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Presented by Dr. Matoso and prepared by Daniel Miller
This is an 84 year-old woman with a kidney mass
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1. Question
This is an 84 year-old woman with a kidney mass.
Choose the correct diagnosis.
Correct
Answer: B. Mixed epithelial and stromal tumor (MEST)
Histology: Solid and cystic mass with cysts lined by bland columnar/cuboidal to flat cells with occasional hobnail appearance. The stroma is arranged in a fibroadenomatoid/phylloidal pattern.
Discussion: MESTs are more common in middle aged adults and with a strong female predominance (8:1). In male patients, there is often a history of hormonal therapy. Most are unifocal and the clinical presentation is that of any kidney mass. They are typically unencapsulated but well-circumscribed. MEST and cystic neprhoma are considered within the same category of “Mixed epithelial and stromal tumour family” in the WHO classification of tumors of the Urinary System and Male Genital Organs. The epithelial component consists mostly of medium sized cysts and sometimes large cysts with phyllodes-type architecture. The lining cells can be flat, cuboidal, hobnail and rarely columnar with eosinophilic, amphophilic, or vacuolated cytoplasm. The stromal component can be occasionally markedly hypercellular with condensation around the cysts. The main differential diagnosis should be with other mesenchymal tumors with entrapped tubules, particularly synovial sarcoma. Lipomatous and smooth muscle differentiation can be seen. Ovarian-like stroma is often present and can undergo luteinization. Malignant transformation can rarely occur.
References:
Int J Surg Pathol. 2018 Feb;26(1):56-63.
Am J Surg Pathol. 2016 Nov;40(11):1538-1549.Incorrect
Answer: B. Mixed epithelial and stromal tumor (MEST)
Histology: Solid and cystic mass with cysts lined by bland columnar/cuboidal to flat cells with occasional hobnail appearance. The stroma is arranged in a fibroadenomatoid/phylloidal pattern.
Discussion: MESTs are more common in middle aged adults and with a strong female predominance (8:1). In male patients, there is often a history of hormonal therapy. Most are unifocal and the clinical presentation is that of any kidney mass. They are typically unencapsulated but well-circumscribed. MEST and cystic neprhoma are considered within the same category of “Mixed epithelial and stromal tumour family” in the WHO classification of tumors of the Urinary System and Male Genital Organs. The epithelial component consists mostly of medium sized cysts and sometimes large cysts with phyllodes-type architecture. The lining cells can be flat, cuboidal, hobnail and rarely columnar with eosinophilic, amphophilic, or vacuolated cytoplasm. The stromal component can be occasionally markedly hypercellular with condensation around the cysts. The main differential diagnosis should be with other mesenchymal tumors with entrapped tubules, particularly synovial sarcoma. Lipomatous and smooth muscle differentiation can be seen. Ovarian-like stroma is often present and can undergo luteinization. Malignant transformation can rarely occur.
References:
Int J Surg Pathol. 2018 Feb;26(1):56-63.
Am J Surg Pathol. 2016 Nov;40(11):1538-1549.
