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Published on: March 30, 2015
Exploring Multiphoton Microscopy as a Novel Tool to Differentiate Chromophobe Renal Cell Carcinoma From Oncocytoma in
Manu Jain, Brian D Robinson, Binlin Wu
1From the Departments of Pathology and Laboratory Medicine (Drs Jain, Robinson, and Khani), Urology (Drs Robinson and Khani), and Biochemistry (Drs Wu and Mukherjee), Weill Cornell Medical College, New York, New York; the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Jain); and the Physics Department and CSCU Center for Nanotechnology, Southern Connecticut State University, New Haven (Dr Wu). Drs Robinson and Wu contributed equally to this article.
Context:
- Distinguishing chromophobe renal cell carcinoma (chRCC), especially in the presence of eosinophilic cytoplasm, from oncocytoma on hematoxylin-eosin can be difficult and often requires time-consuming ancillary procedures that ultimately may not be informative.
Objective:
- To explore the potential of multiphoton microscopy (MPM) as an alternative and rapid diagnostic tool in differentiating oncocytoma from chRCC at subcellular resolution without tissue processing.
Design:
- Unstained, deparaffinized tissue sections from 27 tumors (oncocytoma [n = 12], chRCC [n = 12], eosinophilic variant of chRCC [n = 1], and atypical oncocytic renal neoplasm [n = 2]) were imaged with MPM. Morphologic evaluation and automated quantitative morphometric analysis were conducted to distinguish between chRCC and oncocytoma.
Results:
- The typical cases of oncocytomas (12 of 12) and chRCC (12 of 12) could be readily differentiated on MPM based on the morphologic features similar to hematoxylin-eosin. The most striking MPM signature of both of the tumors was the presence of autofluorescent intracytoplasmic granules, which are not seen on hematoxylin-eosin-stained slides. Although we saw these granules in both types of tumors, they appeared distinct, based on their size, shape, cytoplasmic distribution, and autofluorescence wavelengths, and were valuable in arriving at a definitive diagnosis. For oncocytomas and chRCC, high diagnostic accuracies of 100% and 83.3% were achieved on blinded MPM and morphometric analysis, respectively.
Conclusions:
- To the best of our knowledge, this is the first demonstration of MPM to distinguish chRCC from oncocytoma in fixed tissues. Our study was limited by small sample size and only a few variants of oncocytic tumors. Prospective studies are warranted to assess the utility of MPM as a diagnostic aid in oncocytic renal tumors.
