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  Indian J Med Microbiol
 

Figure 2: Gross findings and different morphologic patterns of hereditary leiomyomatosis and RCC syndrome (HLRCC)-associated renal cell carcinoma. (a) Gross appearance of HLRCC-associated renal cell carcinoma demonstrating a widely infiltrative multinodular tan-white tumor with prominent invasion of renal sinus fat. (b) HLRCC-associated renal cell carcinoma case with a papillary growth pattern (×200). Note the tumor cells with prominent enlarged nucleoli; (c) A different growth pattern with tubular differentiation from the same case in image A with similar nuclear features and scattered perinuclear haloes (×200); (d) Prominent glandular differentiation in HLRCC-associated renal cell carcinoma (×200). The tumor cells exhibit uniformly prominent macronucleoli with high-grade cytologic features. The infiltrative malignant tubules impart an appearance resembling collecting duct carcinoma; (e) Intracystic papillary growth pattern in an HLRCC-associated renal cell carcinoma with oncocytic features mimicking type 2 papillary renal cell carcinoma (×200). Characteristic nuclear features are present; (f) Sarcomatoid differentiation in noted in this high-grade/poorly differentiated carcinoma (×100); (g) Metastatic HLRCC-associated renal cell carcinoma with a tubulocystic pattern amid bony trabeculae in a vertebral body biopsy. The tumor is composed of bland tubules lined by a single layer of cuboidal cells (×100); (h) A corresponding biopsy image of the renal mass from the same case as image G demonstrating the presence of poorly differentiated foci with an infiltrating adenocarcinoma-like growth pattern accompanied by a desmoplastic stromal response (×100); (i) Absent fumarate hydratase immunohistochemical staining in the metastatic focus of carcinoma with a tubulocystic pattern depicted in image G (immunoperoxidase, ×200); (j) Loss of fumarate hydratase staining in the poorly differentiated foci of HLRCC-associated renal cell carcinoma with a tubulocystic component (images g, i). Staining is retained in the internal control vasculature and further corroborates the absence of staining in the tumor cells (immunoperoxidase, ×200) (hematoxylin and eosin staining, except i and j)

Figure 2: Gross findings and different morphologic patterns of hereditary leiomyomatosis and RCC syndrome (HLRCC)-associated renal cell carcinoma. (a) Gross appearance of HLRCC-associated renal cell carcinoma demonstrating a widely infiltrative multinodular tan-white tumor with prominent invasion of renal sinus fat. (b) HLRCC-associated renal cell carcinoma case with a papillary growth pattern (×200). Note the tumor cells with prominent enlarged nucleoli; (c) A different growth pattern with tubular differentiation from the same case in image A with similar nuclear features and scattered perinuclear haloes (×200); (d) Prominent glandular differentiation in HLRCC-associated renal cell carcinoma (×200). The tumor cells exhibit uniformly prominent macronucleoli with high-grade cytologic features. The infiltrative malignant tubules impart an appearance resembling collecting duct carcinoma; (e) Intracystic papillary growth pattern in an HLRCC-associated renal cell carcinoma with oncocytic features mimicking type 2 papillary renal cell carcinoma (×200). Characteristic nuclear features are present; (f) Sarcomatoid differentiation in noted in this high-grade/poorly differentiated carcinoma (×100); (g) Metastatic HLRCC-associated renal cell carcinoma with a tubulocystic pattern amid bony trabeculae in a vertebral body biopsy. The tumor is composed of bland tubules lined by a single layer of cuboidal cells (×100); (h) A corresponding biopsy image of the renal mass from the same case as image G demonstrating the presence of poorly differentiated foci with an infiltrating adenocarcinoma-like growth pattern accompanied by a desmoplastic stromal response (×100); (i) Absent fumarate hydratase immunohistochemical staining in the metastatic focus of carcinoma with a tubulocystic pattern depicted in image G (immunoperoxidase, ×200); (j) Loss of fumarate hydratase staining in the poorly differentiated foci of HLRCC-associated renal cell carcinoma with a tubulocystic component (images g, i). Staining is retained in the internal control vasculature and further corroborates the absence of staining in the tumor cells (immunoperoxidase, ×200) (hematoxylin and eosin staining, except i and j)