Indian Journal of Pathology and Microbiology

LETTER TO EDITOR
Year
: 2010  |  Volume : 53  |  Issue : 2  |  Page : 379--380

Conventional clear renal cell carcinoma with granulomatous reaction


Vinaya B Shah1, Puneet Sharma1, Hemant R Pathak2,  
1 Department of Pathology, T N Medical College & B Y L Nair Hospital, Mumbai- 400 034, India
2 Department of Urology, T N Medical College & B Y L Nair Hospital, Mumbai- 400 034, India

Correspondence Address:
Vinaya B Shah
Flat no 38, Building No 2, K K Marg, Govt Colony, Next to Race Course Haji Ali , Mumbai- 400 034
India




How to cite this article:
Shah VB, Sharma P, Pathak HR. Conventional clear renal cell carcinoma with granulomatous reaction.Indian J Pathol Microbiol 2010;53:379-380


How to cite this URL:
Shah VB, Sharma P, Pathak HR. Conventional clear renal cell carcinoma with granulomatous reaction. Indian J Pathol Microbiol [serial online] 2010 [cited 2020 Jul 14 ];53:379-380
Available from: http://www.ijpmonline.org/text.asp?2010/53/2/379/64307


Full Text

Sir,

Granulomatous reaction occurring within lymph nodes draining carcinomas, though a well known phenomenon, is an uncommon occurrence. [1] Rarer is the occurrence of granulomas within the stroma of malignancies reported in breast and hepatocellular carcinomas. [2],[3],[4] The occurrence of granulomas within the stroma of renal cell carcinomas appears to be much more rare, with only few case reports in the English literature. [3],[4] This case is, to the best of our knowledge, the first reported in literature in the Indian context. An uncommon and rare case of renal cell carcinoma containing non-caseating granulomas (NCG) is described.

A 62-year-old man was assessed for hematuria of six months duration. Computed tomograghy (CT) scan revealed 5 x 4.5cm heterogeneously enhancing mass in the lower pole of the left kidney. Subsequently left nephrectomy was done. The kidney specimen was enlarged and showed 5 x 5cm well circumscribed mass in the lower pole of the left kidney. The capsule over the mass was stretched and there was no breach in the capsule. The hilar vessels and the ureter were unremarkable. The cut section of the tumor mass showed variegated appearance with yellow areas, hemorrhagic foci and few cystic areas.

The microscopic section from the tumor showed sheets and nests of tumor cells supported on fine vascular stroma. The most conspicuous feature noted was the presence of multiple foci of non caseating granulomas within the tumor parenchyma. [Figure 1] These granulomas had Langhan`s type of multinucleate giant cells. [Figure 2] The tumor cells showed clear cytoplasm with nuclear features corresponding to Fuhrman grade 1. [Figure 2] Histopathological diagnosis offered was conventional clear renal cell carcinoma with granulomatous reaction. We have not found any asteroid and Schaumann bodies or calcium oxalate crystals. There were no fungi or mycobacteria within the granulomas or within the tumor. Ziehl-Neelsen stain for acid fast bacilli was negative. Tuberculosis was excluded by a thorough clinical check up and relevant investigations. There was no progression of granulomas seen after nephrectomy. One year later the patient is alive, well and regaining weight.

However, the occurrence of non-caseating granulomas within tumorous stroma or within the parenchyma of epithelial tumors is quite a rare phenomenon.

The occurrence of non-caseating granulomas in lymph nodes, draining malignant neoplasm, is a well documented phenomenon with cervical and breast carcinomas thought to be the most likely to elicit this response. [1] Less commonly, non-caseating epithelioid granulomas and metastatic malignancy occur simultaneously within lymph nodes but this distinctly unusual phenomenon has been described only with metastatic nasopharyngeal carcinoma, seminoma, and malignant melanoma. [5] An equally rare phenomenon is that of a granulomatous response occurring within the stroma of a variety of carcinomas, including breast, renal, and hepatocellular carcinomas. [1],[2],[3],[4] The granulomatous reaction may be a response to necrotic material ( a foreign body inflammatory response) or an immunological reaction, with the granulomatous response within draining lymph nodes representing a response to soluble tumor related antigens and the stromal reaction representing a T cell mediated immunological response to cell surface antigens. In our case sarcoidosis and tuberculosis were clinically excluded. It supports the contention that this could be an immunological response to surface antigens.

References

1Coyne JD, Haboubi NY. Invasive carcinoma with a granulomatous stromal response. Histopathology 1994;25:397-400.
2Watterson J. Epithelioid granulomas associated with hepatocellular carcinoma. Arch Pathol Lab Med 1982;106:538-9.
3Campbell F, Douglas-Jones A. Sarcoid-like granulomas in primary renal cell carcinoma. Sarcoidosis 1993;10:128-31.
4Hes O, Hora M, Vanecek T, Sima R, Sulc M, Havelicek F, et al. Conventional renal cell carcinoma with granulomatous reaction: A report of three cases. Virchows Archiv 2003;443:221-2.
5Coyne JD, Banerjee SS, Menasce LP, Mene A. Granulomatous lymphadenitis associated with metastatic malignant melanoma. Histopathology 1996;28:470-2.