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Presented by Jonathan Epstein, M.D. and prepared by Doreen Nguyen, M.D.
Case 1: A 35-year-old male underwent a partial nephrectomy for a renal mass.
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Question 1 of 1
1. Question
Week 553: Case 1
A 35-year-old male underwent a partial nephrectomy for a renal mass.
Correct
Answer: Metanephric adenoma
Histology: The lesion is a well-circumscribed solid mass. At low power it has a very “blue/basophilic” appearance due to scant neoplastic cell cytoplasm (high N/C ratio). The tumor is composed of tightly packed tubules admixed with numerous aborted papillary structures lined by bland cells as is the tubular lining. Calcifications are numerous. Nuclei are small round to oval where nucleoli are not discernible. Mitotic figures are rare.
Discussion: In contrast, solid variant of papillary RCC has a light eosinophilic low power appearance imparted by low N/C ratio. These tumors are composed of stubby glomeruloid papillary structure admixed with tubular proliferation lined by polygonal epithelial cells with moderate amount of granular/foamy eosinophilic cytoplasm. If there is a question based on the H&E, metanephric adenomas are WT-1 positive and CK7 negative with the opposite for solid variant of papillary RCC. Epithelial Wilms Tumor is most likely to be confused with metanephric adenoma. The epithelial component attempts to recapitulate epithelial nephrogenesis with tubules and glomeruloid structures. There is a high N/C ratio with molded round oval nuclei with coarse chromatin. Focally, can have areas of maturity, with tubules lined by similar bland cells seen in metanephric adenoma. Some cases have nuclear anaplasia, but even cases without anaplasia have more atypia than metanephric adenoma. In Wilms tumor there are frequent mitotic figures. Both metanephric adenoma and Wilms Tumor are WT1 positive. Metanephric adenoma is benign.
Incorrect
Answer: Metanephric adenoma
Histology: The lesion is a well-circumscribed solid mass. At low power it has a very “blue/basophilic” appearance due to scant neoplastic cell cytoplasm (high N/C ratio). The tumor is composed of tightly packed tubules admixed with numerous aborted papillary structures lined by bland cells as is the tubular lining. Calcifications are numerous. Nuclei are small round to oval where nucleoli are not discernible. Mitotic figures are rare.
Discussion: In contrast, solid variant of papillary RCC has a light eosinophilic low power appearance imparted by low N/C ratio. These tumors are composed of stubby glomeruloid papillary structure admixed with tubular proliferation lined by polygonal epithelial cells with moderate amount of granular/foamy eosinophilic cytoplasm. If there is a question based on the H&E, metanephric adenomas are WT-1 positive and CK7 negative with the opposite for solid variant of papillary RCC. Epithelial Wilms Tumor is most likely to be confused with metanephric adenoma. The epithelial component attempts to recapitulate epithelial nephrogenesis with tubules and glomeruloid structures. There is a high N/C ratio with molded round oval nuclei with coarse chromatin. Focally, can have areas of maturity, with tubules lined by similar bland cells seen in metanephric adenoma. Some cases have nuclear anaplasia, but even cases without anaplasia have more atypia than metanephric adenoma. In Wilms tumor there are frequent mitotic figures. Both metanephric adenoma and Wilms Tumor are WT1 positive. Metanephric adenoma is benign.
