Acceptance of emerging renal oncocytic neoplasms: a survey of urologic pathologists
Authors: Mohanty Sambit K. , Lobo Anandi , Jha Shilpy , Sangoi Ankur R. , Akgul Mahmut , Trpkov Kiril , Hes Ondrej , Mehra Rohit , Hirsch Michelle S. , Moch Holger , Smith Steven C. , Shah Rajal B. , Cheng Liang , Amin Mahul B. , Epstein Jonathan I. , Parwani Anil V. , Delahunt Brett , Desai Sangeeta , Przybycin Christopher G. , Manini Claudia , Luthringer Daniel J. , Sirohi Deepika , Jain Deepika , Midha Divya , Jain Ekta , Maclean Fiona , Giannico Giovanna A. , Paner Gladell P. , Martignoni Guido , Al-Ahmadie Hikmat A. , McKenney Jesse , Srigley John R. , Lopez Jose Ignacio , Kunju L. Priya , Browning Lisa , Aron Manju , Picken Maria M. , Tretiakova Maria , Zhou Ming , Sable Mukund , Kuroda Naoto , Pattnaik Niharika , Gupta Nilesh S. , Rao Priya , Fine Samson W. , Mishra Pritinanda , Adhya Amit K. , Kulkarni Bijal N. , Dixit Mallika , Baisakh Manas R. , Arora Samriti , Sancheti Sankalp , Menon Santosh , Wobker Sara E. , Tickoo Satish K. , Kaushal Seema , Soni Shailesh , Kandukuri Shivani , Sharma Shivani , Mitra Suvradeep , Reuter Victor E. , Malik Vipra , Rao Vishal , Chen Ying-Bei , Williamson Sean R. 
Published: September 2024

Oncocytic renal neoplasms are a major source of diagnostic challenge in genitourinary pathology; however, they are typically nonaggressive in general, raising the question of whether distinguishing different subtypes, including emerging entities, is necessary. Emerging entities recently described include eosinophilic solid and cystic renal cell carcinoma (ESC RCC), low-grade oncocytic tumor (LOT), eosinophilic vacuolated tumor (EVT), and papillary renal neoplasm with reverse polarity (PRNRP). A survey was shared among 65 urologic pathologists using SurveyMonkey.com (Survey Monkey, Santa Clara, CA, USA). De-identified and anonymized respondent data were analyzed. Sixty-three participants completed the survey and contributed to the study. Participants were from Asia (n = 21; 35%), North America (n = 31; 52%), Europe (n = 6; 10%), and Australia (n = 2; 3%). Half encounter oncocytic renal neoplasms that are difficult to classify monthly or more frequently. Most (70%) indicated that there is enough evidence to consider ESC RCC as a distinct entity now, whereas there was less certainty for LOT (27%), EVT (29%), and PRNRP (37%). However, when combining the responses for sufficient evidence currently and likely in the future, LOT and EVT yielded > 70% and > 60% for PRNRP. Most (60%) would not render an outright diagnosis of oncocytoma on needle core biopsy. There was a dichotomy in the routine use of immunohistochemistry (IHC) in the evaluation of oncocytoma (yes = 52%; no = 48%). The most utilized IHC markers included keratin 7 and 20, KIT, AMACR, PAX8, CA9, melan A, succinate dehydrogenase (SDH)B, and fumarate hydratase (FH). Genetic techniques used included TSC1/TSC2/MTOR (67%) or TFE3 (74%) genes and pathways; however, the majority reported using these very rarely. Only 40% have encountered low-grade oncocytic renal neoplasms that are deficient for FH. Increasing experience with the spectrum of oncocytic renal neoplasms will likely yield further insights into the most appropriate work-up, classification, and clinical management for these entities.