Skip to main content

Advertisement

SpringerLink
Log in

Low-grade oncocytic tumor: a review of radiologic and clinical features

  • Kidneys, Ureters, Bladder, Retroperitoneum
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

The 2022 World Health Organization classification of renal neoplasia expanded the spectrum of oncocytic neoplasms to encompass newly established and emerging entities; one of the latter is the low-grade oncocytic tumor (LOT). This study reports the radiologic appearance and clinical behavior of LOT.

Methods

In this IRB-approved, HIPPA-compliant retrospective study, our institution’s pathology database was searched for low-grade oncocytic tumors or neoplasms. Patient age, gender, and comorbidities were obtained from a review of electronic medical records, and imaging characteristics of the tumors were assessed through an imaging platform.

Results

The pathology database search yielded 14 tumors in 14 patients. Four patients were excluded, as radiologic images were not available in three, and one did not fulfill diagnostic criteria after pathology re-review. The resulting cohort consisted of 10 tumors (median diameter 2.3 cm, range 0.7–5.1) in 10 patients (median age 68 years, range 53–91, six women). All tumors presented as a solitary, well-circumscribed, mass with solid components. All enhanced as much or almost as much as adjacent renal parenchyma; all but one enhanced heterogeneously. None had lymphadenopathy, venous invasion, or metastatic disease at presentation or at clinical follow-up (median, 22.2 months, range 3.4–71.6). Among five tumors undergoing active surveillance, mean increase in size was 0.4 cm/year at imaging follow-up (median 16.7 months, range 8.9–25.4).

Conclusion

LOT, a recently described pathologic entity in the kidney, can be considered in the differential diagnosis of an avidly and typically heterogeneously enhancing solid renal mass in an adult patient.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Moch H, Amin MG, Berney DM, Comperat EM, Gill AJ, Hartmann A, Menon S, Raspollini MR, Rubin MA, Srigley JR, Tan PH, Tickoo SK, Tsuzuki T, Turajlic S, Cree I, Netto GJ (2022) The 2022 world health.organization classification of tumours of the urinary system and male genital organs—part A: renal, penile, and testicular tumours. Eur Urol 82(5):458-468. https://https://doi.org/10.1016/j.eururo.2022.06.016

    Article  PubMed  Google Scholar 

  2. WHO Classification of Tumours Editorial Board. Urinary and male genital tumours [Internet]. Lyon (France): International Agency for Research on Cancer; 2022 [cited 2023.06.15]. (WHO classification of tumours series, 5th ed.; vol. 8). https://tumourclassification.iarc.who.int/chapters/36

  3. Lobo J, Ohashi R, Amin M, Berney D, Comperat EM, Cree IA, Gill AJ, Hartmann A, Menon S, Netto GJ, Raspollini MR, Rubin MA, Tan PH, Tickoo SK, Txuzuki T, Turajlic S, Zhou M, Srigley JR, Moch H (2022) WHO 2022 landscape of papillary and chromophobe renal cell carcinoma. Histopath 81:426-438. https://doi:https://doi.org/10.1111/his.14700

    Article  Google Scholar 

  4. Trpkov K, Hes O, Williamson SR, et al (2021) New developments in existing WHO entities and evolving molecular concepts: The Genitourinary Pathology Society (GUPS) update on renal neoplasia. Mod Pathol 34:1392–424. https://doi:https://doi.org/10.1038/s4139-021-00779-w

    Article  PubMed  Google Scholar 

  5. Trpkov K, Williamson SR, Gill AJ, et al (2021) Novel, emerging and provisional renal entities: the Genitourinary Pathology Society (GUPS) update on renal neoplasia. Mod Pathol 34:1167–84 https://doi.https://doi.org/10.1038/s4139-021-00737-6

    Article  CAS  PubMed  Google Scholar 

  6. Siegmund SE, Al-Obaidy KI, Tsai HK, Idrees MT, Akgul M, Acosta AM, Hirsch MS (2023) Concordance of MTOR Pathway Mutations and the Diagnosis of Renal Low-Grade Oncocytic Tumor (LOT). Int J Surg Pathol. https://doi:10.https://doi.org/10.1177/10668969231178032

    Article  PubMed  Google Scholar 

  7. Trpkov K, Hes O (2019) New and emerging renal entities: a perspective post-WHO 2016 classification. Histopath 74:31–59. https://doi.org/https://doi.org/10.1111/his.13727

    Article  Google Scholar 

  8. Trpkov K., Williamson S.R., Gao Y., Martinek P., Cheng L., Sangoi A.R., Yilmaz A., Wang C., San Miguel Fraile P., Perez Montiel D.M., et al (2019) Low-grade oncocytic tumor of kidney (CD117 negative, cytokeratin 7 positive): A distinct entity? Histopath 75:174–184. https://doi.org/10.1111/his.13865.

