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Rhalem I, Bouanani Z, Akammar A, El Bouardi N, Alami B, Lamrani MYA, Hammas N, Maaroufi M, Boubbou M, Haloua M. Using imaging to diagnose renal tumors beyond nephroblastoma. Radiol Case Rep 2024; 19:2773-2780. [PMID: 38680746 PMCID: PMC11046045 DOI: 10.1016/j.radcr.2024.03.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Wilm's tumor (WT) accounted for the vast majority of renal tumors in children (92%). However, there are many atypical or rare forms of kidney cancer, and it is certainly useful to have a diagnostic orientation in imaging to differentiate between the different diagnoses, guiding that way the therapeutic management. We report the cases of 3 patients who were initially diagnosed with nephroblastoma on the basis of radiological data (via PACS search), underwent pre-operative chemotherapy and then nephrectomy, and whose anatomopathological evidence came back in favor of benign renal tumors. Nephroblastoma is the most common renal tumor in children, but other benign tumors should not be neglected, radiological signs that may point to this entity should be taken into account, so that neoadjuvant chemotherapy with its enfeebling side effects can be avoided.
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Affiliation(s)
- Insaf Rhalem
- Department of radiology and interventional imaging, CHU Hassan II, FEZ, Sidi Mohammed Ben Abdellah University, Morocco
| | - Zineb Bouanani
- Department of radiology and interventional imaging, CHU Hassan II, FEZ, Sidi Mohammed Ben Abdellah University, Morocco
| | - Amal Akammar
- Department of radiology and interventional imaging, CHU Hassan II, FEZ, Sidi Mohammed Ben Abdellah University, Morocco
| | - Nizar El Bouardi
- Department of radiology and interventional imaging, CHU Hassan II, FEZ, Sidi Mohammed Ben Abdellah University, Morocco
| | - Badreeddine Alami
- Department of radiology and interventional imaging, CHU Hassan II, FEZ, Sidi Mohammed Ben Abdellah University, Morocco
| | - Moulay Youssef Alaoui Lamrani
- Department of radiology and interventional imaging, CHU Hassan II, FEZ, Sidi Mohammed Ben Abdellah University, Morocco
| | - Nawal Hammas
- Department of anathomopathology, CHU Hassan II, FEZ, Sidi Mohammed Ben Abdellah University, Morocco
| | - Mustapha Maaroufi
- Department of radiology and interventional imaging, CHU Hassan II, FEZ, Sidi Mohammed Ben Abdellah University, Morocco
| | - Meryem Boubbou
- Department of radiology and interventional imaging, CHU Hassan II, FEZ, Sidi Mohammed Ben Abdellah University, Morocco
| | - Meriem Haloua
- Department of radiology and interventional imaging, CHU Hassan II, FEZ, Sidi Mohammed Ben Abdellah University, Morocco
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2
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Thorner PS, Chong AL, Apellaniz-Ruiz M, Benlimame N, Marrano P, Brimo F, Shuangshoti S, Shuangshoti S, Foulkes WD. Estrogen Receptor Expression in DICER1-related Lesions is Associated With the Presence of Cystic Components. Am J Surg Pathol 2024; 48:733-741. [PMID: 38539053 DOI: 10.1097/pas.0000000000002209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
DICER1 tumor predisposition syndrome results from pathogenic variants in DICER1 and is associated with a variety of benign and malignant lesions, typically involving kidney, lung, and female reproductive system. Over 70% of sarcomas in DICER1 tumor predisposition syndrome occur in females. Notably, pediatric cystic nephroma (pCN), a classic DICER1 tumor predisposition syndrome lesion, shows estrogen receptor (ER) expression in stromal cells. There are also renal, hepatic, and pancreatic lesions unassociated with DICER1 tumor predisposition syndrome that have an adult female predominance and are characterized/defined by ER-positive stromal cells. Except for pCN, the expression of ER in DICER1-associated lesions remains uninvestigated. In the present study, ER expression was assessed by immunohistochemistry in 89 cases of DICER1-related lesions and 44 lesions lacking DICER1 pathogenic variants. Expression was seen in stromal cells in pCN and pleuropulmonary blastoma (PPB) types I and Ir, whereas anaplastic sarcoma of kidney and PPB types II and III were typically negative, as were other solid tumors of non-Müllerian origin. ER expression was unrelated to the sex or age of the patient. Expression of ER showed an inverse relationship to preferentially expressed antigen in melanoma (PRAME) expression; as lesions progressed from cystic to solid (pCN/anaplastic sarcoma of kidney, and PPB types I to III), ER expression was lost and (PRAME) expression increased. Thus, in DICER1 tumor predisposition syndrome, there is no evidence that non-Müllerian tumors are hormonally driven and antiestrogen therapy is not predicted to be beneficial. Lesions not associated with DICER1 pathogenic variants also showed ER-positive stromal cells, including cystic pulmonary airway malformations, cystic renal dysplasia, and simple renal cysts in adult kidneys. ER expression in stromal cells is not a feature of DICER1 perturbation but rather is related to the presence of cystic components.
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Affiliation(s)
- Paul Scott Thorner
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Anne-Laure Chong
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montreal, Canada
- Cancer Axis, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Maria Apellaniz-Ruiz
- Cancer Axis, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Human Genetics, McGill University, Montreal, Canada
- Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec
| | - Naciba Benlimame
- Research Pathology Facility, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
| | - Paula Marrano
- Department of Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto
| | - Fadi Brimo
- Department of Pathology, McGill University Health Centre, Montreal, QC, Canada
| | - Somruetai Shuangshoti
- Institute of Pathology, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand
| | - Shanop Shuangshoti
- Department of Pathology and Chulalongkorn GenePRO Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - William D Foulkes
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montreal, Canada
- Cancer Axis, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Human Genetics, McGill University, Montreal, Canada
- Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec
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3
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Simforoosh N, Zabihi MS, Dadpour M. Partial nephrectomy in multiple mixed epithelial and stromal tumors (MEST). Urol Case Rep 2024; 54:102731. [PMID: 38645771 PMCID: PMC11033083 DOI: 10.1016/j.eucr.2024.102731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/05/2024] [Indexed: 04/23/2024] Open
Abstract
Mixed epithelial and stromal tumor (MEST) of the kidney is not a common diagnosis. This tumor usually mimics solid-cystic malignant renal tumors and most cases are treated surgically. Here, we presented a 35-year-old female with simultaneous two separate large solid-cystic masses with contrast enhancement in lower and upper pole of left kidney which were managed surgically via partial nephrectomy. Microscopic evaluation showed solid-cystic tumor with variably sized cysts lined by flattened to cuboidal epithelium that was compatible with MEST. Follow up evaluation revealed normal parenchymal renal tissue and proper function without any evidence of local recurrence.
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Affiliation(s)
- Nasser Simforoosh
- Shahid Beheshti University of Medical Sciences, Shahid Labbafinejad Medical Center, Center of Excellence in Urology, Urology and Nephrology Research Center, Tehran, Iran
| | - Mohammad Sajjad Zabihi
- Shahid Beheshti University of Medical Sciences, Shahid Labbafinejad Medical Center, Center of Excellence in Urology, Urology and Nephrology Research Center, Tehran, Iran
| | - Mehdi Dadpour
- Shahid Beheshti University of Medical Sciences, Shahid Labbafinejad Medical Center, Center of Excellence in Urology, Urology and Nephrology Research Center, Tehran, Iran
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4
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Baston C, Parosanu AI, Mihai M, Moldoveanu O, Stanciu IM, Nitipir C. Tumor-to-Tumor Metastasis of Lung Cancer to Kidney Cancer: A Review of the Literature and Our Experience. Diagnostics (Basel) 2024; 14:553. [PMID: 38473025 DOI: 10.3390/diagnostics14050553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/24/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
Tumor-to-tumor metastasis (TTM) is a rare phenomenon documented in patients with multiple primary cancers. This condition is defined as a metastasis between two true primary tumors. The most frequently reported recipient tumor is renal cell carcinoma (RCC), and the lung carcinomas are the most common metastatic tumor donors. Therefore, this paper attempts to address the current gap in knowledge about this rare phenomenon. The first part of this review outlines the recently proposed models and mechanisms involved in the TTM process. The second part then summarizes and analyzes previous case reports in the literature. We also present our experience with the case of lung cancer that metastasized into RCC. Given the sporadic incidence of TTM, no specific management guidelines exist. Therefore, considering TTM in patients with multiple primary tumors is important as it could potentially modify the oncological management offered.
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Affiliation(s)
- Catalin Baston
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Sanitary Heroes Boulevard, 050474 Bucharest, Romania
- Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Andreea Ioana Parosanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Sanitary Heroes Boulevard, 050474 Bucharest, Romania
- Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Mihaela Mihai
- Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Oana Moldoveanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Sanitary Heroes Boulevard, 050474 Bucharest, Romania
- Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Ioana Miruna Stanciu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Sanitary Heroes Boulevard, 050474 Bucharest, Romania
- Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Cornelia Nitipir
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Sanitary Heroes Boulevard, 050474 Bucharest, Romania
- Elias University Emergency Hospital, 011461 Bucharest, Romania
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5
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Dharwadkar A, Gore C, Bhuibhar G, Viswanathan V. Unmasking the Mystery of Renal Neoplasm in a Perimenopausal Woman: A Case Report. Cureus 2024; 16:e56970. [PMID: 38665735 PMCID: PMC11044075 DOI: 10.7759/cureus.56970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Mixed epithelial and stromal tumor (MEST) is a benign, complex, and rarely encountered renal neoplasm. This case involves a 46-year-old perimenopausal woman who presented with symptoms, such as abdominal pain, burning sensation during urination, increased urinary frequency, and hesitancy. Computed tomography (CT) urography revealed an exophytic, heterogeneously hyperdense mass originating from the interpolar and lower pole parenchyma of the left kidney, suggesting a neoplastic origin. Due to concerns about malignancy and the presence of local symptoms, a laparoscopic-assisted left radical nephrectomy was performed. Histopathological examination of the excised tissue revealed a biphasic neoplasm consisting of epithelial and stromal elements. The epithelial component exhibited cysts and glands of variable sizes, lined by columnar cells and surrounded by stromal tissue. The diagnosis of MESTs of the kidney was established and confirmed through immunohistochemistry. This unique type of benign kidney tumor can be effectively managed through conservative surgery and is associated with a favorable prognosis.
