Renal Epithelioid Angiomyolipoma With Atypia: A Series of 40 Cases With Emphasis on Clinicopathologic Prognostic Indicators of Malignancy

异型性 恶性肿瘤 病理 系列(地层学) 医学 血管平滑肌脂肪瘤 生物 放射科 内科学 古生物学
作者
Fadi Brimo,Brian Robinson,Charles C. Guo,Ming Zhou,Matthieu Latour,Jonathan I. Epstein
出处
期刊:The American Journal of Surgical Pathology [Ovid Technologies (Wolters Kluwer)]
卷期号:34 (5): 715-722 被引量:225
标识
DOI:10.1097/pas.0b013e3181d90370
摘要

As epithelioid cellular morphology can be seen in clinically benign usual angiomyolipomas (AMLs), we divide epithelioid AMLs into those without and with atypia, the latter category associated in the literature with malignant potential. We herein report the histologic spectrum and biologic behavior of 40 consecutive cases of epithelioid AML with atypia and assess whether cases can be stratified prognostically based on clinical and pathologic features. Atypical epithelioid cells were defined as atypical polygonal cells with abundant cytoplasm, vesicular nuclei, prominent nucleoli, and nuclear size that exceeds x2 the size of adjacent nuclei. The degree of atypia was divided to moderate and severe. Cases with bland epithelioid cells with minimal variation in nuclear size were not included. Mean age was 50.5 years (range 17 to 81), and the female to male ratio was 1.6:1. Average tumor size was 7.2 cm (range 1.0 to 17.7). The percentage of epithelioid component ranged from 5%-100% (mean 68%). Of the epithelioid component, the percentage of cells exhibiting nuclear atypia ranged in individual cases from 5% to 100% (mean of 58.4% atypical cells); 26/40 (65%) cases showed severe nuclear atypia. Cells displaying severe nuclear atypia were typically of large size with abundant cytoplasm, compared with those with moderate atypia being of small to intermediate in size with scant to moderate amount of cytoplasm. Neoplastic multinucleated giant cells and necrosis was present in 22 cases (55%) and 15 cases (37.5%), respectively. Mitoses were identified in 72.5% (29/40) of cases and ranged from 1 to 6 per 10 hpf with 7 cases showing atypical mitotic figures. Lymphovascular invasion or renal vein invasion was present in 3 cases each. Hilar and perinephric fat involvement was present in 5 and 6 cases, respectively. Clinical follow-up was available in 34 out of the 40 cases. Of the 34 cases, 9 (26%) were malignant and showed local recurrence or distant metastases. Of the 9 patients with malignant tumors, 4 died of the disease at 6, 12, 15, and 34 months after the original diagnosis was rendered, and 4 were alive with disease (mean follow-up period of 52 mo, range 24 to 72 mo). Twenty-four patients showed no evidence of recurrence and/or metastases with a mean follow-up period of 34 months (range 1 to 156 mo). We compared the 21 cases of atypical epithelioid AMLs that exhibited a benign clinical course with a minimum follow-up period of 6 months postsurgery to the 9 cases with malignant behavior. All of these were more frequently observed in clinically malignant cases: older age, larger tumor size, higher percentage of epithelioid component, severe atypia, higher percentage of atypical cells, higher mitotic count, atypical mitotic figures, necrosis, lymphovascular invasion, and renal vein invasion. Using these features, we developed a predictive model of 4 atypical features that included: (1) > or =70% atypical epithelioid cells, (2) > or =2 mitotic figures per 10 hpf, (3) atypical mitotic figures, and (4) necrosis; the presence of 3 or all of the features was highly predictive of malignant behavior. This model accurately categorized 78% of clinically malignant and 100% of the clinically benign epithelioid AMLs with atypia.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
大幅提高文件上传限制,最高150M (2024-4-1)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
科目三应助半只兔子采纳,获得30
1秒前
欢呼的棒棒糖完成签到,获得积分10
1秒前
re发布了新的文献求助10
1秒前
wsh发布了新的文献求助10
2秒前
wsff发布了新的文献求助10
3秒前
qq完成签到 ,获得积分10
3秒前
Binggui发布了新的文献求助10
3秒前
4秒前
烂漫的白梦关注了科研通微信公众号
5秒前
5秒前
5秒前
6秒前
彭于彦祖应助坦率的亦绿采纳,获得30
8秒前
...发布了新的文献求助10
8秒前
随大溜发布了新的文献求助30
9秒前
Ava应助Binggui采纳,获得10
10秒前
zhw发布了新的文献求助10
11秒前
MOON完成签到,获得积分10
12秒前
哆小咪完成签到 ,获得积分10
14秒前
科研通AI2S应助FIN采纳,获得50
16秒前
16秒前
随机获取昵称完成签到,获得积分10
16秒前
现实的俊驰完成签到,获得积分10
19秒前
21秒前
ding应助WQ采纳,获得10
21秒前
花道完成签到,获得积分10
22秒前
22秒前
DIY101完成签到,获得积分10
23秒前
火星上的柏柳完成签到 ,获得积分10
25秒前
26秒前
27秒前
稚屿发布了新的文献求助10
27秒前
HEIGE发布了新的文献求助30
28秒前
29秒前
29秒前
科研菜鸟完成签到 ,获得积分10
30秒前
30秒前
就是笨怎么了完成签到,获得积分20
32秒前
32秒前
咩咩羊完成签到,获得积分10
33秒前
高分求助中
Evolution 10000
ISSN 2159-8274 EISSN 2159-8290 1000
Becoming: An Introduction to Jung's Concept of Individuation 600
Heteroatom-Doped Carbon Allotropes: Progress in Synthesis, Characterization, and Applications 500
A new species of Coccus (Homoptera: Coccoidea) from Malawi 500
A new species of Velataspis (Hemiptera Coccoidea Diaspididae) from tea in Assam 500
PraxisRatgeber: Mantiden: Faszinierende Lauerjäger 500
热门求助领域 (近24小时)
化学 医学 生物 材料科学 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 基因 遗传学 催化作用 物理化学 免疫学 量子力学 细胞生物学
热门帖子
关注 科研通微信公众号,转发送积分 3159874
求助须知:如何正确求助?哪些是违规求助? 2810842
关于积分的说明 7889629
捐赠科研通 2469910
什么是DOI,文献DOI怎么找? 1315243
科研通“疑难数据库(出版商)”最低求助积分说明 630742
版权声明 602012