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Priya Rao, MD Profile picture
@priyaraomd
May 3, 2020 β€’ 4 tweets β€’ 2 min read β€’ Read on X
Renal tumor in a 19 year old. Stains and diagnosis πŸ‘‡ #GUpath ImageImageImage
CD117 and Synaptophysin (pictures) +. PAX8 - Image
CD34+ (pic) keratin - Image
Diagnosis: Juxtaglomerular cell tumor. #GUpath

Often in young patients and in the D/D of oncocytic renal tumors. Always a good idea to run a keratin and a PAX8 when in doubt. Don't be fooled by the CD117 staining.

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More from @priyaraomd

Priya Rao, MD Profile picture
Sep 3, 2020
#GUPath twitter brain trust. Posting for a colleague.

37yo man with a renal mass.

Pos for PAX8, keratin. Neg for NE markers, GATA, WT1 and everything else.

We are stumped. Thoughts? Anyone seen something like this before? We thought of adult Wilms’s but IHC doesn’t support. ImageImageImageImage
@Williamson_SR @Kiril_T_Can @johncheville @rovingatuscap @MichelleDunno17 @FionaMacPath @daniel_berney #GUPath
Tumor is primary to the kidney. He’s older and PAX8 +++ so we didn’t think this was teratoma. I did consider it briefly.
Read 5 tweets
Priya Rao, MD Profile picture
May 15, 2020
Renal bx from a woman in her late 50s, with a renal mass and metastasis. This biopsy is from the kidney. This was a highly infiltrative, high grade tumor with a desmoplastic background. Continued πŸ‘‡ #GUpath ImageImage
The referring institute reported + PAX8, CK7, - GATA3, CK20, TTF1. O/S diagnosis was collecting duct carcinoma.

Upon review by us, we realized that the pt was AA and ordered an INI-1 which was negative.

Diagnosis: Renal medullary carcinoma (confirmed by Hb electophoresis) πŸ‘‡
True CDC of the kidney is extremely rare and is a diagnosis of exclusion. All tumors that look like a high grade adenoca, automatically get an INI-1. (I always exclude Uca and mets.)

RMC is usually a disease in younger pts, but can present at any age. #GUpath @PavlosMsaouel πŸ‘‡
Read 4 tweets
Priya Rao, MD Profile picture
May 14, 2020
Continuing yesterdays theme. Renal bx from a mass in a 55 yo. This one showed more stroma and the nuclei lining the cysts were less "ugly". Continued πŸ‘‡#GUpath ImageImageImage
Mass was resected and was <4 cm and well circumscribed. πŸ‘‡ ImageImageImage
Always run an FH stain (pic) on anything that looks tubulocystic . This was also positive for CK7, P504S and neg for CAIX and CD117.

Final diagnosis: Tubulocystic RCC

Continued πŸ‘‡ Image
Read 4 tweets
Priya Rao, MD Profile picture
May 12, 2020
Incidental renal mass. Stains and diagnosis πŸ‘‡#GUpath ImageImageImage
PAX8 (highlighting epithelium) and HMB45 (stains stromal component). ImageImage
Diagnosis: Angiomyolipoma with epithelial cysts (AMLEC) ER highlights condensed subepithelial stroma below the cyst epithelium. Cystic change may be very focal or extensive. Pay attention, especially on biopsies, for a cyst lining. #GUpath Image
Read 4 tweets
Priya Rao, MD Profile picture
Apr 30, 2020
I had a colleague from private practice ask me if I ever make a diagnosis of RCC with leiomyomatous stroma (RCCLMS). I thought this would be a good time to share an example. Continued πŸ‘‡ ImageImage
An excellent summary of the molecular findings was published this mth in AJSP by @rajalbshah & @Kiril_T_Can suggests that these are unique tumors that harbor mutations in the TSC, MTOR and ELOC (TCEB) genes and are distinct CCRCC. Diffuse expression of CK7 is key.
These are sporadic counterparts of similar tumors seen in the setting of TSC. I have seen several cases like this and there was not a consensus on what these should be classified as. I like this terminology and will be using this in my practice. cc: @SurenaMatinMD
Read 5 tweets

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