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      Clinicopathological study on thyroid follicular carcinoma-like renal tumor related to serious hypertension : Case report and review of the literature

      case-report
      , Master a , b , , Master c , , Doctor a , , , Doctor c ,
      Medicine
      Wolters Kluwer Health
      hypertension, kidney, thyroid follicular-like renal tumor

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          Abstract

          Rationale:

          Thyroid carcinoma-like tumor of the kidney (TLFCK) is an extremely rare variant of renal cell carcinoma. Most cases were incidentally found, while we report the first case of TLFCK presented with hypertension.

          Patient concerns:

          A 25-year-old woman was admitted to our hospital presenting with hypertension for ∼20 months, without gross hematuria, weight loss, and flank pain.

          Diagnoses:

          Imaging studies revealed a right renal mass with multiple calcifications. Histologically, the tumor had striking follicles with dense, colloid-like material resembling thyroid follicular carcinoma while the tumor cells were negative for thyroid markers (thyroglobulin and thyroid transcription factor-1).

          Interventions:

          The patient successfully underwent nephron sparing surgery with an uneventful recovery.

          Outcomes:

          Hypertension returned to normal without any medication interference. Two years after surgery, the patient is still in good health without recurring disease or related hypertension.

          Lessons:

          Recognition of the cytomorphological features of TLFCK can avoid misdiagnosis of this renal tumor as a metastatic carcinoma and the objective of surgical management is to remove the tumor and preserve renal function.

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          Most cited references11

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          2004 WHO classification of the renal tumors of the adults.

          The recently introduced 2004 World Health Organisation (WHO) classification of the adult renal epithelial neoplasms is meant to replace the previous 1998 WHO classification. The 2004 WHO classification is based on pathology and genetic abnormalities. The description of categories has been expanded to improve their recognition and new diagnostic categories are included. Emphasis has been placed on defining familial renal cancer, carcinoma associated with Xp11 translocations, carcinoma associated with neuroblastoma, multilocular cystic renal cell carcinoma, tubular, mucinous and spindle cells carcinoma; and mixed epithelial and stromal tumour. The potentially aggressive epithelioid angiomyolipoma is recognised. Recognising these categories may have important implications in patients' clinical management.
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            Primary thyroid-like follicular carcinoma of the kidney: report of 6 cases of a histologically distinctive adult renal epithelial neoplasm.

            Thyroidization of kidney reminiscent of thyroid follicles with accumulation of inspissated colloid-like material in renal tubules is a hallmark of chronic pyelonephritis. We identified 6 tumors in the kidney, distinct from currently known subtypes of renal cell carcinoma, with a striking histology that closely mimicked well-differentiated thyroid follicular neoplasms and raised the possibility of metastatic follicular thyroid carcinoma. Three occurred in males and 3 in females with an age range of 29 to 83 years and size range from 1.9 to 4 cm. All tumors were encapsulated and exclusively demonstrated follicular architecture comprising of microfollicles and macrofollicles containing inspissated colloid-like material. A minor component of small tightly packed follicles devoid of secretions was also noted. The follicles were lined by cells with moderate amphophilic to eosinophilic cytoplasm with round nuclei and occasional prominent nucleoli. The tumors were nonimmunoreactive with thyroglobulin and thyroid transcription factor 1 and for markers contemporarily used for renal differentiation. The tumors had a gene expression profile distinct from clear cell and chromophobe renal cell carcinoma. Comparative genetic hybridization failed to reveal cytogenetic alterations. Mean follow-up of 47.3 months (range: 7 to 84 mo) showed that 5 patients had no evidence of disease and 1 developed a metastasis to the renal hilar lymph nodes in which the follicular architecture with colloid was retained. Thyroid-like follicular renal cell carcinoma represents a unique histologic subtype of renal cell carcinoma of low malignant potential and its primary importance is to distinguish it from metastatic carcinoma from the thyroid.
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              Thyroid follicular carcinoma-like tumor of kidney: a case report with morphologic, immunohistochemical, and genetic analysis.

              We present an unusual renal tumor, which has not been classified under a known subtype of renal cell carcinoma (RCC) and characteristically shows similar histology to thyroid follicular carcinoma. The patient was a 32-year-old asymptomatic woman who was found to have a kidney mass during her annual physical examination. She had no lesions in the thyroid during physical and ultrasound examinations, and there was no abnormal thyroid function test. Neither mediastinal nor ovarian abnormalities were observed. The resected kidney showed a well-defined nodular tumor measuring 11.8x8.0x8.0 cm. The mass was protruding into the pelvic cavity with areas of yellowish geographic necrosis. Histologically, the tumor showed follicular architectures with inspissated colloid-like material in their lumina. No conventional (clear cell) RCC or any other known subtypes of RCC component was observed. Immunohistochemically, the tumor cells showed intensive staining for cytokeratin (CK) cocktail AE1/AE3 and CD10 and were not reactive to thyroid transcription factor-1 and thyroglobulin. The staining of CK35betaH11 and vimentin revealed focal cytoplasmic reaction. The tumor cells were completely negative for CK7, CK19, CK20, CK34betaE12, carcinoembryonic antigen, epithelial membrane antigen, and CD15. Chromosomal gains of 7q36, 8q24, 12, 16, 17p11-q11, 17q24, 19q, 20q13, 21q22.3, and Xp and losses of 1p36, 3, and 9q21-33 were detected by comparative genomic hybridization. These findings are dissimilar to previously classified renal neoplasm. Only a report that included three cases of primary thyroid-like renal tumor has been described in the abstract form. However, there is no fully documented case on this unusual form of RCC, which morphologically resembles that of thyroid follicular carcinoma. Herein, we present a new case of thyroid follicular carcinoma-like tumor of the kidney with a chromosomal study and review of the literature.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                March 2017
                24 March 2017
                : 96
                : 12
                : e6419
                Affiliations
                [a ]Department of Urology, Qilu Hospital of Shandong University, Jinan
                [b ]Department of Urology, Dezhou People Hospital, Dezhou City, Shandong Province
                [c ]Department of Urology, Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, He Xi District, Tianjin, China.
                Author notes
                []Correspondence: Zhonghua Xu, Department of Urology ,Qilu Hospital of Shandong University, Jinan, Shandong Province, China (e-mail: 421325862@ 123456qq.com ); Gang Li, Department of Urology, Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, He Xi District, Tianjin, China (e-mail: gangli797980@ 123456hotmail.com ).
                Article
                MD-D-17-00601 06419
                10.1097/MD.0000000000006419
                5371481
                28328844
                1174e446-32b7-4650-aefe-6b4865d4e6b1
                Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                : 29 January 2017
                : 21 February 2017
                : 25 February 2017
                Categories
                7300
                Research Article
                Clinical Case Report
                Custom metadata
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                hypertension,kidney,thyroid follicular-like renal tumor

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