Nephrogenic adenoma

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Nephrogenic adenoma, also known as mesonephric adenoma,[1] and nephrogenic metaplasia, is a rare lesion that is classically in the urinary bladder and can mimic adenocarcinoma.

Nephrogenic adenoma
Diagnosis in short

Nephrogenic adenoma. H&E stain.
Synonyms mesonephric adenoma, nephrogenic metaplasia
LM tubular structures with a microcystic appearance lined by hobnailed cells +/-thick eosinophilic basement membrane, usually associated with chronic inflammation
LM DDx urothelial carcinoma microcystic and nested variants, prostatic adenocarcinoma, clear cell adenocarcinoma
IHC CK7 +ve, PAX8 +ve, p53 -ve, CEA -ve, Ki-67 low (<5%)
Site urothelium - usu. urinary bladder
Prevalence uncommon
Prognosis benign

It should not be confused with metanephric adenoma.

General

Features:[2]

  • Benign.
    • May mimic adenocarcinoma!
  • Classic location is the urinary bladder.
    • 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.[3]

Microscopic

Features:[2]

  • Tubular structures - key feature.
    • Hobnailed cells.
    • +/-Thick eosinophilic basement membrane.
    • Microcystic appearance.
  • Usually associated with chronic inflammation.

Notes:

  • May mimic vascular/lymphatic channels - can be sorted-out with IHC.

DDx:

Images

  • Nephrogenic adenoma - low mag. (WC/Nephron)

  • Nephrogenic adenoma - intermed. mag. (WC/Nephron)

  • Nephrogenic adenoma - high mag. (WC/Nephron)

  • Nephrogenic adenoma - very high mag. (WC/Nephron)

www:

IHC

Features:[7]

  • CK7 +ve.
  • PAX2 +ve.[8]
  • PAX8 +ve.
  • AMACR +ve/-ve.

Others:[2]

  • p53 -ve.
  • CEA -ve.
  • Ki-67 low (<5%).
  • MUC1 +ve.
    • Marks distal renal tubule.[9]
  • PSA -ve.[10]
  • PSAP -ve.[10]
  • CD34 -ve.[11]

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PROSTATE TISSUE, TRANSURETHRAL RESECTION OF THE PROSTATE (TURP):
- BENIGN PROSTATE TISSUE WITH GLANDULAR AND STROMAL PROLIFERATION.
- UROTHELIAL MUCOSA WITH A MILD LYMPHOCYTIC INFILTRATE AND CHANGES CONSISTENT
  WITH CYSTITIS CYSTICA.
- BENIGN CALCIFICATIONS.
- NEPHROGENIC METAPLASIA (MESONEPHRIC ADENOMA), SEE COMMENT.
- NEGATIVE FOR MALIGNANCY.

COMMENT:
Nephrogenic metaplasia is a benign finding.  It is confirmed with immunostaining 
(POSITIVE for CK7, PAX8; NEGATIVE for AMACR, CK34betaE12 (very focal staining)).

See also

References

  1. ↑ Singh, KJ. (Jan 2011). "Mesonephric adenoma in remnant ureteric stump: A rare entity.". Indian J Urol 27 (1): 140-1. doi:10.4103/0970-1591.78414. PMID 21716880.
  2. ↑ 2.0 2.1 2.2 Gokaslan, ST.; Krueger, JE.; Albores-Saavedra, J. (Jul 2002). "Symptomatic nephrogenic metaplasia of ureter: a morphologic and immunohistochemical study of four cases.". Mod Pathol 15 (7): 765-70. doi:10.1097/01.MP.0000019578.51568.24. PMID 12118115. http://www.nature.com/modpathol/journal/v15/n7/full/3880603a.html. Cite error: Invalid <ref> tag; name "pmid12118115" defined multiple times with different content
  3. ↑ Mazal, PR.; Schaufler, R.; Altenhuber-Müller, R.; Haitel, A.; Watschinger, B.; Kratzik, C.; Krupitza, G.; Regele, H. et al. (Aug 2002). "Derivation of nephrogenic adenomas from renal tubular cells in kidney-transplant recipients.". N Engl J Med 347 (9): 653-9. doi:10.1056/NEJMoa013413. PMID 12200552.
  4. ↑ Doddamani, D.; Ansari, MS.; Gupta, NP.; Aron, M.; Singh, I.; Datta Gupta, S. (2002). "Mesonephroid adenocarcinoma of the bladder and urethra: a case report.". Int Urogynecol J Pelvic Floor Dysfunct 13 (1): 47-9. PMID 11999207.
  5. ↑ Abbas, M.; Kramer, MW.; Wolters, M.; Herrman, TR.; Becker, JU.; Kreipe, HH. (Feb 2013). "Adenocarcinoma of the urinary bladder, mesonephroid type: a rare case.". Rare Tumors 5 (1): e3. doi:10.4081/rt.2013.e3. PMID 23772302.
  6. ↑ Kunju, LP. (Oct 2010). "Nephrogenic adenoma: report of a case and review of morphologic mimics.". Arch Pathol Lab Med 134 (10): 1455-9. doi:10.1043/2010-0226-CR.1. PMID 20923300.
  7. ↑ Alexiev, BA.; Levea, CM. (Mar 2012). "Nephrogenic Adenoma of the Urinary Tract: A Review.". Int J Surg Pathol. doi:10.1177/1066896912439095. PMID 22415059.
  8. ↑ Tong, GX.; Melamed, J.; Mansukhani, M.; Memeo, L.; Hernandez, O.; Deng, FM.; Chiriboga, L.; Waisman, J. (Mar 2006). "PAX2: a reliable marker for nephrogenic adenoma.". Mod Pathol 19 (3): 356-63. doi:10.1038/modpathol.3800535. PMID 16400326.
  9. ↑ Fromont, G.; Barcat, L.; Gaudin, J.; Irani, J. (Nov 2009). "Revisiting the immunophenotype of nephrogenic adenoma.". Am J Surg Pathol 33 (11): 1654-8. doi:10.1097/PAS.0b013e3181b40061. PMID 19730362.
  10. ↑ 10.0 10.1 Malpica, A.; Ro, JY.; Troncoso, P.; Ordoñez, NG.; Amin, MB.; Ayala, AG. (Apr 1994). "Nephrogenic adenoma of the prostatic urethra involving the prostate gland: a clinicopathologic and immunohistochemical study of eight cases.". Hum Pathol 25 (4): 390-5. PMID 7512941.
  11. ↑ Aldenborg, F.; Peeker, R.; Fall, M.; Olofsson, A.; Enerbäck, L. (Jul 1998). "Metaplastic transformation of urinary bladder epithelium: effect on mast cell recruitment, distribution, and phenotype expression.". Am J Pathol 153 (1): 149-57. doi:10.1016/S0002-9440(10)65555-1. PMID 9665475.
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