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Presented by Pedram Argani, M.D. and prepared by Shiyama Mudali, M.D.
Case 3: This is a 48 year old female with a 4cm renal tumor.
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Question 1 of 1
1. Question
Week 443: Case 3
is a 48 year old female with a 4cm renal tumor.images/1alex/07192010case3image1.jpg
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images/1alex/07192010case3image4.jpgCorrect
Answer: Metanephric adenoma
Histology: This is an epithelial neoplasm characterized by blue cells forming tubules and papillae. The cells have a high nucleus to cytoplasm ratio because they have almost no cytoplasm. Mitoses are not evident, and abundant psammomatous calcifications are present. The neoplastic cells label for WT-1, but not for EMA. These are the typical features of metanephric adenoma.
Discussion: Papillary renal cell carcinoma type 1 would not demonstrate nuclear labeling for WT1, and typically labels for EMA. Wilms tumor would also label for WT1, but would show more columnar nuclei with mitotic activity and often necrosis. Some consider metanephric adenoma to represent a differentiated epithelial Wilms tumor. Metanephric adenofibroma is a biphasic lesion which includes a stromal component which is identical to metanephric stromal tumor, in addition to an epithelial component which is identical to metanephric adenoma.
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Answer: Metanephric adenoma
Histology: This is an epithelial neoplasm characterized by blue cells forming tubules and papillae. The cells have a high nucleus to cytoplasm ratio because they have almost no cytoplasm. Mitoses are not evident, and abundant psammomatous calcifications are present. The neoplastic cells label for WT-1, but not for EMA. These are the typical features of metanephric adenoma.
Discussion: Papillary renal cell carcinoma type 1 would not demonstrate nuclear labeling for WT1, and typically labels for EMA. Wilms tumor would also label for WT1, but would show more columnar nuclei with mitotic activity and often necrosis. Some consider metanephric adenoma to represent a differentiated epithelial Wilms tumor. Metanephric adenofibroma is a biphasic lesion which includes a stromal component which is identical to metanephric stromal tumor, in addition to an epithelial component which is identical to metanephric adenoma.
