6.-ONCOCYTOMA RENAL AND SUDDEN UNEXPECTED DEATH.
PROF.GARFIA.A
CASE REPORT
The case is described of a 57 year-old male who died suddenly in the field where he worked. The body was found several hours later and showed erosion and bruising on the right temple, coinciding with the zone of impact on falling to the ground. From the medical history the family pointed out the existence of a stroke, cardiopathy and non-insulin dependent diabetes.
At autopsy the heart (520 g) shows left concentric ventricular hypertrophy.It was found the existence of a spherical renal tumor about 6 cm in diameter, and orange color on cutting; the centre of the tumor was a cystic cavity lined with whitish fibrous-like tissue.
The probable causal relationships between the existence of the tumor, the hypertensive heart disease and stroke, suffered by the man, and his sudden death is discussed.
Oncocytoma and chromophobe cell carcinoma are two well recognised histological entities in the current classification of renal tumors. Both entities are closely related and arise in the distal portion of the neprhon or in the collector tubules. From a forensic point of view, it is important to point at the incidental autopsy finding of this tumor and, until we know, the classical triad of palpable mass, flank pain or hematuria was absent in this case.
I think that Sudden Death presentation was consecuence of the Hypertensive Heart Disease and the oncocytoma, unfortunatly, an incidental autopsy finding.
 |
| BLOG 6 FORENSICPATHOLOGYFORUM PROF.GARFIA.A |
Fig.1.- Gross examination shows a well circumscribed tumor, with encapsulated appearance (arrows), uniforme yellow color and with a central stellate cystic scar (C) which shows striking similarities with a pathological renal pelvis. Is it a kidney (collecting tubules and pelvis) inside the Kidney? Prof.Garfia.A
 |
| BLOG 6 FORENSICPATHOLOGYFORUM PROF. GARFIA.A |
Fig. 2.- Detail to show the seudocapsule (arrows), and the central stellate cystic scar (C). Prof.Garfia.A
 |
| BLOG 6 FORENSICPATHOLOGYFORUM PROF. GARFIA.A |
Fig.3.-Microscopical aspect of the seudocapsule. (arrows).
Prof.Garfia.A
 |
| BLOG 6 FORENSICPATHOLOGYFORUM PROF. GARFIA.A |
Fig.4.-To show the microscopic tubular pattern inside the tumor (arrow: transversal tubular section from a good differentiated tubule) and differents longitudinal tubular sections (T), where we can see how some tubules are originating from others through a gemmation process (T, at the right side). Haematoxilin-eosin-floxine. Prof.Garfia.A
 |
| BLOG 6 FORENSICPATHOLOGYFORUM PROF. GARFIA.A |
Fig. 5.-Reticulin stain to demonstrate basal membranes which show a microscopic tubular pattern delimiting renal tubules (T). Prof.Garfia.A
 |
| BLOG 6 FORENSICPATHOLOGYFORUM PROF. GARFIA.A |
Fig.6.-In others microscopical fields some structures show striking similarities with primitive glomeruli and contain a tuff of mesangial matrix (M) containing primitive capillaries (at the rihgt figure, just over the letter M. Prof.Garfia.A
