1
|
Gohla G, Bongers MN, Kaufmann S, Kraus MS. Case Report: MRI, CEUS, and CT Imaging Features of Metanephric Adenoma with Histopathological Correlation and Literature Review. Diagnostics (Basel) 2022; 12:diagnostics12092071. [PMID: 36140473 PMCID: PMC9497561 DOI: 10.3390/diagnostics12092071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/08/2022] [Accepted: 08/22/2022] [Indexed: 01/08/2023] Open
Abstract
The metanephric adenoma is an extremely rare, benign, embryonal-epithelial neoplasm of the kidney and has a good prognosis with appropriate treatment. It can present at any age and is often asymptomatic. Histologically, the lesion is well established; however, there have been only a few cases described with available detailed imaging findings, most of them with large renal masses typically depicted by computed tomography (CT). This case report includes imaging of contrast-enhanced MRI, contrast-enhanced ultrasound (CEUS), and CT, and thus adds to the information available, potentially promoting a nephron-sparing clinical pathway. We report on the clinical presentation, imaging, histopathological diagnosis, and treatment data of a 27-year-old female, in whom an incidental, symptomatic kidney tumor was detected. CT, CEUS, and MRI showed a suspicious unifocal renal lesion with inhomogeneous enhancement, which was indistinguishable from renal cell carcinoma. After laparoscopic resection, a metanephric adenoma with microscopically partially glandular, partially nest-like solid growth and without distinctive atypia was diagnosed pathohistologically. Immunohistochemistry results were positive for Wilms Tumor 1 and CD57 and negative for EMA and CK7: 2–3% positive cells in MIB1 coloring. At 3-month and 1-year follow-up, the patient was asymptomatic and imaging showed no recurrence of renal masses or metastases.
Collapse
|
2
|
de Jel DVC, Hol JA, Ooms AHAG, de Krijger RR, Jongmans MCJ, Littooij AS, Drost J, van Grotel M, van den Heuvel-Eibrink MM. Paediatric metanephric tumours: a clinicopathological and molecular characterisation. Crit Rev Oncol Hematol 2020; 150:102970. [PMID: 32371339 DOI: 10.1016/j.critrevonc.2020.102970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 02/05/2020] [Accepted: 04/15/2020] [Indexed: 12/21/2022] Open
Abstract
To characterize metanephric tumours in children, we performed a literature review investigating paediatric metanephric adenomas (MA), metanephric stromal tumours (MST) and metanephric adenofibromas (MAF). Including two patients from our own institution (MA, MAF), 110 individual cases (41 MA, 20 MAF, 49 MST) were identified. Additionally, fifteen composite tumours were identified, with areas of MA/MAF and Wilms tumour (WT) or papillary carcinoma. No distinct clinical or radiological features could be defined. In pure metanephric tumours, histologically proven distant metastases were reported once (MA), relapse was reported once (MST) and one tumour-related death occurred (MST). Somatic BRAF-V600E mutations were tested in 15 cases, and identified in 3/6 MA, 3/3 MAF, and 6/6 MST. In our institution the MA harboured a somatic KRAS-G12R mutation. Overall, paediatric metanephric tumours are difficult to discriminate from other renal tumours at presentation, behave relatively benign, and the occurrence of composite tumours warrants analysis of underlying (genetic) pathways.
