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Presented by Pedram Argani, M.D. and prepared by Jeremy Vincent M.D.
Case 3: This is a 69 year old female with a renal mass.
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1. Question
Week 519: Case 3
This is a 69 year old female with a renal mass.images/vincent/12_5478_01.jpg
images/vincent/12_5478_02.jpg
images/vincent/12_5478_03.jpgCorrect
Answer: Metanephric adenoma
Histology: This is a cellular lesion, which features embryonal cells forming small tubules. The cells have a very high nucleus to cytoplasm ratio as there is minimal cytoplasm; however, there is essentially no mitotic activity. The lesion has a non-encapsulated interface with the native kidney. The lesion demonstrates diffuse labeling for WT-1, supporting the diagnosis of Metanephric adenoma.
Discussion: Metanephric adenofibroma would have a stromal component which is morphologically identical to metanephric stromal tumor. Papillary renal cell carcinoma would demonstrate a more vesicular chromatin, and would not label for WT-1. Wilms tumor may on occasion overlap with metanephric adenoma; however, Wilms tumors of the epithelial type generally have more columnar nuclei and mitotic activity, and frequently show necrosis.
Metanephric adenomas typically occur in adult females, as in the current case.
Incorrect
Answer: Metanephric adenoma
Histology: This is a cellular lesion, which features embryonal cells forming small tubules. The cells have a very high nucleus to cytoplasm ratio as there is minimal cytoplasm; however, there is essentially no mitotic activity. The lesion has a non-encapsulated interface with the native kidney. The lesion demonstrates diffuse labeling for WT-1, supporting the diagnosis of Metanephric adenoma.
Discussion: Metanephric adenofibroma would have a stromal component which is morphologically identical to metanephric stromal tumor. Papillary renal cell carcinoma would demonstrate a more vesicular chromatin, and would not label for WT-1. Wilms tumor may on occasion overlap with metanephric adenoma; however, Wilms tumors of the epithelial type generally have more columnar nuclei and mitotic activity, and frequently show necrosis.
Metanephric adenomas typically occur in adult females, as in the current case.
