinoma, Mucinous stroma, Low grade

Cite this article

Himmi Y, Moutah B, Slaoui A, Tarik K, Khalid E, et al. (2022) Mucinous Tubular and Spindle Cell Renal Cell Carcinoma: About an Observation and Review of the Literature. J Urol Res 9(1): 1132.

INTRODUCTION

Mucinous tubular and spindle cell renal cell carcinoma is a rare kidney cancer, which was first described in 1998. It has already been designated in the category of unclassifiable Renal Cell Carcinoma (RCC) [1], in the classification of the World Health Organization (WHO), kidney tumors. In 2004, it was incorporated as a new entity apart from renal cell carcinomas [2]. Although CTM has been reported to have a relatively good prognosis, follow-up data is limited and the clinical behavior of this tumor remains to be established, and there is a need to collect more clinicopathologic characteristics of CTM for better understanding. Thus, we present the case of a tubulo-mucinous and fusiform carcinoma of low malignancy grade in a 60-year-old man with a review of the literature.

OBSERVATION

M BM, 60 years old, chronic smoker at the rate of 30 packs/ year. He had been complaining for 2 months of low-intensity left low back pain associated with a single episode of haematuria, with no other associated urinary or digestive disorder. On clinical examination, the patient was afebrile. His conjunctivae were normally stained, and his abdomen supple. The lymph node areas were free.

Computed tomography revealed a well-defined superior polar left renal mass, 20 cm in long axis, hypodense before injection, slightly enhanced after injection of the contrast product (Figure 1).

Frontal CT scan showing the mass an upper polar tissue mass of the left kidney.

Figure 1 Frontal CT scan showing the mass an upper polar tissue mass of the left kidney.

This mass pushes the calicielles cavities and the renal pedicle forwards (Figure 2). With the presence of a 10 mm latero left aortic lymphadenopathy. Biologically, the patient had a hemoglobin level at 13 g/dl, leukocytes at 6400/mm3 , normal renal function with a creatinine level at 8.5 mg. The patient was operated on subcostally. After detachment of the left colic angle, he underwent radical left nephrectomy. The postoperative course was simple.

Axial CT scan showing the hypodense left renal mass with low enhancement occupying the intracortical hilar region.

Figure 2 Axial CT scan showing the hypodense left renal mass with low enhancement occupying the intracortical hilar region.

On macroscopic examination, the kidney is the seat of a 20 cm mass, solid, beige-yellow in color and includes areas of hemorrhagic changes. This tumor was poorly borderline not encapsulated and coming into contact with the renal capsule.

Microscopic examination revealed proliferation of monotonous cubic eosinophilic epithelial cells. The cells are arranged in tubular structures and in parallel cell cords. These tubular structures are continuous with spindle-shaped sectors which are also of low nuclear grades. The microvacuolar stroma contains a mucinous substance with an inflammatory histiocyte infiltrate (Figure 3,4).

Fusiform cell proliferations of nuclear low grades with eosinophilic cytoplasm (HES, ×40).

Figure 3 Fusiform cell proliferations of nuclear low grades with eosinophilic cytoplasm (HES, ×40).

Proliferation of tubular and fusiform architecture within a myxoid stroma microvacuolar (HE×250).

Figure 4 Proliferation of tubular and fusiform architecture within a myxoid stroma microvacuolar (HE×250).

No vascular emboli were seen in the peri-tumor, nor capsular invasion or sarcomatoid contingent.

This morphological and histological analysis concluded that Furhman Grade I was tubulomucinous and fusiform carcinoma of the kidney.

DISCUSSION

Mucinous tubular and spindle cell carcinoma is a rare malignant epithelial tumor of the kidney, recognized since 2004 as a new entity of renal cell carcinoma. CTM has a female predominance and a good prognosis [3]. More than 80 cases have been listed in the literature [2]. The rare morphology of CTM has produced much confusion in the past.

The tubular architecture of the CTM showing focal papillae is strong evidence that may be in favor of papillary renal cell carcinoma. In cases with a predominant fusiform configuration, this appearance can lead to confusion with leiomyomas or even sarcomas [4].

