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International Journal of Molecular... Feb 2022Renal oncocytoma represents the most common type of benign neoplasm that is an increasing concern for urologists, oncologists, and nephrologists due to its difficult... (Review)
Review
Renal oncocytoma represents the most common type of benign neoplasm that is an increasing concern for urologists, oncologists, and nephrologists due to its difficult differential diagnosis and frequent overtreatment. It displays a variable neoplastic parenchymal and stromal architecture, and the defining cellular element is a large polygonal, granular, eosinophilic, mitochondria-rich cell known as an oncocyte. The real challenge in the oncocytoma treatment algorithm is related to the misdiagnosis due to its resemblance, at an initial radiological assessment, to malignant renal cancers with a completely different prognosis and medical treatment. Unfortunately, percutaneous renal biopsy is not frequently performed due to the possible side effects related to the procedure. Therefore, the majority of oncocytoma are diagnosed after the surgical operation via partial or radical nephrectomy. For this reason, new reliable strategies to solve this issue are needed. In our review, we will discuss the clinical implications of renal oncocytoma in daily clinical practice with a particular focus on the medical diagnosis and treatment and on the potential of novel promising molecular biomarkers such as circulating microRNAs to distinguish between a benign and a malignant lesion.
Topics: Adenoma, Oxyphilic; Carcinoma, Renal Cell; Diagnosis, Differential; Humans; Kidney Neoplasms; Nephrectomy
PubMed: 35269747
DOI: 10.3390/ijms23052603 -
European Urology Jan 2021Renal oncocytoma (RO) accounts for 5% of renal cancers and generally behaves as a benign tumor with favorable long-term prognosis. It is difficult to confidently...
Renal oncocytoma (RO) accounts for 5% of renal cancers and generally behaves as a benign tumor with favorable long-term prognosis. It is difficult to confidently distinguish between benign RO and other renal malignancies, particularly chromophobe renal cell carcinoma (chRCC). Therefore, RO is often managed aggressively with surgery. We sought to identify molecular biomarkers to distinguish RO from chRCC and other malignant renal cancer mimics. In a 44-patient discovery cohort, we identified a significant differential abundance of nine genes in RO relative to chRCC. These genes were used to train a classifier to distinguish RO from chRCC in an independent 57-patient cohort. The trained classifier was then validated in five independent cohorts comprising 89 total patients. This nine-gene classifier trained on the basis of differential gene expression showed 93% sensitivity and 98% specificity for distinguishing RO from chRCC across the pooled validation cohorts, with a c-statistic of 0.978. This tool may be a useful adjunct to other diagnostic modalities to decrease the diagnostic and management uncertainty associated with small renal masses and to enable clinicians to recommend more confidently less aggressive management for some tumors. PATIENT SUMMARY: Renal oncocytoma is generally a benign form of kidney cancer that does not necessarily require surgical removal. However, it is difficult to distinguish renal oncocytoma from other more aggressive forms of kidney cancer, so it is treated most commonly with surgery. We built a classification tool based on the RNA levels of nine genes that may help avoid these surgeries by reliably distinguishing renal oncocytoma from other forms of kidney cancer.
Topics: Adenoma, Oxyphilic; Carcinoma, Renal Cell; Diagnosis, Differential; Gene Expression; Humans; Kidney Neoplasms
PubMed: 32972793
DOI: 10.1016/j.eururo.2020.09.017 -
Human Pathology May 2017Well-differentiated hepatocellular carcinoma (HCC) shares overlapping histological features with benign hepatocellular lesions, including hepatocellular adenoma and... (Review)
Review
Well-differentiated hepatocellular carcinoma (HCC) shares overlapping histological features with benign hepatocellular lesions, including hepatocellular adenoma and focal nodular hyperplasia in non-cirrhotic liver, and with high-grade dysplastic nodule in cirrhotic liver. Several metastatic tumors, such as neuroendocrine tumor, renal cell carcinoma, adrenocortical carcinoma, melanoma, and epithelioid angiomyolipoma, can be indistinguishable from HCC on histologic grounds. Since this distinction has important therapeutic implications, judicious use of immunohistochemical markers plays an important role in establishing an accurate diagnosis, especially when limited material of tumor is available on cell block or a small core biopsy. This review describes commonly used immunohistochemical markers used in the diagnosis of HCC, highlighting advantages and disadvantages of each marker, and suggests appropriate immunohistochemical panels for specific clinicopathologic situations.
