Difference between revisions of "Metanephric adenoma"
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = Metanephric_adenoma_-_very_high_mag.jpg | | Image = Metanephric_adenoma_-_very_high_mag.jpg | ||
| Width = | | Width = | ||
| Caption = Metanephric adenoma. [[H&E stain]]. | | Caption = Metanephric adenoma. [[H&E stain]]. | ||
| Synonyms = | | Synonyms = | ||
| Micro = small uniform cells with fine chromatin, no apparent [[nucleolus]], and a relatively smooth nuclear membrane; variable architecture - may be sheets or | | Micro = small uniform cells with fine chromatin, no apparent [[nucleolus]], and a relatively smooth nuclear membrane; variable architecture - may be sheets, ductal or micropapillary, +/-[[psammoma bodies]] | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = [[Wilms tumour]], [[papillary renal cell carcinoma]] (type 1) | | LMDDx = [[Wilms tumour]], [[papillary renal cell carcinoma]] (type 1), [[renal mucinous tubular and spindle cell carcinoma]] | ||
| Stains = | | Stains = | ||
| IHC = WT-1 +ve, CD57 +ve, AMACR -ve | | IHC = WT-1 +ve, CD57 +ve, AMACR -ve, CD56 -ve | ||
| EM = | | EM = | ||
| Molecular = | | Molecular = | ||
| Line 40: | Line 40: | ||
*Afflicts adults and occasionally children. | *Afflicts adults and occasionally children. | ||
*May be associated with [[polycythemia]].<ref name=pmid21220212>{{Cite journal | last1 = Le Nué | first1 = R. | last2 = Marcellin | first2 = L. | last3 = Ripepi | first3 = M. | last4 = Henry | first4 = C. | last5 = Kretz | first5 = JM. | last6 = Geiss | first6 = S. | title = Conservative treatment of metanephric adenoma. A case report and review of the literature. | journal = J Pediatr Urol | volume = 7 | issue = 4 | pages = 399-403 | month = Aug | year = 2011 | doi = 10.1016/j.jpurol.2010.09.010 | PMID = 21220212 }}</ref> | *May be associated with [[polycythemia]].<ref name=pmid21220212>{{Cite journal | last1 = Le Nué | first1 = R. | last2 = Marcellin | first2 = L. | last3 = Ripepi | first3 = M. | last4 = Henry | first4 = C. | last5 = Kretz | first5 = JM. | last6 = Geiss | first6 = S. | title = Conservative treatment of metanephric adenoma. A case report and review of the literature. | journal = J Pediatr Urol | volume = 7 | issue = 4 | pages = 399-403 | month = Aug | year = 2011 | doi = 10.1016/j.jpurol.2010.09.010 | PMID = 21220212 }}</ref> | ||
==Gross== | |||
*Sharply circumscribed. | |||
*Not encapsulated.<ref name=pmid23551615>{{Cite journal | last1 = Mantoan Padilha | first1 = M. | last2 = Billis | first2 = A. | last3 = Allende | first3 = D. | last4 = Zhou | first4 = M. | last5 = Magi-Galluzzi | first5 = C. | title = Metanephric adenoma and solid variant of papillary renal cell carcinoma: common and distinctive features. | journal = Histopathology | volume = 62 | issue = 6 | pages = 941-53 | month = May | year = 2013 | doi = 10.1111/his.12106 | PMID = 23551615 }}</ref> | |||
==Microscopic== | ==Microscopic== | ||
| Line 47: | Line 51: | ||
**No apparent [[nucleolus]]. | **No apparent [[nucleolus]]. | ||
**A relatively smooth nuclear membrane. | **A relatively smooth nuclear membrane. | ||
*Variable architecture - may be sheets or | *Variable architecture - may be sheets, ductal or micropapillary. | ||
*+/-[[Psammoma bodies]]. | |||
DDx: | DDx: | ||
| Line 55: | Line 60: | ||
**Mitoses (rare in ''metanephric adenoma''). | **Mitoses (rare in ''metanephric adenoma''). | ||
*[[Papillary renal cell carcinoma|Papillary RCC]].<ref name=Ref_WMSP284>{{Ref WMSP|284}}</ref> | *[[Papillary renal cell carcinoma|Papillary RCC]].<ref name=Ref_WMSP284>{{Ref WMSP|284}}</ref> | ||
*[[Renal mucinous tubular and spindle cell carcinoma]]. | |||
*Other [[small round cell tumours]], e.g. [[small cell carcinoma]]. | |||
===Images=== | ===Images=== | ||
<gallery> | <gallery> | ||
Image:Metanephric_adenoma_high_mag.jpg | Metanephric adenoma (WC/Nephron) | Image:Metanephric_adenoma_high_mag.jpg | Metanephric adenoma. [[PAS stain]]. (WC/Nephron) | ||
Image:Metanephric_adenoma_high_mag_cropped.jpg | Metanephric adenoma - cropped (WC/Nephron) | Image:Metanephric_adenoma_high_mag_cropped.jpg | Metanephric adenoma - cropped. [[PAS stain]]. (WC/Nephron) | ||
</gallery> | </gallery> | ||
<gallery> | <gallery> | ||
| Line 74: | Line 81: | ||
*CD57 +ve.<ref name=pmid24083046/> | *CD57 +ve.<ref name=pmid24083046/> | ||