CTM presents clinically with a clinical symptomatology that combines haematuria, lumbar pain and a palpable mass [5]. Radiological explorations found calcifications in 34% of cases, a figure six times higher than in other kidney tumours. There is also a greater frequency of invasion of the retroperitoneal space and greater tumor hypovascularization. But in general, there are no specific imaging criteria for the diagnosis of CTM. These features may resemble other variants of renal cell carcinoma, such as chromophobe cell carcinoma or papillary carcinoma of nothing, which have a less favorable prognosis. However, renal CTM should be suspected.

Faced with a large, well-circumscribed mass, the enhancement is weak after injection of the contrast product, with a weak or intermediate signal on T2-weighting, especially if in association with nephrolithiasis [1]. The size of the CTM is variable. It ranges from less than 1.0 cm in diameter to more than 18.0 cm, with most tumors measuring between 2.0-4.0 cm in the longest axis [6]. Macroscopically, the CTM are essentially of medullary location, well limited, firm, and often homogeneous, with a whitish-grey or more rarely brownish appearance. Hemorrhagic or necrotic changes are rare [7].

Histologically, the architecture is compact at low magnification with tubular sectors in continuity with fusiform sectors seeming to come from the compression of the tubes [8-10]. The tubes are stretched, interconnected, and sometimes arranged in parallel cellular cords, close to the structure of the loop of Henlé. They are composed of cuboidal cells with eosinophilic or clarified cytoplasm, centered by an oval or elongated nucleus without a prominent nucleolus. Mitoses are rare. The fusiform sectors can in places evoke a proliferation of smooth muscle cells. Between the tubes, a myxoid stroma is visible, positive for alcian blue. A few foci of inflammatory cells, notably containing foamy macrophages, may be present.

These tumors have a complex phenotype, expressing a wide variety of epithelial markers (EMA, AE1/AE3, CK7, CK19), and distal nephron markers (EMA, CK 19, E-cadherin).

The immunohistochemical profiles of these tumors reported in the literature are not clearly defined, they are inconsistent or even contradictory due to the heterogeneity of these tumors and the insufficient number of cases studied [8,11,12]. Indeed, the expression of the RCC Ma is inconstant; a recent study showed that 92% of the cases studied expressed this marker 4. This figure was 45% and only 7% in other series. Other markers are also of variable expression such as EMA, CD 15 and PS 100.

It is obvious that tumors with a similar morphological appearance may have different immunohistochemical expression without this necessarily implying that they are different. Several classifications of tumors in different organs have been mainly based on their morphology, the immunophenotype not always being exactly the same for tumors classified in the same type. Some authors suggest classifying tumors with the morphological characteristics of Mucinous tubular and spindle cell carcinoma according to the expression of different markers [13]. However, the expression of these antigens does not seem to be sufficient to separate tumors with the same clinical presentations, microscopic and evolutionary characteristics.

In the literature, cytogenetic data indicate various chromosomal losses and associated gains, but no loss of 3p or trisomy 7 and/or trisomy 17. Using comparative genomic hybridization and FISH (fluorescence in hybridization situ), we find characteristic combinations generally involving the loss of chromosomes 1, 4, 6, 8, 13 and 14 and the gains of chromosomes 7, 11, 16 and 17 [14].

The prognosis, according to data from the literature and in agreement with the histological appearance of low grade, seems favorable; however, cases with local recurrence, distant and regional metastases associated with the presence of metastatic lymphadenopathy have been reported in the literature [11,15- 17]. Recently, 5 cases of CTM with sarcomatoid differentiation and aggressive behavior have been reported in the literature, among these five cases three had distant metastases with fatal outcome for the patients [16,18]. It can be suggested that the changes observed in CTMs with sarcomatoid differentiation are related to the biobehavior of the kidney CTM. But given the low number of published cases and the duration of follow-up of these cases, the true biological potential and the morphological criteria that define it remain unknown [19]. Surgical resection is therefore always recommended, associated with careful followup of the patient.

