Difference between revisions of "Nephrogenic adenoma"

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Nephrogenic adenoma (view source)

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      = Nephrogenic_adenoma_-_very_high_mag.jpg
| Image      = Nephrogenic_adenoma_-_very_high_mag.jpg  
| Width      =
| Width      =
| Caption    = Nephrogenic adenoma. [[H&E stain]].
| Caption    = Nephrogenic adenoma. [[H&E stain]].
| Synonyms  = mesonephric adenoma, nephrogenic metaplasia
| Synonyms  = mesonephric adenoma, nephrogenic metaplasia
| Micro      = tubular structures with a microcystic appearance lined by hobnailed cells +/-thick eosinophilic basement membrane, usually associated with chronic inflammation
| Micro      = classically tubular structures with a microcystic appearance lined by [[hobnail]]ed cells +/-thick eosinophilic basement membrane; may have tubulocystic, polypoid, papillary or fibromyxoid architecture; usually associated with chronic inflammation
| Subtypes  =
| Subtypes  =
| LMDDx      = [[urothelial carcinoma]] microcystic and nested variants, [[prostatic adenocarcinoma]], [[clear cell adenocarcinoma]]
| LMDDx      = [[urothelial carcinoma]] microcystic and nested variants, [[prostatic adenocarcinoma]], [[clear cell adenocarcinoma]] ([[clear cell adenocarcinoma of the urethra]], [[clear cell carcinoma of the urinary bladder]], metastatic clear cell adenocarcinoma)
| Stains    =
| Stains    =
| IHC        = CK7 +ve, PAX8 +ve, p53 -ve, CEA -ve, Ki-67 low (<5%)
| IHC        = CK7 +ve, PAX8 +ve, p53 -ve, CEA -ve, Ki-67 low (<5%)
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| Bloodwork  =
| Bloodwork  =
| Rads      =
| Rads      =
| Endoscopy  =
| Endoscopy  = occasionally a papillary-like mass ''or'' flat velvety lesion
| Prognosis  = benign
| Prognosis  = benign
| Other      =
| Other      =
| ClinDDx    =
| ClinDDx    = no treatment necessary (?)
}}
}}
'''Nephrogenic adenoma''', also known as '''mesonephric adenoma''',<ref name=pmid21716880>{{Cite journal  | last1 = Singh | first1 = KJ. | title = Mesonephric adenoma in remnant ureteric stump: A rare entity. | journal = Indian J Urol | volume = 27 | issue = 1 | pages = 140-1 | month = Jan | year = 2011 | doi = 10.4103/0970-1591.78414 | PMID = 21716880 }}</ref> and '''nephrogenic metaplasia''', is a rare lesion that is classically in the [[urinary bladder]] and can mimic [[adenocarcinoma]].
'''Nephrogenic adenoma''', also known as '''mesonephric adenoma''',<ref name=pmid21716880>{{Cite journal  | last1 = Singh | first1 = KJ. | title = Mesonephric adenoma in remnant ureteric stump: A rare entity. | journal = Indian J Urol | volume = 27 | issue = 1 | pages = 140-1 | month = Jan | year = 2011 | doi = 10.4103/0970-1591.78414 | PMID = 21716880 }}</ref> and '''nephrogenic metaplasia''', is a rare lesion that is classically in the [[urinary bladder]] and can mimic [[adenocarcinoma]].
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**Also reported in ureter and prostatic urethra.
**Also reported in ureter and prostatic urethra.
*It is thought to result from displacement of renal tubular cells, as this entity in renal transplant recipients is graft derived.<ref>{{Cite journal  | last1 = Mazal | first1 = PR. | last2 = Schaufler | first2 = R. | last3 = Altenhuber-Müller | first3 = R. | last4 = Haitel | first4 = A. | last5 = Watschinger | first5 = B. | last6 = Kratzik | first6 = C. | last7 = Krupitza | first7 = G. | last8 = Regele | first8 = H. | last9 = Meisl | first9 = FT. | title = Derivation of nephrogenic adenomas from renal tubular cells in kidney-transplant recipients. | journal = N Engl J Med | volume = 347 | issue = 9 | pages = 653-9 | month = Aug | year = 2002 | doi = 10.1056/NEJMoa013413 | PMID = 12200552 }}</ref>
*It is thought to result from displacement of renal tubular cells, as this entity in renal transplant recipients is graft derived.<ref>{{Cite journal  | last1 = Mazal | first1 = PR. | last2 = Schaufler | first2 = R. | last3 = Altenhuber-Müller | first3 = R. | last4 = Haitel | first4 = A. | last5 = Watschinger | first5 = B. | last6 = Kratzik | first6 = C. | last7 = Krupitza | first7 = G. | last8 = Regele | first8 = H. | last9 = Meisl | first9 = FT. | title = Derivation of nephrogenic adenomas from renal tubular cells in kidney-transplant recipients. | journal = N Engl J Med | volume = 347 | issue = 9 | pages = 653-9 | month = Aug | year = 2002 | doi = 10.1056/NEJMoa013413 | PMID = 12200552 }}</ref>
==Gross==
Features:
*Usually an incidental finding only seen on microscopy.
*May manifest as:
**A papillary-like mass.<ref name=amin2-27>{{Ref Amin|2-27}}</ref>
**A flat velvety lesion with an irregular border.<ref name=amin2-27>{{Ref Amin|2-27}}</ref>


