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 ductal
| 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  =
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*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==
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**No apparent [[nucleolus]].
**No apparent [[nucleolus]].
**A relatively smooth nuclear membrane.   
**A relatively smooth nuclear membrane.   
*Variable architecture - may be sheets or ductal.
*Variable architecture - may be sheets, ductal or micropapillary.
*+/-[[Psammoma bodies]].


DDx:
DDx:
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**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>
Image:Metanephric_adenoma_-_low_mag.jpg | Metanephric adenoma - PaRCC-like - low mag. (WC/Nephron)
Image:Metanephric_adenoma_-_intermed_mag.jpg | Metanephric adenoma - PaRCC-like - intermed. mag. (WC/Nephron)
Image:Metanephric_adenoma_-_intermed_mag.jpg | Metanephric adenoma - PaRCC-like - intermed. mag. (WC/Nephron)
Image:Metanephric_adenoma_-_high_mag.jpg | Metanephric adenoma - PaRCC-like - very high mag. (WC/Nephron)
Image:Metanephric_adenoma_-_very_high_mag.jpg | Metanephric adenoma - PaRCC-like - very high mag. (WC/Nephron)
Image:Metanephric_adenoma_-_very_high_mag.jpg | Metanephric adenoma - PaRCC-like - very high mag. (WC/Nephron)
</gallery>
</gallery>
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*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==
*[[Kidney tumours]].
*[[Kidney tumours]].
*[[Mesonephric adenoma]].


==References==
==References==

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:

Images

www:

IHC

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

  1. 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.
  2. 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. 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. 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. 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.

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