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Case report

Rhabdoid differentiation in different types of renal cell carcinoma: A report of two cases and literature review

By
Milena Potić-Floranović Orcid logo ,
Milena Potić-Floranović
Ana Ristić-Petrović Orcid logo ,
Ana Ristić-Petrović
Filip Veličković ,
Filip Veličković
Milan Potić ,
Milan Potić
Tanja Džopalić Orcid logo ,
Tanja Džopalić
Ljubinka Janković-Veličković Orcid logo
Ljubinka Janković-Veličković

Abstract

Rhabdoid morphology is a rare differentiation pattern that can occur in any type of renal cell carcinoma. In approximately 5% of renal tumors, a variable percent of rhabdoid cells can be seen. Even though these cells resemble rhabdomyoblasts, they are large, with large eccentric nuclei and prominent nucleoli; they have different immunophenotype and ultrastructural features. Tumors with rhabdoid differentiation are classified as grade 4, they have aggressive clinical behavior and poor prognosis. We present two cases of 83-year-old and 60-year-old male patients. Samples of both patients were obtained after radical nephrectomy. In the first patient, papillary renal cell carcinoma was verified, and its phenotype was immunohistochemically demonstrated. Cells with papillary morphology were mixed with rhabdoid cells arranged in sheet-like, pseudotubular and organoid structures. The second patient had the incidentally discovered clear cell renal cell carcinoma with rhabdoid differentiation, together with adenocarcinoma of the colon. Histopathological evaluation showed cells that were typical for clear cell carcinoma and large non-cohesive rhabdoid cells as well. Giant, bizarre multinuclear cells were also noted. Homogenous rhabdoid morphology accounted for about 60% of the tumor. Rhabdoid differentiation in renal cell carcinoma is a high-grade morphological feature. It is associated with poor outcome, and distant metastases are commonly present at the time of diagnosis. In order to clarify the significance of this type of divergent differentiation on prognosis, future treatment options and outcome of the disease, further analysis of a larger number of cases is necessary.

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