Metanephric adenoma pathophysiology: Difference between revisions

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==Overview==
==Overview==
On gross pathology, a sharply circumscribed, nonencapsulated solitary [[mass]] is the characteristic finding of metanephric adenoma. On microscopic histopathological analysis, small uniform cells with fine [[chromatin]] and smooth [[nuclear membrane]], variable architecture, and [[Psammoma body|psammoma bodies]] are characteristic findings of metanephric adenoma. <ref>Metanephric adenoma. Libre Pathology 2015. http://librepathology.org/wiki/index.php/Metanephric_adenoma Accessed on November 9, 2015 </ref>


==Genetics==
* Allelic changes of a [[tumor suppressor gene]] on [[chromosome]] 2p13 may be involved in the pathogenesis of metanephric adenoma.<ref name="pmid11172302">{{cite journal |vauthors=Pesti T, Sükösd F, Jones EC, Kovacs G |title=Mapping a tumor suppressor gene to chromosome 2p13 in metanephric adenoma by microsatellite allelotyping |journal=[[Human Pathology]] |volume=32 |issue=1 |pages=101–4 |year=2001 |pmid=11172302 |doi=10.1053/hupa.2001.21132 |url=http://linkinghub.elsevier.com/retrieve/pii/S0046-8177(01)63640-2 |issn=}}</ref>


==Pathology==
==Gross Pathology==
Characteristic findings of metanephric adenoma on gross pathology include:<ref>Metanephric adenoma. Libre Pathology 2015. http://librepathology.org/wiki/index.php/Metanephric_adenoma Accessed on November 9, 2015 </ref>
* Solitary [[mass]]
* Sharply circumscribed
* Not encapsulated


===Histopathology===
==Microscopic Pathology==
Metanephric adenoma is diagnosed histologically. The tumours can be located at upper pole, lower pole and mid-hilar region of the kidney; they are well circumscribed but unencapsulated, tan pink, with possible cystic and hemorrhagic foci. They show a uniform architecture of closely packed acinar or tubular structures of mature and bland appearance with scanty interposed stroma.<ref name=pmid9390023>{{Cite journal  | last1 = Kovacs | first1 = G. | last2 = Akhtar | first2 = M. | last3 = Beckwith | first3 = BJ. | last4 = Bugert | first4 = P. | last5 = Cooper | first5 = CS. | last6 = Delahunt | first6 = B. | last7 = Eble | first7 = JN. | last8 = Fleming | first8 = S. | last9 = Ljungberg | first9 = B. | last10 = Medeiros | first10 = L. Jeffrey | last11 = Moch | first11 = Holger | last12 = Reuter | first12 = Victor E. | last13 = Ritz | first13 = Eberhard | last14 = Roos | first14 = Göran | last15 = Schmidt | first15 = Dietmar | last16 = Srigley | first16 = John R. | last17 = Störkel | first17 = Stephan | last18 = Van Den Berg | first18 = Eva | last19 = Zbar | first19 = Bert | title = The Heidelberg classification of renal cell tumours | journal = J Pathol | volume = 183 | issue = 2 | pages = 131–3 |date=Oct 1997 | doi = 10.1002/(SICI)1096-9896(199710)183:2<131::AID-PATH931>3.0.CO;2-G | pmid = 9390023 | display-authors = 8 }}</ref><ref name=pmid1333853>{{Cite journal  | last1 = Brisigotti | first1 = M. | last2 = Cozzutto | first2 = C. | last3 = Fabbretti | first3 = G. | last4 = Sergi | first4 = C. | last5 = Callea | first5 = F. | title = Metanephric adenoma | journal = Histol Histopathol | volume = 7 | issue = 4 | pages = 689–92 |date=Oct 1992 | doi =  | pmid = 1333853 }}</ref><ref name=pmid7755148>{{Cite journal | last1 = Jones | first1 = E. C. | last2 = Pins | first2 = M. | last3 = Dickersin | first3 = G. R. | last4 = Young | first4 = R. H. | title = Metanephric adenoma of the kidney. A clinicopathological, immunohistochemical, flow cytometric, cytogenetic, and electron microscopic study of seven cases | journal = The American journal of surgical pathology | volume = 19 | issue = 6 | pages = 615–626 | year = 1995 | pmid = 7755148 | doi=10.1097/00000478-199506000-00001}}</ref><ref name=bostwick>Bostwick DG, Eble JN (2008) Urologic Surgical Pathology. St Louis, Mosby, p118.</ref><ref name=pmid9503505>{{Cite journal | last1 = Grignon | first1 = D. J. | last2 = Eble | first2 = J. N. | title = Papillary and metanephric adenomas of the kidney | journal = Seminars in diagnostic pathology | volume = 15 | issue = 1 | pages = 41–53 | year = 1998 | pmid = 9503505}}</ref> Cells are small with dark staining nuclei and inconspicuous nucleoli. Blastema is absent whereas calcospherites may be present. Glomeruloid figures are a striking finding, reminiscent of early fetal metenephric tissue. The lumen of the acini may contain otherwise epithelial infoldings or fibrillary material but it is quite often empty. Mitoses are conspicuously absent.<ref name=pmid9390023/><ref name=pmid1333853/><ref name=pmid7755148>{{Cite journal | last1 = Jones | first1 = E. C. | last2 = Pins | first2 = M. | last3 = Dickersin | first3 = G. R. | last4 = Young | first4 = R. H. | title = Metanephric adenoma of the kidney. A clinicopathological, immunohistochemical, flow cytometric, cytogenetic, and electron microscopic study of seven cases | journal = The American journal of surgical pathology | volume = 19 | issue = 6 | pages = 615–626 | year = 1995 | pmid = 7755148 | doi=10.1097/00000478-199506000-00001}}</ref><ref name=bostwick/><ref name=pmid9503505>{{Cite journal | last1 = Grignon | first1 = D. J. | last2 = Eble | first2 = J. N. | title = Papillary and metanephric adenomas of the kidney | journal = Seminars in diagnostic pathology | volume = 15 | issue = 1 | pages = 41–53 | year = 1998 | pmid = 9503505}}</ref>
The characteristics of metanephric adenomas include:<ref>Metanephric adenoma. Libre Pathology 2015. http://librepathology.org/wiki/index.php/Metanephric_adenoma Accessed on November 9, 2015 </ref>
In the series reported by Jones ''et al.'' tumour cells were reactive for Leu7 in 3 cases of 5, to vimentine in 4 of 6, to cytocheratin in 2 of 6, to epithelial membrane antigen in 1 of 6 cases and muscle specific antigen in 1 of 6.<ref>Jones EC, Pins M, Dickersin GR, Young RH (1995) Metanephric adenoma of the kidney. A clinicopathological, immunohistochemical, flow cytometry, cytogenetic and electron microscopic study of seven cases. Am J Surg Pathol 19(6):615-626.</ref>
* Small uniform cells with:
Olgac ''et al.'' found that intense and diffuse immunoreactivity for alpha-methylacyl-CoA racemase (AMACR) is useful in differentiating renal cell carcinoma from MA but a panel including AMACR, CK7 and CD57 is better in this differential diagnosis.<ref>Olgac S, Hutchinson B, Tickoo  SK, Reuter VE (2006) Alpha-methylacyl-CoA racemase as a marker in the differential diagnosis of metanephric adenoma. Mod Pathol 19:218-224.</ref>
:* Fine chromatin
Differential diagnosis may be quite difficult indeed as exemplified by the three malignancies initially diagnosed as MA that later metastasized, in the report by Pins et al.<ref>Pins MR, Jones EC, Martul EV, Kamat BR, Umlas J, Renshaw AA (1999) Metanephric adenoma-like tumours of the kidney. Report of three malignancies with emphasis on discriminating features. Arch Pathol Lab Med. 123:415-420.</ref>
:* No apparent [[nucleolus]]
:* Smooth [[nuclear membrane]]
* Variable architecture:
:* May be sheets, ductal or micropapillary
* [[Psammoma body|Psammoma bodies]] may be present


