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Difference between revisions of "Papillary renal neoplasm with reverse polarity"
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Papillary renal neoplasm with reverse polarity (view source)
Revision as of 14:09, 16 August 2024
, 16 Augustno edit summary
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = | | Image = Papillary renal neoplasm with reverse polarity - alt -- high mag.jpg | ||
| Width = | | Width = | ||
| Caption = | | Caption = Papillary renal neoplasm with reverse polarity. [[H&E stain]]. | ||
| Synonyms = | | Synonyms = | ||
| Micro = papillary structures, eosinophilic cytoplasm, reverse polarity of nuclei (nuclei at luminal aspect of cell), low nuclear grade | | Micro = papillary structures, eosinophilic cytoplasm, reverse polarity of nuclei (nuclei at luminal aspect of cell), low nuclear grade | ||
| Line 31: | Line 31: | ||
| Tx = | | Tx = | ||
}} | }} | ||
'''Papillary renal neoplasm with reverse polarity''' is a rare [[renal tumour]] and evolving entity.<ref name=pmid31135486>{{cite journal |authors=Al-Obaidy KI, Eble JN, Cheng L, Williamson SR, Sakr WA, Gupta N, Idrees MT, Grignon DJ |title=Papillary Renal Neoplasm With Reverse Polarity: A Morphologic, Immunohistochemical, and Molecular Study |journal=Am J Surg Pathol |volume=43 |issue=8 |pages=1099–1111 |date=August 2019 |pmid=31135486 |doi=10.1097/PAS.0000000000001288 |url=}}</ref> | '''Papillary renal neoplasm with reverse polarity''' is a rare [[renal tumour]] and an evolving entity.<ref name=pmid31135486>{{cite journal |authors=Al-Obaidy KI, Eble JN, Cheng L, Williamson SR, Sakr WA, Gupta N, Idrees MT, Grignon DJ |title=Papillary Renal Neoplasm With Reverse Polarity: A Morphologic, Immunohistochemical, and Molecular Study |journal=Am J Surg Pathol |volume=43 |issue=8 |pages=1099–1111 |date=August 2019 |pmid=31135486 |doi=10.1097/PAS.0000000000001288 |url=}}</ref> It has a distinctive morphology that matches the name. | ||
==General== | ==General== | ||
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*Early data suggests an indolent behaviour.<ref name=pmid31135486>{{cite journal |authors=Al-Obaidy KI, Eble JN, Cheng L, Williamson SR, Sakr WA, Gupta N, Idrees MT, Grignon DJ |title=Papillary Renal Neoplasm With Reverse Polarity: A Morphologic, Immunohistochemical, and Molecular Study |journal=Am J Surg Pathol |volume=43 |issue=8 |pages=1099–1111 |date=August 2019 |pmid=31135486 |doi=10.1097/PAS.0000000000001288 |url=}}</ref> | *Early data suggests an indolent behaviour.<ref name=pmid31135486>{{cite journal |authors=Al-Obaidy KI, Eble JN, Cheng L, Williamson SR, Sakr WA, Gupta N, Idrees MT, Grignon DJ |title=Papillary Renal Neoplasm With Reverse Polarity: A Morphologic, Immunohistochemical, and Molecular Study |journal=Am J Surg Pathol |volume=43 |issue=8 |pages=1099–1111 |date=August 2019 |pmid=31135486 |doi=10.1097/PAS.0000000000001288 |url=}}</ref> | ||
== | ==Microscopic== | ||
Features:<ref name=pmid31135486/> | Features:<ref name=pmid31135486/> | ||
*Branching papillae with: | *Branching papillae with: | ||
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DDx: | DDx: | ||
*Eosinophilic [[papillary renal cell carcinoma]] - considered distinct from this entity. | |||
*[[Renal tumours with eosinophilic cytoplasm]]. | *[[Renal tumours with eosinophilic cytoplasm]]. | ||
===Images=== | |||
<gallery> | |||
Image: Papillary renal neoplasm with reverse polarity -- very low mag.jpg | PRNRP - very low mag. | |||
Image: Papillary renal neoplasm with reverse polarity -- low mag.jpg | PRNRP - low mag. | |||
Image: Papillary renal neoplasm with reverse polarity - alt -- low mag.jpg | PRNRP - low mag. | |||
Image: Papillary renal neoplasm with reverse polarity -- intermed mag.jpg | PRNRP - intermed. mag. | |||
Image: Papillary renal neoplasm with reverse polarity -- high mag.jpg | PRNRP - high mag. | |||
Image: Papillary renal neoplasm with reverse polarity -- very high mag.jpg | PRNRP - very high mag. | |||
</gallery> | |||
==IHC== | ==IHC== | ||
Features:<ref name=pmid31135486/> | Features:<ref name=pmid31135486/> | ||
* | *GATA3 +ve (43 of 43 cases<ref name=pmid37797754/>) - '''key stain'''. | ||
* | **Negative in other papillary RCCs.<ref name=pmid37797754/> | ||
* | *CK7 +ve (88% +ve, 37 of 42 cases<ref name=pmid37797754/>). | ||
*CD10 +ve/-ve (50% +ve, 21 of 42 cases<ref name=pmid37797754/>). | |||
*Vimentin -ve (all cases). | *Vimentin -ve (all cases). | ||
*CD117 -ve. | *CD117 -ve. | ||
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*EMA +ve. | *EMA +ve. | ||
*L1CAM +ve. | *L1CAM +ve. | ||
*PAX8 +ve. | |||
*AMACR -ve (4 of 43 cases<ref name=pmid37797754/>). | |||
*RCC -ve (1 of 43 cases<ref name=pmid37797754/>). | |||
===Differentiating between papillary RCC and PRNRP=== | |||
Adapted from Kim ''et al.'':<ref name=pmid37797754/> | |||
{| class="wikitable sortable" | |||
!Diagnosis | |||
!GATA3 | |||
!AMACR | |||
!RCC | |||
!Vimentin | |||
|- | |||
|Papillary RCC | |||
| 0% +ve | |||
| 85-90% +ve | |||
| 60-75% +ve | |||
| 60-70% +ve | |||
|- | |||
|PRNRP | |||
| 100% +ve | |||
| ~10% +ve | |||
| ~2% +ve | |||
| ~2% +ve | |||
|- | |||
|} | |||
==Molecular== | ==Molecular== | ||
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Comment: | Comment: | ||
The tumour has a papillary architecture, eosinophilic cytoplasm and reversed nuclear polarity. | The tumour has a papillary architecture, eosinophilic cytoplasm, low nuclear grade, and reversed nuclear polarity. | ||
It stains as follows: | It stains as follows: | ||
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NEGATIVE: vimentin (stroma), CD117, CD10. | NEGATIVE: vimentin (stroma), CD117, CD10. | ||
PRNRP is thought to be distinct from papillary RCC.[1][2] Limited data suggests PRNRP has an indolent behaviour.[3] Follow-up is recommended. | The findings are in keeping with papillary renal neoplasm with reverse polarity (PRNRP). PRNRP is thought to be distinct from papillary RCC.[1][2] Limited data suggests PRNRP has an indolent behaviour.[3] Follow-up is recommended. | ||
1. Pathol Int. 2024 Apr;74(4):222-226. doi: 10.1111/pin.13417. https://pubmed.ncbi.nlm.nih.gov/38456605/ | 1. Pathol Int. 2024 Apr;74(4):222-226. doi: 10.1111/pin.13417. https://pubmed.ncbi.nlm.nih.gov/38456605/ | ||