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.

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

www:

IHC

Features:[5]

  • CK7 +ve.
  • PAX2 +ve.[6]
  • PAX8 +ve.
  • AMACR +ve/-ve.

Others:[2]

  • p53 -ve.
  • CEA -ve.
  • Ki-67 low (<5%).
  • MUC1 +ve.
    • Marks distal renal tubule.[7]

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. 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.
  5. Alexiev, BA.; Levea, CM. (Mar 2012). "Nephrogenic Adenoma of the Urinary Tract: A Review.". Int J Surg Pathol. doi:10.1177/1066896912439095. PMID 22415059.
  6. 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.
  7. 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.