Nadir Görülen Bir Böbrek Tümörü: Müsinöz Tubuler ve İğsi Hücreli Karsinoma

Öz

Müsinöz tübüler ve iğsi hücreli karsinoma; oldukça nadir görülen renal epitelyal bir neoplazmdır. Olgu sunumumuzda müsinöz tübüler ve iğsi hücreli karsinoma saptanan olgu sunulmuş ve hastalığın epidemiyolojisi, radyolojik bulguları ve histopatolojik özellikleri ilgili literatür eşliğinde kısaca tartışılmıştır. 43 yaşındaki erkek hasta, sol yan ağrısı şikayeti ile başvurduğu dış merkezde yapılan radyolojik incelemede, sol böbreğinde kitle saptanması üzerine ileri tanı ve tedavi için hastanemiz üroloji polikliniğine yönlendirildi. Yapılan fizik muayene ve tetkikler doğrultusunda renal hücreli karsinoma düşünülen olguya radikal nefrektomi operasyonu planlandı. Materyalden hazırlanan kesitlerin mikroskobik incelemesinde; miksoid stroma içerisinde, eozinofilik sitoplazmalı, iğsi şekilli, düşük gradeli nükleer özellikler gösteren hücrelerin, uzamış veya birbiri ile anastomozlaşan tubul benzeri yapılanmalarından oluşan tümöral lezyon dikkati çekti. Histopatolojik ve immünohistokimyasal bulgular doğrultusunda olguya müsinöz tübüler ve iğsi hücreli karsinoma tanısı verildi. Tüm renal neoplazilerin %1'den azını oluşturan bu tümörlerin prognozu, diğer epitelyal böbrek tümörlerine kıyasla daha iyidir. Bu nedenle müsinöz tübüler ve iğsi hücreli karsinoma olgularını ayırıcı tanıya girdikleri papiller renal hücreli karsinoma olgularından ayırmak son derece önemlidir.

Anahtar Kelimeler

• Müsinöz tubuler ve iğsi hücreli karsinoma,Patoloji,Renal tümör

A Rarely Seen Renal Epithelial Tumor: Mucinous Tubular and Spindle Cell Carcinoma

Öz

Mucinous tubular and spindle cell carcinoma has recently been recognized as a rare distinctive type of renal epithelial carcinoma. In our case report, we report a case of mucinous tubular and spindle cell carcinoma and epidemiology, radiological findings and histopathologic features of the disease were briefly discussed in literature data. A 43-year-old male was referred to our urology outpatient clinic for further diagnosis and treatment after a mass on the left kidney was detected in a radiological examination at the external center with the complaint of left flank pain. Radical nephrectomy was planned for the case who was thought to have a diagnosis of renal cell carcinoma according to physical examination and tests. In the microscopic examination of the specimen, tumoral lesion consisting of elongated or anastomotic tubulus-like structures of the spindle shaped cells with eosinophilic cytoplasm indicating low-grade nuclear features consistent in myxoid stroma were observed. The patient was diagnosed as mucinous tubular and spindle cell carcinoma according to the histopathological and immunohistochemical findings. These tumors, which constitute less than 1% of all renal neoplasms, have a better prognosis than other epithelial renal tumors. Therefore, it is very important to distinguish mucinous tubular and spindle cell carcinoma cases from papillary renal cell carcinoma cases in differential diagnosis.

Anahtar Kelimeler

• Mucinous tubular and Spindle cell carcinoma,Pathology,Renal tumor

Kaynakça

1. 1. Moch H, Humphrey PA, Ulbright TM, Reuter VE. World Health Organization classification of Tumours of Urinary System and Male Genital Organs: Mucinous tubular and spindle cell carcinoma. 4th ed. Lyon, France: IARC Press, 2016;37.
2. 2. MacLennan GT, Farrow GM, Bostwick DG. Low-grade collecting duct carcinoma of the kidney: report of 13 cases of low-grade mucinous tubulocystic renal carcinoma of possible collecting duct origin. Urology. 1997;50:679–84.
3. 3. Lopez-Beltran A, Scarpelli M, Montironi R, Kirkali Z. 2004 WHO classification of the renal tumors of the adults. Eur Urol. 2006 May;49(5):798-805. Epub 2006 Jan 17.
4. 4. Sun N, Fu Y, Wang Y, Tian T, An W, Yuan T. Mucinous tubular and spindle cell carcinoma of the kidney: A case report and review of the literature. Oncol Lett. 2014 Mar;7(3):811-4. Epub 2014 Jan 7.
5. 5. Simon RA, di Sant'agnese PA, Palapattu GS, et al. Mucinous tubular and spindle cell carcinoma of the kidney with sarcomatoid differentiation. Int J Clin Exp Pathol. 2008;1:180-4.
6. 6. 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;33:44-9
7. 7. Shen SS, Ro JY, Tamboli P, et al. Mucinous tubular and spindle cell carcinoma of kidney is probably a variant ofpapillary renal cell carcinoma with spindle cell features. Ann Diagn Pathol. 2007;11(1): 13- 21.
8. 8. Zhou M, Netto G, Epstein J. Uropathology:High-Yield Pathology: Mucinous tubular and spindle cell carcinoma. 1th ed. Philadelphia, 2012;287-8.

