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Adult multilocular cystic nephroma: Report of six cases with clinical, radio-pathologic correlation and review of literature.

Wilkinson C, Palit V, Bardapure M, Thomas J, Browning AJ, Gill K, Biyani CS - Urol Ann (2013)

Bottom Line: No cells with clear cytoplasm, blastemal or immature elements were seen.In one case, foci of inflammatory cells and histiocytes were present.MCN is a benign cystic lesion and clinical presentations are nonspecific with symptoms such as abdominal pain, hematuria and urinary tract infection.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Pinderfields General Hospital, Wakefield, West Yorkshire, UK.

ABSTRACT

Background: Cystic renal neoplasms of the kidney can be benign or malignant. Multicystic nephroma (MCN) represents a rare benign cystic lesion of the kidney, which usually presents as a unilateral multicystic renal mass without solid elements. According to the World Health Organization (WHO) classification of the renal neoplasms, it is grouped along with mixed epithelial-stromal tumor of the kidney.

Materials and methods: We report a retrospective review of six cases of MCN of kidney. Patient demographics, imaging findings, operative details and final histology were recorded.

Results: All patients had suspicious/malignant features on radiological examination, leading to a radical nephrectomy. However, microscopically these lesions were lined by cuboidal epithelium, and in a few places hobnail epithelium. No cells with clear cytoplasm, blastemal or immature elements were seen. In one case, foci of inflammatory cells and histiocytes were present.

Conclusions: MCN is a benign cystic lesion and clinical presentations are nonspecific with symptoms such as abdominal pain, hematuria and urinary tract infection. These nonspecific clinical presentations and confusing radiological features create difficult preoperative differentiation from malignant cystic renal neoplasms.

No MeSH data available.


Related in: MedlinePlus

Microscopy showing hobnail appearance of cyst lining ×40
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Figure 4: Microscopy showing hobnail appearance of cyst lining ×40

Mentions: The pathological features of the multilocular cystic renal neoplasms including cystic nephroma and cystic hamartoma, which show cystic growth pattern, are very difficult to separate radiographically.[24] Fine needle aspiration cytology (FNAC) has been attempted in order to establish a preoperative diagnosis. Papanicolaou staining of the cyst fluid showed markedly atypical cells forming papillary clusters. However, though not very conclusive, low cellularity, absence of necrosis, and paucity of single cells should be viewed with suspicion of MCN.[25] All six cases in this study had lesions lined by cuboidal epithelium [Figure 3], and in a few places hobnail epithelium [Figure 4] was seen. The stroma was composed of varying amounts of hyalinized spindle cells, fibroblasts, and smaller renal tubules lined by single layer of cuboidal epithelium. No cells with clear cytoplasm, blastemal or immature elements were seen. However, foci of inflammatory cells and histiocytes were noted in one case. On immunohistochemistry, all six cases had an ovarian-like stroma in between the cysts, positive for both estrogen receptor (ER) and progesterone receptor (PR). No serological markers or immunohistochemistry features are conclusive in differentiating between MCN, cystic partially differentiated nephroma and cystic renal cell carcinoma.[5] Stromal positivity for ER or PR was seen in all of our cases, indicating that such positivity should support a diagnosis of MCN. Frozen section could be an option in deciding between radical and nephron-sparing nephrectomy, but partially cystic renal cell carcinoma may be potentially missed on frozen section. None of the cases in the present series was deemed suitable for partial nephrectomy because of the size and position of the lesion.


Adult multilocular cystic nephroma: Report of six cases with clinical, radio-pathologic correlation and review of literature.

Wilkinson C, Palit V, Bardapure M, Thomas J, Browning AJ, Gill K, Biyani CS - Urol Ann (2013)

Microscopy showing hobnail appearance of cyst lining ×40
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3643315&req=5

Figure 4: Microscopy showing hobnail appearance of cyst lining ×40
Mentions: The pathological features of the multilocular cystic renal neoplasms including cystic nephroma and cystic hamartoma, which show cystic growth pattern, are very difficult to separate radiographically.[24] Fine needle aspiration cytology (FNAC) has been attempted in order to establish a preoperative diagnosis. Papanicolaou staining of the cyst fluid showed markedly atypical cells forming papillary clusters. However, though not very conclusive, low cellularity, absence of necrosis, and paucity of single cells should be viewed with suspicion of MCN.[25] All six cases in this study had lesions lined by cuboidal epithelium [Figure 3], and in a few places hobnail epithelium [Figure 4] was seen. The stroma was composed of varying amounts of hyalinized spindle cells, fibroblasts, and smaller renal tubules lined by single layer of cuboidal epithelium. No cells with clear cytoplasm, blastemal or immature elements were seen. However, foci of inflammatory cells and histiocytes were noted in one case. On immunohistochemistry, all six cases had an ovarian-like stroma in between the cysts, positive for both estrogen receptor (ER) and progesterone receptor (PR). No serological markers or immunohistochemistry features are conclusive in differentiating between MCN, cystic partially differentiated nephroma and cystic renal cell carcinoma.[5] Stromal positivity for ER or PR was seen in all of our cases, indicating that such positivity should support a diagnosis of MCN. Frozen section could be an option in deciding between radical and nephron-sparing nephrectomy, but partially cystic renal cell carcinoma may be potentially missed on frozen section. None of the cases in the present series was deemed suitable for partial nephrectomy because of the size and position of the lesion.

Bottom Line: No cells with clear cytoplasm, blastemal or immature elements were seen.In one case, foci of inflammatory cells and histiocytes were present.MCN is a benign cystic lesion and clinical presentations are nonspecific with symptoms such as abdominal pain, hematuria and urinary tract infection.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Pinderfields General Hospital, Wakefield, West Yorkshire, UK.

ABSTRACT

Background: Cystic renal neoplasms of the kidney can be benign or malignant. Multicystic nephroma (MCN) represents a rare benign cystic lesion of the kidney, which usually presents as a unilateral multicystic renal mass without solid elements. According to the World Health Organization (WHO) classification of the renal neoplasms, it is grouped along with mixed epithelial-stromal tumor of the kidney.

Materials and methods: We report a retrospective review of six cases of MCN of kidney. Patient demographics, imaging findings, operative details and final histology were recorded.

Results: All patients had suspicious/malignant features on radiological examination, leading to a radical nephrectomy. However, microscopically these lesions were lined by cuboidal epithelium, and in a few places hobnail epithelium. No cells with clear cytoplasm, blastemal or immature elements were seen. In one case, foci of inflammatory cells and histiocytes were present.

Conclusions: MCN is a benign cystic lesion and clinical presentations are nonspecific with symptoms such as abdominal pain, hematuria and urinary tract infection. These nonspecific clinical presentations and confusing radiological features create difficult preoperative differentiation from malignant cystic renal neoplasms.

No MeSH data available.


Related in: MedlinePlus