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Fu G, Xiao R, Yang X, Lu T. Case Report: A rare case of mixed epithelial and stromal tumor of the kidney in an adolescent: imaging findings and literature review. Front Pediatr 2025; 13:1550425. [PMID: 40406359 PMCID: PMC12095007 DOI: 10.3389/fped.2025.1550425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Accepted: 04/21/2025] [Indexed: 05/26/2025] Open
Abstract
Mixed epithelial and stromal tumor of the kidney (MESTK) is an unusual biphasic benign renal neoplasm. It predominantly occurs in perimenopausal women, with only eight cases reported in children. Owing to its rarity, only limited radiological information has been reported in the literature, in none of the previous pediatric cases were both CT and MRI findings of the tumor provided. Herein, we report a rare case of MESTK in a 13-year-old girl. This case was the largest observed in children to date. Findings from our report provide novel insights into the MRI features of a large pediatric MESTK and indicate the importance of MRI for observing adipose components and the absence of diffusion restriction within the tumor. Radiologists should consider the possibility of MESTK in children when they observe a large, solid renal tumor without diffusion restriction in children.
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Affiliation(s)
- Guang Fu
- Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Rong Xiao
- Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xudan Yang
- Department of Pathology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Tao Lu
- Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
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2
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Simonds WF, Li Y, Jha S. Genotype-Phenotype Correlations in the Hyperparathyroidism-Jaw Tumor Syndrome. J Clin Endocrinol Metab 2025; 110:931-939. [PMID: 39775826 PMCID: PMC11913099 DOI: 10.1210/clinem/dgae909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Revised: 11/27/2024] [Accepted: 01/02/2025] [Indexed: 01/11/2025]
Abstract
Establishing genotype-phenotype correlations in disorders of hereditary endocrine neoplasia is important for clinical screening, genetic counseling, prognostication, surveillance, and surgical strategy, and may also provide clues about disease pathogenesis. Important genotype-phenotype correlations are recognized, for example, in pheochromocytoma/paraganglioma and multiple endocrine neoplasia type 2A. The presence of such correlations has been less clear in other familial endocrine disorders associated with primary hyperparathyroidism including multiple endocrine neoplasia type 1, and the hyperparathyroidism-jaw tumor syndrome (HPT-JT). Characteristic features of HPT-JT, apart from fibro-osseous jaw tumors and uterine lesions, include renal neoplasms, such as Wilms tumor and mixed epithelial and stromal tumor ("renal hamartomas"), and a high incidence of parathyroid cancer. Emerging evidence suggests two different genotype-phenotype correlations in HPT-JT based on the type of variant in the CDC73 tumor suppressor gene. Although multiple CDC73 genotypes can give rise to the Wilms tumor phenotype in HPT-JT, the development of mixed epithelial and stromal tumor of the kidney specifically correlates with the presence of a start-loss variant affecting the initiator methionine codon of parafibromin, the protein product encoded by CDC73. Furthermore, the risk of parathyroid cancer in HPT-JT also appears to correlate with genotype: CDC73 frameshift indel, splice-site, and stop-gain genotypes are associated with a greatly increased risk of parathyroid carcinoma compared to carriers of CDC73 missense and nonframeshift indel variants. The recognition of such genotype-phenotype correlations in HPT-JT may impact genetic counseling, patient care and disease surveillance.
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Affiliation(s)
- William F Simonds
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA
| | - Yulong Li
- Division of Endocrinology, Metabolism & Lipid Research, John T. Milliken Department of Internal Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Smita Jha
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA
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3
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Chen K, Zhao J, Sasani A, Sabour R, Cho H, Bansal R, Shu C, O'Connell R, Houshyar R. Role of imaging in the diagnosis and management of mixed epithelial and stromal tumors of the kidney: Case series and comprehensive review. Radiol Case Rep 2025; 20:1726-1735. [PMID: 39868056 PMCID: PMC11760803 DOI: 10.1016/j.radcr.2024.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Revised: 12/07/2024] [Accepted: 12/14/2024] [Indexed: 01/28/2025] Open
Abstract
Mixed epithelial and stromal tumor (MEST) of the kidney is a rare benign neoplasm composed of both stromal and epithelial components. MEST is mainly seen in adults with a strong predilection for perimenopausal women with history of hormone replacement therapy. While MEST is generally benign, there are reported cases of malignant transformation and adverse clinical outcomes. This case series will present 7 cases of this rare renal neoplasm with emphasis on radiological imaging as an important tool in the guidance of clinical management. Considering the rarity of this tumor and its variable presentation, understanding the radiological features on multiple modalities can guide appropriate clinical and surgical management of MEST patients.