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Affiliation(s)
- Arpana Dharwadkar
- Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University) Pimpri, Pune, IND
| | - Charusheela Gore
- Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University) Pimpri, Pune, IND
| | - Gayatri Bhuibhar
- Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University) Pimpri, Pune, IND
| | - Vidya Viswanathan
- Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University) Pimpri, Pune, IND
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6
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Dan C, Sahai A, Suri P, Singh J, Trehan RS. Mixed Epithelial Stromal Tumor of the Kidney With a Mesenteric Lymph Node: A Case Report and Literature Review. Cureus 2023; 15:e46058. [PMID: 37900393 PMCID: PMC10605561 DOI: 10.7759/cureus.46058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Mixed epithelial and stromal tumor (MEST) of the kidney belongs to the broad spectrum of renal neoplasms, distinguished by their varying composition of stromal to epithelial components. The histopathological display of the biphasic growth pattern of mesenchymal and epithelial elements, often with estrogen and progesterone receptor positivity, clinches the diagnosis. It is typically benign, with low recurrence rates and excellent prognosis after surgical resection. MEST constitutes a rare and unique subset, with limited research and understanding, requiring differentiation from other renal tumors. Our patient's presentation of a morphologically benign renal MEST with an imaging-positive inferior mesenteric lymph node renders this case exceptionally rare.
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Affiliation(s)
- Chitramalya Dan
- Hematology and Oncology, Greater Washington Oncology Associates, Silver Spring, USA
| | - Akshat Sahai
- Hematology and Oncology, Greater Washington Oncology Associates, Silver Spring, USA
| | - Priyasha Suri
- Hematology and Oncology, Greater Washington Oncology Associates, Silver Spring, USA
| | - Jaideep Singh
- Hematology and Oncology, Greater Washington Oncology Associates, Silver Spring, USA
| | - Ram S Trehan
- Hematology and Oncology, Greater Washington Oncology Associates, Silver Spring, USA
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Alrumayyan M, Raveendran L, Lawson KA, Finelli A. Cystic Renal Masses: Old and New Paradigms. Urol Clin North Am 2023; 50:227-238. [PMID: 36948669 DOI: 10.1016/j.ucl.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Cystic renal masses describe a spectrum of lesions with benign and/or malignant features. Cystic renal masses are most often identified incidentally with the Bosniak classification system stratifying their malignant potential. Solid enhancing components most often represent clear cell renal cell carcinoma yet display an indolent natural history relative to pure solid renal masses. This has led to an increased adoption of active surveillance as a management strategy in those who are poor surgical candidates. This article provides a contemporary overview of historical and emerging clinical paradigms in the diagnosis and management of this distinct clinical entity.
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Affiliation(s)
- Majed Alrumayyan
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Lucshman Raveendran
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Keith A Lawson
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
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8
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Feng R, Zhang T, Ke C, Tao Y, Wang Y. Mixed epithelial and stromal tumor of the kidney: A retrospective clinicopathological evaluation. Ann Diagn Pathol 2023; 63:152088. [PMID: 36577187 DOI: 10.1016/j.anndiagpath.2022.152088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Mixed epithelial and stromal tumor of the kidney (MESTK) is a rare renal tumor for which there is limited clinical case experience. The aim of this study was to investigate the clinicopathological features, imaging manifestations, immunohistochemical phenotype, diagnosis, and differential diagnosis of MESTK. METHODS We systematically evaluated the clinicopathological characteristics of 13 patients diagnosed with MESTK from 2016 to 2022. RESULTS There were 12 female cases and 1 male case, and their age ranged from 24 to 62 (mean age 47 years). The tumor was located in the left kidney in 11 patients. Seven of these patients were located in the upper pole of the left kidney. The mean diameter of the tumor was 4.6 cm (range 1.3-8.6 cm), and the main body of the tumor was mainly located in the medulla or medulla. In 7 cases, the tumors were clearly outlined, 4 cases had clear but irregular borders, and in 3 cases, the masses broke through the renal capsule but did not invade the surrounding organs. All tumors had varying proportions of cystic and solid components. In most tumors, the epithelial cell component was predominant. Among the epithelial components, we observed a predominance of large cysts. Small cysts and tubular structures were also seen; the least common were papillary structures. The most common types of lining epithelium were flat and cuboidal. The cell cytoplasm was predominantly eosinophilic with hyaline degeneration. The tumor cells were composed of different proportions of sparse hypocellular areas and dense hypercellular areas between these cells. In most cases, the cellular stroma had an ovarian-like appearance. It is characterized histologically by mature adipocytes, thick-walled blood vessels, and chronic inflammatory cells. Calcification and collagenization were seen in a few cases. In all female patients, estrogen and progesterone receptors in the interstitial component were almost always positively expressed. In male patients, all interstitial components showed locally positive expression of androgens. CONCLUSION MESTK had unique characteristics with complex and variable lesion shapes. There was a high degree of overlap with cystic kidney cancer, and the rate of missed and misdiagnosis was extremely high. The diagnosis could not be confirmed by preoperative imaging. The final diagnosis depended on pathomorphology.
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Affiliation(s)
- Runlin Feng
- Department of Pathology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan, China
| | - Tao Zhang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan, China
| | - Changxing Ke
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan, China
| | - Yanping Tao
- Department of Emergency, The Third People's Hospital of Kunming, Kunming 650000, Yunnan, China.
| | - Yan Wang
- Department of Pathology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan, China.
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9
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Yu J, Yu S, Jia M, Gao H, Sun PL. Malignant Mixed Epithelial and Stromal Tumor of the Kidney: Report of a Carcinosarcoma Case and an Updated Literature Review. Int J Surg Pathol 2023; 31:195-202. [PMID: 35477307 DOI: 10.1177/10668969221097389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mixed epithelial and stromal tumors of the kidney (MESTK) are rare and recently defined entities that comprise both epithelial and stromal cells. MESTK is mostly benign; however, to date, 18 borderline or malignant cases have been reported. In this study, we report a case of carcinosarcoma exhibiting a large carcinoma and small sarcoma component, and review the relevant literature. The patient was a 59-year-old woman who presented with a large mass in the left kidney having solid and focal cystic components. The patient underwent left radical nephrectomy. The tumor was gray-white and solid-cystic, with a relatively clear boundary. Microscopically, the tumor revealed benign and malignant components. The benign component consisted of multiple tubules, variable-sized cysts lined with benign epithelium, and hyalinized stroma. The malignant component was composed of predominantly small cell neuroendocrine carcinoma and a small quantity of adenocarcinoma, squamous cell carcinoma, and sarcoma. Finally, a diagnosis of the malignant MESTK was made. Certain cases of borderline or malignant transformation of MESTK have been published, so it is important to enhance findings made by other studies.
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Affiliation(s)
- Jiaqi Yu
- Department of Pathology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Shili Yu
- Department of Pathology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Meng Jia
- Department of Pathology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Hongwen Gao
- Department of Pathology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Ping-Li Sun
- Department of Pathology, The Second Hospital of Jilin University, Changchun, Jilin, China
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10
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Mixed Epithelial and Stromal Tumor: A Rare Renal Neoplasm-Case Report with Clinicopathologic Features and Review of the Literature. Case Rep Pathol 2023; 2023:3528377. [PMID: 36644654 PMCID: PMC9833914 DOI: 10.1155/2023/3528377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/11/2022] [Accepted: 12/24/2022] [Indexed: 01/06/2023] Open
Abstract
Mixed epithelial and stromal tumor (MEST) is a rare benign renal neoplasm composed of epithelial and stromal components. Here, we report a 61-year-old woman presenting with a left complex cystic renal mass. The lesion was found incidentally on ultrasound for abdominal discomfort. CT scan and MRI showed a 7.4 cm complex cystic lesion in the left kidney. The differential diagnoses included complex renal cyst and cystic renal cell carcinoma. Laparoscopic nephrectomy showed a large 7.5 cm multicystic tumor with thick and thin septae and smooth walled-cysts containing clear watery fluid. Histologic examination showed variable sized cysts lined by flattened, cuboidal to columnar epithelium with focal hobnailing. No significant cytologic atypia or mitoses were noted. The cyst lining epithelium was positive for CK7 and high molecular weight cytokeratin (34Be12). The stroma was positive for alpha smooth muscle actin, CD10, estrogen receptor, and progesterone receptor. This report contributes an additional case to our collective knowledge of these lesions and summarizes the literature around these rare neoplasms.
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11
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Sekine A, Hidaka S, Moriyama T, Shikida Y, Shimazu K, Ishikawa E, Uchiyama K, Kataoka H, Kawano H, Kurashige M, Sato M, Suwabe T, Nakatani S, Otsuka T, Kai H, Katayama K, Makabe S, Manabe S, Shimabukuro W, Nakanishi K, Nishio S, Hattanda F, Hanaoka K, Miura K, Hayashi H, Hoshino J, Tsuchiya K, Mochizuki T, Horie S, Narita I, Muto S. Cystic Kidney Diseases That Require a Differential Diagnosis from Autosomal Dominant Polycystic Kidney Disease (ADPKD). J Clin Med 2022; 11:6528. [PMID: 36362756 PMCID: PMC9657046 DOI: 10.3390/jcm11216528] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/14/2022] [Accepted: 11/01/2022] [Indexed: 09/05/2023] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary cystic kidney disease, with patients often having a positive family history that is characterized by a similar phenotype. However, in atypical cases, particularly those in which family history is unclear, a differential diagnosis between ADPKD and other cystic kidney diseases is important. When diagnosing ADPKD, cystic kidney diseases that can easily be excluded using clinical information include: multiple simple renal cysts, acquired cystic kidney disease (ACKD), multilocular renal cyst/multilocular cystic nephroma/polycystic nephroma, multicystic kidney/multicystic dysplastic kidney (MCDK), and unilateral renal cystic disease (URCD). However, there are other cystic kidney diseases that usually require genetic testing, or another means of supplementing clinical information to enable a differential diagnosis of ADPKD. These include autosomal recessive polycystic kidney disease (ARPKD), autosomal dominant tubulointerstitial kidney disease (ADTKD), nephronophthisis (NPH), oral-facial-digital (OFD) syndrome type 1, and neoplastic cystic kidney disease, such as tuberous sclerosis (TSC) and Von Hippel-Lindau (VHL) syndrome. To help physicians evaluate cystic kidney diseases, this article provides a review of cystic kidney diseases for which a differential diagnosis is required for ADPKD.
