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Renal adenomas: pathological differential diagnosis with malignant tumors.

Algaba F - Adv Urol (2008)

Bottom Line: The renal adenomas can be confused by imaging diagnosis with malignant renal tumors, but there are also real biological dilemmas to determine their behavior.The consensus decisions are the following. (1) The adenoma of clear cells is not accepted, instead it is considered that all the clear-cell tumors are carcinomas, with greater or lesser aggressiveness. (2) Among the papillary neoplasms the WHO 2004 renal cell tumors classification are considered as papillary adenomas tumors with a maximum diameter of 5 mm and may represent a continuum biological process to papillary renal cell carcinoma.The papillary adenomas associated with End-kidney and/or acquired cystic disease may have a different pathogenesis. (3) To consider a tumor as an oncocytoma the size is not important, only the cytological features, microscopic, ultrastructural, and immunohistochemically can help, but some chromosomal observations introduce some questions about its relation with the chromophobe renal cell carcinoma. (4) Finally, the metanephric adenoma, a tumor with some morphological similarity with the nephroblastoma must be considered in the renal adenomas diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Pathology section, Fundació Puigvert, Universitat Autónoma de Barcelona (UAB), 08025 Barcelona, Spain. falgaba@fundacio-puivert.es

ABSTRACT
The renal adenomas can be confused by imaging diagnosis with malignant renal tumors, but there are also real biological dilemmas to determine their behavior. The consensus decisions are the following. (1) The adenoma of clear cells is not accepted, instead it is considered that all the clear-cell tumors are carcinomas, with greater or lesser aggressiveness. (2) Among the papillary neoplasms the WHO 2004 renal cell tumors classification are considered as papillary adenomas tumors with a maximum diameter of 5 mm and may represent a continuum biological process to papillary renal cell carcinoma. The papillary adenomas associated with End-kidney and/or acquired cystic disease may have a different pathogenesis. (3) To consider a tumor as an oncocytoma the size is not important, only the cytological features, microscopic, ultrastructural, and immunohistochemically can help, but some chromosomal observations introduce some questions about its relation with the chromophobe renal cell carcinoma. (4) Finally, the metanephric adenoma, a tumor with some morphological similarity with the nephroblastoma must be considered in the renal adenomas diagnosis.

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Cystic nephroma: cystic neoplasm with fibrous stroma an flat epithelium covering the wall.
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fig1: Cystic nephroma: cystic neoplasm with fibrous stroma an flat epithelium covering the wall.

Mentions: Having established thisaxiomatic attitude, there is no problem of differential diagnosis; however,from the morphological point of view, the cysticnephroma (Figure 1), formed by multiple separate cysts (which are also knownas multilocular cyst) covered by epithelium without nuclear atypia, monolayer,with eosinophilic cytoplasma, can occasionally be covered by cells of clearcytoplasma, without nuclear atypia. In this case, clear cells must not be foundin the walls and the intercystic stroma. The cystic nephroma does not have anyrelation to the multilocular clear cell carcinoma (despite certain similaritywith it) [5]. Currently, it is being related to other benign neoplasias such asthe mixed epithelial and stromal tumor of the kidney, all of them are much morefrequent in women and with estrogen and progesterone receptors in the stromalcomponent [6].


Renal adenomas: pathological differential diagnosis with malignant tumors.

Algaba F - Adv Urol (2008)

Cystic nephroma: cystic neoplasm with fibrous stroma an flat epithelium covering the wall.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2563151&req=5

fig1: Cystic nephroma: cystic neoplasm with fibrous stroma an flat epithelium covering the wall.
Mentions: Having established thisaxiomatic attitude, there is no problem of differential diagnosis; however,from the morphological point of view, the cysticnephroma (Figure 1), formed by multiple separate cysts (which are also knownas multilocular cyst) covered by epithelium without nuclear atypia, monolayer,with eosinophilic cytoplasma, can occasionally be covered by cells of clearcytoplasma, without nuclear atypia. In this case, clear cells must not be foundin the walls and the intercystic stroma. The cystic nephroma does not have anyrelation to the multilocular clear cell carcinoma (despite certain similaritywith it) [5]. Currently, it is being related to other benign neoplasias such asthe mixed epithelial and stromal tumor of the kidney, all of them are much morefrequent in women and with estrogen and progesterone receptors in the stromalcomponent [6].

Bottom Line: The renal adenomas can be confused by imaging diagnosis with malignant renal tumors, but there are also real biological dilemmas to determine their behavior.The consensus decisions are the following. (1) The adenoma of clear cells is not accepted, instead it is considered that all the clear-cell tumors are carcinomas, with greater or lesser aggressiveness. (2) Among the papillary neoplasms the WHO 2004 renal cell tumors classification are considered as papillary adenomas tumors with a maximum diameter of 5 mm and may represent a continuum biological process to papillary renal cell carcinoma.The papillary adenomas associated with End-kidney and/or acquired cystic disease may have a different pathogenesis. (3) To consider a tumor as an oncocytoma the size is not important, only the cytological features, microscopic, ultrastructural, and immunohistochemically can help, but some chromosomal observations introduce some questions about its relation with the chromophobe renal cell carcinoma. (4) Finally, the metanephric adenoma, a tumor with some morphological similarity with the nephroblastoma must be considered in the renal adenomas diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Pathology section, Fundació Puigvert, Universitat Autónoma de Barcelona (UAB), 08025 Barcelona, Spain. falgaba@fundacio-puivert.es

ABSTRACT
The renal adenomas can be confused by imaging diagnosis with malignant renal tumors, but there are also real biological dilemmas to determine their behavior. The consensus decisions are the following. (1) The adenoma of clear cells is not accepted, instead it is considered that all the clear-cell tumors are carcinomas, with greater or lesser aggressiveness. (2) Among the papillary neoplasms the WHO 2004 renal cell tumors classification are considered as papillary adenomas tumors with a maximum diameter of 5 mm and may represent a continuum biological process to papillary renal cell carcinoma. The papillary adenomas associated with End-kidney and/or acquired cystic disease may have a different pathogenesis. (3) To consider a tumor as an oncocytoma the size is not important, only the cytological features, microscopic, ultrastructural, and immunohistochemically can help, but some chromosomal observations introduce some questions about its relation with the chromophobe renal cell carcinoma. (4) Finally, the metanephric adenoma, a tumor with some morphological similarity with the nephroblastoma must be considered in the renal adenomas diagnosis.

No MeSH data available.


Related in: MedlinePlus