525231
research-article2014
IJSXXX10.1177/1066896914525231International Journal of Surgical PathologyHes et al
Letter to the Editor International Journal of Surgical Pathology 2014, Vol. 22(5) 478–479 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1066896914525231 ijs.sagepub.com
Adult biphasic renal tumors Ondrej Hes, MD, PhD1, Petr Kujal, MD, PhD2, Josef Sach, MD2, Petr Nencka, MD2, and Michal Michal, MD1 Dear Editor, We have read, with interest, the article by Dr Mudaliar and colleagues.1 The authors reported a highly unusual and fascinating mixed epithelial and stromal tumor of the kidney (MESTK) with papillary renal cell carcinoma (type 1) arising in one of the cysts. Apparently, the papillary component was an integral part of the main tumorous mass. We have come across a similar case, composed of typical MESTK in a 55-year-old Caucasian male. His past medical history was unremarkable, without any hormonal or antihormonal therapy. No other tumors were disclosed by computed tomography scan. The tumor was located in the left kidney. The largest diameter was 45 mm, and the stage was pT1b according TMN 2009. The tumor was composed of a solid Mullerian stromal component and variable cystic structures (Figures 1 and 2). The cystic component was formed by large tubules or smaller cysts lined with hobnail type of epithelium, sometimes with ciliated columnar cells. The epithelial lining of the cysts and tubules was positive for progesterone, estrogen receptors (Figure 3), and CK7. AMACR and vimentin were negative in the epithelial component. The Mullerian stroma was positive for vimentin and negative for CK7 and estrogen and progesterone receptors. At the edge of the MESTK was located a small lowgrade papillary renal tumor. The size of the tumor was less than 5 mm, with a tubopapillary architecture and uniform, basophilic cells. No mitoses, necrosis, foam cells, or siderophages were seen. The tumor was positive for vimentin and AMACR and negative for estrogen and progesterone receptors. Diagnosis of papillary adenoma of the kidney (PA) was established. We performed a FISH study of the status of chromosomes 7 and 17 on both components, that is, on MESTK and PA. Both chromosomes were polysomic in PA component. Disomy of chromosomes 7 and 17 was disclosed in MESTK. It seems that our case differs from the previously reported composite tumor in several aspects. The patient was male, which is a highly unusual situation. A limited number of the cases in adult patients have been published in the English written literature.2-4 Noteworthy is that the patient did not undergo any antiandrogenic or hormonal therapy. The PA was not an integral part of the tumorous mass. It had a different immunohistochemical profile and a
Figure 1. Low magnification showed MESTK with papillary renal adenoma located at the edge of the main tumorous mass (left).
different status of chromosomes 7 and 17. Structures of PA were located in the edge of the MESTK and were relatively well demarcated from the main tumorous mass of the MESTK. There were no transitional or overlapping areas between PA and MESTK. Thus, it seems that our case was a collision tumor rather than PA arising on the background of MESTK. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
1
Charles University in Prague, Faculty of Medicine in Plzenˇ , Plzenˇ , Czech Republic 2 Kralovske Vinohrady University Hospital, 3rd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic Corresponding Author: Ondrej Hes, Department of Pathology, Charles University, Medical Faculty, and Charles University Hospital Plzenˇ , Alej Svobody 80, 304 60 Plzenˇ , Czech Republic. Email: [email protected]
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Hes et al
Figure 2. The main tumor (MESTK) was composed of a solid Mullerian stromal component (A) and variable cystic structures (B). Supported by Ministry of Health, Czech Republic: Conceptual Development of Research Organization (Faculty Hospital in Pilsen—FNPl, 00669806).
References
Figure 3. The epithelial lining of the cysts and tubules of MESTK component was positive for estrogen receptor, whereas papillary adenoma was negative.
Funding
1. Mudaliar KM, Mehta V, Gupta GN, Picken MM. Expanding the morphologic spectrum of adult biphasic renal tumors— mixed epithelial and stromal tumor of the kidney with focal papillary renal cell carcinoma: case report and review of the literature [published online May 27, 2013]. Int J Surg Pathol. doi:10.1177/1066896913488823. 2. Moses KA, Oliva IV, Osunkoya AO, Carney KJ. An unusual presentation of a mixed epithelial and stromal tumor in an elderly male. Scientific World Journal. 2010;10:1810-1813. 3. Colombo P, Naspro R, Vallieri L, et al. Non-hormoneinduced mixed epithelial and stromal tumor of kidney in a man: description of a rare case. Urology. 2008;71:168.e7-e9. 4. Mai KT, Elkeilani A, Veinot JP. Mixed epithelial and stromal tumour (MEST) of the kidney: report of 14 cases with male and PEComatous variants and proposed histopathogenesis. Pathology. 2007;39:235-240.