CONCLUSION

MTSCC is a new entity in the pathological classification proposed by the WHO in recent years. It is essential to recognize CTM because of its favorable prognosis. Further cytogenetic and immunohistochemical studies as well as greater clinical experience are needed for a better characterization of these tumors.

REFERENCES

1. Lima MS, Barros-Silva GE, Pereira RA, Ravinal RC, Costa RS, Muglia VF, et al. The imaging and pathological features of a mucinous tubular and spindle cell carcinoma of the kidney: a case report. World J Surg Oncol. 2013; 11: 1-4.

2. Yang G, Breyer BN, Weiss DA, MacLennan G. Mucinous tubular and spindle cell carcinoma of the kidney. J Urol. 2010; 183: 738-739.

3. Lopez-Beltran A, Scarpelli M, Montironi R, Kirkali Z. 2004 WHO classification of the renal tumors of the adults. Eur Urol. 2006; 49: 798-805.

4. MacLennan GT, Cheng L (2008) Neoplasms of the kidney. In:Bostwick DG, Cheng L (eds) Urologic surgical pathology, 2nd edition . Mosby– Elsevier, Philadelphia, pp 104–6

5. Cheville JC, Lohse CM, Zincke H, Weaver AL, Leibovich BC, Frank I, et al. Sarcomatoid renal cell carcinoma an examination of underlying histologic subtype and an analysis of associations with patient outcome. Am J Surg Pathol. 2004; 28: 435-441.

6. Srigley JR, Delahunt B. Uncommon and recently described renal carcinomas. Mod Pathol. 2009; 22: S2-S23.

7. Ferlicot S, Allory Y, Compérat E, Mege-Lechevalier F, Dimet S, Sibony M, et al. Mucinous tubular and spindle cell carcinoma: a report of 15 cases and a review of the literature. Virchows Arch. 2005; 447: 978- 983.

8. Compérat EV, Vasiliu V, Ferlicot S, Camparo P, SibonyM, Vieillefond A. Tumors of the kidneys: new entities. Ann.Pathol. 2005; 25: 117-133.

9. Srigley JR. Mucinous tubular and spindle cell carcinoma. Eble JN, Sauter G, Epstein JI, Sesterhenn IA. World Health Organization Classification of Tumors: Pathology and genetics of tumors of the urinary system and male genital organs. 2004; 40.

10.Dubé V, Bergcron S, Laroche B, Fouquette B. An unusual renal tumour. An unusual renal neoplasm. Ann. Pathol. 2005; 25: 403-404.

11.Shen SS, Ro JY, Tamboli P, Truong LD, Zhai Q, JungSJ, et al. Mucinous tubular and spindle cell carcinoma of kidney is probably a variant of papillary renal cell carcinoma with spindle cell featurcs. Ann Diagn Pathol. 2007; 11: 13-21.

12.Arias LF, Blanco J, Hernández S, Bocardo G, González L. Immunohistochemical profile and clinical features of mucinous tubular and spindle renal cell carcinoma. Actas Urol Esp. 2006; 30: 649-654.

13.Gaafar A, Valentí C, Echevarria C, Laforga JB, López JI. Renal mucinous and tubular spindle cell carcinoma: A clinicopathological study of 4 cases. Ann.Saudi Med. 2006; 26: 466-470.

14.Srigley JR, Eble JN, Grignon DJ, Hartwick RWJ: Unusual renal cell carcinoma (RCC) with prominent spindle cell change possibly related to the loop of Henle. Mod Pathol. 1999; 12: 107.

15.Ursani NA, Robertson AR, Schieman SM, Bainbridge T, Srigley JR. Mucinous tubular and spindle cell carcinoma of kidney without sarcomatoid change showing metastases to liver and retroperitoneal lymph node. Hum Pathol. 2011; 42: 444-448.

16.Dhillon J, Amin MB, Selbs E, Turi GK, Paner GP, Reuter VE. Mucinous tubular and spindle cell carcinoma of the kidney with sarcomatoid change. Am J Surg Pathol. 2009; 33: 44-49.