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Affiliation(s)
- Akinari Sekine
- Nephrology Center, Toranomon Hospital, Tokyo 105-8470, Japan
| | - Sumi Hidaka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Tomofumi Moriyama
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Fukuoka 830-0011, Japan
| | - Yasuto Shikida
- Department of Nephrology, Saiseikai Nakatsu Hospital, Osaka 530-0012, Japan
| | - Keiji Shimazu
- Department of Nephrology, Saiseikai Nakatsu Hospital, Osaka 530-0012, Japan
| | - Eiji Ishikawa
- Department of Nephrology, Saiseikai Matsusaka General Hospital, Mie 515-8557, Japan
| | - Kiyotaka Uchiyama
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Hiroshi Kataoka
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
| | - Haruna Kawano
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan
- Department of Advanced Informatics for Genetic Disease, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan
| | - Mahiro Kurashige
- Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo 105-8461, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo 157-8535, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital, Tokyo 105-8470, Japan
| | - Shinya Nakatani
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Tadashi Otsuka
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Hirayasu Kai
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan
| | - Kan Katayama
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Mie 514-8507, Japan
| | - Shiho Makabe
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
| | - Shun Manabe
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
| | - Wataru Shimabukuro
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
| | - Koichi Nakanishi
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
| | - Saori Nishio
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Fumihiko Hattanda
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Kazushige Hanaoka
- Department of General Internal Medicine, Daisan Hospital, Jikei University, School of Medicine, Tokyo 105-8471, Japan
| | - Kenichiro Miura
- Department of Pediatric Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
| | - Hiroki Hayashi
- Department of Nephrology, Fujita Health University, Aichi 470-1192, Japan
| | - Junichi Hoshino
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
| | - Ken Tsuchiya
- Department of Blood Purification, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
| | | | - Shigeo Horie
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan
- Department of Advanced Informatics for Genetic Disease, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Satoru Muto
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan
- Department of Urology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan
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12
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Shahrokh S, Abolhasani M, Nayeri RK. Malignant mixed epithelial and stromal tumor of the kidney with rhabdomyosarcomatous transformation presenting with gross hematuria. Proc AMIA Symp 2022; 35:837-839. [DOI: 10.1080/08998280.2022.2090788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Soroush Shahrokh
- Department of Internal Medicine, University of Houston College of Medicine/HCA Houston Healthcare-Kingwood, Houston, Texas
| | - Maryam Abolhasani
- Department of Pathology, Hasheminejad Kidney Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Kaffash Nayeri
- Department of Urology and Urological Oncology, Iran University of Medical Sciences, Tehran, Iran
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13
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Chen J, Liu H, Li M, Liu W, Masokano IB, Pei Y, Li W. Differentiating the clinical and computed tomography imaging features of mixed epithelial and stromal tumors of the kidney to establish a treatment plan. J Appl Clin Med Phys 2021; 23:e13486. [PMID: 34861098 PMCID: PMC8803287 DOI: 10.1002/acm2.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/18/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To differentiate the clinical features and computed tomography imaging features in the two types of mixed epithelial and stromal tumor of the kidney (MESTK) and to establish a treatment plan for the MESTK types. Methods Seventeen patients who underwent multidetector computed tomography (MDCT) before surgery and had a pathological diagnosis of MESTK were enrolled. Their clinical information (R.E.N.A.L. nephrometry score (R.E.N.A.L.‐NS), radical nephrectomy (RN), partial nephrectomy (PN), etc.) were collected. The radiological features included renal sinus fat invagination (SFI), maximal diameter (MD), capsule and septa of the tumor, etc., were also analyzed. They were divided into two types according to the MDsolid/MDtumor ratio (solid type with >60%; cystic type with ≤60%). An independent‐sample t‐test and Fisher exact test were used to assess the differences between the two groups. Results MESTKs demonstrated a variable multi‐septate cystic and solid components with a delayed enhancement. There were nine patients for solid type and eight patients for cystic type. Compared with solid type, the lesions in cystic type have larger MD (81.00 ± 37.91 vs. 41.22 ± 24.19, p = 0.020), higher R.E.N.A.L.‐NS (10.03 ± 0.50 vs. 8.95 ± 1.26, p < 0.001), higher RN (75.00% vs. 22.22%, p = 0.015), larger SFI (87.5% vs. 33.3%, p = 0.05), more septa (100% vs. 0%, p < 0.001), and more capsule (100% vs. 11.1%, p < 0.001). Conclusion Cystic type MESTK has more hazardous features (such as larger MD, higher R.E.N.A.L.‐NS, more RN, greater SFI, multiple septa) compared with solid type, suggesting that RN is more suitable for cystic type and PN for solid type.
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Affiliation(s)
- Juan Chen
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hui Liu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Mengsi Li
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenguang Liu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ismail Bilal Masokano
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yigang Pei
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Postdoctoral Fellow, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenzheng Li
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
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14
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Mixed epithelial and stromal tumor (MEST) in a young adult male: A case report and literature review. Ann Med Surg (Lond) 2021; 70:102888. [PMID: 34691429 PMCID: PMC8519805 DOI: 10.1016/j.amsu.2021.102888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction and importance A MEST is a rare renal tumor, with stromal as well as epithelial components. It is predominantly benign and local recurrence is not very common. In the majority of the cases, it occurs in females. Its occurrence in a young male makes it a rarity. Case presentation A 24 years old male presented at SIUT with the complaint of left flank pain on and off for one month. CT scan showed soft tissue density mass in left renal pelvis extending from mid-pole calyces to pelviuretric junction, leading to obstruction and ultimately mild uropathy. We found a partially obstructing staghorn calculus with asymmetrical cortical thinning. Left Robot-Assisted Nephro-ureterectomy plus excision of bladder cuff was planned in which 3 × 4 cm mass involving the left renal pelvis was excised. To date, there is no radiologic evidence of disease recurrence. Clinical discussion MEST in young adults is an extremely rare tumor. They have been referred to by many alternate synonyms including 'adult mesoblastic nephroma' and 'cystic nephroma' with 'ovarian' or 'cellular' type stroma. Majority of patients with MEST present, with hematuria, abdominal pain, palpable flank mass, recurrent urinary tract infections. Similarly, our patient presented initially with nonspecific pain in the left flank region. Majority of cases in the literature presented with the tumor in benign stage, with localized spread, and without recurrence. Conclusion Mixed epithelial and stromal tumors (MEST) of the kidney are distinct entities of benign kidney tumors. MEST in young males is a very rare entity, and a small number of cases exist. Histopathology plays a very cardinal role in diagnosis, and overall the disease has a promising outcome with conservative surgery.
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15
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Peired AJ, Campi R, Angelotti ML, Antonelli G, Conte C, Lazzeri E, Becherucci F, Calistri L, Serni S, Romagnani P. Sex and Gender Differences in Kidney Cancer: Clinical and Experimental Evidence. Cancers (Basel) 2021; 13:cancers13184588. [PMID: 34572815 PMCID: PMC8466874 DOI: 10.3390/cancers13184588] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Kidney cancer is a frequent malignant tumor that accounts for approximately 5% of all cancer incidences. It affects both males and females, but males are twice as likely to develop kidney cancer than females. Evidence shows that this discrepancy takes root in individual differences, such as genetics or pathologies that affect the patient. It is then reflected in the clinical characteristics of the tumors, as males have larger and more aggressive tumors. Understanding the sex- and gender-based differences in kidney cancer is essential to be able to offer patients individualized medicine that would better cover their needs in terms of prevention, diagnosis and treatment. Abstract Sex and gender disparities have been reported for different types of non-reproductive cancers. Males are two times more likely to develop kidney cancer than females and have a higher death rate. These differences can be explained by looking at genetics and genomics, as well as other risk factors such as hypertension and obesity, lifestyle, and female sex hormones. Examination of the hormonal signaling pathways bring further insights into sex-related differences. Sex and gender-based disparities can be observed at the diagnostic, histological and treatment levels, leading to significant outcome difference. This review summarizes the current knowledge about sex and gender-related differences in the clinical presentation of patients with kidney cancer and the possible biological mechanisms that could explain these observations. Underlying sex-based differences may contribute to the development of sex-specific prognostic and diagnostic tools and the improvement of personalized therapies.
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Affiliation(s)
- Anna Julie Peired
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Viale Morgagni 50, 50134 Florence, Italy; (M.L.A.); (G.A.); (C.C.); (E.L.); (L.C.); (P.R.)
- Correspondence:
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, 50134 Florence, Italy; (R.C.); (S.S.)
- Department of Experimental and Clinical Medicine, University of Florence, Viale Morgagni 50, 50134 Florence, Italy
| | - Maria Lucia Angelotti
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Viale Morgagni 50, 50134 Florence, Italy; (M.L.A.); (G.A.); (C.C.); (E.L.); (L.C.); (P.R.)
| | - Giulia Antonelli
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Viale Morgagni 50, 50134 Florence, Italy; (M.L.A.); (G.A.); (C.C.); (E.L.); (L.C.); (P.R.)
| | - Carolina Conte
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Viale Morgagni 50, 50134 Florence, Italy; (M.L.A.); (G.A.); (C.C.); (E.L.); (L.C.); (P.R.)
| | - Elena Lazzeri
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Viale Morgagni 50, 50134 Florence, Italy; (M.L.A.); (G.A.); (C.C.); (E.L.); (L.C.); (P.R.)
| | - Francesca Becherucci
- Nephrology and Dialysis Unit, Meyer Children’s University Hospital, Viale Pieraccini 24, 50139 Florence, Italy;
| | - Linda Calistri
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Viale Morgagni 50, 50134 Florence, Italy; (M.L.A.); (G.A.); (C.C.); (E.L.); (L.C.); (P.R.)
