Morphologic and immunophenotypic correlation between primary renal cell carcinoma resections and matched metastatic cytology specimens.

Authors

Mason Marshall, Sigfred Lajara, Gabriela Quiroga-Garza, Michaela Kop, Dimitrios Korentzelos, Samer Khader

Published in

Journal of the American Society of Cytopathology. Jul 24, 2026. Epub Jul 24, 2026.

Abstract

Renal cell carcinoma (RCC), comprising approximately 5% of adult malignancies, exhibits diverse morphologic and immunophenotypic features at primary and metastatic sites. Approximately one-third of patients present with metastatic disease at the time of diagnosis, and another 40% go on to develop metastases after nephrectomy. Accurate cytologic diagnosis of metastatic RCC is critical for prognosis, especially when tissue samples are limited. Few studies have evaluated concordance between primary RCC resections and matched metastatic cytology specimens. We evaluated morphologic and immunophenotypic concordances between primary RCCs and matched cytology specimens.
We conducted a 25-year retrospective review of RCC patients with available resection and cytology specimens, including fine-needle aspiration, core needle biopsy, and touch preparation specimens. Demographic data, patient staging and prognostic information, cytologic features, and immunohistochemical (IHC) profiles were collected. Morphologic features and IHC profiles were compared across matched histologic and cytologic specimens.
We identified 80 matched cytology cases from 74 patients. Clear cell RCC accounted for 57 cases (77%). Most cases demonstrated concordance of morphologic and immunophenotypic features. Clear cytoplasm (86.8%), rhabdoid (89.7%), sarcomatoid (96.2%), and papillary (95.0%) features demonstrated strong cytohistologic concordance. Nuclear grading concordance was more modest (76.2%), with most discordant cases representing minor differences involving grade 2 tumors. High concordance was also observed for PAX-8 (94.1%), CD10 (91.7%), and CA-9 (90.0%).
Cytologic features of metastatic RCC generally reflect the morphologic and immunophenotypic profile of the primary tumor, with particularly strong concordance for clear cytoplasm, papillary architecture, sarcomatoid/rhabdoid differentiation, and key IHC markers. Although nuclear grading showed more modest concordance, most discrepancies were minor and involved lower-grade tumors. Awareness of primary tumor morphologic characteristics and immunophenotype can enhance diagnostic confidence at metastatic sites. These findings support the diagnostic and prognostic utility of cytology specimens in metastatic RCC, particularly when tissue is limited.

PMID:
42701057
Bibliographic data and abstract were imported from PubMed on 06 Sep 2026.

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