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Affiliation(s)
- Kasha Chen
- Department of Radiology, University of California, Irvine, CA, USA
| | - Jasmine Zhao
- Department of Radiology, University of California, Irvine, CA, USA
| | - Ali Sasani
- Department of Radiology, University of California, Irvine, CA, USA
| | - Ryan Sabour
- Department of Radiology, University of California, Irvine, CA, USA
| | - Hannah Cho
- Department of Radiology, University of California, Irvine, CA, USA
| | - Riya Bansal
- Department of Radiology, University of California, Irvine, CA, USA
| | - Chang Shu
- Department of Radiology, University of California, Irvine, CA, USA
| | - Ryan O'Connell
- Department of Pathology, University of California, Irvine, CA, USA
| | - Roozbeh Houshyar
- Department of Radiology, University of California, Irvine, CA, USA
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M YH, Fayaz SN, Ganesh SR, Lazim NM, Tp R, Fathima R. Mixed Epithelial and Stromal Tumor of the Kidney: Clinicopathologic Features and Surgical Outcomes in Four Patients. Cureus 2025; 17:e77562. [PMID: 39958071 PMCID: PMC11830114 DOI: 10.7759/cureus.77562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2024] [Indexed: 02/18/2025] Open
Abstract
Mixed epithelial and stromal tumor (MEST) is a rare neoplasm of the kidney that is seen mostly in middle-aged women with a history of hormonal contraceptive consumption. Mixed epithelial and stromal tumors are usually benign tumors with minimal chances of metastasis and recurrence. However, few malignant transformations of MEST have been recorded. In perimenopausal patients presenting with a complex cystic renal mass in the renal system with a history of selective estrogen receptor modulator (SERM) therapy, MEST must be a differential diagnosis. The key treatment in MEST is surgical resection of the tumor. A MEST is similar to adult cystic nephroma (ACN), but MEST has complex epithelial and stromal components. We present a case series of four patients with a characteristic tumor of the kidney with the presence of mixed epithelial and stromal components. The ages of the patients ranged from 48 years to 55 years (mean age being 51 years). One of these cases is relatively rare as the patient is male and has no history of taking hormonal medications. Patients underwent surgical removal of tumors, and all of the patients recovered well postoperatively.
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Affiliation(s)
- Yateesh H M
- Surgery, Yenepoya Medical College Hospital, Mangalore, IND
| | | | - Sri Ram Ganesh
- Surgery, Yenepoya Medical College Hospital, Mangalore, IND
| | | | - Rajeev Tp
- Urology, K S Hegde Medical Academy, Mangalore, IND
| | - Rana Fathima
- Surgery, Yenepoya Medical College Hospital, Mangalore, IND
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5
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Nishiyama H, Tominaga M, Ito K, Hasegawa G, Ishida K, Hara N, Nishiyama T. Is it possible to diagnose mixed epithelial and stromal tumor of kidney prior to surgery? A case report. SAGE Open Med Case Rep 2024; 12:2050313X241308688. [PMID: 39713603 PMCID: PMC11660054 DOI: 10.1177/2050313x241308688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Accepted: 12/04/2024] [Indexed: 12/24/2024] Open
Abstract
We present a case in which renal mixed epithelial and stromal tumor (MEST) was considered in the differential diagnosis based on preoperative imaging findings. A 38-year-old woman was found to have a right renal tumor during an abdominal ultrasound examination conducted as part of a health checkup. Contrast-enhanced computed tomography revealed a 50 × 40-mm mass in the middle of the right kidney. The possibility of papillary renal cell carcinoma was considered. However, given the patient's age, sex, and characteristics of the mass, MEST was also considered a differential diagnosis. The patient underwent laparoscopic radical right nephrectomy. The tumor was diagnosed as MEST.
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Affiliation(s)
- Hiroki Nishiyama
- Department of Urology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minamiuonuma, Niigata, Japan
| | - Masaki Tominaga
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan
| | - Kozue Ito
- Department of Pathology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minamiuonuma, Niigata, Japan
| | - Go Hasegawa
- Department of Pathology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minamiuonuma, Niigata, Japan
| | - Kyohei Ishida
- Department of Urology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minamiuonuma, Niigata, Japan
| | - Noboru Hara
- Department of Urology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minamiuonuma, Niigata, Japan
| | - Tsutomu Nishiyama
- Department of Urology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minamiuonuma, Niigata, Japan
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Guo HP, Xu W, Hao YW, Kang HH, Zhang XJ, Ding XH, Zhao J, Bai X, Zhou SP, Ye HY, Wang HY. Differentiating mixed epithelial and stromal tumor family from predominantly cystic renal cell carcinoma using magnetic resonance imaging-based Bosniak classification system version 2019. Jpn J Radiol 2024; 42:1021-1030. [PMID: 38767732 DOI: 10.1007/s11604-024-01588-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 05/01/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE To differentiate mixed epithelial and stromal tumor family (MESTF) of the kidney from predominantly cystic renal cell carcinoma (RCC) using the magnetic resonance imaging (MRI)-based Bosniak classification system version 2019 (v2019). MATERIALS AND METHODS The study included 36 consecutive patients with MESTF and 77 with predominantly cystic RCC who underwent preoperative renal MRI. One radiologist evaluated and documented the clinical and MRI characteristics (age, sex, laterality, R.E.N.A.L. Nephrometry Score [RNS], surgical approach, the