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, 50134 Florence, Italy; (R.C.); (S.S.)
- Department of Experimental and Clinical Medicine, University of Florence, Viale Morgagni 50, 50134 Florence, Italy
| | - Paola Romagnani
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Viale Morgagni 50, 50134 Florence, Italy; (M.L.A.); (G.A.); (C.C.); (E.L.); (L.C.); (P.R.)
- Nephrology and Dialysis Unit, Meyer Children’s University Hospital, Viale Pieraccini 24, 50139 Florence, Italy;
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16
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Baniak N, Barletta JA, Hirsch MS. Key Renal Neoplasms With a Female Predominance. Adv Anat Pathol 2021; 28:228-250. [PMID: 34009777 DOI: 10.1097/pap.0000000000000301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Renal neoplasms largely favor male patients; however, there is a growing list of tumors that are more frequently diagnosed in females. These tumors include metanephric adenoma, mixed epithelial and stromal tumor, juxtaglomerular cell tumor, mucinous tubular and spindle cell carcinoma, Xp11.2 (TFE3) translocation-associated renal cell carcinoma, and tuberous sclerosis complex (somatic or germline) associated renal neoplasms. The latter category is a heterogenous group with entities still being delineated. Eosinophilic solid and cystic renal cell carcinoma is the best-described entity, whereas, eosinophilic vacuolated tumor is a proposed entity, and the remaining tumors are currently grouped together under the umbrella of tuberous sclerosis complex/mammalian target of rapamycin-related renal neoplasms. The entities described in this review are often diagnostic considerations when evaluating renal mass tissue on biopsy or resection. For example, Xp11.2 translocation renal cell carcinoma is in the differential when a tumor has clear cell cytology and papillary architecture and occurs in a young or middle-aged patient. In contrast, tuberous sclerosis complex-related neoplasms often enter the differential for tumors with eosinophilic cytology. This review provides an overview of the clinical, gross, microscopic, immunohistochemical, genetic, and molecular alterations in key renal neoplasms occurring more commonly in females; differential diagnoses are also discussed regardless of sex predilection.
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Affiliation(s)
- Nicholas Baniak
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Michelle S Hirsch
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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17
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Martínez-Corral ME, Núñez-Otero JJ, Toucedo-Caamaño V, García-Acuña SM, García-Figueiras R, García-Freire C. Mixed epithelial and stromal tumor of the kidney. Actas Urol Esp 2021; 45:412-415. [PMID: 34088442 DOI: 10.1016/j.acuroe.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/02/2021] [Indexed: 11/17/2022]
Affiliation(s)
- M E Martínez-Corral
- Servicio de Urología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
| | - J J Núñez-Otero
- Servicio de Urología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - V Toucedo-Caamaño
- Servicio de Urología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - S M García-Acuña
- Servicio de Anatomía Patológica, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - R García-Figueiras
- Servicio de Radiodiagnóstico, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - C García-Freire
- Servicio de Urología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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18
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Baio R, Spiezia N, Schettini M. Cystic nephroma treated with nephron-sparing technique: A case report. Mol Clin Oncol 2021; 14:109. [PMID: 33859823 PMCID: PMC8042535 DOI: 10.3892/mco.2021.2271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 03/01/2021] [Indexed: 11/06/2022] Open
Abstract
Multilocular cystic nephroma is a rare benign kidney tumor, which is typically characterized by a unilateral, multicystic renal mass without solid elements. Cystic nephroma has a bimodal distribution and two-thirds of tumors involve children aged between 3 months and 2 years, with male predominance; a second peak affects the age group >30 years old, in which females are predominantly affected. The incidence rate for this rare tumor in patients aged 5-30 years is only 5%. The present study reports a case of a 31-year-old woman affected by a multilocular cystic nephroma in the upper pole of the right kidney, with direct tumor extension into the renal pelvis through a calyx. After a partial nephrectomy on the patient, the pathological examination confirmed a multilocular cystic nephroma in the right renal specimens.
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Affiliation(s)
- Raffaele Baio
- Department of Urology, University of Salerno, I-84081 Salerno, Italy
| | - Nicola Spiezia
- Department of Urology, Lourdes Clinic, I-80040 Massa di Somma, Italy
| | - Manlio Schettini
- Department of Urology, Lourdes Clinic, I-80040 Massa di Somma, Italy
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19
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Van Treeck BJ, Horton RK, Lee HE, Rosty C, Pai RK, Graham RP. Mesenteric and Retroperitoneal Mucinous Cystic Neoplasms: A Case Series. Int J Surg Pathol 2021; 29:606-614. [PMID: 33736504 DOI: 10.1177/1066896921993536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims. Mucinous cystic neoplasms (MCNs) are cystic neoplasms with mucinous epithelium surrounded by ovarian-like stroma. Extraovarian MCN occurring in the liver and pancreas have been well characterized. However, only rare case reports of MCN arising outside of these locations have been reported. MCNs arising in unusual locations should enter the differential diagnosis of mucinous intra-abdominal tumors and must be distinguished from more common mimics. Therefore, we aimed to examine a series of MCNs of the retroperitoneum and mesentery to characterize the clinicopathologic features of this entity. Methods and results. Seven MCNs arising in the abdominal mesentery or retroperitoneum were retrospectively identified. A clinicopathologic, histologic, and immunohistochemical (keratin 7, keratin 19, keratin 20, calretinin, inhibin-α, steroidogenic factor-1 (SF-1), estrogen receptor (ER), progesterone receptor (PR), PAX8, CDX2, and CD10) analysis was performed. All 7 MCNs were from females with a median age of 41 years old and a median size of 8 cm. All cases demonstrated mucinous with or without concomitant non-mucinous epithelium overlying spindle cell ovarian-like stroma. Luteinized cells were noted. The epithelium was positive for keratin 7 and keratin 19 in all 7 cases, while the stroma expressed ER, PR, and SF-1 in all cases stained. Calretinin was focally positive in the stroma of 3 of 7 cases, while inhibin-α was focally expressed in 5 of 6 cases. Conclusions. These results highlight the clinicopathologic, histologic, and immunophenotypic similarities between MCNs of the mesentery, retroperitoneum, pancreas, and liver. Overlapping features suggest a common histogenesis for all MCNs, which could include periductal fetal mesenchyme, aberrant migration of primordial germ cells, or abnormal differentiation or metaplasia of the embryonic coelomic epithelium.
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Affiliation(s)
| | | | | | - Christophe Rosty
- Envoi Pathology, Brisbane, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia.,University of Melbourne, Melbourne, Victoria, Australia
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20
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Martínez-Corral M, Núñez-Otero J, Toucedo-Caamaño V, García-Acuña S, García-Figueiras R, García-Freire C. Mixed epithelial and stromal tumor of the kidney. Actas Urol Esp 2021. [PMID: 33685665 DOI: 10.1016/j.acuro.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Magnelli LL, Metra B, Falzarano SM, Grajo JR. A MEST up classification? Review of the re-classification of mixed epithelial and stromal tumor and adult cystic nephroma for the abdominal radiologist. Abdom Radiol (NY) 2021; 46:696-702. [PMID: 32757072 DOI: 10.1007/s00261-020-02687-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/18/2020] [Accepted: 07/25/2020] [Indexed: 12/16/2022]
Abstract
Mixed epithelial and stromal tumor (MEST) and the tumor formerly known as adult cystic nephroma (ACN) are uncommon renal tumors that have historically been described as separate entities in terms of histologic and imaging findings. However, these entities share many epidemiologic, radiologic, and pathologic features. While recent surgical and pathological literature has supported classifying MEST and ACN within the same tumor family, most radiologists and radiology texts continue to describe MEST and ACN as separate entities.
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22
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Tatsuya S, Hirotaka A, Yuki A, Akiko T, Masahiro H, Shigeo O, Shuji M, Ryuichi M, Mototsugu O, Masahiro J. Radiologic features of mixed epithelial and stromal tumors of the kidney: Hyperattenuating on unenhanced computed tomography and T2-hypointensity on magnetic resonance imaging. Radiol Case Rep 2021; 16:858-862. [PMID: 33552340 PMCID: PMC7850961 DOI: 10.1016/j.radcr.2021.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 11/30/2022] Open
Abstract
In the 2016 World Health Organization renal tumor classification, the mixed epithelial and stromal tumor family was introduced as a new entity. This family encompasses a spectrum of tumors, ranging from predominantly cystic tumors (adult cystic nephromas) to tumors that are variably solid (mixed epithelial and stromal tumors). The majority of previous studies incorporating “mixed epithelial and stromal tumor” in the titles were actually reports of imaging findings of adult cystic nephroma. Thus, the solid component of mixed epithelial and stromal tumors has not been well evaluated. In this study, we present 2 cases of mixed epithelial and stromal tumors, as defined by the 2016 World Health Organization classification, showing a predominantly solid component. The characteristic findings of the solid component of these tumors were T2-hypointensity on magnetic resonance imaging and hyperattenuation on unenhanced computed tomography. Angiomyolipoma with epithelial cysts and epithelioid angiomyolipoma should be considered in the differential diagnosis of mixed epithelial and stromal tumors.