Collapse
Affiliation(s)
| | - Janna A Hol
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
| | - Ariadne H A G Ooms
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands; Department of Pathology, Pathan, Rotterdam, The Netherlands
| | - Ronald R de Krijger
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands; Department of Pathology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Marjolijn C J Jongmans
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands; Department of Clinical Genetics, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Annemieke S Littooij
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands; Department of Radiology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Jarno Drost
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands; Oncode Institute, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | | |
Collapse
|
3
|
Jiang T, Li W, Lin D, Wang J, Liu F, Ding Z. Imaging features of metanephric adenoma and their pathological correlation. Clin Radiol 2019; 74:408.e9-408.e17. [PMID: 30803811 DOI: 10.1016/j.crad.2019.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 01/23/2019] [Indexed: 11/17/2022]
Abstract
AIM To analyse the imaging features of metanephric adenoma (MA) and their pathological correlation. MATERIALS AND METHODS The imaging findings in 11 patients with MA were studied retrospectively. Ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) findings were studied in seven, 11, and six patients, respectively. The enhancement pattern, attenuation, lesion location, size, cystic or solid appearance, capsule sign, and presence of calcifications were evaluated. RESULTS On ultrasonography, MA presented as hypoechoic (4/7), slightly hyperechoic (1/7), isoechoic (2/7), and with a clear boundary. Unenhanced CT showed unclear boundaries (11/11), homogeneous isodensity (8/11), with calcification (1/11), necrosis (1/11), and heterogeneous hyperattenuation (1/11). Mean CT attenuation values on unenhanced and enhanced CT (cortical phase, corticomedullary phase, and excretory phase) were 38.87±6.66, 55.71±17.74, 67.77±16.86, and 65.62±15.99 HU, respectively. The degree of enhancement of the lesions in each phase was statistically significantly lower than that of the surrounding normal renal parenchyma (p=0.00). The pattern of enhancement of the solid component was slight and gradual enhancement (9/11). The tumour was located entirely within the renal medulla in nine cases, and two cases demonstrated an exophytic pattern. All tumours showed a clear boundary on enhanced CT, but capsules were not found. The mean greatest tumour diameter was 3.5 cm. MA showed markedly hyperintense on the diffusion-weighted MRI sequence (DWI) and delayed enhancement of the tumour capsule on enhanced MRI. CONCLUSIONS Imaging features of MA are usually solid and hypovascular, and show prolonged, and homogeneous mild enhancement that is less than that of the surrounding normal renal parenchyma in all phases. MA is markedly hyperintense on DWI.
Collapse
Affiliation(s)
- T Jiang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266555, China
| | - W Li
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266555, China.
| | - D Lin
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, 266555, China
| | - J Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266555, China
| | - F Liu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266555, China
| | - Z Ding
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, 266555, China
| |
Collapse
|
4
|
Chang CB, Ng KF, Wong YC, Lee SY, Chuang CK, Wang LJ. Metanephric adenoma with low apparent diffusion coefficient value mimicking renal cell carcinoma: A case report. Medicine (Baltimore) 2018; 97:e13539. [PMID: 30544462 PMCID: PMC6310553 DOI: 10.1097/md.0000000000013539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Metanephric adenoma (MA) is a rare and often benign tumor. Most MAs were misdiagnosed as renal cell carcinomas (RCCs) preoperatively. Diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping can help to differentiate benign and malignant tumors. However, there are still pitfalls in using DWI and ADC to discriminate benign and malignant lesions. PATIENT CONCERNS A 56-year-old woman had a right renal metanephric adenoma. The tumor showed very low ADC value preoperatively and was misdiagnosed as a renal cell carcinoma. DIAGNOSIS Intraoperative ultrasound-guided percutaneous biopsy of tumor was performed. Based on the histopathological findings and immunohistochemical stains, a diagnosis of metanephric adenoma was suggested. INTERVENTIONS The patient received percutaneous cryoablation of this tumor. Five years later, she underwent right partial nephrectomy because local recurrence was revealed on a follow-up computed tomography (CT). OUTCOMES MA was confirmed again by histological examination. The patient was uneventful after surgery. LESSONS ADC mapping can be used for differentiating RCCs from other benign tumors by their lower ADC values. However, some benign and malignant lesions have overlapped low ADC values. This case illustrated that a benign lesion such as MA could mimic RCC on ADC, by its highly cellular component. Cryoablation is an optional treatment, which has an increased risk of local recurrence. Follow-up CT or MRI is useful and necessary for detection of local recurrence by depicting enhancing solid parts in a tumor over time.