Topics: Adenoma, Liver Cell; Biomarkers, Tumor; Biopsy; Carcinoma, Hepatocellular; Cell Differentiation; Diagnosis, Differential; Focal Nodular Hyperplasia; Humans; Immunohistochemistry; Liver Neoplasms; Neoplasm Metastasis; Predictive Value of Tests; Prognosis; Reproducibility of Results
PubMed: 28087475
DOI: 10.1016/j.humpath.2016.12.025 -
Human Pathology Aug 2015Metanephric neoplasms of the kidney are uncommon, and some cases are associated with papillary carcinoma. Most cases of metanephric adenoma occur in adults, with fewer...
Metanephric neoplasms of the kidney are uncommon, and some cases are associated with papillary carcinoma. Most cases of metanephric adenoma occur in adults, with fewer than 25 cases reported in children, and metanephric adenofibroma is even less common. The few metanephric tumors studied at the genetic level have not shown the gains of chromosomes 7 and 17 commonly seen in renal cell carcinoma, suggesting that the carcinoma arising in this setting has a separate genetic origin from the adenoma. However, the assumption that this carcinoma has the same chromosome gains as sporadic renal cell carcinoma has never been validated. We studied 4 cases of metanephric tumors in children, including 1 metanephric adenofibroma with papillary carcinoma. The composite tumor was studied by single nucleotide polymorphism array and fluorescence in situ hybridization, with the adenoma and carcinoma components analyzed separately. No copy number alterations were detected in either component. A BRAF V600E mutation has been reported in most cases of metanephric adenoma in adults. We performed BRAF V600E immunostaining and sequencing in our 4 pediatric cases. Three cases had a BRAF V600E mutation including the composite tumor, with both the adenoma and carcinoma components showing the same mutation. This finding provides the first genetic evidence that these 2 tumors are biologically linked. Ten cases each of pediatric renal cell carcinoma and Wilms tumor were immunonegative. Thus, BRAF V600E immunostaining is a helpful marker for pediatric metanephric adenoma, and additional research is required on the possible role of this mutation in the development of renal carcinoma.
Topics: Adenoma; Carcinoma, Papillary; Child; Child, Preschool; DNA Mutational Analysis; Humans; Immunohistochemistry; In Situ Hybridization, Fluorescence; Kidney Neoplasms; Male; Mutation; Neoplasms, Complex and Mixed; Polymerase Chain Reaction; Polymorphism, Single Nucleotide; Proto-Oncogene Proteins B-raf
PubMed: 26014474
DOI: 10.1016/j.humpath.2015.03.019 -
Pathology, Research and Practice Jul 2017Nephrogenic adenoma is an uncommon benign lesion that occurs at several sites in urinary tract, from the renal pelvis to urethra, with the highest frequency in urinary... (Review)
Review
BACKGROUND
Nephrogenic adenoma is an uncommon benign lesion that occurs at several sites in urinary tract, from the renal pelvis to urethra, with the highest frequency in urinary bladder. Nephrogenic adenoma displays a broad spectrum of architectural and cytological features. Hence, recognition of its characteristic histopathological features is needed to distinguish this lesion from its mimickers.
MATERIALS AND METHODS
A retrospective series of 21 cases of nephrogenic adenoma in 18 patients, which were diagnosed in our department between 2010 and 2016, were analyzed. All histological slides were reviewed by two pathologists and the diagnosis of each case was confirmed. Immunohistochemistry was performed for PAX-8 in all cases. CK7, PAX-2, PSA, p53, p63, GATA-3 and α-methylacyl-CoA racemase (AMACR) were applied in problematic cases.
