mTOR eosinophilic renal cell carcinoma: a distinctive tumor characterized by mTOR mutation, loss of chromosome 1, cathepsin-K expression, and response to target therapy

mTOR 嗜酸性肾细胞癌:一种以 mTOR 突变、1 号染色体缺失、组织蛋白酶 K 表达和对靶向治疗有反应为特征的独特肿瘤

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作者:Anna Caliò #, Stefano Marletta #, Giulio Settanni, Mimma Rizzo, Stefano Gobbo, Serena Pedron, Lavinia Stefanizzi, Enrico Munari, Matteo Brunelli, Lisa Marcolini, Anna Pesci, Stefano Fratoni, Francesco Pierconti, Maria Rosaria Raspollini, Antonio Marchetti, Claudio Doglioni, Mahul B Amin, Camillo Por

Abstract

In the spectrum of oncocytic renal neoplasms, a subset of tumors with high-grade-appearing histologic features harboring pathogenic mutations in mammalian target of rapamycin (mTOR) and hitherto clinical indolent behavior has been described. Three cases (2F,1 M) with histologically documented metastases (lymph node, skull, and liver) were retrieved and extensively investigated by immunohistochemistry, FISH, and next-generation sequencing. Tumors were composed of eosinophilic cells with prominent nucleoli (G3 by ISUP/WHO) arranged in solid to nested architecture. Additionally, there were larger cells with perinuclear cytoplasmic shrinkage and sparse basophilic Nissl-like granules, superficially resembling the so-called spider cells of cardiac rhabdomyomas. The renal tumors, including the skull and liver metastases, showed immunoexpression PAX8, CK8-18, and cathepsin-K, and negativity for vimentin. NGS identified mTOR genetic alterations in the three cases, including the skull and liver metastases. One patient was then treated with Everolimus (mTOR inhibitors) with clinical response (metastatic tumor shrinkage). We present a distinct renal tumor characterized by high-grade eosinophilic cells, cathepsin-K immunohistochemical expression, and harboring mTOR gene mutations demonstrating a malignant potential and showing responsiveness to mTOR inhibitors.

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