Renal oncocytoma: a challenging diagnosis

Abstract

Purpose of reviewThe aim of the review is to provide an update on the current and evolving approaches to diagnosing the challenging clinical entity of renal oncocytoma. Recent findingsRenal oncocytoma is being increasingly recognized among patients with renal masses, and it can be found in up to 50% of benign small renal masses (SRMs) less than 4 cm. Renal oncocytomas have benign clinical biology but distinguishing them from some of the other renal masses with more malignant potential can be challenging due to overlapping imaging, histologic, and immunophenotypic characteristics. Increasing integration of various imaging modalities, histologic characteristics, cytogenetics, and molecular and metabolic signatures is helping better define and characterize renal masses.

Oncocytoma-Like Angiomyolipoma of the Kidney: A Closer Look into the Clinicopathologic, Immunohistochemical, and Molecular Characteristics of a Rare Entity with Review of the Literature

“…In contrast, a key morphologic difference involves nuclear cytology. 7 The nuclei of renal oncocytoma are round, have vesicular chromatin, and small, frequently prominent, centrally located nucleoli. Degenerative atypia imparting a look of pleomorphism may be present.…”

“…Degenerative atypia imparting a look of pleomorphism may be present. 7 Translocation RCCs, involving transcription factors such as TFE3 and TFEB , have variable morphology based on their fusion partner gene. 8 For instance, ASPSCR1::TFE3 translocation RCC presents with nested architecture composed of cells with voluminous granular eosinophilic cytoplasm, high-grade nuclear features, and abundant psammoma bodies.…”

A Giant Oncocytoma in an Elderly Female Patient: A Case Report

“…They are more common in men and peak in the sixth to seventh decade of life. Oncocytomas may be bilateral in 4-5% of cases and multifocal in up to 13% [ 2 ].…”

“…Oncocytomas arise from the neoplastic growth of intercalated epithelial cells of the collecting duct [ 2 ]. Specific genetic abnormalities have been associated with renal oncocytomas, including translocations in 11q13, loss of chromosome Y, loss of chromosome 1, and loss of heterozygosity on chromosome 14q.…”

“…Cross-sectional imaging (CT or MRI) may identify a renal tumor; the presence of a central scar and hypervascularity, although not pathognomonic, should raise suspicion of oncocytoma. Unfortunately, there are no definitive radiologic criteria to distinguish an oncocytoma from a malignant lesion, and oncocytomas may coexist with renal cell carcinoma in 10-32% of cases [ 2 ].…”