RESULTS
The most common location of the lesion was urinary bladder (14 patients) followed by renal pelvis (2 patients), ureter (1 patient) and urethra (1 patient). A history of urothelial carcinoma and repeated TUR procedures were observed in 12 patients. There were 2 pediatric patients aged 3 years. Both of them had undergone previous urosurgery because of megaureter in one and bladder exstrophy in the other. Other clinical antecedents included bladder diverticulum (1 patient), cystitis (1 patient) and nephrolithiasis (1 patient). Recurrence of lesion was seen in two patients (once in one case and twice in the other one). The median time to disease recurrence in these patients was 11 months (range, 2-20 months). Histologically, the lesions exhibited various morphological findings, with mixed (15 cases, 71.4%), pure tubular (3 cases, 14.3%), pure papillary (2 cases, 9.5%) and pure flat (1 case, 4.8%) growth patterns. Of the 15 cases with mixed patterns, 8 cases were tubulocystic and flat, 3 cases were tubular and flat, 2 cases were tubular, papillary and flat, 1 case was tubulocystic, papillary and flat, and 1 case was tubular and papillary. Flat pattern was observed in 15 cases (71.4%). It was seen in association with other patterns in 14 cases (mixed morphology) and purely in 1 case. Our findings suggested that the flat pattern is a frequent finding in nephrogenic adenomas. Notably one case in this series showed superficial extension into bladder muscularis propria.
CONCLUSIONS
Histologically nephrogenic adenoma may simulate a variety of malignancies. Awareness of characteristic morphologic features of nephrogenic adenoma is needed to diagnose this lesion correctly.
Topics: Adenoma; Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Biopsy; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Immunohistochemistry; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Predictive Value of Tests; Retrospective Studies; Time Factors; Treatment Outcome; Turkey; Urologic Neoplasms; Young Adult
PubMed: 28554748
DOI: 10.1016/j.prp.2017.03.001 -
Histopathology Jun 2021Papillary renal neoplasm with reverse polarity (PRNRP) is a newly defined entity with distinct histomorphology and recurrent KRAS mutation. It has been estimated to...
AIMS
Papillary renal neoplasm with reverse polarity (PRNRP) is a newly defined entity with distinct histomorphology and recurrent KRAS mutation. It has been estimated to constitute 4% of previously diagnosed papillary renal cell carcinoma (PRCC). Renal papillary adenoma (PA) is suggested to be the precursor of PRCC. This study aimed to investigate the association between PRNRP and PA, particularly the morphologically similar type D PA.
METHODS AND RESULTS
Nephrectomy specimens of PRCC and PA from our 10-year pathology archives were retrieved and reviewed. GATA3 immunohistochemistry and RAS/BRAF testing were performed in all cases reclassified as PRNRP and all PAs with sufficient materials. Overall, PRNRP accounted for 9.1% (10 of 110) of PRCC and there was no recurrence/metastasis with a mean follow-up period of 39 months. Three novel morphological features were described, including clear cell change, mast cell infiltration and metaplastic ossification. Nine of the 10 PRNRPs showed diffuse and strong GATA3 expression and KRAS missense mutations at codon 12. One case exhibited moderate GATA3 staining on 80% of the tumour cells and RAS/BRAF wild-type. In a total of 73 PAs, 11 were classified as type D. GATA3 expression was significantly more frequent in type D versus non-type D PAs (100 versus 35%, P < 0.01). KRAS missense mutations were identified in six of eight (75%) of the type D PAs but none of the 18 non-type D PAs.
CONCLUSIONS
Type D PA was different from other types of PA and represented an analogue or a small-sized PRNRP for their identical morphology, immunophenotype and molecular signature.
Topics: Adenoma; Aged; Aged, 80 and over; Biomarkers, Tumor; Carcinoma, Papillary; Carcinoma, Renal Cell; Diagnosis, Differential; Female; GATA3 Transcription Factor; Humans; Immunohistochemistry; Kidney; Kidney Neoplasms; Male; Middle Aged; Mutation; Proto-Oncogene Proteins p21(ras)
PubMed: 33351968
DOI: 10.1111/his.14320 -
Frontiers in Endocrinology 2021To assess the efficacy and safety of ultrasound-guided microwave ablation (MWA) in the treatment of primary hyperparathyroidism (PHPT), and to investigate whether MWA...
