Thyroid-like Follicular Carcinoma of the Kidney

Definition

• Carcinoma of the kidney with a predominant follicular pattern

Diagnostic Criteria

• Rare - under 10 cases reported
  • Only series reported is 6 cases (Amin)
• Micro- and macrofollicular pattern reminiscent of thyroid carcinoma
  • Most follicles filled with eosinophilic proteinaceous fluid
  • No papillae
• Lined by cells with eosinophilic or amphophilic cytoplasm
  • May have nuclear pseudoinclusions or grooves
• Surrounded by prominent pseudocapsule
• Metastasis from the thyroid must be ruled out
  • Must be negative for TTF1 and thyroglobulin
  • Must have no clinical or imaging evidence of thyroid primary
• Behavior uncertain
  • One case reported with widespread metastases (Dhillon)
• One problematic case reported (Sterlacci)
  • Renal tumor was negative for TTF1 and thyroglobulin
  • Subsequent lung metastasis was TTF1 positive, thyroglobulin not reported

John P Higgins MD
Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting:: January 24, 2011

Supplemental studies

Immunohistology

Classification / Lists

Renal epithelial neoplasms

• Classical types
  • Clear cell (conventional) renal cell carcinoma
  • Multilocular clear cell renal cell carcinoma
  • Papillary renal cell carcinoma
  • Chromophobe renal cell carcinoma
  • Carcinoma of collecting ducts of Bellini
  • Renal cell carcinoma unclassified
  • Oncocytoma
  • Papillary adenoma
  • (Sarcomatoid)
• Newer variants and types
  • Renal medullary carcinoma
  • Mucinous tubular and spindle cell carcinoma
  • Tubulocystic carcinoma
  • Xp11 translocation carcinoma
  • Neuroblastoma associated renal cell carcinoma
  • Renal cell carcinoma associated with end stage renal disease
  • Thyroid-like follicular carcinoma of the kidney
  • Clear cell tubulopapillary renal cell carcinoma
  • Oncocytic papillary renal cell carcinoma
• Neuroendocrine tumors
  • Carcinoid
  • Neuroendocrine carcinoma

Bibliography

• Srigley JR, Delahunt B. Uncommon and recently described renal carcinomas. Mod Pathol. 2009 Jun;22 Suppl 2:S2-S23.
• Dhillon J, Tannir NM, Matin SF, Tamboli P, Czerniak BA, Guo CC. Thyroid-like follicular carcinoma of the kidney with metastases to the lungs and retroperitoneal lymph nodes. Hum Pathol. 2010 Oct 22. [Epub ahead of print]
  
• Amin MB, Gupta R, Ondrej H, McKenney JK, Michal M, Young AN, Paner GP, Junker K, Epstein JI. Primary thyroid-like follicular carcinoma of the kidney: report of 6 cases of a histologically distinctive adult renal epithelial neoplasm. Am JSurg Pathol. 2009 Mar;33(3):393-400.
  
• Jung SJ, Chung JI, Park SH, Ayala AG, Ro JY. Thyroid follicular carcinoma-like tumor of kidney: a case report with morphologic, immunohistochemical, and genetic analysis. Am J Surg Pathol. 2006 Mar;30(3):411-5.
• W, Verdorfer I, Gabriel M, Mikuz G. Thyroid follicular carcinoma-like renal tumor: a case report with morphologic, immunophenotypic, cytogenetic, and scintigraphic studies. Virchows Arch. 2008 Jan;452(1):91-5.