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Castañeda Millán DA, Álvarez Restrepo JC, Romero Nieto VI, Camacho Nieto D, Donoso Donoso W, Forero Muñoz J. Adenoma metanéfrico: diagnóstico diferencial del carcinoma urotelial del tracto urinario superior. Reporte de un caso. CASE REPORTS 2022. [DOI: 10.15446/cr.v8n1.92283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: Metanephric adenoma is a rare benign kidney tumor. Patients with these tumors are usually asymptomatic, although polycythemia occurs in up 12% of cases. These masses are often described on diagnostic imaging as solid, single, well-defined, oval-shaped, unilateral lesions, located primarily in the renal medulla and without extrarenal involvement. These neoplasms are difficult to differentiate from malignant neoplasms of the upper urinary tract, so the definitive diagnosis is achieved by histopathology. Currently, the treatment of choice is radical nephrectomy.
Case presentation: A 51-year-old woman from Bogotá (Colombia) was referred to the urology service of a tertiary care hospital due to bilateral lumbar pain of non-specific characteristics. At the time of consultation, the patient was asymptomatic. Renal and urinary tract ultrasound showed hydronephrosis and right renal mass. Computed tomography urography was requested, which revealed a lesion in the right renal pelvis with parenchymal invasion highly suggestive of high-risk upper urinary tract urothelial carcinoma, as well as adenopathies in the para-aortic lymph nodes. The patient underwent a radical nephroureterectomy with bladder cuff, which allowed establishing a final diagnosis of metanephric adenoma according to the histopathological study.
Conclusions: Metanephric adenoma is a rare tumor that is difficult to diagnose through imaging, so it is necessary to explore additional tools to establish an accurate pre-surgical diagnosis that allows preserving the affected renal unit. Also, given their non-specificity, these tumors should be included in the differential diagnosis of lesions suggestive of upper tract urothelial carcinoma.
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Shachner TR, Nodit L, Hubbard E, Van Meter S. Improving ROSE: Discrepant touch preparation and histology findings in cytology of renal masses: A 10-year retrospective review. Diagn Cytopathol 2019; 47:999-1006. [PMID: 31190420 DOI: 10.1002/dc.24253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/30/2019] [Accepted: 05/30/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND The number of "renal incidentalomas" is on the rise due to increasing use of radiologic studies. Image-guided core needle biopsies (CNB) with touch preparations are performed to guide specimen collection and triage of sample for additional studies. Results allow the clinical team to make appropriate treatment decisions. DESIGN Our electronic database was searched for a 10-year period to identify 180 image-guided biopsies of renal masses with rapid on-site evaluations (ROSE) and corresponding biopsy/resection specimens. Touch preparations were classified as non-diagnostic, negative/benign, adequate/positive for malignancy/oncocytic predominance, or atypical. These results were compared to the final diagnosis on the biopsy or resection specimen (if available). Diagnostic accuracy, sensitivity, specificity, and positive and negative predictive values were determined. Non-diagnostic cases and cases in which ROSE and final diagnosis were discordant were reviewed by cytopathologists blinded to the original interpretation to reconcile discrepancies and highlight interpretation pitfalls. RESULTS A ROSE diagnosis was rendered in 133 of 180 cases; 47 cases were non-diagnostic. Of the 133 diagnostic cases, the ROSE diagnosis was concordant with the core biopsy final diagnosis in 125 cases, yielding a diagnostic accuracy of 94%. The overall sensitivity was calculated to be 80.1%; specificity 72.4%; positive predictive value 94%; and negative predictive value 41.2%. CONCLUSIONS Touch preparation slides are vital but imperfect tools in evaluating renal masses. In our study, distinction between malignant and benign samples was accomplished in most cases (94% accuracy), but there are limitations. Awareness of interpretation pitfalls allows informed decisions to be made regarding specimen collection and patient management.