OBJECTIVE
To assess the efficacy and safety of ultrasound-guided microwave ablation (MWA) in the treatment of primary hyperparathyroidism (PHPT), and to investigate whether MWA can improve the bone turnover and renal function.
METHODS
A total of 20 consecutive PHPT patients with 21 parathyroid lesions treated with MWA in our center from May 2019 to March 2021 were recruited in this study. Serum parathyroid hormone (PTH), calcium and phosphorus levels before MWA and at 20 minutes, 4 hours, 1 day, 3 months, 6 months and 12 months after MWA were measured. Bone turnover biomarkers, renal function and lesion volume with volume reduction rate (VRR) before MWA and at the last follow-up were compared. Any complication related with MWA was evaluated. The technical and clinical success rates of MWA in the treatment of PHPT were calculated. Clinical success was defined as normal serum PTH and calcium without PHPT-associated manifestations at more than 6 months after ablation. Technical success was defined as complete ablation indicated by immediate postoperative contrast-enhanced ultrasound.
RESULTS
The serum PTH, calcium and phosphorus levels at their respective follow-up time points dropped significantly after MWA (0.05). The volume of parathyroid lesions at the final examination was significantly reduced, compared with pre-ablation volume (0.001), with a median VRR reaching 89%. The technical and clinical success rates were 100% and 63.6%, respectively. Substantial changes of bone turnover biomarkers were observed before and after MWA (0.05), but the differences in renal function were not statistically significant. No major complications were reported in all cases. Pre-MWA serum PTH, lesion volume, maximum diameter of lesion and ablation time were significantly different between patients with successful and failed MWA.
CONCLUSIONS
PHPT can be effectively and safely treated by ultrasound-guided MWA, as proven by drop in serum PTH and reduction in the volume of parathyroid adenomas. Besides, MWA can impede bone remodeling to suppress hyperparathyroidism in the condition of PHPT.
Topics: Adenoma; Adult; Biomarkers; Bone Remodeling; Female; Follow-Up Studies; Humans; Hyperparathyroidism, Primary; Male; Microwaves; Middle Aged; Parathyroid Hormone; Parathyroid Neoplasms; Radiofrequency Ablation; Ultrasonography, Interventional
PubMed: 34925241
DOI: 10.3389/fendo.2021.782050 -
Cancer Cytopathology Dec 2020The goal of this study was to evaluate the morphology, immunoprofile, and management of renal oncocytoma (RO), hybrid oncocytic tumor (HOT), and chromophobe renal cell...
BACKGROUND
The goal of this study was to evaluate the morphology, immunoprofile, and management of renal oncocytoma (RO), hybrid oncocytic tumor (HOT), and chromophobe renal cell carcinoma (ChRCC).
METHODS
Forty-seven cases of RO, 7 cases of HOT, and 25 cases of ChRCC were included in the study. Tissue microarrays were prepared for immunohistochemical evaluation.
RESULTS
Large sheets of cells with transverse vessels, and higher nuclear grade were seen more often in ChRCC than in RO or HOT. Tumor cells of RO were more uniform in size and shape relative to HOT and ChRCC. The cytoplasmic features of RO were more uniformly granular relative to HOT and ChRCC, which exhibited variable cytoplasmic features. CK7 and MUC1 were expressed more frequently and diffusely in ChRCC (54% and 94%, respectively) than RO (4% and 52%, respectively) and HOT (0% and 71%, respectively). AMACR and PAX8 were more frequently expressed diffusely in RO (67% and 42%, respectively) than in HOT (0% and 0%, respectively) or ChRCC (14% and 11%, respectively). Most HOT (57%) and CHRCC (60%) patients underwent nephrectomy. Cryoablation was the treatment of choice for 24% of patients with ChRCC, 2% of patients with RO, and 0% of patients with HOT. The majority of patients with RO (88%) opted for active surveillance-a much higher rate than that for patients with HOT (29%) or ChRCC (12%).
