The characteristic morphologic spectrum of tubulocystic renal cell carcinoma (TC-RCC) may include areas resembling papillary RCC (PRCC). Our study includes 15 RCCs with tubulocystic pattern: 6 TC-RCCs, 1 RCC-high grade with tubulocystic architecture, 5 TC-RCCs with foci of PRCC, 2 with high-grade RCC (HGRCC) not otherwise specified, and 1 with a clear cell papillary RCC/renal angiomyoadenomatous tumor-like component. We analyzed aberrations of chromosomes 7, 17, and Y; mutations of VHL and FH genes; and loss of heterozygosity at chromosome 3p. Genetic analysis was performed separately in areas of classic TC-RCC and in those with other histologic patterns. The TC-RCC component demonstrated disomy of chromosome 7 in 9/15 cases, polysomy of chromosome 17 in 7/15 cases, and loss of Y in 1 case. In the PRCC component, 2/3 analyzable cases showed disomy of chromosome 7 and polysomy of chromosome 17 with normal Y. One case with focal HGRCC exhibited only disomy 7, whereas the case with clear cell papillary RCC/renal angiomyoadenomatous tumor-like pattern showed polysomies of 7 and 17, mutation of VHL, and loss of heterozygosity 3p. FH gene mutation was identified in a single case with an aggressive clinical course and predominant TC-RCC pattern. The following conclusions were drawn: (1) TC-RCC demonstrates variable status of chromosomes 7, 17, and Y even in cases with typical/uniform morphology. (2) The biological nature of PRCC/HGRCC-like areas within TC-RCC remains unclear. Our data suggest that heterogenous TC-RCCs may be associated with an adverse clinical outcome. (3) Hereditary leiomyomatosis-associated RCC can be morphologically indistinguishable from "high-grade" TC-RCC; therefore, in TC-RCC with high-grade features FH gene status should be tested.

*Ljudevit Jurak Department of Pathology Sestre milosrdnice Clinical Hospital Center †Department of Pathology School of Medicine University of Zagreb Zagreb Croatia ‡Department of Pathology and Cytology Clinical Center of the University of Sarajevo Sarajevo Bosnia and Hercegovina §Department of Pathology New York School of Medicine NYU Langone Medical Center New York NY ‡‡Department of Pathology and Laboratory Medicine University of Kansas Medical Center Kansas City KS Departments of ∥Pathology Urology **Otorhinolaryngology Charles University Medical Faculty and Charles University Hospital Plzen ¶¶Biomedical Centre Faculty of Medicine in Plzen Charles University Prague Plzen Czech Republic ¶Department of Pathology Centro Medico ∥∥Department of Pathology Institute Nacional de Cancerologia Mexico City Mexico ††Department of Pathology East University Riga Latvia §§Department of Pathology Cytopathos Bratislava Slovakia

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$a Ulamec, Monika $u *Ljudevit Jurak Department of Pathology, Sestre milosrdnice Clinical Hospital Center †Department of Pathology, School of Medicine, University of Zagreb, Zagreb, Croatia ‡Department of Pathology and Cytology, Clinical Center of the University of Sarajevo, Sarajevo, Bosnia and Hercegovina §Department of Pathology, New York School of Medicine, NYU Langone Medical Center, New York, NY ‡‡Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS Departments of ∥Pathology #Urology **Otorhinolaryngology, Charles University, Medical Faculty and Charles University Hospital Plzen ¶¶Biomedical Centre, Faculty of Medicine in Plzen, Charles University in Prague, Plzen, Czech Republic ¶Department of Pathology, Centro Medico ∥∥Department of Pathology, Institute Nacional de Cancerologia, Mexico City, Mexico ††Department of Pathology, East University, Riga, Latvia §§Department of Pathology, Cytopathos, Bratislava, Slovakia.

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$a Molecular Genetic Alterations in Renal Cell Carcinomas With Tubulocystic Pattern: Tubulocystic Renal Cell Carcinoma, Tubulocystic Renal Cell Carcinoma With Heterogenous Component and Familial Leiomyomatosis-associated Renal Cell Carcinoma. Clinicopathologic and Molecular Genetic Analysis of 15 Cases / $c M. Ulamec, F. Skenderi, M. Zhou, B. Krušlin, P. Martínek, P. Grossmann, K. Peckova, I. Alvarado-Cabrero, K. Kalusova, B. Kokoskova, P. Rotterova, M. Hora, O. Daum, M. Dubova, K. Bauleth, D. Slouka, M. Sperga, W. Davidson, B. Rychly, D. Perez Montiel, M. Michal, O. Hes,

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$a The characteristic morphologic spectrum of tubulocystic renal cell carcinoma (TC-RCC) may include areas resembling papillary RCC (PRCC). Our study includes 15 RCCs with tubulocystic pattern: 6 TC-RCCs, 1 RCC-high grade with tubulocystic architecture, 5 TC-RCCs with foci of PRCC, 2 with high-grade RCC (HGRCC) not otherwise specified, and 1 with a clear cell papillary RCC/renal angiomyoadenomatous tumor-like component. We analyzed aberrations of chromosomes 7, 17, and Y; mutations of VHL and FH genes; and loss of heterozygosity at chromosome 3p. Genetic analysis was performed separately in areas of classic TC-RCC and in those with other histologic patterns. The TC-RCC component demonstrated disomy of chromosome 7 in 9/15 cases, polysomy of chromosome 17 in 7/15 cases, and loss of Y in 1 case. In the PRCC component, 2/3 analyzable cases showed disomy of chromosome 7 and polysomy of chromosome 17 with normal Y. One case with focal HGRCC exhibited only disomy 7, whereas the case with clear cell papillary RCC/renal angiomyoadenomatous tumor-like pattern showed polysomies of 7 and 17, mutation of VHL, and loss of heterozygosity 3p. FH gene mutation was identified in a single case with an aggressive clinical course and predominant TC-RCC pattern. The following conclusions were drawn: (1) TC-RCC demonstrates variable status of chromosomes 7, 17, and Y even in cases with typical/uniform morphology. (2) The biological nature of PRCC/HGRCC-like areas within TC-RCC remains unclear. Our data suggest that heterogenous TC-RCCs may be associated with an adverse clinical outcome. (3) Hereditary leiomyomatosis-associated RCC can be morphologically indistinguishable from "high-grade" TC-RCC; therefore, in TC-RCC with high-grade features FH gene status should be tested.

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