0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Clinical Note |

Primary Description of a New Entity, Renal Cell–Like Carcinoma of the Nasal Cavity:  van Meegeren in the House of Vermeer

Karen Bracha Zur, MD; Margaret Brandwein, MD; Beverly Wang, MD; Peter Som, MD; Ronald Gordon, PhD; Mark L. Urken, MD
Arch Otolaryngol Head Neck Surg. 2002;128(4):441-447. doi:10.1001/archotol.128.4.441.
Text Size: A A A
Published online

Background  Few sinonasal malignancies can manifest, histologically, as clear cell neoplasia. The most likely such tumor to be encountered is metastatic renal cell carcinoma. Primary sinonasal tumors that can appear as clear cell malignancies include squamous cell carcinoma and mucoepidermoid carcinoma. Primary salivary clear cell carcinoma occurs almost exclusively in the oral cavity and has not been described in the nasal cavity.

Objective  To report a unique sinonasal clear cell malignancy that mimicked metastatic renal carcinoma.

Study Design  Case report.

Outcome Measurements  Radiography, histology, histochemistry, immunohistochemistry, and electron microscopy.

Results  Histologically, the tumor was identical to renal cell carcinoma. No evidence of renal malignancy was found by abdominal computed tomographic scan or gadolinium-enhanced magnetic resonance imaging. Histochemistry confirmed the presence of tumor glycogen but no mucin. Immunohistochemistry confirmed strong expression of low- and high-molecular-weight keratin and S100, and no vimentin expression. Electron microscopy showed tumor myofibroblastic differentiation and cytoplasmic glycogen, neutral lipid vacuoles, and cholesterol.

Conclusions  There was no clinical evidence of renal cell carcinoma. The immunohistochemical and ultrastructural findings were inconsistent with the diagnosis of renal cell carcinoma and showed features also inconsistent with the diagnosis of primary salivary clear cell carcinoma. We therefore conclude that this tumor represents a new and distinct entity, notable in its presentation as a "counterfeit renal cell carcinoma."

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Place holder to copy figure label and caption
Figure 1.

Axial noncontrast computed tomographic scan viewed with wide windows showing an ovoid mass with smooth displacement of the upper septum and medial antral wall displacement.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

A, Coronal T1-weighted image showing an ovoid mass in the left midnasal and upper-nasal fossa, and obstructed higher-signal–intensity secretions in the left ethmoidal and maxillary sinuses. B, Coronal T2-weighted sequence showing tumor low signal intensity, entrapped high-signal secretions, and obstructed secretions in the left ethmoidal and maxillary sinuses. C, Coronal T1-weighted fat-suppressed sequence shows tumor signal enhancement.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.

Low-power histologic section of clear cell malignancy forming follicular, glandlike structures (hematoxylin-eosin, original magnification ×100).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.

Higher-power view of clear cells. Note the round, basally located nuclei within the columnar cells. A second population of basal cells can be identified, which are spindled, with clear cytoplasm (hematoxylin-eosin, original magnification ×400).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 5.

Nuclear pleomorphism and prominent vascularity (hematoxylin-eosin, original magnification ×400).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 6.

Immunohistochemistry for S100 protein showing strong expression (original magnification ×400).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 7.

Nests of cells surrounded by a basement membrane and separated by connective tissue with myofibroblastic and smooth muscle cells. Cytoplasmic neutral lipid vacuoles and cholesterol (arrow) are present (ultrathin sections stained with uranyl acetate and lead citrate, original magnification ×3700). The inset shows basal cells adjacent to the basement membrane, with cellular processes containing dense bodies, typical of myoepithelial differentiation (ultrathin sections stained with uranyl acetate and lead citrate, original magnification ×15 400).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 8.

Salivary clear cell carcinoma. This tumor is composed of cuboidal cells with rounded, condensed, or triangular peripheral nuclei. The cells of clear cell carcinoma are generally smaller than those of renal cell carcinoma, with a higher nuclear-cytoplasmic ratio (hematoxylin-eosin, original magnification ×400).

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();