Collapse
Affiliation(s)
- Chun-Bi Chang
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Keelung, Keelung
| | | | - Yon-Cheong Wong
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention
| | | | - Cheng-Keng Chuang
- Department of Urology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Gueishan, Taoyuan, Taiwan
| | - Li-Jen Wang
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention
| |
Collapse
|
5
|
Yan J, Cheng JL, Li CF, Lian YB, Zheng Y, Zhang XP, Wang CY. The findings of CT and MRI in patients with metanephric adenoma. Diagn Pathol 2016; 11:104. [PMID: 27784295 PMCID: PMC5081663 DOI: 10.1186/s13000-016-0535-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 09/01/2016] [Indexed: 11/28/2022] Open
Abstract
Background Metanephric adenoma (MA) is a benign renal tumor that is difficult to distinguish from a malignant tumor via traditional radiography. The diagnosis of MA is often dependent on postsurgical histopathological examination. In the present report, the imaging features of MA on computer tomography (CT) and magnetic resonance imaging (MRI) were retrospectively evaluated. Methods Eight MA patients, 17–67 years of age, were pathologically confirmed and recruited between April 2009 and November 2014. Four of the eight patients were female. All patients underwent CT scanning, and one patient underwent MRI scanning. Three patients underwent CTA of the renal arteries. All patients underwent resection surgery (radical nephrectomy in five and nephron-sparing surgery in three patients). Results The average tumor size was 44.0 ± 23.6 mm. The lesions in 87.5 % cases were located both in the renal cortex and medulla and exhibited exophytic growth. Plain CT showed that MA tumors were solid, and the average CT value was 37.9 ± 6.7 HU. Dynamic contrast-enhanced CT revealed that enhanced degrees of MA tumors in the renal cortex, renal parenchymal, and pelvic phase were all lower than that of normal renal parenchyma. A slight enhancement in the renal cortex phase and an even higher enhancement in the renal parenchymal phase were observed in seven of the cases. Progressive enhancement in the pelvic phase was found in five cases and a slight decreased enhancement in the pelvic phase in two cases. MRI revealed that MA tumor was isointense on T1WI and isointense on T2WI with some slightly hyperintense areas in the center. CTA of the renal arteries revealed the nutrient artery in one patient and no nutrient artery in two. Immunohistochemical experiments demonstrated that most tumor cells were positive for vimentin, CK, and EMA. Conclusions MA is a rare benign renal neoplasm. Detailed knowledge of the CT and MRI characteristics of MA plays an important role in MA diagnosis and treatment.
Collapse
Affiliation(s)
- Jing Yan
- Department of MRI, the First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Rd, Erqi District, Zhengzhou, 450052, Henan Province, China
| | - Jing-Liang Cheng
- Department of MRI, the First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Rd, Erqi District, Zhengzhou, 450052, Henan Province, China.
| | - Chen-Fei Li
- Department of Pathology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yan-Bang Lian
- Department of Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yuan Zheng
- Operation Department, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xue-Ping Zhang
- Department of MRI, the First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Rd, Erqi District, Zhengzhou, 450052, Henan Province, China
| | - Chao-Yan Wang
- Department of MRI, the First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Rd, Erqi District, Zhengzhou, 450052, Henan Province, China
| |
Collapse
|
6
|
Dusan R, Relja K, Marija M, Jelena R, Vesna K, Milijana T, Vladimir P, Irena M, Dragan H. A Case of Metanephric Adenoma and Acute Myocardial Infarction. ACTA CARDIOLOGICA SINICA 2016; 32:502-5. [PMID: 27471365 DOI: 10.6515/acs20151013c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Metanephric adenoma (MA) is a rare neoplasm that acounts for 0.2% of adult renal neoplasms. MAs are typically discover incidentally during detailed examinations for nonspecific symptoms such as abdominal or flank pain, hematuria, fever and palpable abdominal mass. Additionally, polycythemia has occasionally been reported as well. Herein we describe a case of metanephric adenoma which was an incidental finding in the course of a clinical autopsy in a patient with complete AV block and polycythemia. Histologically, the tumor was composed of small and uniform tubular structures reminiscent of renal tubuli, without signs of cellular atypia and pleomorphism. Such tumor histomorphology was consistent with the diagnosis of metanephric adenoma. Thrombosis is a common complication of polycythemia that often causes death. Polycythemia with an increasing number of blood cells causes hyperviscosity and, in 20-40% of cases, lethal thrombosis or hemorrhage. Hyperviscosity and coronary artery disease in our patient caused acute myocardial infarction with the subsequent rupture of posterior left ventricle wall and hemopericardium.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Matic Irena
- Department of Cardiology, General Hospital Valjevo
| | - Hrncic Dragan
- Insitute of Physiology, Faculty of Medicine, Belgrade
| |
Collapse
|
7
|
Saremian J, Kubik MJ, Masood S. Cytologic features of metanephric adenoma of the kidney: case report and review of the literature. Lab Med 2016; 46:153-8; quiz e30. [PMID: 25918196 DOI: 10.1309/lmw2mhdm6eilgqh2] [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] [Indexed: 10/23/2022] Open
Abstract
Metanephric adenoma (MA) is a rare, benign renal tumor that can be found in individuals of any age. The histological features of this lesion are well known; however, cytological features of this entity have rarely been described. Herein, we present the case of a 37-year-old white woman with multiple endocrine dysfunctions and a renal mass. The diagnosis of metanephric adenoma was suggested as a differential diagnosis during imprint cytology; this diagnosis was later confirmed by core needle biopsy (CNB) and the results of immunostaining. To our knowledge, this is the first time in the literature that the diagnosis of metanephric adenoma was initially suggested on imprint cytologic testing of a CNB. We review the literature regarding the cytologic features and immunohistochemical reactivity of this tumor to raise awareness of this entity among pathologists and to distinguish it from other lesions, such as renal-cell carcinoma, so physicians can use this information to help them avoid calling for an unnecessary radical nephrectomy.