==Microscopic==
==Microscopic==
Features:<ref name=pmid12118115>{{Cite journal  | last1 = Gokaslan | first1 = ST. | last2 = Krueger | first2 = JE. | last3 = Albores-Saavedra | first3 = J. | title = Symptomatic nephrogenic metaplasia of ureter: a morphologic and immunohistochemical study of four cases. | journal = Mod Pathol | volume = 15 | issue = 7 | pages = 765-70 | month = Jul | year = 2002 | doi = 10.1097/01.MP.0000019578.51568.24 | PMID = 12118115 | url = http://www.nature.com/modpathol/journal/v15/n7/full/3880603a.html }}</ref>
Features:<ref name=pmid12118115>{{Cite journal  | last1 = Gokaslan | first1 = ST. | last2 = Krueger | first2 = JE. | last3 = Albores-Saavedra | first3 = J. | title = Symptomatic nephrogenic metaplasia of ureter: a morphologic and immunohistochemical study of four cases. | journal = Mod Pathol | volume = 15 | issue = 7 | pages = 765-70 | month = Jul | year = 2002 | doi = 10.1097/01.MP.0000019578.51568.24 | PMID = 12118115 | url = http://www.nature.com/modpathol/journal/v15/n7/full/3880603a.html }}</ref>
*Tubular structures - '''key feature'''.
*Tubular structures - the classic morphology. †
**Hobnailed cells.
**Lined by a single cell layer - classically [[hobnail]]ed. ‡
**+/-Thick eosinophilic basement membrane.
**+/-Thick eosinophilic basement membrane.
**Microcystic appearance.
**Typically microcystic appearance.
*Usually associated with chronic inflammation.
*Usually associated with chronic inflammation.


Notes:
Notes:
*May mimic vascular/lymphatic channels - can be sorted-out with IHC.
*May mimic vascular/lymphatic channels - can be sorted-out with IHC.
*† May be tubulocystic, polypoid, papillary or fibromyxoid.<ref name=pmid23328975>{{Cite journal  | last1 = Piña-Oviedo | first1 = S. | last2 = Shen | first2 = SS. | last3 = Truong | first3 = LD. | last4 = Ayala | first4 = AG. | last5 = Ro | first5 = JY. | title = Flat pattern of nephrogenic adenoma: previously unrecognized pattern unveiled using PAX2 and PAX8 immunohistochemistry. | journal = Mod Pathol | volume = 26 | issue = 6 | pages = 792-8 | month = Jun | year = 2013 | doi = 10.1038/modpathol.2012.239 | PMID = 23328975 }}</ref>
*‡ May be flat.<ref name=pmid23328975/>
*Should not have [[necrosis]] or mitoses.


