Renal Tumors Associated With Germline SDHB Mutation Show Distinctive Morphology

Anthony J. Gill, Nicholas S. Pachter, Angela Chou, Barbara Young, Adele Clarkson, Katherine M. Tucker, Ingrid M. Winship, Peter Earls, Diana E. Benn, Bruce G. Robinson, Stewart Fleming, Roderick J. Clifton-Bligh

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    Abstract

    Germline succinate dehydrogenase B (SDHB) mutation causes pheochromocytoma/paraganglioma syndrome type 4 (PGL4). PGL4 is characterized by pheochromocytoma and paraganglioma, type 2 (SDHB negative) gastrointestinal stromal tumors and renal tumors, which are usually classified as carcinoma. We report 4 kindreds with 5 PGL4-associated renal tumors. Four of the tumors occurred before the age of 30 years, 4 were in the left kidney, 3 were in female patients, and 4 demonstrated consistent but previously unrecognized morphology. The tumors were composed of cuboidal cells with bubbly eosinophilic cytoplasm and indistinct cell borders. Many of the cells displayed distinctive cytoplasmic inclusions, which were vacuolated or contained eosinophilic fluid-like material. The cells were arranged in solid nests or in tubules surrounding central spaces. The tumors were well circumscribed or lobulated and frequently showed cystic change. Benign tubules or glomeruli were often entrapped at the edges of the tumors. The fifth tumor lacked these features but displayed sarcomatoid dedifferentiation. Immunohistochemistry for SDHB was completely negative in all 4 available tumors. Death from metastatic disease occurred in the patient with dedifferentiated tumor 1 year after diagnosis, whereas the other 4 tumors were cured by local excision alone (mean follow-up, 11 y; range, 2 to 30 y). We conclude that morphology supported by negative immunohistochemistry for SDHB can be used to identify kindreds with germline SDHB mutations (PGL4 syndrome) presenting with this unique type of renal tumor. These renal tumors appear to have a good prognosis after complete excision unless there is sarcomatoid dedifferentiation.

    Original languageEnglish
    Pages (from-to)1578-1585
    Number of pages8
    JournalAmerican Journal of Surgical Pathology
    Volume35
    Issue number10
    DOIs
    Publication statusPublished - Oct 2011

    Keywords

    • SDHB
    • renal carcinoma
    • PGL4
    • hereditary renal carcinoma
    • GIST
    • paraganglioma
    • pheochromocytoma
    • oncocytoma
    • clear cell carcinoma
    • gastrointestinal stromal tumor
    • GASTROINTESTINAL STROMAL TUMORS
    • CELL CARCINOMA
    • SUCCINATE-DEHYDROGENASE
    • PARAGANGLIOMA
    • PHEOCHROMOCYTOMA
    • GENE

    Cite this

    Gill, A. J., Pachter, N. S., Chou, A., Young, B., Clarkson, A., Tucker, K. M., Winship, I. M., Earls, P., Benn, D. E., Robinson, B. G., Fleming, S., & Clifton-Bligh, R. J. (2011). Renal Tumors Associated With Germline SDHB Mutation Show Distinctive Morphology. American Journal of Surgical Pathology, 35(10), 1578-1585. https://doi.org/10.1097/PAS.0b013e318227e7f4