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Affiliation(s)
- Tracy R Shachner
- Department of Pathology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - Laurentia Nodit
- Department of Pathology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - Elizabeth Hubbard
- Department of Pathology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - Stuart Van Meter
- Department of Pathology, University of Tennessee Medical Center, Knoxville, Tennessee
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Metanephric Adenoma in the Pediatric Population: Diagnostic Challenges and Follow-up. Urology 2018; 120:211-215. [DOI: 10.1016/j.urology.2018.06.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/25/2018] [Accepted: 06/29/2018] [Indexed: 11/23/2022]
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Ulamec M, Skenderi F, Trpkov K, Kruslin B, Vranic S, Bulimbasic S, Trivunic S, Montiel DP, Peckova K, Pivovarcikova K, Ondic O, Daum O, Rotterova P, Dusek M, Hora M, Michal M, Hes O. Solid papillary renal cell carcinoma: clinicopathologic, morphologic, and immunohistochemical analysis of 10 cases and review of the literature. Ann Diagn Pathol 2016; 23:51-7. [PMID: 27209513 DOI: 10.1016/j.anndiagpath.2016.04.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 04/22/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Monika Ulamec
- Ljudevit Jurak Pathology Department, Clinical Hospital Center Sestre milosrdnice, Zagreb, Croatia; Pathology Department, Medical University, Medical Faculty Zagreb, Croatia
| | - Faruk Skenderi
- Department of Pathology, Clinical Centre of the University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Kiril Trpkov
- Department of Pathology, Calgary Laboratory Services and University of Calgary, Calgary, AB, Canada
| | - Bozo Kruslin
- Ljudevit Jurak Pathology Department, Clinical Hospital Center Sestre milosrdnice, Zagreb, Croatia; Pathology Department, Medical University, Medical Faculty Zagreb, Croatia
| | - Semir Vranic
- Department of Pathology, Clinical Centre of the University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Stela Bulimbasic
- Pathology Department, Medical University, Medical Faculty Zagreb, Croatia; Department of Pathology, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Sandra Trivunic
- Department of Pathology, Medical Faculty, University of Novi Sad, Serbia
| | - Delia Perez Montiel
- Department of Pathology, Institute Nacional de Cancerologia, Mexico City, Mexico
| | - Kvetoslava Peckova
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic
| | - Kristyna Pivovarcikova
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic
| | - Ondrej Ondic
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic
| | - Ondrej Daum
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic
| | - Pavla Rotterova
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic
| | - Martin Dusek
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic
| | - Milan Hora
- Department of Urolology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic
| | - Michal Michal
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic
| | - Ondrej Hes
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic.
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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.
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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
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Spaner SJ, Yu Y, Cook AJ, Boag G. Pediatric metanephric adenoma: case report and review of the literature. Int Urol Nephrol 2013; 46:677-80. [PMID: 24097278 DOI: 10.1007/s11255-013-0575-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 09/21/2013] [Indexed: 11/26/2022]
Abstract
Metanephric adenomas are rare benign renal neoplasms, uncommonly seen in the pediatric population. They are typically detected incidentally on imaging studies performed for unrelated clinical presentations. Preoperatively, the imaging appearance of this tumor overlaps with the appearance of more common and more aggressive renal neoplasms such as Wilms' tumor or renal cell carcinoma. We present a case of a pathologically proven metanephric adenoma, monitored preoperatively for approximately 5 years, prior to definitive nephrectomy. As the majority of solid renal masses are resected soon after they are detected, to the best of our knowledge, this case is the first to demonstrate the natural in vivo progression of a pathologically proven metanephric adenoma.
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Affiliation(s)
- Shelley Jane Spaner
- University of Calgary, #120 6707 Elbow Drive SW, Calgary, AB, T2V0E3, Canada,
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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
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Blanco LZ, Schein CO, Patel T, Heagley DE, Cimbaluk DJ, Reddy V, Gattuso P. Fine-needle aspiration of metanephric adenoma of the kidney with clinical, radiographic and histopathologic correlation: a review. Diagn Cytopathol 2013; 41:742-51. [PMID: 23447142 DOI: 10.1002/dc.22962] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 09/24/2012] [Accepted: 12/31/2012] [Indexed: 11/05/2022]
Abstract
Metanephric adenoma of the kidney is an uncommon benign epithelial neoplasm with only a small number of reports that describe its cytologic features. We describe two additional cases of metanephric adenoma diagnosed on fine-needle aspiration biopsy and review the available literature. Our cases showed similar cytology and were composed of cellular smears with numerous clusters of small, oval to round cells arranged in a microfollicular pattern and papillary configurations. The tumor cells had scant cytoplasm, fine chromatin and absent nucleoli. Psamomma bodies, nuclear atypia, cellular cpleomorphism, necrosis, and mitoses were absent. Because of the rarity of this tumor and the common cytologic features it shares with other lesions, including malignant tumors such as Wilms' tumor and papillary renal cell carcinoma, awareness of the cytologic features of metanephric adenoma may aid in avoiding a diagnosis of malignancy, especially preoperatively, and in guiding the proper management for the patients.
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Affiliation(s)
- Luis Z Blanco
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA.
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Zhu P, Yan F, Yang Z, Meng L, Ao Q. Composite tumor of metanephric adenoma and Wilms' tumor of the kidney: A case report and review of the literature. Oncol Lett 2013; 5:1311-1314. [PMID: 23599785 PMCID: PMC3629044 DOI: 10.3892/ol.2013.1148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 01/04/2013] [Indexed: 11/06/2022] Open
Abstract
Metanephric adenoma (MA) and Wilms' tumor (WT) are two distinct types of renal tumors. Composite MA and WT of the kidney are extremely rare. Here, a rare case of composite MA and WT of the kidney in a 36-year-old male is described. MA and WT each have their own histopathological features, respectively, and they focally share morphological similarities, which can be a diagnostic challenge. Immunohistochemistry is useful in the differential diagnosis of MA and WT. The histopathological features and differential diagnosis of the composite tumor are emphasized here to promote a better and broader understanding of this less understood subject.
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Affiliation(s)
- Pengcheng Zhu
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030
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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.
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Affiliation(s)
- Siva P Raman
- Department of Radiology, Johns Hopkins University, JHOC 3251, 601 N. Caroline Street, Baltimore, MD 21287, USA.
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