17.Simon RA, di Sant’agnese PA, Palapattu GS, Singer EA, Candelario GD, Huang J, et al. Mucinous tubular and spindle cell carcinoma of the kidney with sarcomatoid differentiation. Int J Clin Exp Pathol. 2008; 1: 180-184.

18.Bulimbasic S, Ljubanovic D, Sima R, Michal M, Hes O, Kuroda N, et al. Aggressive high-grade mucinous tubular and spindle cell carcinoma. Hum Pathol. 2009; 40: 906-907.

19.Fine SW, Argani P, DeMarzo AM, Delahunt B, Sebo TJ, Reuter VE, et al. Expanding the histologic spectrum of mucinous tubular and spindle cell carcinoma of the kidney. Am J Surg Pathol. 2006; 30: 1554-1560.

Himmi Y, Moutah B, Slaoui A, Tarik K, Khalid E, et al. (2022) Mucinous Tubular and Spindle Cell Renal Cell Carcinoma: About an Observation and Review of the Literature. J Urol Res 9(1): 1132.

Received : 17 May 2022
Accepted : 24 Jun 2022
Published : 26 Jun 2022
Journals
Annals of Otolaryngology and Rhinology
ISSN : 2379-948X
Launched : 2014
JSM Schizophrenia
Launched : 2016
Journal of Nausea
Launched : 2020
JSM Internal Medicine
Launched : 2016
JSM Hepatitis
Launched : 2016
JSM Oro Facial Surgeries
ISSN : 2578-3211
Launched : 2016
Journal of Human Nutrition and Food Science
ISSN : 2333-6706
Launched : 2013
JSM Regenerative Medicine and Bioengineering
ISSN : 2379-0490
Launched : 2013
JSM Spine
ISSN : 2578-3181
Launched : 2016
Archives of Palliative Care
ISSN : 2573-1165
Launched : 2016
JSM Nutritional Disorders
ISSN : 2578-3203
Launched : 2017
Annals of Neurodegenerative Disorders
ISSN : 2476-2032
Launched : 2016
Journal of Fever
ISSN : 2641-7782
Launched : 2017
JSM Bone Marrow Research
ISSN : 2578-3351
Launched : 2016
JSM Mathematics and Statistics
ISSN : 2578-3173
Launched : 2014
Journal of Autoimmunity and Research
ISSN : 2573-1173
Launched : 2014
JSM Arthritis
ISSN : 2475-9155
Launched : 2016
JSM Head and Neck Cancer-Cases and Reviews
ISSN : 2573-1610
Launched : 2016
JSM General Surgery Cases and Images
ISSN : 2573-1564
Launched : 2016
JSM Anatomy and Physiology
ISSN : 2573-1262
Launched : 2016
JSM Dental Surgery
ISSN : 2573-1548
Launched : 2016
Annals of Emergency Surgery
ISSN : 2573-1017
Launched : 2016
Annals of Mens Health and Wellness
ISSN : 2641-7707
Launched : 2017
Journal of Preventive Medicine and Health Care
ISSN : 2576-0084
Launched : 2018
Journal of Chronic Diseases and Management
ISSN : 2573-1300
Launched : 2016
Annals of Vaccines and Immunization
ISSN : 2378-9379
Launched : 2014
JSM Heart Surgery Cases and Images
ISSN : 2578-3157
Launched : 2016
Annals of Reproductive Medicine and Treatment
ISSN : 2573-1092
Launched : 2016
JSM Brain Science
ISSN : 2573-1289
Launched : 2016
JSM Biomarkers
ISSN : 2578-3815
Launched : 2014
JSM Biology
ISSN : 2475-9392
Launched : 2016
Archives of Stem Cell and Research
ISSN : 2578-3580
Launched : 2014
Annals of Clinical and Medical Microbiology
ISSN : 2578-3629
Launched : 2014
JSM Pediatric Surgery
ISSN : 2578-3149
Launched : 2017
Journal of Memory Disorder and Rehabilitation
ISSN : 2578-319X
Launched : 2016
JSM Tropical Medicine and Research
