Tubulocystic carcinoma of the kidney: a histologic, immunohistochemical, and ultrastructural study

Tubulocystic carcinoma of the kidney (TCCK) is a tumor entity, which is not yet included in the WHO classification of renal tumors. The histogenesis of this neoplasm is uncertain. This study was undertaken to determine (1) the incidence of TCCK and (2) immunohistochemical and ultrastructural characteristics of those tumors that qualify as TCCK by the current definitions. From January 1, 2003 to December 31, 2012, a total of 615 renal cell carcinomas (RCCs) were seen by the Department of Pathology, University of Maryland Medical Center. Four TCCKs were identified (4/615, <1 %). TCCK is a distinctive group of kidney tumors with a male predominance and noteworthy macroscopic spongy appearance. Microscopically, the tumors were composed of tubules and cysts lined by a single layer of eosinophilic, columnar, cuboidal, flat, or hobnail cells with large nuclei and prominent nucleoli separated by a thin fibrotic stroma. In all TCCKs, the majority of neoplastic cells showed immunohistochemical (CD10⁺, RCC⁺, vimentin⁺, and AMACR⁺) and ultrastructural (abundant long brush border microvilli) characteristics of proximal renal tubules. In few cells, the microvilli were shorter and sparse with cytoplasmic interdigitation analogous to intercalated cells of the collecting ducts. Focal positivity for BerEP4 (a marker preferentially expressed in distal renal tubules) was also noted. The major differential diagnostic considerations are oncocytoma, multilocular cystic renal cell carcinoma, and cystic nephroma/mixed epithelial and stromal tumor of the kidney. TCCK seems to have a favorable prognosis. In the current series, none of the patients had local recurrence or metastatic disease.