Collapse
Affiliation(s)
- Jinous Saremian
- Department of Pathology and Laboratory Medicine, University of Florida College of Medicine, Jacksonville, Florida
| | - Melanie J Kubik
- Department of Pathology and Laboratory Medicine, University of Florida College of Medicine, Jacksonville, Florida
| | - Shahla Masood
- Department of Pathology and Laboratory Medicine, University of Florida College of Medicine, Jacksonville, Florida
| |
Collapse
|
8
|
Li G, Fu F, Song H, Niu Y, Su Y. CT imaging spectrum and the histopathological features of adult metanephric adenoma. Br J Radiol 2015; 88:20140807. [PMID: 25966289 DOI: 10.1259/bjr.20140807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To retrospectively evaluate the radiopathological features of adult metanephric adenoma (MA) and explore whether MA can be differentiated on CT images, including the basis of their morphological features and enhancement patterns. METHODS 18 consecutive MA cases (age range, 18-66 years; 9 males and 9 females) were pathologically proven and recruited in our study between January 2004 and June 2014. Unenhanced and contrast-enhanced CT were performed and correlated with corresponding pathological findings to differentiate between MA and other renal tumours. The enhancement pattern, lesion contour and presence of calcifications were evaluated. RESULTS On unenhanced CT scan, the most common (n = 15, 83.3%) CT imaging characteristics were the presence of homogeneity and well-defined solid renal masses; the minority (n = 3, 16.7%) were heterogeneous or centrally located low-attenuation masses. Contrast-enhanced CT image revealed hypoattenuating heterogeneous masses with varying degrees of contrast enhancement in 16 (88.9%) cases, in contrast to those without increased attenuation in 2 (11.1%) cases. Scattered calcification was found only in one case (5.6%). Pathological results revealed that a total of 6 (33.3%) cases had concomitant malignant carcinoma components; 2 (11.1%) patients had malignant MA; and pure MA was found in 10 cases, with a surprisingly high proportion of malignant tumours. CONCLUSION The positive-predictive values of "high" enhancement seemed relatively characteristic for the diagnosis of malignant and composite MA. ADVANCES IN KNOWLEDGE Radiopathological features of adult MA and exploring whether MA can be differentiated on CT images, including the basis of their morphological features and enhancement patterns.
Collapse
Affiliation(s)
- G Li
- 1 Department of Urology, The second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin, China
| | - F Fu
- 2 Department of Radiology, The People's Hospital of Bin Zhou, Bin Zhou, China
| | - H Song
- 1 Department of Urology, The second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin, China
| | - Y Niu
- 1 Department of Urology, The second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin, China
| | - Y Su
- 3 Department of Urology, Tianjin Union Medicine Center, Tianjin, China
| |
Collapse
|
9
|
Hu YC, Wu L, Yan LF, Zhang W, Cui GB. The imaging features of metanephric adenoma: a case report and review of literature. Onco Targets Ther 2015; 8:445-9. [PMID: 25709478 PMCID: PMC4335625 DOI: 10.2147/ott.s68819] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Metanephric adenoma (MA) is a rare epithelial tumor of the kidney with a characteristic histology. To date, the imaging features of the tumor have not been clearly described. Until now, MA was considered to be benign, but the majority of MA cases underwent nephrectomy. Here, we report a case of MA confirmed by surgical pathology, and we will analyze the ultrasound and computed tomography findings. The radiological features of MA are presented along with a brief review of the pertinent literature to deepen the understanding of MA’s imaging features.