CONCLUSION
Some cytologic features and immunomarkers are useful in differentiating RO, HOT, and ChRCC. Because no immunomarker or morphologic finding is specific by itself, a combination of morphologic features with immunohistochemistry appears to be the most reliable way to distinguish ChRCC, HOT, and RO on biopsy samples. Subclassification of renal oncocytic tumors into specific categories impacts clinical management and downstream treatment selection.
Topics: Adenoma, Oxyphilic; Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Biopsy, Fine-Needle; Carcinoma, Renal Cell; Cytodiagnosis; Diagnosis, Differential; Disease Management; Female; Follow-Up Studies; Humans; Immunohistochemistry; Kidney Neoplasms; Male; Middle Aged; Nephrectomy; Prognosis; Retrospective Studies
PubMed: 32697415
DOI: 10.1002/cncy.22330 -
Diagnostic and Interventional Imaging Jun 2016Dual energy computed tomography (CT) is an imaging technique based on data acquisition at two different energy settings. Recent advances in CT have allowed data... (Review)
Review
Dual energy computed tomography (CT) is an imaging technique based on data acquisition at two different energy settings. Recent advances in CT have allowed data acquisition and almost simultaneously analysis of two spectra of X-rays at different energy levels resulting in novel developments in the field of abdominal imaging. This technique is widely used in cardiovascular imaging, especially for pulmonary embolism work-up but is now also increasingly developed in the field of abdominal imaging. With dual-energy CT it is possible to obtain virtual unenhanced images from monochromatic reconstructions as well as attenuation maps of different elements, thereby improving detection and characterization of a variety of renal, adrenal, hepatic and pancreatic abnormalities. Also, dual-energy CT can provide information regarding urinary calculi composition. This article reviews and illustrates the different applications of dual-energy CT in routine abdominal imaging.
Topics: Adenoma; Adrenal Gland Neoplasms; Artifacts; Humans; Kidney Calculi; Kidney Neoplasms; Liver Neoplasms; Mesenteric Ischemia; Pancreatic Neoplasms; Radiation Dosage; Radiography, Abdominal; Radiography, Dual-Energy Scanned Projection; Tomography, X-Ray Computed
PubMed: 26993967
DOI: 10.1016/j.diii.2015.11.018 -
Critical Reviews in Oncology/hematology Jun 2020To characterize metanephric tumours in children, we performed a literature review investigating paediatric metanephric adenomas (MA), metanephric stromal tumours (MST)... (Review)
Review
To characterize metanephric tumours in children, we performed a literature review investigating paediatric metanephric adenomas (MA), metanephric stromal tumours (MST) and metanephric adenofibromas (MAF). Including two patients from our own institution (MA, MAF), 110 individual cases (41 MA, 20 MAF, 49 MST) were identified. Additionally, fifteen composite tumours were identified, with areas of MA/MAF and Wilms tumour (WT) or papillary carcinoma. No distinct clinical or radiological features could be defined. In pure metanephric tumours, histologically proven distant metastases were reported once (MA), relapse was reported once (MST) and one tumour-related death occurred (MST). Somatic BRAF-V600E mutations were tested in 15 cases, and identified in 3/6 MA, 3/3 MAF, and 6/6 MST. In our institution the MA harboured a somatic KRAS-G12R mutation. Overall, paediatric metanephric tumours are difficult to discriminate from other renal tumours at presentation, behave relatively benign, and the occurrence of composite tumours warrants analysis of underlying (genetic) pathways.
Topics: Adenoma; Biomarkers, Tumor; Carcinoma, Papillary; Child; DNA Mutational Analysis; Humans; Immunohistochemistry; Immunophenotyping; Kidney Neoplasms; Neoplasm Recurrence, Local; Proto-Oncogene Proteins p21(ras); Wilms Tumor
PubMed: 32371339
DOI: 10.1016/j.critrevonc.2020.102970