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 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 4  |  Issue : 2  |  Page : 258-259

Conventional renal cell carcinoma with granulomatous reaction: A rare entity


Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

Date of Web Publication9-Mar-2015

Correspondence Address:
Reetika Sharma
Department of Pathology, Indira Gandhi Medical College, Shimla . 171 001, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-0513.148937

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  Abstract 

Granulomas may develop in a number of immunologically mediated infectious and noninfectious conditions. Granulomas may also occur within the malignancies like carcinomas of the breast, colon, and Hodgkin's lymphoma. Granulomatous reaction in association with renal cell carcinoma (RCC) is uncommon, with only fewer published reports in the literature. We reported a case of a conventional (clear cell) RCC associated with epithelioid granulomas within the tumor parenchyma.

Keywords: Conventional renal cell carcinoma, granulomas, tuberculosis


How to cite this article:
Sharma R, Kaushal V. Conventional renal cell carcinoma with granulomatous reaction: A rare entity. Clin Cancer Investig J 2015;4:258-9

How to cite this URL:
Sharma R, Kaushal V. Conventional renal cell carcinoma with granulomatous reaction: A rare entity. Clin Cancer Investig J [serial online] 2015 [cited 2019 Oct 23];4:258-9. Available from: http://www.ccij-online.org/text.asp?2015/4/2/258/148937


  Introduction Top


Granuloma is characterized by accumulation of activated macrophages that often develop an epithelioid appearance. Granulomas may develop in a number of immunologically mediated infectious and noninfectious conditions. [1] Granulomas may be associated with malignancies like carcinomas of the breast, colon and Hodgkin's lymphoma. [2],[3]

Granulomatous reaction in association with renal cell carcinoma (RCC) is uncommon, with only fewer published reports in the literature. [4],[5],[6] Also, in regions, where there is a high incidence of tuberculosis, it is important to differentiate tumor-related granulomatous reactions from tuberculosis for the purpose of treatment.


  Case report Top


A 52-year-old man who presented with hematuria of 3 months duration presented for the study. Computerized tomography scan revealed 2 cm × 2 cm heterogeneously enhancing mass in the mid pole of the left kidney. Subsequently partial nephrectomy was done. Grossly we received a part of the kidney measuring 4 cm × 4 cm × 3 cm. The capsule over the mass was stretched, and there was no breach in the capsule. The cut section showed well encapsulated tumor nodule of 2 cm × 2 cm having variegated appearance with yellow areas, hemorrhagic foci, and few tiny cystic areas [Figure 1].

The microscopic section from the tumor showed nests and tubules of tumor cells supported on fine vascular stroma. The most conspicuous feature noted was the presence of multiple foci of non caseating granulomas with Langhans type of giant cells in the tumor parenchyma and periphery of the tumor [Figure 2] and [Figure 3]. The tumor cells showed clear cytoplasm with nuclear features corresponding to Fuhrman grade 2. Histopathological diagnosis was conventional RCC with granulomatous reaction. There were no asteroid/Schaumann bodies and no evidence of fungi or mycobacteria within the granulomas/within the tumor. Tuberculosis was excluded by a thorough clinical check-up and relevant investigations.
Figure 1: Partial nephrectomy with well encapsulated tumor with yellow, tan-brown and cystic areas

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Figure 2: Non caseating granulomas with Langhans type of giant cells in the parenchyma of conventional renal cell carcinoma (H and E, ×100)

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Figure 3: Part of granuloma with Langhans type of giant cell and adjacent tumor component (H and E, ×400)

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  Discussion Top


The occurrence of non caseating granulomas in lymph nodes is a well-documented phenomenon with cervical and breast carcinomas. [7] But this phenomenon is very rare in the case of RCC. The location of granulomas is variable. It can be within the tumor parenchyma, tumor stroma or periphery of the tumor. [4],[5],[6] In our case, the granulomas were both within the tumor parenchyma and at the periphery.

Granulomas that are associated with tumor, represent an immune response of the tumor stroma to antigens expressed by the tumor. [5],[6] The possibilities to be considered in any tumor associated with granulomatous reaction are: (a) The granulomas are a reaction to tumor-related antigens and (b) there is co-existence of chronic granulomatous process like tuberculosis/sarcoidosis and tumor.


  Conclusion Top


Based on the morphological features of granulomas, it is not possible to entirely exclude concomitant tuberculosis, especially in a country like India where there is a high incidence of tuberculosis. However, the lack of granulomas in the adjoining parenchyma along with the absence of supportive evidence of clinical and radiological features favor the tumor related granulomatous reaction. From a therapeutic point of view, it is difficult but important to distinguish between these two conditions.

 
  References Top

1.
Kumar V, Abbas AK, Fausto N. Acute and chronic inflammation. In: Pathologic Basis of Disease. 7 th ed . Saunders Elsevier Philadelphia: ; 2006. p. 47-86   Back to cited text no. 1
    
2.
Coyne JD. Colonic carcinoma with granulomatous (sarcoid) reaction. J Clin Pathol 2002;55:708-9.  Back to cited text no. 2
    
3.
Santini D, Pasquinelli G, Alberghini M, Martinelli GN, Taffurelli M. Invasive breast carcinoma with granulomatous response and deposition of unusual amyloid. J Clin Pathol 1992;45:885-8.  Back to cited text no. 3
    
4.
Hes O, Hora M, Vanecek T, Sima R, Sulc M, Havlicek F, et al. Conventional renal cell carcinoma with granulomatous reaction: A report of three cases. Virchows Arch 2003;443:220-1.  Back to cited text no. 4
    
5.
Campbell F, Douglas-Jones AG. Sarcoid-like granulomas in primary renal cell carcinoma. Sarcoidosis 1993;10:128-31.  Back to cited text no. 5
    
6.
Kovacs J, Varga A, Bessenyei M, Gomba S. Renal cell cancer associated with sarcoid-like reaction. Pathol Oncol Res 2004;10:169-71.  Back to cited text no. 6
    
7.
Coyne JD, Haboubi NY. Invasive carcinoma with a granulomatous stromal response. Histopathology 1994;25:397.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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