DDx:
DDx:
*[[Urothelial carcinoma]], microcystic and nested variants.
*[[Urothelial carcinoma]], microcystic and nested variants.
*[[Clear cell adenocarcinoma]].
**[[Clear cell adenocarcinoma of the urethra]].
**[[Mesonephroid adenocarcinoma]]<ref>{{Cite journal  | last1 = Doddamani | first1 = D. | last2 = Ansari | first2 = MS. | last3 = Gupta | first3 = NP. | last4 = Aron | first4 = M. | last5 = Singh | first5 = I. | last6 = Datta Gupta | first6 = S. | title = Mesonephroid adenocarcinoma of the bladder and urethra: a case report. | journal = Int Urogynecol J Pelvic Floor Dysfunct | volume = 13 | issue = 1 | pages = 47-9 | month =  | year = 2002 | doi =  | PMID = 11999207 }}</ref> (also known as ''clear cell carcinoma''<ref name=pmid23772302>{{Cite journal  | last1 = Abbas | first1 = M. | last2 = Kramer | first2 = MW. | last3 = Wolters | first3 = M. | last4 = Herrman | first4 = TR. | last5 = Becker | first5 = JU. | last6 = Kreipe | first6 = HH. | title = Adenocarcinoma of the urinary bladder, mesonephroid type: a rare case. | journal = Rare Tumors | volume = 5 | issue = 1 | pages = e3 | month = Feb | year = 2013 | doi = 10.4081/rt.2013.e3 | PMID = 23772302 }}</ref>) - may be deceptively bland.
*[[Prostatic adenocarcinoma]].
*[[Prostatic adenocarcinoma]].
*[[Clear cell adenocarcinoma]], e.g. [[clear cell adenocarcinoma of the urethra]].
 
*Metastatic [[clear cell renal cell carcinoma]].
*Metastatic tumours.
*Mesonephroid adenocarcinoma - very rare.<ref>{{Cite journal  | last1 = Doddamani | first1 = D. | last2 = Ansari | first2 = MS. | last3 = Gupta | first3 = NP. | last4 = Aron | first4 = M. | last5 = Singh | first5 = I. | last6 = Datta Gupta | first6 = S. | title = Mesonephroid adenocarcinoma of the bladder and urethra: a case report. | journal = Int Urogynecol J Pelvic Floor Dysfunct | volume = 13 | issue = 1 | pages = 47-9 | month =  | year = 2002 | doi =  | PMID = 11999207 }}</ref><ref>{{Cite journal  | last1 = Abbas | first1 = M. | last2 = Kramer | first2 = MW. | last3 = Wolters | first3 = M. | last4 = Herrman | first4 = TR. | last5 = Becker | first5 = JU. | last6 = Kreipe | first6 = HH. | title = Adenocarcinoma of the urinary bladder, mesonephroid type: a rare case. | journal = Rare Tumors | volume = 5 | issue = 1 | pages = e3 | month = Feb | year = 2013 | doi = 10.4081/rt.2013.e3 | PMID = 23772302 }}</ref>
**[[Clear cell renal cell carcinoma]].
**Other [[clear cell tumours]].


