Primary Malignant Melanoma of Renal Pelvis with Extensive Clear Cell Change

Liapis, George; Sarlanis, Helen; Poulaki, Elpida; Stravodimos, Konstantinos; Riccioni, Olga; Lazaris, Andreas C.

doi:10.7759/cureus.583

Cited by 5 publications

(9 citation statements)

References 13 publications

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“…169,170 Similarly, primary melanoma of the kidney is an extremely rare type of tumor. 15,[171][172][173] Rather, the kidney is often affected by metastatic melanoma mainly in the form of multiple cortical micrometastases; however, large solitary masses can also be seen (Figure 10, A). 171 The median overall survival from primary tumor diagnosis and metastatic diagnosis was 3 years and 1 year, respectively, in the largest recent study.…”

Section: Clinical and Prognosismentioning

confidence: 99%

“…15,[171][172][173] Rather, the kidney is often affected by metastatic melanoma mainly in the form of multiple cortical micrometastases; however, large solitary masses can also be seen (Figure 10, A). 171 The median overall survival from primary tumor diagnosis and metastatic diagnosis was 3 years and 1 year, respectively, in the largest recent study. 165 For patients treated with surgery, the median overall survival from primary tumor diagnosis was 5 years, and overall survival from metastatic diagnosis was 2 years.…”

Section: Clinical and Prognosismentioning

confidence: 99%

“…Multiple reports also exist of melanoma presenting as a presumed primary small renal tumor within the renal pelvis, presenting as a mass in the renal pelvis protruding in the calyx, or presenting as a large mass, occupying more than 90% of the renal parenchyma (Figure 10, A). 15,16,171,172,176 On cut sections, the tumor may be solid and white or pigmented, and is often necrotic and hemorrhagic. 171,177 The microscopic appearance is highly variable, depending both on the primary site and degree of differentiation.…”

Section: Gross and Microscopicmentioning

confidence: 99%

“…15,16,171,172,176 On cut sections, the tumor may be solid and white or pigmented, and is often necrotic and hemorrhagic. 171,177 The microscopic appearance is highly variable, depending both on the primary site and degree of differentiation. Some cases may resemble primary renal tumors, while others may simply be poorly differentiated carcinoma, necessitating IHC to confirm the diagnosis.…”

Section: Gross and Microscopicmentioning

confidence: 99%

“…174,179,180 Nests of tumor cells may be encountered within and beneath the urothelium with a resemblance to nevoid melanoma, which may also mimic pagetoid spread of urothelial carcinoma in situ. 171 Moreover, melanoma may have a clear cell appearance, thereby mimicking conventional clear cell RCC, 16 and/or a spindle cell component, mimicking sarcomatoid differentiation in an RCC (Figure 10, B).…”

Section: Gross and Microscopicmentioning

confidence: 99%

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The Differential Diagnosis of Medullary-Based Renal Masses

Baniak

Tsai

Hirsch

2021

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Renal malignancies can be divided into cortical- and medullary-based tumors, the latter of which classically infiltrate the renal parenchyma by extending between nonneoplastic structures. Although high-grade cortical tumors can rarely exhibit the same growth pattern, the infiltrative morphology should elicit a differential diagnosis to be considered in each case. However, these diagnoses can be challenging to distinguish, especially on small renal biopsy samples. Objective.— To provide an overview of the clinical, gross, and microscopic findings; genetic and molecular alterations; and immunohistochemical evaluation of medullary-based renal tumors and other tumor types with overlapping morphologies and growth patterns. Data Sources.— Literature review and personal observations were used to compile the information in this review. Conclusions.— Collecting duct carcinoma is a prototypical medullary-based tumor, and although diagnostic criteria exist, it remains a diagnosis of exclusion, especially with ancillary techniques aiding the recognition of established as well as more recently described neoplasms. Other medullary-based malignancies included in the differential diagnosis include renal medullary carcinoma/renal cell carcinoma unclassified with medullary phenotype, fumarate hydratase–deficient renal cell carcinoma, and upper tract urothelial carcinoma. Moreover, other rare entities should be excluded, including metastatic carcinoma, lymphoma, and melanoma. In addition to potential prognostic differences, accurate diagnoses can have important surgical and clinical management implications.

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Section: Clinical and Prognosismentioning

confidence: 99%

Section: Clinical and Prognosismentioning

confidence: 99%

Section: Gross and Microscopicmentioning

confidence: 99%

Section: Gross and Microscopicmentioning

confidence: 99%

Section: Gross and Microscopicmentioning

confidence: 99%

See 3 more Smart Citations

The Differential Diagnosis of Medullary-Based Renal Masses

Baniak

Tsai

Hirsch

2021

Archives of Pathology &Amp; Laboratory Medicine

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Genitourinary melanoma: An overview for the clinician

DePalo

Elleson

Carr

et al. 2022

Asian Journal of Urology

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Sarcomatoid and Rhabdoid Renal Cell Carcinoma

Adeniran,

Shuch,

Humphrey

2024

American Journal of Surgical Pathology

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Renal cell carcinoma (RCC) with sarcomatoid and rhabdoid morphologies has an aggressive biological behavior and a typically poor prognosis. The current 2022 WHO classification of renal tumors does not include them as distinct histologic entities but rather as transformational changes that may arise in a background of various distinct histologic types of RCC. The sarcomatoid component shows malignant spindle cells that may grow as intersecting fascicles, which is reminiscent of pleomorphic undifferentiated sarcoma. The rhabdoid cells are epithelioid cells with eccentrically located vesicular nuclei with prominent nucleoli and large intracytoplasmic eosinophilic inclusions. Studies have shown that RCCs with sarcomatoid and rhabdoid differentiation have distinctive molecular features. Sarcomatoid RCC harbors shared genomic alterations in carcinomatous and rhabdoid components, but also enrichment of specific genomic alterations in the sarcomatoid element, suggesting molecular pathways for development of sarcomatoid growth from a common clonal ancestor. Rhabdoid differentiation also arises through clonal evolution although less is known of specific genomic alterations in rhabdoid cells. Historically, treatment has lacked efficacy, although recently immunotherapy with PD-1/PD-L1/CTLA-4 inhibitors has produced significant clinical responses. Reporting of sarcomatoid and rhabdoid features in renal cell carcinoma is required by the College of American Pathologists and the International Collaboration on Cancer Reporting. This manuscript reviews the clinical, pathologic, and molecular features of sarcomatoid RCC and rhabdoid RCC with emphasis on the morphologic features of these tumors, significance of diagnostic recognition, the molecular mechanisms of tumorigenesis and differentiation along sarcomatoid and rhabdoid lines, and advances in treatment, particularly immunotherapy.

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Primary Malignant Melanoma of Renal Pelvis with Extensive Clear Cell Change

Cited by 5 publications

References 13 publications

The Differential Diagnosis of Medullary-Based Renal Masses

The Differential Diagnosis of Medullary-Based Renal Masses

Genitourinary melanoma: An overview for the clinician

Sarcomatoid and Rhabdoid Renal Cell Carcinoma

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