Analysis of Clinicopathologic Features and Imaging Findings of TFE3-Rearranged Renal Cell Carcinoma.
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OBJECTIVE: To examine the imaging features and clinicopathologic features of TFE3-rearranged renal cell carcinoma and highlight key imaging findings for clinical decision-making. METHODS: The imaging and clinicopathological data of 49 pathologically confirmed cases of TFE3-rearranged renal cell carcinoma from multiple institutions between January 2018 and December 2024 were retrospectively analyzed. RESULTS: Of the 49 patients, 17 were male and 32 were female; aged 44 ± 15 years (range: 10-82 years) , 22 were asymptomatic and 27 were symptomatic. Tumor size averaged 7.0 (range: 2.0-14.9) cm. Imaging showed 28 round-like and 21 lobulated lesions; 18 had distinct margins, while 31 had indistinct margins. A pseudocapsule was present in 36 cases, 24 of which were incomplete. Additionally, 42 tumors showed uneven density with necrosis or cystic degeneration; there were 25 cases of hemorrhage, 27 cases of irregular calcification, Peritumoral vessels were noted in 23 cases. Imaging modalities included CT (44 cases: 41 with both plain and enhanced scans, 3 with plain only), MRI (13 cases with plain and enhanced scans), and ultrasonography (15 cases, including 5 with contrast enhancement). Treatment included partial nephrectomy (21 cases), total nephrectomy (22 cases) , and biopsy (6 cases).With a median follow-up of 30 months (range: 1-72 months) until December 2024, 6 patients experienced tumor recurrence, 14 developed metastasis, and 7 died, while 5 patients were lost to follow-up. CONCLUSION: TFE3-rearranged renal cell carcinoma is a rare renal tumor with distinct imaging and clinical features that can inform preoperative diagnosis, treatment, and prognosis.