Soft tissue tumours of the genitourinary tract are both rare and encompass a diverse range of mesenchymal neoplasms with varied histogenesis and clinical behaviour. This review provides an up-to-date overview of these tumours, incorporating recent updates in classification, grading and molecular diagnostics.
The molecular characteristics and intricate relationships between tumours exhibiting overlapping features of metanephric adenoma (MA) and epithelial Wilms tumour (WT), as well as their pure forms, remain largely enigmatic.
Herein, we conducted a comprehensive genetic analysis of nine epithelial-predominant Wilms tumours, focusing on genetic alterations through expanded targeted sequencing and RNA sequencing (RNA-seq) methodologies. The patients ranged in age from 13 to 61 years, with a mean and median age of 43 and 48 years, respectively. The cohort included seven males and two females. These tumours exhibited immune reactivity for BRAF, WT1, and CD57, and harboured frequent TERT promoter mutations (7/9) and BRAF V600E mutations (8/9). RNA sequencing-based clustering revealed a close similarity between the tumours and MAs, suggesting that they may represent a distinct subset within the Wilms tumour spectrum. Two patients were lost to follow-up, while the remaining seven (7/7) were alive without tumour recurrences or metastases at the time of analysis, with a mean follow-up duration of 78.1 months.
Our research supports the notion previously described that epithelial-predominant Wilms tumours, characterized by frequent TERT promoter and BRAF V600E mutations, represent a distinct subset within the Wilms tumour spectrum. These tumours display an expression profile closely resembling that of metanephric adenomas and are associated with a favourable prognosis.
The cover image is based on the article Renal cell carcinoma with fibromyomatous stroma (RCC FMS) and with hemangioblastoma-like areas is part of the RCC FMS spectrum in patients with tuberous sclerosis complex by Katherina Baranovaet al., https://doi.org/10.1111/his.15505.
Immunohistochemistry (IHC) for p16 is widely used as a surrogate marker for HPV involvement in oropharyngeal squamous cell carcinoma (OPSCC), among other tumours. Confirming HPV status in OPSCC is critical, as HPV-positive tumours have better overall survival and may require de-escalated therapy compared to HPV-independent OPSCC in the future. However, discordance exists between p16 and HPV, and direct HPV testing is occasionally required to ensure an accurate diagnosis. The aim of this study is to highlight the genomic basis behind the limitation of relying on p16 IHC as a surrogate marker for HPV involvement.
Through a multi-institutional collaboration, this case series compiled four patients with a ‘false’ negative p16 staining pattern in HPV-positive non-keratinizing head and neck squamous cell carcinoma. All cases demonstrated minimal to no p16 IHC staining and were positive for HPV by direct RNA in situ hybridization. Through CDKN2A fluorescence in situ hybridization testing, three patients demonstrated a homozygous deletion of CDKN2A and one demonstrated a heterozygous deletion.
This series highlights the genomic basis for the ‘false’ negative p16 results, raising awareness of a significant diagnostic pitfall while emphasizing the importance of careful consideration of clinicopathologic parameters in the clinical workup of these cases.
To investigate histological and copy number variations (CNVs) in Leydig cell tumours (LCTs) of the testis. Although usually benign, a small minority of cases can be associated with a poor prognosis and metastasis.
We performed whole copy number analysis to compare the genomic profile of atypical (defined by the presence of any atypical features) versus benign LCTs. Our sample consisted of one malignant (with biopsy-proven metastasis), five atypical and five benign cases.
We found increased genomic instability in the malignant tumour and within two out of five (40%) atypical cases. One benign case revealed a likely pathogenic mutation in the neurofibromatosis type 2 gene, but all benign cases lacked genomic instability. Apart from the malignant case (which had metastatic spread to the scrotal skin), all remaining atypical cases did not reveal evidence of recurrence or metastatic spread.
CNVs by themselves are not sufficient to discriminate between cases that are benign versus those with malignant potential, without the use of histomorphological parameters. Genomic instability was only detected in the malignant and atypical cases, and not in any of the benign tumours. Thus, genomic instability may represent an early step in malignant progression. The presence of metastasis remains the only malignant criterion for LCTs.
Hepatocellular adenomas (HCAs) are rare in children and often arise in distinct clinical contexts, despite sharing classification frameworks with adult cases. This series evaluates the clinicopathologic features of HCAs in patients 21 years or younger, highlighting phenotype–genotype correlations and the clinical relevance of molecular testing.
27 HCAs from 26 patients (69% female; mean age: 16.2 years) were analyzed. Based on morphology and immunohistochemistry (IHC), most cases were unclassified (46%), followed by inflammatory (35%), HNF1A-inactivated (15%) and β-catenin-activated (4%) subtypes. Most patients (69%) had multifocal disease. In addition to classic risk factors such as oral contraceptive use and obesity, 35% had a history of neoplasm and 15% had glycogen storage disease. Next-generation sequencing was performed on 13 HCAs; germline testing was available in 1 patient with familial adenomatous polyposis. While molecular testing had limited impact on reclassification, it was valuable in cases with ambiguous IHC profiles and in guiding management of patients with atypical or syndromic presentations by excluding variants associated with malignant potential.
Paediatric HCAs arise in diverse clinical contexts and may require individualized treatment planning. While histologic and immunophenotypic evaluation is sufficient in most cases, molecular profiling adds value in diagnostically challenging scenarios and may help guide management decisions.
We aimed to evaluate tumour-infiltrating lymphocytes (TILs), tertiary lymphoid structures (TLSs) and myxoid stroma in breast biopsies diagnosed with atypical ductal hyperplasia (ADH) and ductal carcinoma in situ (DCIS). We hypothesized that these stromal features may help identify patients at high risk for upstaging to invasive carcinoma.
Analysis included 592 patients diagnosed with ADH or DCIS via breast biopsy. TILs, TLSs and myxoid stroma were correlated with high-risk features, including larger lesion size, higher BIRADS scores, higher nuclear grade, comedonecrosis, oestrogen receptor (ER) negativity and HER2 overexpression, and were associated with an increased risk of upstaging. In a multivariate logistic regression model incorporating stromal TILs or TLSs, myxoid stroma and basic pathological factors, both stromal TILs or TLSs and myxoid stroma showed independent predictive value, with an AUC of 0.77. The AUC further increased to 0.87 when clinical factors and immunohistochemistry (ER and HER2) were included. Both stromal TILs or TLSs and myxoid stroma demonstrated predictive power exceeding that of comedonecrosis and comparable with nuclear grade. The two pathologists showed moderate to high interobserver agreement in evaluating these stromal and immune features. A simplified scoring system based on six clinicopathological variables retained strong discriminative ability (AUC 0.84).
Stromal TILs, TLSs and myxoid stroma are robust predictors of upstaging to invasive carcinoma in patients diagnosed with ADH/DCIS on biopsy. These features can be readily assessed by pathologists using only H&E staining and should be considered in future risk stratification models to inform clinical decision-making.
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