===Images===
===Images===
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==IHC==
==IHC==
Features:<ref name=pmid22415059>{{Cite journal  | last1 = Alexiev | first1 = BA. | last2 = Levea | first2 = CM. | title = Nephrogenic Adenoma of the Urinary Tract: A Review. | journal = Int J Surg Pathol | volume =  | issue =  | pages =  | month = Mar | year = 2012 | doi = 10.1177/1066896912439095 | PMID = 22415059 }}</ref>
Features:<ref name=pmid22415059>{{Cite journal  | last1 = Alexiev | first1 = BA. | last2 = Levea | first2 = CM. | title = Nephrogenic Adenoma of the Urinary Tract: A Review. | journal = Int J Surg Pathol | volume =  | issue =  | pages =  | month = Mar | year = 2012 | doi = 10.1177/1066896912439095 | PMID = 22415059 }}</ref>
*CK7 +ve.
*[[CK7]] +ve.
*PAX2 +ve.<ref name=pmid16400326>{{Cite journal  | last1 = Tong | first1 = GX. | last2 = Melamed | first2 = J. | last3 = Mansukhani | first3 = M. | last4 = Memeo | first4 = L. | last5 = Hernandez | first5 = O. | last6 = Deng | first6 = FM. | last7 = Chiriboga | first7 = L. | last8 = Waisman | first8 = J. | title = PAX2: a reliable marker for nephrogenic adenoma. | journal = Mod Pathol | volume = 19 | issue = 3 | pages = 356-63 | month = Mar | year = 2006 | doi = 10.1038/modpathol.3800535 | PMID = 16400326 }}</ref>
*PAX2 +ve.<ref name=pmid16400326>{{Cite journal  | last1 = Tong | first1 = GX. | last2 = Melamed | first2 = J. | last3 = Mansukhani | first3 = M. | last4 = Memeo | first4 = L. | last5 = Hernandez | first5 = O. | last6 = Deng | first6 = FM. | last7 = Chiriboga | first7 = L. | last8 = Waisman | first8 = J. | title = PAX2: a reliable marker for nephrogenic adenoma. | journal = Mod Pathol | volume = 19 | issue = 3 | pages = 356-63 | month = Mar | year = 2006 | doi = 10.1038/modpathol.3800535 | PMID = 16400326 }}</ref>
*PAX8 +ve.
*[[PAX8]] +ve.
*[[AMACR]] +ve/-ve.
*[[AMACR]] +ve/-ve.


