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I enjoyed reading the article by Drs. Geller and Dome regarding the significance of local lymph node involvement in pediatric renal cell carcinoma.1 I also was pleased to see the authors were aware of the recent publications describing a unique type of renal cell carcinoma in pediatric patients, the clinical, histologic, and immunohistologic features of which were first characterized in 1999 under the term “voluminous” renal cell carcinoma.2 The genetics of this tumor were subsequently characterized further,3 and the tumor was consequently renamed “translocation-associated renal cell tumor.” However, because the authors relied on the written pathology reports rather than reviewing the slides of the cases they describe, their data may not be entirely accurate. Specifically, a very likely reason why the significance of lymph node involvement in children is different from that in adults is that many if not most of the tumors they describe may in fact be translocation-associated tumors rather than clear cell renal cell carcinomas.

To my knowledge, translocation-associated tumors were first recognized and described in only 1999. Prior to that time, these tumors were routinely misdiagnosed as clear cell and clear and granular cell renal cell carcinomas. As a result, series that fail to recognize translocation-associated tumors always overestimate the percentage of clear cell tumors. When translocation-associated tumors are recognized, clear cell renal cell carcinomas in children are extremely rare in patients without genetic syndromes normally associated with such tumors such as von Hippel-Lindau disease.2

Nevertheless, the data these authors present are intriguing. One would hope they would be willing to have a pathologist who is familiar with translocation-associated tumors as well as the currently accepted classification of renal cell carcinomas4 examine the cases in their series. Then we will be able to determine whether clear cell renal cell carcinomas really do behave differently in children compared with adults, or whether the differences these authors so clearly demonstrate are because they are characterizing two very different types of tumor.

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Andrew Renshaw M.D.*, * Department of Pathology, Baptist Hospital of Miami, Miami, Florida.