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Affiliation(s)
- Suzuki Tatsuya
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Akita Hirotaka
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Arita Yuki
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Tomiyama Akiko
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hashimoto Masahiro
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Okuda Shigeo
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Mikami Shuji
- Department of Diagnostic Pathology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Mizuno Ryuichi
- Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Oya Mototsugu
- Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Jinzaki Masahiro
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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23
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Van Treeck BJ, Lotfalla M, Czeczok TW, Mounajjed T, Moreira RK, Allende DS, Reid MD, Naini BV, Westerhoff M, Adsay NV, Kerr SE, Rizvi SH, Smoot RL, Liu Y, Davila J, Graham RP. Molecular and Immunohistochemical Analysis of Mucinous Cystic Neoplasm of the Liver. Am J Clin Pathol 2020; 154:837-847. [PMID: 32880620 DOI: 10.1093/ajcp/aqaa115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Mucinous cystic neoplasm of the liver is characterized by neoplastic mucinous and/or biliary epithelium surrounded by ovarian-type stroma. Immunohistochemical studies have shown that the ovarian-type stroma expresses estrogen receptor, suggesting potential hormonal responsiveness. The molecular biology of mucinous cystic neoplasm of the liver remains poorly studied. METHODS Transcriptome sequencing and immunohistochemistry were performed on a series of mucinous cystic neoplasms. RESULTS Mucinous cystic neoplasm of the liver exhibited significantly increased RNA expression of ovarian stromal markers WT1, PR, and ER2 and sex cord stromal markers SF-1, inhibin-α, and calretinin compared with nonneoplastic liver. Immunohistochemistry confirmed the RNA-level data. Evidence for sex hormone biosynthesis was identified by significant overexpression of multiple estrogen biosynthetic enzymes. Expression of 17β-hydroxysteroid dehydrogenase 1 was confirmed immunohistochemically. Pathway analysis also identified significant upregulation of the hedgehog and Wnt pathways and significant downregulation of T-helper 1 and T-helper 2 pathways. CONCLUSIONS Mucinous cystic neoplasm of the liver recapitulates ovarian stroma at the morphologic, DNA, RNA, and protein levels. These data support the concept that this tumor likely arises from ectopic primitive gonadal tissue and/or stromal cells with capacity to transdifferentiate to ovarian cortical cells.
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Affiliation(s)
| | - Mira Lotfalla
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | - Bita V Naini
- Department of Pathology, University of California, Los Angeles
| | | | - N Volkan Adsay
- Department of Pathology, Koc University, Istanbul, Turkey
| | | | - Sumera H Rizvi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Rory L Smoot
- Department of Surgery, Mayo Clinic, Rochester, MN
| | - Yuanhang Liu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Jaime Davila
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
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24
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Sawamura M, Sawa N, Yamanouchi M, Ikuma D, Sekine A, Mizuno H, Suwabe T, Hoshino J, Kono K, Kinowaki K, Ohashi K, Nagashima Y, Ubara Y. Renal epithelial and stromal tumor with a multiple cystic lesion localized in the upper portion of the right kidney. CEN Case Rep 2020; 10:230-235. [PMID: 33145653 PMCID: PMC8019406 DOI: 10.1007/s13730-020-00548-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/15/2020] [Indexed: 11/28/2022] Open
Abstract
A 60-year-old Japanese woman was admitted because of the polycystic mass with right flank pain localized in the upper portion of the right kidney. Right nephrectomy was performed because the mass lesion had continuously increased in size over the past 10 years. A surgical specimen showed histology consistent with a mixed epithelial and stromal tumor, which is closely related to multilocular cystic nephroma, and was diagnosed by a defined capsule between the cystic mass lesion and normal renal tissue by CT and MRI, and histology. Localized renal cystic disease that does not have a capsule was excluded from differential diagnosis.
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Affiliation(s)
- Masato Sawamura
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.
| | - Naoki Sawa
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Masayuki Yamanouchi
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Daisuke Ikuma
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Akinari Sekine
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Hiroki Mizuno
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Tatsuya Suwabe
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Junichi Hoshino
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Yoji Nagashima
- Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan. .,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
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25
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Benign Renal Epithelial / Epithelial and Stromal Tumors. KIDNEY CANCER 2020. [DOI: 10.1007/978-3-030-28333-9_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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26
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Ye J, Xu Q, Zheng J, Wang SA, Wu YW, Cai JH, Yuan H. Imaging of mixed epithelial and stromal tumor of the kidney: A case report and review of the literature. World J Clin Cases 2019; 7:2580-2586. [PMID: 31559296 PMCID: PMC6745317 DOI: 10.12998/wjcc.v7.i17.2580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/11/2019] [Accepted: 07/27/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Mixed epithelial and stromal tumors of the kidney (MESTKs) are a rare entity (about a hundred cases reported). They occur almost exclusively in postmenopausal women, with only seven cases reported in men. As this entity is very rare, little is known on its imaging features, especially magnetic resonance imaging (MRI) findings. In women, at MRI, the cystic component shows T1 hypointensity and T2 hyperintensity, while the solid component shows T1 hyperintensity and T2 hypointensity.
CASE SUMMARY We report the computed tomography (CT) and MRI findings of MESTK in a 19-year-old male adolescent. To our knowledge, this case report is the first report of MRI findings of MESTK in male adolescents. The patient was admitted to Subei People's Hospital (Jiangsu Province, China) in July 2017 after a renal mass on the left side was detected by ultrasound during a clinical examination. Blood tests were all normal. Non-enhanced CT showed a round, well-circumscribed complex mass, approximately 45 mm × 40 mm in size. MRI revealed a clear well-circumscribed mass with a mixed arrangement of solid and cystic components. On T2 weighted images, some hypointensities were found in the solid areas. After contrast enhancement, moderate or mild enhancement was found in the solid component, which increased with time. A radical left nephrectomy was performed. The pathology analysis revealed a mixed epithelial and stromal tumor. The patient had no imaging findings of recurrence or metastasis at 12 months following surgery.
CONCLUSION The possibility of MESTK should be considered in male adolescents. MRI can provide useful information for the preoperative diagnosis.
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Affiliation(s)
- Jing Ye
- Department of Medical Imaging, Clinic Medical School, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou 225000, Jiangsu Province, China
| | - Qing Xu
- Department of Medical Imaging, Clinic Medical School, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou 225000, Jiangsu Province, China
| | - Jing Zheng
- Department of Medical Imaging, Clinic Medical School, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou 225000, Jiangsu Province, China
| | - Shou-An Wang
- Department of Medical Imaging, Clinic Medical School, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou 225000, Jiangsu Province, China
| | - Ya-Wei Wu
- Department of Medical Imaging, Clinic Medical School, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou 225000, Jiangsu Province, China
| | - Jun-Hui Cai
- Dalian Medical University, Dalian 116000, Liaoning Province, China
| | - Hu Yuan
- Dalian Medical University, Dalian 116000, Liaoning Province, China
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27
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Williamson SR. Renal cell carcinomas with a mesenchymal stromal component: what do we know so far? Pathology 2019; 51:453-462. [DOI: 10.1016/j.pathol.2019.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/16/2019] [Accepted: 04/28/2019] [Indexed: 02/07/2023]
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28
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Imaging of Unusual Renal Tumors. Curr Urol Rep 2019; 20:5. [PMID: 30663008 DOI: 10.1007/s11934-019-0867-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW Renal masses are a wide entity and a common finding in clinical practice. Detection of these masses has increased in the last years, yet mortality rates have slightly decreased. RECENT FINDINGS According to the World Health Organization classification, there are 8 types, 51 subtypes, and a lot more subsequent subclassifications of renal tumors. Histopathological analysis should always be assessed for final diagnosis of theses tumors. However, imaging can be an important diagnostic guidance. The most common diagnoses of renal tumor are clear cell carcinoma, papillary renal cell carcinoma, angiomyolipoma, and transitional cell carcinoma. Nonetheless, a considerable variety of particular tumors can arise from the kidney, challenging the expertise of radiologists and urologists on this subject. The awareness of these unusual entities is vital for professionals working at a complex medical facility with greater volume of patients. We hereby present uncommon renal tumors and its pathological and radiological features.
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29
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Arif-Tiwari H, Kalb BT, Bisla JK, Martin DR. Classification and Diagnosis of Cystic Renal Tumors: Role of MR Imaging Versus Contrast-Enhanced Ultrasound. Magn Reson Imaging Clin N Am 2018; 27:33-44. [PMID: 30466911 DOI: 10.1016/j.mric.2018.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Superior soft tissue and contrast resolution of MR imaging benefits sensitivity to kidney cyst features and classification, which may have an impact on patient management and outcomes. Contrast-enhanced ultrasound (CEUS) may have nearly similar sensitivity for detection of cyst features yet is dependent on patient body habitus and adequacy of visualization windows for the kidneys, which does not have the same impact on MR imaging results. Both MR imaging and CEUS may provide superior kidney cyst assessment compared with contrast-enhanced CT; however, further research is needed, particularly for the identification of role of CEUS.
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30
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Mixed Epithelial and Stromal Tumor of the Kidney with Extension into Inferior Vena Cava: Case Report and Discussion of Adult Biphasic Cystic Renal Lesions and the Significance of Vascular Involvement. Case Rep Pathol 2018; 2018:8234295. [PMID: 30364101 PMCID: PMC6188733 DOI: 10.1155/2018/8234295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 09/17/2018] [Indexed: 11/17/2022] Open
Abstract
Mixed epithelial and stromal tumor (MEST) is a biphasic adult renal lesion composed of solid and cystic areas containing spindle cell stroma and epithelium that lines the tubules and cystic spaces. While most MEST lesions are benign, rare cases with malignant morphology and biology have been reported. We present a case of mixed epithelial and stromal tumor of the kidney (MEST) with extension into the inferior vena cava in a young adult male. We discuss the differential diagnosis of MEST in the context of other biphasic cystic renal lesions and the significance of vascular involvement in the setting of an otherwise benign tumor morphology.
