Difference between revisions of "Metanephric adenoma"

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#redirect [[Kidney_tumours#Metanephric adenoma]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Metanephric_adenoma_-_very_high_mag.jpg
| Width      =
| Caption    = Metanephric adenoma. [[H&E stain]].
| Synonyms  =
| 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  =
| LMDDx      = [[Wilms tumour]], [[papillary renal cell carcinoma]] (type 1), [[renal mucinous tubular and spindle cell carcinoma]]
| Stains    =
| IHC        = WT-1 +ve, CD57 +ve, AMACR -ve, CD56 -ve
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[kidney]] - see ''[[kidney tumours]]''
| Assdx      =
| Syndromes  =
| Clinicalhx = usu. adults, occasionally children
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = good, benign
| Other      =
| ClinDDx    =
| Tx        =
}}
'''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: ''me'''t'''anephric adenoma is a '''t'''umour''.
 
==General==
*Benign.
*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>
 
==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==
Features:<ref name=Ref_WMSP284>{{Ref WMSP|284}}</ref>
*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 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===
<gallery>
Image:Metanephric_adenoma_high_mag.jpg | Metanephric adenoma. [[PAS stain]]. (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_-_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>
www:
*[http://www.nature.com/modpathol/journal/v16/n10/fig_tab/3880886f1.html Metanephric adenoma (nature.com)].
 
==IHC==
*WT-1 +ve.<ref name=pmid24083046>{{Cite journal  | last1 = Watanabe | first1 = S. | last2 = Naganuma | first2 = H. | last3 = Shimizu | first3 = M. | last4 = Ota | first4 = S. | last5 = Murata | first5 = S. | last6 = Nihei | first6 = N. | last7 = Matsushima | first7 = J. | last8 = Mikami | first8 = S. | last9 = Kuroda | first9 = N. | title = Adult nephroblastoma with predominant epithelial component: a differential diagnostic candidate of papillary renal cell carcinoma and metanephric adenoma-report of three cases. | journal = Case Rep Pathol | volume = 2013 | issue =  | pages = 675875 | month =  | year = 2013 | doi = 10.1155/2013/675875 | PMID = 24083046 }}</ref>
*CD57 +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==
*[[Kidney tumours]].
*[[Mesonephric adenoma]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Kidney tumours]].

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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