Surgical Pathology Criteria

MiT Family Translocation Renal Cell Carcinoma

Differential Diagnosis

Immunohistochemistry for the differential diagnosis of renal MiT translocation carcinomas

  CD10 Racemase CK7 EMA CD117
MiT Translocation Ca >90% >90% neg neg neg
Clear Cell Ca >90% 0-20% neg >90% neg
Papillary Ca >90% >90% >90% >90% neg
Chromophobe Ca neg neg >90% >90% >90%
Nuclear staining for TFE3 and/or TFEB (if available) appears to be sensitive and specific for translocation carcinoma

MiT Family Translocation Renal Cell Carcinoma Clear Cell Papillary Renal Cell Carcinoma
Frequently occurs under age 20 Mean age 60
Typically high grade nuclear features Low grade nuclear features, nuclei linear, apical
Voluminous cytoplasm Moderate amount of clear cytoplasm
TFEB or TPF3 immunostain or FISH positive Lacks TFEB or TPF3 translocations
CK7 and other keratins negative to weak, CD10 pos, Racemase/AMACR pos CK7 strong pos, CD10 neg, Racemase/AMACR neg
Variable expression of melanocytic markers Melanocytic markers neg
CA9 negative CA9 basolateral positive

MiT Family Translocation Renal Cell Carcinoma Papillary Renal Cell Carcinoma
Frequently occurs under age 20 Mean age 60
Mixed papillary and clear cell areas Clear cell areas focal to absent
Voluminous cytoplasm Moderately abundant cytoplasm at most
Typically high grade nuclear features May have any grade nuclear features
TFEB or TPE3 immunostain or FISH positive Lacks TFEB or TPE3 translocations
CK7 & EMA negative to weak CK7 & EMA frequently strong positive (but may be negative)

MiT Family Translocation Renal Cell Carcinoma Clear Cell Renal Cell Carcinoma
Frequently occurs under age 20 Mean age 60
Frequently papillary Papillary pattern not prominent
Typically high grade nuclear features Variable nuclear grrade
Voluminous cytoplasm Moderate amount of clear cytoplasm
TFEB or TPF3 immunostain nuclear positive, CA9 negative Lacks TFEB or TPF3 staining, CA9 positive
Keratins and EMA negative to weak Keratins and EMA generallly positive
Variable expression of melanocytic markers Melanocytic markers neg
Translocations involving TFE3 or TFEB Often VHL mutation or chromosoome 3p loss
Psammoma bodies may be promiinent Psammoma bodies rare

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