    Article  Google Scholar 

  9. Siadat F, Trypkov K (2020) ESC, ALK, HOT and LOT: three letter acronyms of emerging renal entities knocking on the door of the WHO classification. Cancers 12(1):168-184. https://doi.org/https://doi.org/10.3390/cancers12010168

    Article  PubMed  PubMed Central  Google Scholar 

  10. Yi M, Wang S, Wang P, Wang Z, Lu J, Liu Y (2023) Eosinophilic solid and cystic renal cell carcinoma: a review of literature focused on radiological findings and differential diagnosis. Abdom Radiol 48:350-357. https://doiorg/https://doi.org/10.1007/s00261-022-3694-z

    Article  Google Scholar 

  11. Kapur P, Gao M, Zhong H, Rakheja D, Cai Q, Pedrosa I, Margulis V, Xu L, Kinch L, Brugarolas J (2021) Eosinophilic vacuolated tumor of the kidney: a review of evolving concepts in this novel subtype with additional insights from a case with MTOR mutation and concomitant chromosome 1 loss. Adv Anat Path 28(4):251-257. https://doi:https://doi.org/10.1097/pap.0000000000000299

    Article  Google Scholar 

  12. Kartal I, Ivelik HI, Coser S, Tunc H, Acikalin MF (2022) Eosinophilic vacuolated tumor of the kidney: clinical perspective of a new pathologic emerging entity. Cureus 14(5):e24716. doi:https://doi.org/10.7759/cureus.24716.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Shinagare AB, Davenport MS, Park H, Pedrosa I, Remer EM, Chandarana H, Doshi AM, Schieda N, Smith AD, Vikram R, Wang ZJ, Silverman SG. Lexicon for renal mass terms at CT and MRI: a consensus of the society of abdominal radiology disease-focused panel on renal cell carcinoma. Abdom Radiol 2021;46(2):703-722. https://doi:https://doi.org/10.1007/s00261-020-02644-x

    Article  Google Scholar 

  14. Sasaguri K, Takahashi N, Gomez-Cardona D, Leng S, Schmit GD, Carter RE, Leibovich BC, Kawashima A (2015) Small (<4cm) renal mass: differentiation of oncocytoma from renal cell carcinoma on biphasic contrast-enhanced CT. AJR 205:999-1007. https://doi.https://doi.org/10.2214/AJR.14.13966

    Article  PubMed  Google Scholar 

  15. Allen BC, Tirman P, Jennings Clingan M, Manny J, Del Gaizo, AJ, Leyendecker JR (2018) Characterizing solid renal neoplasms with MRI in adults. Abd Imaging 9:358-387. https:/doi.https://doi.org/10.1007/s00261-014-0074-4

    Article  Google Scholar 

  16. Perez-Ordonez B, Hamed G. Campbell S, Erlandson RA, Russo P, Gaudin PB, Reuter VE (1997) Renal oncocytoma: a clinicopathologic study of 70 cases. Am J Surg Pathol 21(8):871-883 https://doi:https://doi.org/10.1097/00000478-199708000-00001

    Article  CAS  PubMed  Google Scholar 

  17. Marko J, Craig R, Nguyen A, Udager AM, Wolfman D (2021) Chromophobe renal cell carcinoma with radiologic-pathologic correlation. Radiographics 41(5):1408-1419. https://doi.org/https://doi.org/10.1148/rg.2021200206

    Article  PubMed  Google Scholar 

  18. Schieda N, Davenport MS, Silverman SG, Bagga B, Barkmeier D, Blank Z, Cuci NE, Doshi AM, Downey RT, Edney E, Granader E, Gujrathi I, Hibbert RM, Hindman N, Walsh C, Ramsay T, Shinagare AB, Pedrosa I (2022) Multicenter evaluation of multiparametric MRI clear cell likelihood scores in solid indeterminate small renal masses. Radiol 303(3):590-599. https://doi.org/https://doi.org/10.1148/radiol.211680