===Cytogenetic characteristics===
<gallery>
 
Image:
Brunelli ''et al.'' stated  that genetic analysis of chromosome 7, 17, and Y may facilitate discrimination of MA from papillary renal cell carcinoma in difficult cases. Their study showed that MA lacks the frequent gain of chromosomes 7 and 17 and losses of the Y chromosome that are typical of papillary renal cell neoplasms, suggesting that MA is not related to renal cell carcinoma and papillary adenoma.<ref>Brunelli M, Eble JN, Zhang S, Martignoni G, Cheng L (2003) Metanephric adenoma lacks the gains of chromosomes 7 and 17 and loss of Y that are typical of papillary renal cell carcinoma and papillary adenoma. Mod Pathol 16(10):1060-1063.</ref>
Metanephric adenoma1.jpg|Metanephric adenoma<ref>Metanephric adenoma. Libre Pathology 2015. http://librepathology.org/wiki/index.php/Metanephric_adenoma Accessed on November 9, 2015 </ref>
</gallery>


==References==
==References==

Latest revision as of 15:08, 17 November 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shanshan Cen, M.D. [2]

Overview

On gross pathology, a sharply circumscribed, nonencapsulated solitary mass is the characteristic finding of metanephric adenoma. On microscopic histopathological analysis, small uniform cells with fine chromatin and smooth nuclear membrane, variable architecture, and psammoma bodies are characteristic findings of metanephric adenoma. [1]

Genetics

Gross Pathology

Characteristic findings of metanephric adenoma on gross pathology include:[3]

  • Solitary mass
  • Sharply circumscribed
  • Not encapsulated

Microscopic Pathology

The characteristics of metanephric adenomas include:[4]

  • Small uniform cells with:
  • Variable architecture:
  • May be sheets, ductal or micropapillary
  • Metanephric adenoma[5]

    Metanephric adenoma[5]

References

  1. ↑ Metanephric adenoma. Libre Pathology 2015. http://librepathology.org/wiki/index.php/Metanephric_adenoma Accessed on November 9, 2015
  2. ↑ Pesti T, Sükösd F, Jones EC, Kovacs G (2001). "Mapping a tumor suppressor gene to chromosome 2p13 in metanephric adenoma by microsatellite allelotyping". Human Pathology. 32 (1): 101–4. doi:10.1053/hupa.2001.21132. PMID 11172302.
  3. ↑ Metanephric adenoma. Libre Pathology 2015. http://librepathology.org/wiki/index.php/Metanephric_adenoma Accessed on November 9, 2015
  4. ↑ Metanephric adenoma. Libre Pathology 2015. http://librepathology.org/wiki/index.php/Metanephric_adenoma Accessed on November 9, 2015
  5. ↑ Metanephric adenoma. Libre Pathology 2015. http://librepathology.org/wiki/index.php/Metanephric_adenoma Accessed on November 9, 2015

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