ISSN : 2578-3165
Launched : 2016
JSM Head and Face Medicine
ISSN : 2578-3793
Launched : 2016
JSM Cardiothoracic Surgery
ISSN : 2573-1297
Launched : 2016
JSM Bone and Joint Diseases
ISSN : 2578-3351
Launched : 2017
JSM Bioavailability and Bioequivalence
ISSN : 2641-7812
Launched : 2017
JSM Atherosclerosis
ISSN : 2573-1270
Launched : 2016
Journal of Genitourinary Disorders
ISSN : 2641-7790
Launched : 2017
Journal of Fractures and Sprains
ISSN : 2578-3831
Launched : 2016
Journal of Autism and Epilepsy
ISSN : 2641-7774
Launched : 2016
Annals of Marine Biology and Research
ISSN : 2573-105X
Launched : 2014
JSM Health Education & Primary Health Care
ISSN : 2578-3777
Launched : 2016
JSM Communication Disorders
ISSN : 2578-3807
Launched : 2016
Annals of Musculoskeletal Disorders
ISSN : 2578-3599
Launched : 2016
Annals of Virology and Research
ISSN : 2573-1122
Launched : 2014
JSM Renal Medicine
ISSN : 2573-1637
Launched : 2016
Journal of Muscle Health
ISSN : 2578-3823
Launched : 2016
JSM Genetics and Genomics
ISSN : 2334-1823
Launched : 2013
JSM Anxiety and Depression
ISSN : 2475-9139
Launched : 2016
Clinical Journal of Heart Diseases
ISSN : 2641-7766
Launched : 2016
Annals of Medicinal Chemistry and Research
ISSN : 2378-9336
Launched : 2014
JSM Pain and Management
ISSN : 2578-3378
Launched : 2016
JSM Women's Health
ISSN : 2578-3696
Launched : 2016
Clinical Research in HIV or AIDS
ISSN : 2374-0094
Launched : 2013
Journal of Endocrinology, Diabetes and Obesity
ISSN : 2333-6692
Launched : 2013
Journal of Substance Abuse and Alcoholism
ISSN : 2373-9363
Launched : 2013
JSM Neurosurgery and Spine
ISSN : 2373-9479
Launched : 2013
Journal of Liver and Clinical Research
ISSN : 2379-0830
Launched : 2014
Journal of Drug Design and Research
ISSN : 2379-089X
Launched : 2014
JSM Clinical Oncology and Research
ISSN : 2373-938X
Launched : 2013
JSM Bioinformatics, Genomics and Proteomics
ISSN : 2576-1102
Launched : 2014
JSM Chemistry
ISSN : 2334-1831
Launched : 2013
Journal of Trauma and Care
ISSN : 2573-1246
Launched : 2014
JSM Surgical Oncology and Research
ISSN : 2578-3688
Launched : 2016
Annals of Food Processing and Preservation
ISSN : 2573-1033
Launched : 2016
Journal of Radiology and Radiation Therapy
ISSN : 2333-7095
Launched : 2013
JSM Physical Medicine and Rehabilitation
ISSN : 2578-3572
Launched : 2016
Annals of Clinical Pathology
ISSN : 2373-9282
Launched : 2013
Annals of Cardiovascular Diseases
ISSN : 2641-7731
Launched : 2016
Journal of Behavior
ISSN : 2576-0076
Launched : 2016
Annals of Clinical and Experimental Metabolism
ISSN : 2572-2492
Launched : 2016
Clinical Research in Infectious Diseases
ISSN : 2379-0636
Launched : 2013
JSM Microbiology
ISSN : 2333-6455
Launched : 2013
Journal of Family Medicine and Community Health
ISSN : 2379-0547
Launched : 2013
Annals of Pregnancy and Care
ISSN : 2578-336X
Launched : 2017
JSM Cell and Developmental Biology
ISSN : 2379-061X
Launched : 2013
Annals of Aquaculture and Research
ISSN : 2379-0881
Launched : 2014
Clinical Research in Pulmonology
ISSN : 2333-6625