*AMACR -ve.<ref name=pmid24083046/> | *AMACR -ve.<ref name=pmid24083046/> | ||
*CD56 -ve.<ref name=pmid11688464/> | |||
**Positive in Wilms tumour<ref name=pmid11688464/> and small cell carcinoma. | |||
*CK7 +ve (focal).<ref name=pmid11688464>{{Cite journal | last1 = Muir | first1 = TE. | last2 = Cheville | first2 = JC. | last3 = Lager | first3 = DJ. | title = Metanephric adenoma, nephrogenic rests, and Wilms' tumor: a histologic and immunophenotypic comparison. | journal = Am J Surg Pathol | volume = 25 | issue = 10 | pages = 1290-6 | month = Oct | year = 2001 | doi = | PMID = 11688464 }}</ref> | |||
*TTF-1 -ve.{{fact}} | |||
==Sign out== | |||
<pre> | |||
Left Kidney, Total Nephrectomy: | |||
- Metanephric adenoma, see comment. | |||
COMMENT: | |||
The tumour stains as follows: | |||
POSITIVE: WT1, CD57, PAX8. | |||
NEGATIVE: CD56, TTF-1, AMACR. | |||
</pre> | |||
==See also== | ==See also== | ||
Latest revision as of 17:06, 17 December 2017
| Metanephric adenoma | |
|---|---|
| Diagnosis in short | |
 Metanephric adenoma. H&E stain. | |
|
| |
| LM | small uniform cells with fine chromatin, no apparent nucleolus, and a relatively smooth nuclear membrane; variable architecture - may be sheets, ductal or micropapillary, +/-psammoma bodies |
| LM DDx | Wilms tumour, papillary renal cell carcinoma (type 1), renal mucinous tubular and spindle cell carcinoma |
| IHC | WT-1 +ve, CD57 +ve, AMACR -ve, CD56 -ve |
| Site | kidney - see kidney tumours |
|
| |
| Clinical history | usu. adults, occasionally children |
| Prevalence | uncommon |
| Prognosis | good, benign |
Metanephric adenoma is a benign tumour of the kidney.
It should not be confused mesonephric adenoma, another term for nephrogenic adenoma.
This can be remembered as follows: metanephric adenoma is a tumour.
General
- Benign.
- Afflicts adults and occasionally children.
- May be associated with polycythemia.[1]
Gross
- Sharply circumscribed.
- Not encapsulated.[2]
Microscopic
Features:[3]
- Small uniform cells with:
- Fine chromatin.
- No apparent nucleolus.
- A relatively smooth nuclear membrane.
- Variable architecture - may be sheets, ductal or micropapillary.
- +/-Psammoma bodies.
DDx:
- Epithelioid nephroblastoma (Wilms tumour) - these typically have:
- Irregular nuclear membrane.
- Nucleoli.
- Mitoses (rare in metanephric adenoma).
- Papillary RCC.[3]
- Renal mucinous tubular and spindle cell carcinoma.
- Other small round cell tumours, e.g. small cell carcinoma.
Images
Metanephric adenoma - PaRCC-like - low mag. (WC/Nephron)
Metanephric adenoma - PaRCC-like - intermed. mag. (WC/Nephron)
Metanephric adenoma - PaRCC-like - very high mag. (WC/Nephron)
Metanephric adenoma - PaRCC-like - very high mag. (WC/Nephron)
www:
IHC
- WT-1 +ve.[4]
- CD57 +ve.[4]
- AMACR -ve.[4]
- CD56 -ve.[5]
- Positive in Wilms tumour[5] and small cell carcinoma.
- CK7 +ve (focal).[5]
- TTF-1 -ve.[citation needed]
Sign out
Left Kidney, Total Nephrectomy: - Metanephric adenoma, see comment. COMMENT: The tumour stains as follows: POSITIVE: WT1, CD57, PAX8. NEGATIVE: CD56, TTF-1, AMACR.
See also
References
- ↑ Le Nué, R.; Marcellin, L.; Ripepi, M.; Henry, C.; Kretz, JM.; Geiss, S. (Aug 2011). "Conservative treatment of metanephric adenoma. A case report and review of the literature.". J Pediatr Urol 7 (4): 399-403. doi:10.1016/j.jpurol.2010.09.010. PMID 21220212.
- ↑ Mantoan Padilha, M.; Billis, A.; Allende, D.; Zhou, M.; Magi-Galluzzi, C. (May 2013). "Metanephric adenoma and solid variant of papillary renal cell carcinoma: common and distinctive features.". Histopathology 62 (6): 941-53. doi:10.1111/his.12106. PMID 23551615.
- ↑ 3.0 3.1 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 284. ISBN 978-0781765275.
- ↑ 4.0 4.1 4.2 Watanabe, S.; Naganuma, H.; Shimizu, M.; Ota, S.; Murata, S.; Nihei, N.; Matsushima, J.; Mikami, S. et al. (2013). "Adult nephroblastoma with predominant epithelial component: a differential diagnostic candidate of papillary renal cell carcinoma and metanephric adenoma-report of three cases.". Case Rep Pathol 2013: 675875. doi:10.1155/2013/675875. PMID 24083046.
- ↑ 5.0 5.1 5.2 Muir, TE.; Cheville, JC.; Lager, DJ. (Oct 2001). "Metanephric adenoma, nephrogenic rests, and Wilms' tumor: a histologic and immunophenotypic comparison.". Am J Surg Pathol 25 (10): 1290-6. PMID 11688464.
.