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31
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Elias KM, Tsantoulis P, Tille JC, Vitonis A, Doyle LA, Hornick JL, Kaya G, Barnes L, Cramer DW, Puppa G, Stuckelberger S, Hooda J, Dietrich PY, Goggins M, Kerr CL, Birrer M, Hirsch MS, Drapkin R, Labidi-Galy SI. Primordial germ cells as a potential shared cell of origin for mucinous cystic neoplasms of the pancreas and mucinous ovarian tumors. J Pathol 2018; 246:459-469. [PMID: 30229909 DOI: 10.1002/path.5161] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 08/13/2018] [Accepted: 08/25/2018] [Indexed: 12/17/2022]
Abstract
Mucinous ovarian tumors (MOTs) morphologically and epidemiologically resemble mucinous cystic neoplasms (MCNs) of the pancreas, sharing a similar stroma and both occurring disproportionately among young females. Additionally, MOTs and MCNs share similar clinical characteristics and immunohistochemical phenotypes. Exome sequencing has revealed frequent recurrent mutations in KRAS and RNF43 in both MOTs and MCNs. The cell of origin for these tumors remains unclear, but MOTs sometimes arise in the context of mature cystic teratomas and other primordial germ cell (PGC) tumors. We undertook the present study to investigate whether non-teratoma-associated MOTs and MCNs share a common cell of origin. Comparisons of the gene expression profiles of MOTs [including both the mucinous borderline ovarian tumors (MBOTs) and invasive mucinous ovarian carcinomas (MOCs)], high-grade serous ovarian carcinomas, ovarian surface epithelium, Fallopian tube epithelium, normal pancreatic tissue, pancreatic duct adenocarcinomas, MCNs, and single-cell RNA-sequencing of PGCs revealed that both MOTs and MCNs are more closely related to PGCs than to either eutopic epithelial tumors or normal epithelia. We hypothesize that MCNs may arise from PGCs that stopped in the dorsal pancreas during their descent to the gonads during early human embryogenesis, while MOTs arise from PGCs in the ovary. Together, these data suggest a common pathway for the development of MCNs and MOTs, and suggest that these tumors may be more properly classified as germ cell tumor variants. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Kevin M Elias
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA.,Division of Gynecologic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Petros Tsantoulis
- Department of internal medicine specialties, Facutly of Medicine, Université de Genève, Geneva, Switzerland.,Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | - Allison Vitonis
- Department of Obstetrics and Gynecology, Epidemiology Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Leona A Doyle
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Jason L Hornick
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Gurkan Kaya
- Department of internal medicine specialties, Facutly of Medicine, Université de Genève, Geneva, Switzerland.,Division of Dermatology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Laurent Barnes
- Division of Dermatology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Daniel W Cramer
- Harvard Medical School, Boston, MA, USA.,Department of Obstetrics and Gynecology, Epidemiology Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Giacomo Puppa
- Division of Pathology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Sarah Stuckelberger
- Penn Ovarian Cancer Research Center, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jagmohan Hooda
- Penn Ovarian Cancer Research Center, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - Pierre-Yves Dietrich
- Department of internal medicine specialties, Facutly of Medicine, Université de Genève, Geneva, Switzerland.,Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Michael Goggins
- Department of Pathology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Candace L Kerr
- Department of Biochemistry and Molecular Biology, University of Maryland, Baltimore, MD, USA
| | - Michael Birrer
- Division of Hematology-Oncology, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL, USA
| | - Michelle S Hirsch
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Ronny Drapkin
- Penn Ovarian Cancer Research Center, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sana Intidhar Labidi-Galy
- Department of internal medicine specialties, Facutly of Medicine, Université de Genève, Geneva, Switzerland.,Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
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32
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Narayanasamy S, Krishna S, Prasad Shanbhogue AK, Flood TA, Sadoughi N, Sathiadoss P, Schieda N. Contemporary update on imaging of cystic renal masses with histopathological correlation and emphasis on patient management. Clin Radiol 2018; 74:83-94. [PMID: 30314810 DOI: 10.1016/j.crad.2018.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/06/2018] [Indexed: 01/21/2023]
Abstract
This article presents an updated review of cystic renal mass imaging. Most cystic renal masses encountered incidentally are benign and can be diagnosed confidently on imaging and require no follow-up. Hyperattenuating masses discovered at unenhanced or single-phase enhanced computed tomography (CT) measuring between 20-70 HU are indeterminate and can be further investigated first by using ultrasound and, then with multi-phase CT or magnetic resonance imaging (MRI); as the majority represent haemorrhagic/proteinaceous cysts (HPCs). Dual-energy CT may improve differentiation between HPCs and masses by suppressing unwanted pseudo-enhancement observed with conventional CT. HPCs can be diagnosed confidently when measuring >70 HU at unenhanced CT or showing markedly increased signal on T1-weighted imaging. Although the Bosniak criteria remains the reference standard for diagnosis and classification of cystic renal masses, histopathological classification and current management has evolved: multilocular cystic renal cell carcinoma (RCC) has been reclassified as a cystic renal neoplasm of low malignant potential, few Bosniak 2F cystic masses progress radiologically during follow-up; RCC with predominantly cystic components are less aggressive than solid RCC; and Bosniak III cystic masses behave non-aggressively. These advances have led to an increase in non-radical management or surveillance of cystic renal masses including Bosniak 3 lesions. Tubulocystic RCC is a newly described entity with distinct imaging characteristics, resembling a pancreatic serous microcystadenoma. Other benign cystic masses including: mixed epithelial stromal tumours (MEST) are now considered in the spectrum of cystic nephroma and angiomyolipoma (AML) with epithelial cysts (AMLEC) resemble a fat-poor AML with cystic components.
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Affiliation(s)
- S Narayanasamy
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - S Krishna
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - A K Prasad Shanbhogue
- Department of Radiology, New York University School of Medicine, 660 First Avenue, New York, NY 10016, USA
| | - T A Flood
- Department of Anatomic Pathology, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - N Sadoughi
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - P Sathiadoss
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - N Schieda
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada.
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33
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En-bloc resection of a mixed mesenchymal and stromal tumor from the renal pelvis using laparoscopic pyelotomy – A case report. Urol Case Rep 2018; 20:94-97. [PMID: 30101076 PMCID: PMC6073077 DOI: 10.1016/j.eucr.2018.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/11/2018] [Accepted: 06/14/2018] [Indexed: 11/21/2022] Open
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34
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Bakavičius A, Barisienė M, Snicorius M, Valančienė D, Dasevičius D, Žalimas A, Kvaščevičius R, Ramonas H, Sokolovas V, Jankevičius F. Malignant mixed epithelial and stromal tumour of the kidney: a case report and a literature review. Acta Med Litu 2018; 25:31-37. [PMID: 29928155 PMCID: PMC6008004 DOI: 10.6001/actamedica.v25i1.3701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. Mixed epithelial and stromal tumour of the kidney (MEST) is a rare and distinctive neoplasm accounting for 0.2% of all renal cancers. Most of these tumours behave in a benign fashion but 13 cases with malignant transformation have already been reported. We present the first case of an extremely aggressive MEST with rapid recurrence after radical treatment, demonstrating objective response to chemotherapy. Case presentation. A 31-year-old female presented to the hospital complaining of gross hematuria. Computed tomography (CT) revealed an intraparenchymal mass in the left kidney forming a tumour thrombus in the inferior vena cava (IVC). Metastatic disease was ruled out and, under the clinical diagnosis of renal cell carcinoma, left radical nephrectomy with IVC thrombectomy was performed. The histopathological examination confirmed malignant MEST of the kidney. At the follow-up 12 months after surgery, a recurrent tumour in the left paravertebral area and a tumour thrombus in the IVC were detected. A second surgery was recommended and the mass from the paravertebral area was removed, so resection of the IVC with prosthetic replacement was performed. The histopathologic examination confirmed a recurrent malignant MEST. At the follow-up three months after the second surgery disease progression was diagnosed, so chemotherapy with ifosfamide and doxorubicin was initiated. The CT scan performed 14 months after the chemotherapy confirmed a stable process of the disease with no signs of progression. Conclusions. A literature review and our case report confirm the existence of extremely aggressive malignant MEST that shows response to chemotherapy. However, more reports are needed to improve our understanding about the biology of the MEST to develop any recommendations on personalized therapy.
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Affiliation(s)
- Arnas Bakavičius
- Centre of Urology, Vilnius University, Vilnius, Lithuania.,National Cancer Institute, Vilnius, Lithuania
| | | | | | - Dileta Valančienė
- Centre of Radiology and Nuclear Medicine, Vilnius University, Vilnius, Lithuania
| | - Darius Dasevičius
- National Centre of Pathology, Vilnius University, Vilnius, Lithuania
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35
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Ward RD, Remer EM. Cystic renal masses: An imaging update. Eur J Radiol 2018; 99:103-110. [DOI: 10.1016/j.ejrad.2017.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/16/2017] [Accepted: 12/19/2017] [Indexed: 01/20/2023]
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36
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Chuang CK, Pan PY, Kao Y, Chou YC, Ng KF, Wang LJ, Tsai HY, Lee KH. Mixed epithelial stromal tumor of the kidney: The male case and literature review. Urol Case Rep 2018. [PMID: 29541598 PMCID: PMC5849858 DOI: 10.1016/j.eucr.2017.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Cheng-Keng Chuang
- Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Urology, Chang Gung Memorial Hospital, 5, Fushing Street, Kweishan, Taoyuan, Taiwan
| | - Pai-Yen Pan
- Medical Student, School of Medicine, Chang Gung University, Taiwan.,Urology, Chang Gung Memorial Hospital, 5, Fushing Street, Kweishan, Taoyuan, Taiwan
| | - Yuting Kao
- Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Urology, Chang Gung Memorial Hospital, 5, Fushing Street, Kweishan, Taoyuan, Taiwan
| | - Yi-Chun Chou
- Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Urology, Chang Gung Memorial Hospital, 5, Fushing Street, Kweishan, Taoyuan, Taiwan
| | - Kwai-Fong Ng
- Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Urology, Chang Gung Memorial Hospital, 5, Fushing Street, Kweishan, Taoyuan, Taiwan
| | - Li-Jen Wang
- Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Urology, Chang Gung Memorial Hospital, 5, Fushing Street, Kweishan, Taoyuan, Taiwan
| | - Han-Yu Tsai
- Medical Student, School of Medicine, Chang Gung University, Taiwan.,Urology, Chang Gung Memorial Hospital, 5, Fushing Street, Kweishan, Taoyuan, Taiwan
| | - Kun-Han Lee
- School of Medicine, Chang Gung University, Chang Gung Memorial Hospital, 5, Fushing Street, Kweishan, Taoyuan, Taiwan
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37
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Basavaiah S, Khadilkar U, Laxman Prabhu GG, Tapadia R, Rakesh BH. Mixed epithelial and stromal tumor – A solid-cystic renal neoplasm undergoing malignant transformation: A rare case report. INDIAN J PATHOL MICR 2018; 61:123-126. [DOI: 10.4103/ijpm.ijpm_627_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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38
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Minoda R, Takagi T, Toda N, Itagaki H, Kondo T, Ishida H, Nagashima Y, Tanabe K. Bilateral and multiple mixed epithelial and stromal tumors of the kidney: A case report. Mol Clin Oncol 2017; 7:1005-1007. [PMID: 29285364 PMCID: PMC5740850 DOI: 10.3892/mco.2017.1444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 09/28/2017] [Indexed: 11/17/2022] Open
Abstract
Mixed epithelial and stromal tumor (MEST) of the kidney is a benign tumor occurring predominantly in older women. Histologically, MEST comprises tubuloglandular and cystic structures in an ovarian-like stroma. Bilateral and multiple cases are rare. We herein present a case of bilateral and multiple MEST in a 43-year-old woman. The patient presented with gross hematuria and was referred to a primary care physician. A computed tomography scan revealed 5 tumors in the right and 2 in the left kidney. Renal cell carcinoma was suspected, and left partial nephrectomy followed by right radical nephrectomy was planned. After the left partial nephrectomy, the histopathological diagnosis was MEST, which was consistent with the results obtained following needle biopsy. Therefore, the contralateral tumor was also suspected to be MEST, and needle biopsy was performed. The histopathological diagnosis was identical and the right kidney was spared. The patient is currently periodically monitored. As MEST is a benign tumor, preoperative diagnosis is crucial for avoiding overtreatment.