Collapse
Affiliation(s)
- Yu-Chuan Hu
- Department of Radiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, People's Republic of China
| | - Lang Wu
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA
| | - Lin-Feng Yan
- Department of Radiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, People's Republic of China
| | - Wei Zhang
- Department of Pathology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, People's Republic of China
| | - Guang-Bin Cui
- Department of Radiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, People's Republic of China
| |
Collapse
|
10
|
Delzongle M, Boukamel S, Kemeny F, Chaaban I, Abadzhieva D, Sahnoun M, Soyer P, Béroud P. Metanephric adenoma: MR imaging features with histopathological correlation. Diagn Interv Imaging 2014; 96:387-90. [PMID: 25487835 DOI: 10.1016/j.diii.2014.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- M Delzongle
- Department of Medical Imaging, centre hospitalier de Meaux, 6-8, rue Saint-Fiacre, 77100 Meaux, France
| | - S Boukamel
- Department of Urology, centre hospitalier de Meaux, 6-8, rue Saint-Fiacre, 77100 Meaux, France
| | - F Kemeny
- Department of Pathology, hôpital de Marne-la-Vallée, 2-4, cours de la Gondoire, 77600 Jossigny, France
| | - I Chaaban
- Department of Medical Imaging, centre hospitalier de Meaux, 6-8, rue Saint-Fiacre, 77100 Meaux, France
| | - D Abadzhieva
- Department of Medical Imaging, centre hospitalier de Meaux, 6-8, rue Saint-Fiacre, 77100 Meaux, France
| | - M Sahnoun
- Department of Medical Imaging, centre hospitalier de Meaux, 6-8, rue Saint-Fiacre, 77100 Meaux, France
| | - P Soyer
- Department of Radiology, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - P Béroud
- Department of Medical Imaging, centre hospitalier de Meaux, 6-8, rue Saint-Fiacre, 77100 Meaux, France
| |
Collapse
|
11
|
Mantoan Padilha M, Billis A, Allende D, Zhou M, Magi-Galluzzi C. Metanephric adenoma and solid variant of papillary renal cell carcinoma: common and distinctive features. Histopathology 2013; 62:941-53. [DOI: 10.1111/his.12106] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 01/31/2013] [Indexed: 12/01/2022]
Affiliation(s)
| | - Athanase Billis
- Department of Anatomic Pathology; State University of Campinas (UNICAMP); Campinas; SP; Brazil
| | - Daniela Allende
- Department of Anatomic Pathology; Cleveland Clinic Florida; Weston; FL; USA
| | - Ming Zhou
- Department of Pathology; New York University Langone Medical Center; New York; NY; USA
| | | |
Collapse
|
12
|
Masuda A, Kamai T, Mizuno T, Kambara T, Abe H, Tomita S, Fukabori Y, Yamanishi T, Kaji Y, Yoshida KI. Renal metanephric adenoma mimicking papillary renal cell carcinoma on computed tomography: a case report. Urol Int 2012; 90:369-72. [PMID: 23076029 DOI: 10.1159/000341940] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 07/18/2012] [Indexed: 11/19/2022]
Abstract
We present a case of renal metanephric adenoma (MA) mimicking papillary renal cell carcinoma (PRCC) on computed tomography (CT). In the present case, double-phase enhanced CT showed a hypovascular right renal tumor with gradual and prolonged enhancement. The renal tumor was surgically removed. Histological examination of the resected specimen showed renal MA. Although the radiological features of renal MA have been described by some authors, only a few reports have mentioned the pattern of enhancement on multiphase enhanced CT. The pattern of enhancement of a renal tumor is likely to be correlated with its pathological features. Since renal MA is thought to be genetically related to PRCC, these two tumors are likely to demonstrate similar radiological features, so that differentiating between them becomes difficult. In patients with a hypovascular renal mass that shows gradual and prolonged enhancement on multiphase enhanced CT, the diagnosis of renal MA should be considered.
Collapse
Affiliation(s)
- Akinori Masuda
- Department of Urology, Dokkyo Medical University, Mibu, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Abstract
The vast majority of primary renal masses represent clear cell or papillary renal cell carcinomas, angiomyolipomas, or transitional cell carcinomas. However, a number of more rare masses can also be encountered, many of which can be very difficult to differentiate from these more common entities based on their imaging features. These uncommon entities include metanephric adenoma, epithelioid angiomyolipoma, medullary renal cell carcinomas, multilocular cystic nephroma, hemangiopericytoma, hemangioma, leiomyoma, leiomyosarcoma, solitary fibrous tumor, renal plasmacytomas, and mixed epithelial and stromal tumors. In some cases, certain clinical and imaging features can allow one of these unusual entities to be placed in the differential diagnosis, including patient age, degree of tumor enhancement, presence of underlying sickle cell trait or sickle cell disease, the presence of a cystic component to the tumor, and tumor morphology. Even if a radiologist is unable to make a specific diagnosis, knowledge of these entities is important, as it allows radiologists to guide post-surgical follow-up, as well to understand the most common sites of metastatic disease.
Collapse
Affiliation(s)
- Siva P Raman
- Department of Radiology, Johns Hopkins University, JHOC 3251, 601 N. Caroline Street, Baltimore, MD 21287, USA.
| | | | | |
Collapse
|