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BAP1-Mutated Clear Cell Renal Cell Carcinoma.

Alexander J Gallan1, Megan Parilla2, Jeremy Segal2

  • 1Department of Pathology, Medical College of Wisconsin, Milwaukee.

American Journal of Clinical Pathology
|November 19, 2020
PubMed
Summary

Mutations in the BAP1 gene are linked to aggressive clear cell renal cell carcinoma (CCRCC) with distinct pathologic features. Understanding these BAP1-mutated CCRCC characteristics aids in diagnosis and treatment.

Keywords:
BAP1EosinophilicGlobulesKidneyPapillaryRenal cell carcinoma

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Area of Science:

  • Oncology
  • Genetics
  • Pathology

Background:

  • Clear cell renal cell carcinoma (CCRCC) pathogenesis involves VHL gene and chromosome 3p aberrations.
  • Mutations in chromatin remodeling genes, including BAP1, contribute to CCRCC development.
  • BAP1-mutated CCRCC is associated with aggressive clinical behavior.

Purpose of the Study:

  • To define the pathologic phenotype of BAP1-mutated CCRCC.
  • To identify key histologic and immunohistochemical features of BAP1-mutated CCRCC.
  • To differentiate BAP1-mutated CCRCC from other renal cell carcinoma subtypes.

Main Methods:

  • Identified 14 cases of molecularly confirmed BAP1-mutated CCRCC.
  • Investigated clinicopathologic features of these cases.
  • Utilized immunohistochemistry to assess BAP1 and p504S expression.

Main Results:

  • BAP1-mutated CCRCC frequently exhibits papillary, tubulopapillary, or nested architecture with eosinophilic cytoplasm and high-grade nuclei.
  • Morphology overlaps with Xp11 translocation RCC.
  • Loss of BAP1 expression and strong p504S expression are notable immunohistochemical findings.
  • High-stage disease (pT3), renal vein invasion, and metastasis were common.

Conclusions:

  • Histologic and immunohistochemical findings in BAP1-mutated CCRCC are described.
  • These findings have implications for molecular testing, prognosis, and therapeutic strategies.
  • Distinguishing BAP1-mutated CCRCC from other RCC subtypes, like Xp11 translocation RCC, is crucial.