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Affiliation(s)
- Ryo Minoda
- Department of Urology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Naohiro Toda
- Department of Urology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Hiroko Itagaki
- Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Yoji Nagashima
- Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
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39
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Angiomyomatous hamartoma of lymph nodes, revisited: clinicopathologic study of 21 cases, emphasizing its distinction from lymphangioleiomyomatosis of lymph nodes. Hum Pathol 2017; 68:175-183. [DOI: 10.1016/j.humpath.2017.08.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 08/28/2017] [Accepted: 08/30/2017] [Indexed: 01/16/2023]
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40
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Jayalakshmy PS, Jose M, Feroze M, Kumar RK. Renal angiomyoadenomatous tumour. Turk J Urol 2017; 43:378-382. [PMID: 28861315 PMCID: PMC5562262 DOI: 10.5152/tud.2017.32067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 08/01/2016] [Indexed: 02/03/2023]
Abstract
Renal angiomyoadenomatous tumour is a newly described rare neoplasm. This tumour is characterised microscopically by admixture of three components- epithelial cells arranged in tubules and nests, angiomyomatous stroma and capillary sized interconnecting vascular channels in close association with the epithelial cell clusters. Microscopically it has wide range of differential diagnoses which include mixed epithelial and stromal tumour of kidney, angiomyolipoma and clear cell renal cell carcinoma with angiomyolipomatous/angiomyoadenomatous areas. Renal angiomyoadenomatous tumour should be differentiated from these tumours. Till now, only 10 cases have been reported in English medical literature. Here, we are reporting a case of renal angiomyoadenomatous tumour in a 29 year- old female patient who presented with hematuria and low backache and describing its main features so as to differentiate this entity from other renal tumours. To the best of our knowledge, this is the first case to be reported from India.
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Affiliation(s)
- P. S. Jayalakshmy
- Department of Pathology, Government Medical College, Thrissur, Kerala, India,Correspondence: P. S. Jayalakshmy, E-mail:
| | - Merin Jose
- Department of Pathology, Government Medical College, Thrissur, Kerala, India
| | - M. Feroze
- Department of Pathology, Government Medical College, Thrissur, Kerala, India
| | - Rajesh K. Kumar
- Department of Urology, Government Medical College, Thrissur, Kerala, India
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41
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Pediatric Cystic Nephroma Is Morphologically, Immunohistochemically, and Genetically Distinct From Adult Cystic Nephroma. Am J Surg Pathol 2017; 41:472-481. [PMID: 28177962 DOI: 10.1097/pas.0000000000000816] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The term cystic nephroma has traditionally been used to refer to 2 neoplasms, a lesion in adults that is now thought to be part of the spectrum of mixed epithelial stromal tumor (MEST) and a pediatric lesion that has been associated with mutations in the DICER1 gene. A direct detailed morphologic, immunohistochemical, and genetic comparison of these 2 lesions has not been performed. In this study, we compare the morphologic features, immunoreactivity for estrogen receptor and inhibin, and DICER1 genetic status of 12 adult cystic nephroma/MEST (median age 50.5 y, all females) and 7 pediatric cystic nephroma (median age 1.3 y, male:female=6:1). Both lesions (11 of 12 adult cases, 6 of 7 pediatric cases) frequently demonstrated subepithelial accentuation of stromal cellularity, though the increased cellularity frequently included inflammatory cells in the pediatric cases. All adult and pediatric cases labeled for estrogen receptor; however, whereas most (83%) of adult cases labeled for inhibin at least focally, no pediatric case labeled for inhibin. Most adult cases (58%) demonstrated wavy, ropy collagen in association with cellular stroma, whereas this was not found in pediatric cases. 86% of pediatric cases demonstrated DICER1 mutations, whereas only 1 of 10 adult cases demonstrated a DICER1 mutation. In summary, although cellular stroma and estrogen receptor immunoreactivity are commonly present in both adult and pediatric cystic nephroma, ropy collagen and inhibin immunoreactivity are far more common in adult cystic nephroma/MEST, whereas DICER1 mutations are far more prevalent in pediatric cystic nephroma. These results support the current World Health Organization Classification's separation of adult and pediatric cystic nephromas as distinct entities.
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42
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Mixed Epithelial and Stromal Tumor of the Kidney: A Clinicopathologic Study of 53 Cases. Am J Surg Pathol 2017; 40:1538-1549. [PMID: 27635943 DOI: 10.1097/pas.0000000000000733] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Mixed epithelial and stromal tumor of the kidney is an uncommon complex neoplasm, and previous studies have included only a modest number of cases and have left gaps in our understanding of its morphology. We analyzed 53 tumors (46 F, median age: 49 y), collecting data on gross, histologic, and immunohistochemical features. The most common gross appearance was solid and cystic (47%). Hypocellular fibrous and cellular spindle cell stroma were the most common stromal types, followed by smooth muscle differentiation, edematous stroma, and adipose tissue. Hypocellular fibrous stroma and adipose tissue were more common in larger tumors (P=0.003 and 0.04, respectively) and cellular spindle cell stroma in smaller tumors (P=0.0009). Combinations of diverse stromal elements were common: roughly 50% of tumors contained >4 types of stroma. With regard to epithelium, tiny crowded and branching glands were present in 60% of tumors. Round glands lined by tall cuboidal epithelium, reminiscent of thyroid follicles, spatulate papillae reminiscent of phyllodes tumor, glands reminiscent of nephrogenic adenoma, and complex papillae were also frequently found. Combinations of diverse epithelial elements were common: 64% of tumors contained >4 types of epithelium. All of the tumors except 1 were positive for smooth muscle actin in the stroma. Desmin and caldesmon expression were more variable. Stains for progesterone and estrogen receptors showed positivity in the stromal component in 85% and 73% of tumors, respectively. CD10 and CD34 immunolabeling were restricted to pericystic spindle cells. No tumor expressed inhibin. In summary, this study demonstrates a strong tendency for mixed epithelial and stromal tumors to contain multiple types of stroma and epithelium and comprehensively analyzes the immunohistochemical profile.
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Arriola AGP, Taylor BL, Ma S, Malkowicz SB, Lal P. Malignant Mixed Epithelial and Stromal Tumor of the Kidney With 2 Simultaneous Renal Carcinomas in a Male Patient: Case Report and Review of the Literature. Int J Surg Pathol 2017; 26:56-63. [DOI: 10.1177/1066896917720032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The majority of mixed epithelial and stromal tumors (MEST) of the kidney are benign entities found in female patients. Malignant MEST of the kidney is an extremely rare entity that often behaves clinically similar to an undifferentiated sarcoma. We report a case of a malignant MEST with synchronous papillary and clear cell renal cell carcinomas (RCCs) in a 61-year-old Caucasian man who presented with an incidental finding of a left renal mass on workup for back pain. The patient underwent a left radical nephrectomy, with histopathology confirming a malignant MEST, intimately associated papillary RCC, and separate adjacent focus of clear cell RCC.
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Affiliation(s)
| | | | - Sophia Ma
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Priti Lal
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Abstract
Angiomyolipoma with epithelial cysts is a rare mesenchymal tumor of the kidney that enters in the differential diagnosis of adult cystic renal neoplasms. These tumors demonstrate a slight female predominance and can present either incidentally or with symptoms, commonly flank pain and hematuria. Unlike conventional angiomyolipoma, this variant is characterized grossly by both solid and cystic areas, and histologically by the presence of single or multiple cysts lined by epithelial cells, a subepithelial "cambium-like" layer of small stromal cells with a prominent capillary vasculature, and a thick exterior wall composed of poorly formed fascicles of smooth muscle and thick-walled dysplastic blood vessels. Tumors show a distinct immunohistochemical profile and are often reactive for melanocytic markers (HMB-45 and Melan-A), as well as estrogen receptor and progesterone receptor. These tumors have an indolent clinical course, with no reports of progression or metastasis in reported cases thus far.