    Article  Google Scholar 

  19. Hotker AM, Mazaheri Y, Wibmer A, Karlo CA, Zheng, J, Moskowitz CS, Tickoo SK, Russo P, Hricak H, Akin O (2017) Differentiation of clear cell renal cell carcinoma from other renal cortical tumors by use of a quantitative MRI approach. AJR 206(5):85-91. https://doi.org/10.2214/AJR.16.16652

    Article  Google Scholar 

  20. Oliva MR, Glickman JN, Zou KH, Teo SY, Mortele KJ, Rocha MS, Silverman SG (2009) Renal cell carcinoma: T1 and T2 signal intensity characteristics of papillary and clear cell types correlated with pathology. AJR 192:1524-1530. https://doi:https://doi.org/10.2213/AJR.08.1727

    Article  PubMed  Google Scholar 

  21. Sharma D, Pai, T, Prakash G, Desai S, Menon S (2022) Low-grade oncocytic tumor: report of two cases of an emerging entity in the spectrum of oncocytic renal neoplasms. Turk Patoloji Derg 38(2):162-166. https://doi:https://doi.org/10.5146//tjpath.2021.01549

    Article  PubMed  PubMed Central  Google Scholar 

  22. Galeno Ramalho de Andrade Melo C, Vinicius Nunes Xavier M, Soares Pimenta I, Abensur Athanazio D (2020) Low-grade oncocytic tumor of kidney (CD117-negative, cytokeratin 7-positive). Surg and Exp Pathol 22

  23. Bayramoglu Z, Keceli AM, Gonen M, Donmez MI (2021) Recognizing a low-grade oncocytic renal tumor. Bull Urooncol 20(4):273-275. https://doi:https://doi.org/10.4274/uob.galenos.2020.1862

    Article  Google Scholar 

  24. Parkhi M, Chatterjee D, Kumar A, Kumar S (2022). Walking the thin line—low grade oncocytic tumor of kidney: an emerging entity. Med J Armed Forces India 78(3):355-359. https://doi.org/10.1016/j.mjafi.2021.02.003

    Article  PubMed  Google Scholar 

  25. Mansoor M, Siadat F, Trpkov K. Low-grade oncocytic tumor (LOT)—a new renal entity ready for a prime time: an updated review. Histol Histopathol 2022;37(5):405-413. https://doi:https://doi.org/10.14670/HH-18-435

    Article  CAS  PubMed  Google Scholar 

  26. Chen T, Peng Y, Lei T, Wu C, Wang H, Shi Y. Low-grade oncocytic tumour (LOT) of the kidney is characterized by GATA3 positivity, FOXI1 negativity and mTOR pathway mutations. Pathol Oncol Res 2023. https://doi.org/https://doi.org/10.3389/pore.2023.1610852

    Article  PubMed  PubMed Central  Google Scholar 

  27. Lerma L, Schade G, Tretiakova M (2021) Co-existence of ESC-RCC, EVT, and LOT as synchronous and metachronous tumors in six patients with multifocal neoplasia but without clinical features of tuberous sclerosis complex. Hum Pathol 116:1-11

    Article  CAS  PubMed  Google Scholar 

  28. Kapur P, Gao M, Zhong H, Chintalapati S, Mitui M, Barnes S, Zhou Q, Miyata J, Carrillo D, Malladi V, Rakhefa D, Pedrosa I, Xu L, Kinch L, Brugarolas J (2022) Germline and sporadic MTOR pathway mutations in low-grade oncocytic tumor of the kidney. Mod Pathol 35:333-345

    Article  CAS  PubMed  Google Scholar 

  29. Kravtsov O, Gupta s, Cheville J, Sukov W, Rowsey R, Herrera-Hernandez L, Lohse C, Knudson R, Leibovich B, Jimenez R (2021) Low-grade oncocytic tumor of kidney (CK7-positive, CD117-negative): incidence in a single institutional experience with clinicopathological and molecular characteristics. Hum Pathol 114:9-18