Others:<ref name=pmid12118115>{{Cite journal  | last1 = Gokaslan | first1 = ST. | last2 = Krueger | first2 = JE. | last3 = Albores-Saavedra | first3 = J. | title = Symptomatic nephrogenic metaplasia of ureter: a morphologic and immunohistochemical study of four cases. | journal = Mod Pathol | volume = 15 | issue = 7 | pages = 765-70 | month = Jul | year = 2002 | doi = 10.1097/01.MP.0000019578.51568.24 | PMID = 12118115 }}</ref>
Others:<ref name=pmid12118115>{{Cite journal  | last1 = Gokaslan | first1 = ST. | last2 = Krueger | first2 = JE. | last3 = Albores-Saavedra | first3 = J. | title = Symptomatic nephrogenic metaplasia of ureter: a morphologic and immunohistochemical study of four cases. | journal = Mod Pathol | volume = 15 | issue = 7 | pages = 765-70 | month = Jul | year = 2002 | doi = 10.1097/01.MP.0000019578.51568.24 | PMID = 12118115 | url = http://www.nature.com/modpathol/journal/v15/n7/full/3880603a.html }}</ref>
*p53 -ve.
*p53 -ve.
*CEA -ve.
*[[CEA]] -ve.
*Ki-67 low (<5%).
*Ki-67 low (<5%).
*[[MUC1]] +ve.  
*[[MUC1]] +ve.  
**Marks distal renal tubule.<ref name=pmid19730362>{{Cite journal  | last1 = Fromont | first1 = G. | last2 = Barcat | first2 = L. | last3 = Gaudin | first3 = J. | last4 = Irani | first4 = J. | title = Revisiting the immunophenotype of nephrogenic adenoma. | journal = Am J Surg Pathol | volume = 33 | issue = 11 | pages = 1654-8 | month = Nov | year = 2009 | doi = 10.1097/PAS.0b013e3181b40061 | PMID = 19730362 }}</ref>
**Marks distal renal tubule.<ref name=pmid19730362>{{Cite journal  | last1 = Fromont | first1 = G. | last2 = Barcat | first2 = L. | last3 = Gaudin | first3 = J. | last4 = Irani | first4 = J. | title = Revisiting the immunophenotype of nephrogenic adenoma. | journal = Am J Surg Pathol | volume = 33 | issue = 11 | pages = 1654-8 | month = Nov | year = 2009 | doi = 10.1097/PAS.0b013e3181b40061 | PMID = 19730362 }}</ref>
*PSA -ve.<ref name=pmid7512941>{{Cite journal  | last1 = Malpica | first1 = A. | last2 = Ro | first2 = JY. | last3 = Troncoso | first3 = P. | last4 = Ordoñez | first4 = NG. | last5 = Amin | first5 = MB. | last6 = Ayala | first6 = AG. | title = Nephrogenic adenoma of the prostatic urethra involving the prostate gland: a clinicopathologic and immunohistochemical study of eight cases. | journal = Hum Pathol | volume = 25 | issue = 4 | pages = 390-5 | month = Apr | year = 1994 | doi =  | PMID = 7512941 }}</ref>
*PSA -ve.<ref name=pmid7512941>{{Cite journal  | last1 = Malpica | first1 = A. | last2 = Ro | first2 = JY. | last3 = Troncoso | first3 = P. | last4 = Ordoñez | first4 = NG. | last5 = Amin | first5 = MB. | last6 = Ayala | first6 = AG. | title = Nephrogenic adenoma of the prostatic urethra involving the prostate gland: a clinicopathologic and immunohistochemical study of eight cases. | journal = Hum Pathol | volume = 25 | issue = 4 | pages = 390-5 | month = Apr | year = 1994 | doi =  | PMID = 7512941 }}</ref>
*PSAP -ve.<ref name=pmid7512941/>
*[[PSAP]] -ve.<ref name=pmid7512941/>
*CD34 -ve.<ref name=pmid9665475>{{Cite journal  | last1 = Aldenborg | first1 = F. | last2 = Peeker | first2 = R. | last3 = Fall | first3 = M. | last4 = Olofsson | first4 = A. | last5 = Enerbäck | first5 = L. | title = Metaplastic transformation of urinary bladder epithelium: effect on mast cell recruitment, distribution, and phenotype expression. | journal = Am J Pathol | volume = 153 | issue = 1 | pages = 149-57 | month = Jul | year = 1998 | doi = 10.1016/S0002-9440(10)65555-1 | PMID = 9665475 }}</ref> (???)
*CD34 -ve.<ref name=pmid9665475>{{Cite journal  | last1 = Aldenborg | first1 = F. | last2 = Peeker | first2 = R. | last3 = Fall | first3 = M. | last4 = Olofsson | first4 = A. | last5 = Enerbäck | first5 = L. | title = Metaplastic transformation of urinary bladder epithelium: effect on mast cell recruitment, distribution, and phenotype expression. | journal = Am J Pathol | volume = 153 | issue = 1 | pages = 149-57 | month = Jul | year = 1998 | doi = 10.1016/S0002-9440(10)65555-1 | PMID = 9665475 }}</ref> (???)
*p63 -ve (0/32 cases<ref name=pmid23939154>{{Cite journal  | last1 = Shen | first1 = Q. | last2 = Sun | first2 = LH. | last3 = Wang | first3 = JH. | last4 = Liu | first4 = LB. | last5 = He | first5 = Q. | last6 = Jin | first6 = J. | title = [Pathological and immunohistochemical analyses of 32 cases of nephrogenic adenoma]. | journal = Beijing Da Xue Xue Bao | volume = 45 | issue = 4 | pages = 522-6 | month = Aug | year = 2013 | doi =  | PMID = 23939154 }}</ref> ).
*[[CK20]] -ve usually (6 +ve of 32 cases<ref name=pmid23939154/>).
*[[CK34betaE12]] -ve usually (8+ve of 32 cases<ref name=pmid23939154/>).


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