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Affiliation(s)
- Michael A LeRoy
- From the Department of Pathology, MD Anderson Cancer Center, Houston, Texas
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45
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Mixed Epithelial and Stromal Tumor of the Kidney: Mutation Analysis of the DICER 1 Gene in 29 Cases. Appl Immunohistochem Mol Morphol 2017; 25:117-121. [DOI: 10.1097/pai.0000000000000262] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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46
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Zhang C, Li X, Mo C, Peng Z, Yang R, Tang Y, Zhang Y, Wu R. Benign mixed epithelial and stromal tumor of the kidney with inferior vena cava tumor thrombus: A rare case report and review of literature. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2017; 25:831-837. [PMID: 28436411 DOI: 10.3233/xst-16245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Mixed epithelial and stromal tumor of the kidney (MESTK) is a rare renal tumor composed of epithelial and stromal cells. In this study, we report a rare case of MESTK, which was pathologically benign but complicated with renal vein and inferior vena cava tumor thrombus. The 50-year-old female patient was admitted to hospital for a mass on the left kidney. Computed tomography showed a 32 mm×18 mm mass with slight delayed enhancement in the left renal sinus, and neoplastic thrombus was detected in left renal vein and inferior vena cava. A preoperative diagnosis of renal leiomyoma was made by needle biopsy and a laparoscopic radical nephrectomy with thrombectomy was performed. Histologically, the tumor and thrombus were composed of proliferative spindle cells and a small amount of tubular structures. Both kinds of the cells were well differentiated with no atypia or mitosis of nuclei. Immunohistochemical staining showed positive for CK, Ki-67 in the tubular cells and desmin, actin, estrogen receptors, progesterone receptors in the spindle cells. Finally, the diagnosis of MESTK was established. No recurrence or metastasis was found in the patient with a followed-up period of 12 months after the surgery. Due to the difficulty in diagnosis of MESTK, documentation with more cases of MESTK is needed to further understand its pathogenesis, biological behavior, preoperative diagnosis and optimal management of patient treatment.
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Affiliation(s)
- Chi Zhang
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaofei Li
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chengqiang Mo
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhenpeng Peng
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ruilin Yang
- Department of Urology, Central Hospital of Panyu District, Guangzhou, Guangdong, China
| | - Yiming Tang
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Rongpei Wu
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
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47
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Abstract
To better understand pancreatic ductal adenocarcinoma (PDAC) and improve its prognosis, it is essential to understand its origins. This article describes the pathology of the 3 well-established pancreatic cancer precursor lesions: pancreatic intraepithelial neoplasia, intraductal papillary mucinous neoplasm, and mucinous cystic neoplasm. Each of these precursor lesions has unique clinical findings, gross and microscopic features, and molecular aberrations. This article focuses on histopathologic diagnostic criteria and reporting guidelines. The genetics of these lesions are briefly discussed. Early detection and adequate treatment of pancreatic cancer precursor lesions has the potential to prevent pancreatic cancer and improve the prognosis of PDAC.
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Affiliation(s)
- Michaël Noë
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Lodewijk A A Brosens
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
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48
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Jinzaki M, Silverman SG, Akita H, Mikami S, Oya M. Diagnosis of Renal Angiomyolipomas: Classic, Fat-Poor, and Epithelioid Types. Semin Ultrasound CT MR 2016; 38:37-46. [PMID: 28237279 DOI: 10.1053/j.sult.2016.11.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
With the increasing discovery of small renal masses with cross-sectional imaging, there has been the concomitant rise in their treatment. With the intent of early curative surgery for a presumed renal cell carcinoma, many renal masses are being resected at surgery without a confirmed diagnosis. Many of them are benign, and some are angiomyolipomas. The diagnosis of renal angiomyolipoma using imaging is, therefore, is as important as ever. Although most, if not all angiomyolipomas with abundant fat are diagnosed readily, some have too little fat to be detected with imaging. This article reviews the current classification, imaging pitfalls, and diagnosis of angiomyolipoma with an emphasis on the fat-poor types. Proper imaging technique, a thorough search for fat, and the appropriate use of percutanoeus biopsy are all needed to eliminate the unnecessary treatment of these benign neoplasms.
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Affiliation(s)
- Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan.
| | | | - Hirotaka Akita
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Shuji Mikami
- Department of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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49
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Horsanali MO, Yilmaz Y, Ozer K, Kose O, Cakalagaoglu F, Etit D. Mixed Epithelial and Stromal Tumor of the Kidney: Two Case Reports of a Rare Benign Kidney Tumor. Clin Genitourin Cancer 2016; 15:e55-e59. [PMID: 27865685 DOI: 10.1016/j.clgc.2016.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/13/2016] [Accepted: 10/17/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Mustafa Ozan Horsanali
- Department of Urology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.
| | - Yuksel Yilmaz
- Department of Urology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Kutan Ozer
- Department of Urology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Osman Kose
- Department of Urology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Fulya Cakalagaoglu
- Department of Pathology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Demet Etit
- Department of Pathology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
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50
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Foix MP, Dunatov A, Martinek P, Mundó EC, Suster S, Sperga M, Lopez JI, Ulamec M, Bulimbasic S, Montiel DP, Alaghehbandan R, Peckova K, Pivovarcikova K, Ondrej D, Rotterova P, Skenderi F, Prochazkova K, Dusek M, Hora M, Michal M, Hes O. Morphological, immunohistochemical, and chromosomal analysis of multicystic chromophobe renal cell carcinoma, an architecturally unusual challenging variant. Virchows Arch 2016; 469:669-678. [PMID: 27631338 DOI: 10.1007/s00428-016-2022-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/27/2016] [Accepted: 09/05/2016] [Indexed: 12/11/2022]
Abstract
Chromophobe renal cell carcinoma (ChRCC) is typically composed of large leaf-like cells and smaller eosinophilic cells arranged in a solid-alveolar pattern. Eosinophilic, adenomatoid/pigmented, or neuroendocrine variants have also been described. We collected 10 cases of ChRCC with a distinct multicystic pattern out of 733 ChRCCs from our registry, and subsequently analyzed these by morphology, immunohistochemistry, and array comparative genomic hybridization. Of the 10 patients, 6 were males with an age range of 50-89 years (mean 68, median 69). Tumor size ranged between 1.2 and 20 cm (mean 5.32, median 3). Clinical follow-up was available for seven patients, ranging 1-19 years (mean 7.2, median 2.5). No aggressive behavior was documented. We observed two growth patterns, which were similar in all tumors: (1) variable-sized cysts, resembling multilocular cystic neoplasm of low malignant potential and (2) compressed cystic and tubular pattern with slit-like spaces. Raisinoid nuclei were consistently present while necrosis was absent in all cases. Half of the cases showed eosinophilic/oncocytic cytology, deposits of pigment (lipochrome) and microcalcifications. The other half was composed of pale or mixed cell populations. Immunostains for epithelial membrane antigen (EMA), CK7, OSCAR, CD117, parvalbumin, MIA, and Pax 8 were positive in all tumors while negative for vimentin, TFE3, CANH 9, HMB45, cathepsin K, and AMACR. Ki67 immunostain was positive in up to 1 % of neoplastic cells. Molecular genetic examination revealed multiple chromosomal losses in two fifths analyzable tumors, while three cases showed no chromosomal numerical aberrations. ChRCC are rarely arranged in a prominent multicystic pattern, which is probably an extreme form of the microcystic adenomatoid pigmented variant of ChRCC. The spectrum of tumors entering the differential diagnosis of ChRCC is quite different from that of conventional ChRCC. The immunophenotype of ChRCC is identical with that of conventional ChRCC. Chromosomal numerical aberration pattern was variable; no chromosomal numerical aberrations were found in three cases. All the cases in this series have shown an indolent and non-aggressive behavior.
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Affiliation(s)
- Maria Pané Foix
- Department of Pathology, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Ana Dunatov
- Department of Pathology, University of Split, Split, Croatia
| | - Petr Martinek
- Department of Pathology, , Medical Faculty and Charles University Hospital Plzen, Charles University, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - Enric Condom Mundó
- Department of Pathology, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Maris Sperga
- Department of Pathology, East University, Riga, Latvia
| | - Jose I Lopez
- Department of Pathology, Cruces University Hospital, Biocruces Research Institute, University of the Basque Country, Barakaldo, Spain
| | - Monika Ulamec
- "Ljudevit Jurak" Pathology Department, Clinical Hospital Center "Sestre milosrdnice", Zagreb, Croatia
| | - Stela Bulimbasic
- Department of Pathology, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Delia Perez Montiel
- Department of Pathology, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Reza Alaghehbandan
- Department of Pathology, Faculty of Medicine, Royal Columbian Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Kvetoslava Peckova
- Department of Pathology, , Medical Faculty and Charles University Hospital Plzen, Charles University, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - Krystina Pivovarcikova
- Department of Pathology, , Medical Faculty and Charles University Hospital Plzen, Charles University, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - Daum Ondrej
- Department of Pathology, , Medical Faculty and Charles University Hospital Plzen, Charles University, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - Pavla Rotterova
- Department of Pathology, , Medical Faculty and Charles University Hospital Plzen, Charles University, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - Faruk Skenderi
- Department of Pathology, Clinical Center of the University of Srajevo, Sarajevo, Bosnia and Herzegovina
| | - Kristyna Prochazkova
- Department of Urology, Medical Faculty and Charles University Hospital, Charles University, Plzen, Czech Republic
| | - Martin Dusek
- Department of Pathology, , Medical Faculty and Charles University Hospital Plzen, Charles University, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - Milan Hora
- Department of Urology, Medical Faculty and Charles University Hospital, Charles University, Plzen, Czech Republic
| | - Michal Michal
- Department of Pathology, , Medical Faculty and Charles University Hospital Plzen, Charles University, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - Ondrej Hes
- Department of Pathology, , Medical Faculty and Charles University Hospital Plzen, Charles University, Alej Svobody 80, 304 60, Pilsen, Czech Republic.
- Biomedical Centre, Faculty of Medicine in Lzen, Charles University in Prague, Plzen, Czech Republic.
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