    Article  CAS  PubMed  Google Scholar 

  30. Nassour AJ, Jain A, Hui N, Siopis G, Symons J, Woo H (2023) Relative risk of bladder and kidney cancer in Lynch syndrome: systematic review and meta-analysis. Cancers 15(2):506 https://doi:https://doi.org/10.3390/cancers15020506

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Hegemann M, Kroeger N, Stenzi A, Bedke J (2018) Rare and changeable as a chameleon: paraneoplastic syndromes in renal cell carcinoma. World J Urol 6:849-854. https://doi.org/https://doi.org/10.1007/s00345-018-2215-9

    Article  Google Scholar 

  32. Davis CJ, Barton JH, Sesterhenn IA, Mostofi FK (1995) Metanephric adenoma: clinicopathological study of fifty patients. Am J Surg Pathol 19(10):1101-1114

    Article  PubMed  Google Scholar 

  33. Akgul M, Al-OBaidy KI, Cheng L, Idrees MT (2021) Low-grade oncocytic tumour expands the spectrum of renal oncocytic tumours and deserves separate classification: a review of 23 cases from a single tertiary institute. J Clin Pathol 75(11):772-775. https://doi.org/https://doi.org/10.1136/jclinpath-2021-207478

    Article  CAS  PubMed  Google Scholar 

  34. Chai JL, Alencar RO, Hirsch MS, Bhagavatula SK, Bay CP, Siegmund S, Chang SL, Silverman SG (2023) Reliability and management outcomes following a percutaneous biopsy diagnosis of oncocytoma: a 15-year retrospective analysis. Radiol 307(2):1-9. https://doi.org/https://doi.org/10.1148/radiol.221156

    Article  Google Scholar 

  35. Siu W, Hafez KS, Johnston WK, Wolf JS (2007) Growth rates of renal cell carcinoma and oncocytoma under surveillance are similar. Urol Oncol 25(2):115-119. https://doi.org/10.1016/j.urolonc.2006.07.018

    Article  PubMed  Google Scholar 

  36. Kawaguchi S, Fernandes KA, Finelli A, Robinette M, Fleshner N, Jewett MAS (2011) Most renal oncocytomas appear to grow: observations of tumor kinetics with active surveillance. J Urol 186(4):1218‑1222. https://doi:https://doi.org/10.1016/j.juro.2011.05.080

    Article  PubMed  Google Scholar 

  37. Mir MC, Capitanio U, Bertolo R, Ouzaid I, Salagierski M, Kriegmair M, Volpe A, Jewett MAS, Kutikov A, Pierorazio PM (2018) Role of active surveillance for localized renal masses. Eur Urol Oncol 1(3):177-187. https://doi:https://doi.org/10.1016/j.euo.2018.05.001

    Article  PubMed  Google Scholar 

  38. Jewett MAS, Mattar K, Basiuk J, Morash CG, Pautler SE, Siemens DR, Tanguay S, Rendon RA, Gleave ME, Drachenberg DE, Chow R, Chung H, Chin JL, Fleshner NE, Evans AJ, Gallie BL, Haider MA, Kachura JR, Kurban G, Fernandes K, Finelli, A (2012) Renal oncocytoma growth rates before intervention. BJU Int 110(10):1444-1448. https://doi:https://doi.org/10.1111/j.1464-410X.2012.011136.x

    Article  Google Scholar 

Download references

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA, 02115, USA

    Jessie L. Chai & Stuart G. Silverman

  2. Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA

    Stephanie E. Siegmund & Michelle S. Hirsch

Authors
  1. Jessie L. Chai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephanie E. Siegmund
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michelle S. Hirsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stuart G. Silverman
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JLC and SGS: conceptualization. JLC and SGS: methodology. JLC, SES, and MSH: Formal analysis and investigation. JLC: writing—original draft preparation. JLC, SES, MSH, and SGS: writing—review and editing. MSH and SGS: supervision.

Corresponding author

Correspondence to Jessie L. Chai.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chai, J.L., Siegmund, S.E., Hirsch, M.S. et al. Low-grade oncocytic tumor: a review of radiologic and clinical features. Abdom Radiol (2024). https://doi.org/10.1007/s00261-023-04167-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00261-023-04167-7

Keywords

Search

Navigation