Launched : 2013
Journal of Immunology and Clinical Research
ISSN : 2333-6714
Launched : 2013
Annals of Forensic Research and Analysis
ISSN : 2378-9476
Launched : 2014
JSM Biochemistry and Molecular Biology
ISSN : 2333-7109
Launched : 2013
Annals of Breast Cancer Research
ISSN : 2641-7685
Launched : 2016
Annals of Gerontology and Geriatric Research
ISSN : 2378-9409
Launched : 2014
Journal of Sleep Medicine and Disorders
ISSN : 2379-0822
Launched : 2014
JSM Burns and Trauma
ISSN : 2475-9406
Launched : 2016
Chemical Engineering and Process Techniques
ISSN : 2333-6633
Launched : 2013
Annals of Clinical Cytology and Pathology
ISSN : 2475-9430
Launched : 2014
JSM Allergy and Asthma
ISSN : 2573-1254
Launched : 2016
Journal of Neurological Disorders and Stroke
ISSN : 2334-2307
Launched : 2013
Annals of Sports Medicine and Research
ISSN : 2379-0571
Launched : 2014
JSM Sexual Medicine
ISSN : 2578-3718
Launched : 2016
Annals of Vascular Medicine and Research
ISSN : 2378-9344
Launched : 2014
JSM Biotechnology and Biomedical Engineering
ISSN : 2333-7117
Launched : 2013
Journal of Hematology and Transfusion
ISSN : 2333-6684
Launched : 2013
JSM Environmental Science and Ecology
ISSN : 2333-7141
Launched : 2013
Journal of Cardiology and Clinical Research
ISSN : 2333-6676
Launched : 2013
JSM Nanotechnology and Nanomedicine
ISSN : 2334-1815
Launched : 2013
Journal of Ear, Nose and Throat Disorders
ISSN : 2475-9473
Launched : 2016
JSM Ophthalmology
ISSN : 2333-6447
Launched : 2013
Journal of Pharmacology and Clinical Toxicology
ISSN : 2333-7079
Launched : 2013
Annals of Psychiatry and Mental Health
ISSN : 2374-0124
Launched : 2013
Medical Journal of Obstetrics and Gynecology
ISSN : 2333-6439
Launched : 2013
Annals of Pediatrics and Child Health
ISSN : 2373-9312
Launched : 2013
JSM Clinical Pharmaceutics
ISSN : 2379-9498
Launched : 2014
JSM Foot and Ankle
ISSN : 2475-9112
Launched : 2016
JSM Alzheimer's Disease and Related Dementia
ISSN : 2378-9565
Launched : 2014
Journal of Addiction Medicine and Therapy
ISSN : 2333-665X
Launched : 2013
Journal of Veterinary Medicine and Research
ISSN : 2378-931X
Launched : 2013
Annals of Public Health and Research
ISSN : 2378-9328
Launched : 2014
Annals of Orthopedics and Rheumatology
ISSN : 2373-9290
Launched : 2013
Journal of Clinical Nephrology and Research
ISSN : 2379-0652
Launched : 2014
Annals of Community Medicine and Practice
ISSN : 2475-9465
Launched : 2014
Annals of Biometrics and Biostatistics
ISSN : 2374-0116
Launched : 2013
JSM Clinical Case Reports
ISSN : 2373-9819
Launched : 2013
Journal of Cancer Biology and Research
ISSN : 2373-9436
Launched : 2013
Journal of Surgery and Transplantation Science
ISSN : 2379-0911
Launched : 2013
Journal of Dermatology and Clinical Research
ISSN : 2373-9371
Launched : 2013
JSM Gastroenterology and Hepatology
ISSN : 2373-9487
Launched : 2013
TEST Journal of Dentistry
ISSN : 1234-5678
Launched : 2014
Annals of Nursing and Practice
ISSN : 2379-9501
Launched : 2014
JSM Dentistry
ISSN : 2333-7133
Launched : 2013
Author Information X