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article:
Downloaded from ijs.sagepub.com at CALIF STATE POLY UNIV LIBRARY on March 13, 2015
research-article2014
IJSXXX10.1177/1066896914525231International Journal of Surgical PathologyHes et al
Letter to the Editor International Journal of Surgical Pathology 2014, Vol. 22(5) 478–479 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1066896914525231 ijs.sagepub.com
Adult biphasic renal tumors Ondrej Hes, MD, PhD1, Petr Kujal, MD, PhD2, Josef Sach, MD2, Petr Nencka, MD2, and Michal Michal, MD1 Dear Editor, We have read, with interest, the article by Dr Mudaliar and colleagues.1 The authors reported a highly unusual and fascinating mixed epithelial and stromal tumor of the kidney (MESTK) with papillary renal cell carcinoma (type 1) arising in one of the cysts. Apparently, the papillary component was an integral part of the main tumorous mass. We have come across a similar case, composed of typical MESTK in a 55-year-old Caucasian male. His past medical history was unremarkable, without any hormonal or antihormonal therapy. No other tumors were disclosed by computed tomography scan. The tumor was located in the left kidney. The largest diameter was 45 mm, and the stage was pT1b according TMN 2009. The tumor was composed of a solid Mullerian stromal component and variable cystic structures (Figures 1 and 2). The cystic component was formed by large tubules or smaller cysts lined with hobnail type of epithelium, sometimes with ciliated columnar cells. The epithelial lining of the cysts and tubules was positive for progesterone, estrogen receptors (Figure 3), and CK7. AMACR and vimentin were negative in the epithelial component. The Mullerian stroma was positive for vimentin and negative for CK7 and estrogen and progesterone receptors. At the edge of the MESTK was located a small lowgrade papillary renal tumor. The size of the tumor was less than 5 mm, with a tubopapillary architecture and uniform, basophilic cells. No mitoses, necrosis, foam cells, or siderophages were seen. The tumor was positive for vimentin and AMACR and negative for estrogen and progesterone receptors. Diagnosis of papillary adenoma of the kidney (PA) was established. We performed a FISH study of the status of chromosomes 7 and 17 on both components, that is, on MESTK and PA. Both chromosomes were polysomic in PA component. Disomy of chromosomes 7 and 17 was disclosed in MESTK. It seems that our case differs from the previously reported composite tumor in several aspects. The patient was male, which is a highly unusual situation. A limited number of the cases in adult patients have been published in the English written literature.2-4 Noteworthy is that the patient did not undergo any antiandrogenic or hormonal therapy. The PA was not an integral part of the tumorous mass. It had a different immunohistochemical profile and a
Figure 1. Low magnification showed MESTK with papillary renal adenoma located at the edge of the main tumorous mass (left).
different status of chromosomes 7 and 17. Structures of PA were located in the edge of the MESTK and were relatively well demarcated from the main tumorous mass of the MESTK. There were no transitional or overlapping areas between PA and MESTK. Thus, it seems that our case was a collision tumor rather than PA arising on the background of MESTK. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
1
Charles University in Prague, Faculty of Medicine in Plzenˇ , Plzenˇ , Czech Republic 2 Kralovske Vinohrady University Hospital, 3rd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic Corresponding Author: Ondrej Hes, Department of Pathology, Charles University, Medical Faculty, and Charles University Hospital Plzenˇ , Alej Svobody 80, 304 60 Plzenˇ , Czech Republic. Email: [email protected]
Downloaded from ijs.sagepub.com at CALIF STATE POLY UNIV LIBRARY on March 13, 2015
479
Hes et al
Figure 2. The main tumor (MESTK) was composed of a solid Mullerian stromal component (A) and variable cystic structures (B). Supported by Ministry of Health, Czech Republic: Conceptual Development of Research Organization (Faculty Hospital in Pilsen—FNPl, 00669806).
References
Figure 3. The epithelial lining of the cysts and tubules of MESTK component was positive for estrogen receptor, whereas papillary adenoma was negative.
Funding
1. Mudaliar KM, Mehta V, Gupta GN, Picken MM. Expanding the morphologic spectrum of adult biphasic renal tumors— mixed epithelial and stromal tumor of the kidney with focal papillary renal cell carcinoma: case report and review of the literature [published online May 27, 2013]. Int J Surg Pathol. doi:10.1177/1066896913488823. 2. Moses KA, Oliva IV, Osunkoya AO, Carney KJ. An unusual presentation of a mixed epithelial and stromal tumor in an elderly male. Scientific World Journal. 2010;10:1810-1813. 3. Colombo P, Naspro R, Vallieri L, et al. Non-hormoneinduced mixed epithelial and stromal tumor of kidney in a man: description of a rare case. Urology. 2008;71:168.e7-e9. 4. Mai KT, Elkeilani A, Veinot JP. Mixed epithelial and stromal tumour (MEST) of the kidney: report of 14 cases with male and PEComatous variants and proposed histopathogenesis. Pathology. 2007;39:235-240.
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article:
Downloaded from ijs.sagepub.com at CALIF STATE POLY UNIV LIBRARY on March 13, 2015