9. 9. Hes O, Hora M, Perez-Montiel DM, et al. Spindle and cuboidal renal cell carcinoma, a tumour having frequent association with nephrolithiasis: report of 11 cases including a case with hybrid conventional renal cell carcinoma/spindle and cuboidal renal cell carcinoma components. Histopathology 2002;41:549-555.
10. 10. Sahni VA, Hirsch MS, Sadow CA, Silverman SG. Mucinous tubular and spindle cell carcinoma of the kidney: imaging features. Cancer Imaging. 2012 Mar 5;12:66-71. doi: 10.1102/1470-7330.2012.0008.
11. 11. Cornelis F, Ambrosetti D, Rocher L, et al. CT and MR imaging features of mucinous tubular and spindle cell carcinoma of the kidneys. A multi-institutional review. Eur Radiol. 2017 Mar;27(3):1087-1095. doi: 10.1007/s00330-016-4469-1. Epub 2016 Jun 22.
12. 12. Zhang Q, Wang W, Zhang S, Zhao X, Zhang S, Liu G, Guo H. Mucinous tubular and spindle cell carcinoma of the kidney: the contrast-enhanced ultrasonography and CT features of six cases and review of the literature. Int Urol Nephrol. 2014 Dec;46(12):2311-7. doi: 10.1007/s11255-014-0814-y. Epub 2014 Aug 27.
13. 13. Hussain M, Ud Din N, Azam M, Loya A. Mucinous tubular and spindle cell carcinoma of kidney: a clinicopathologic study of six cases. Indian J Pathol Microbiol. 2012 Oct-Dec;55(4):439-42. doi: 10.4103/0377-4929.107776.
14. 14. Huimiao J, Chepovetsky J, Zhou M, et al. Mucinous tubular and spindle cell carcinoma of the kidney: Diagnosis by fine needle aspiration and review of the literature. Cytojournal. 2015 Dec 4;12:28. doi: 10.4103/1742-6413.171135. eCollection 2015.
15. 15. Kenney PA, Vikram R, Prasad SR, et al. Mucinous tubular and spindle cell carcinoma (MTSCC) of the kidney: a detailed study of radiological, pathological and clinical outcomes. BJU Int. 2015 Jul;116(1):85-92. doi: 10.1111/bju.12992. Epub 2015 Mar 12.
16. 16. Chen Q, Gu Y, Liu B. Clinicopathological characteristics of kidney mucinous tubular and spindle cell carcinoma. Int J Clin Exp Pathol. 2015 Jan 1;8(1):1007-12. eCollection 2015.
17. 17. Yörükoğlu K, Tuna B. Üropatoloji: Müsinöz tubuler ve iğsi hücreli karsinoma. 1th ed. Kongre Kitabevi. 2016;74-6.
18. 18. Jung SJ, Yoon HK, Chung JI et al. Mucinous tubular and spindle cell carcinoma of the kidney with neuroendocrine differentiation: report of two cases. Am J Clin Pathol 2006;125:99-104.
19. 19. Farghaly H. Mucin poor mucinous tubular and spindle cell carcinoma of the kidney, with nonclassic morphologic variant of spindle cell predominance and psammomatous calcification. Ann Diagn Pathol 2012;16:59-62.
20. 20. Zhao M, He XL, Teng XD. Mucinous tubular and spindle cell renal cell carcinoma: a review of clinicopathologic aspects. Diagn Pathol. 2015 Sep 17;10:168. doi: 10.1186/s13000-015-0402-1.