signal intensity on T2-weighted imaging, restricted diffusion and enhancement features in corticomedullary phase). Blinded to clinical and pathological information, another two radiologists independently evaluated Bosniak category of all masses. Interobserver agreement based on Bosniak classification system v2019 was measured by the weighted Cohen/Conger's Kappa coefficient. Furthermore, predominantly cystic RCCs and MESTFs were divided into low (categories I, II, and IIF) and high-class (categories III, and IV) tumors. The independent sample t test (Mann-Whitney U test) or Pearson Chi-square test (Fisher's exact probability test) was utilized to compare clinical and imaging characteristics between MESTFs and predominantly cystic RCCs. The performance of the Bosniak classification system v2019 in distinguishing MESTF from predominantly cystic RCC was investigated via receiver operating characteristic curve analysis. RESULTS MESTF and predominantly cystic RCC groups significantly differed in terms of age, lesion size, RNS, restricted diffusion, and obvious enhancement in corticomedullary phase, but not sex, laterality, surgical approach, and the signal intensity on T2WI. Interobserver agreement was substantially based on the Bosniak classification system v2019. There were 24 low-class tumors and 12 high-class tumors in the MESTF group. Meanwhile, 13 low-class tumors and 64 high-class tumors were observed in the predominantly cystic RCC group. The distribution of low- or high-class tumors significantly differed between the MESTF and predominantly cystic RCC groups. Bosniak classification system v2019 had excellent discrimination (cutoff value = category III), and an area under curve value was 0.81; accuracy, 80.5%; sensitivity, 87.0%; and specificity, 66.7%. CONCLUSION The MRI-based Bosniak classification system v2019 can effectively distinguish MESTF from predominantly cystic RCC if category III was used as a cutoff reference.
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Affiliation(s)
- Hui-Ping Guo
- Department of Radiology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Wei Xu
- Department of Radiology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yu-Wei Hao
- Department of Radiology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Huan-Huan Kang
- Department of Radiology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xiao-Jing Zhang
- Department of Radiology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xiao-Hui Ding
- Department of Pathology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jian Zhao
- Department of Radiology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xu Bai
- Department of Radiology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Shao-Peng Zhou
- Department of Radiology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Hui-Yi Ye
- Department of Radiology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Hai-Yi Wang
- Department of Radiology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
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7
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Dharwadkar A, Gore C, Bhuibhar G, Viswanathan V. Unmasking the Mystery of Renal Neoplasm in a Perimenopausal Woman: A Case Report. Cureus 2024; 16:e56970. [PMID: 38665735 PMCID: PMC11044075 DOI: 10.7759/cureus.56970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Mixed epithelial and stromal tumor (MEST) is a benign, complex, and rarely encountered renal neoplasm. This case involves a 46-year-old perimenopausal woman who presented with symptoms, such as abdominal pain, burning sensation during urination, increased urinary frequency, and hesitancy. Computed tomography (CT) urography revealed an exophytic, heterogeneously hyperdense mass originating from the interpolar and lower pole parenchyma of the left kidney, suggesting a neoplastic origin. Due to concerns about malignancy and the presence of local symptoms, a laparoscopic-assisted left radical nephrectomy was performed. Histopathological examination of the excised tissue revealed a biphasic neoplasm consisting of epithelial and stromal elements. The epithelial component exhibited cysts and glands of variable sizes, lined by columnar cells and surrounded by stromal tissue. The diagnosis of MESTs of the kidney was established and confirmed through immunohistochemistry. This unique type of benign kidney tumor can be effectively managed through conservative surgery and is associated with a favorable prognosis.
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Affiliation(s)
- Arpana Dharwadkar
- Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University) Pimpri, Pune, IND
| | - Charusheela Gore
- Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University) Pimpri, Pune, IND
| | - Gayatri Bhuibhar
- Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University) Pimpri, Pune, IND
| | - Vidya Viswanathan
- Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University) Pimpri, Pune, IND
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8
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Domae K, Ichikawa Y, Kubooka M, Nagata M, Ishida M, Kitagawa K, Masui S, Hattori Y, Yoshio Y, Uchida K, Ogawa T, Sakuma H. Mixed epithelial and stromal tumor of the kidney with long-term imaging follow-up. Radiol Case Rep 2023; 18:3212-3217. [PMID: 37448598 PMCID: PMC10336348 DOI: 10.1016/j.radcr.2023.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Mixed epithelial and stromal tumor (MEST) of the kidney is a rare benign tumor with malignant potential, and is characterized by epithelial and stromal proliferation with a variety of cellularity and growth pattern. MEST of the kidney is often depicted as a well-defined, solid mass with a cystic component. However, due to the rarity of the disease, there are no reports of its progression in serial imaging examinations. This report presents the case of a 68-year-old woman with MEST who was followed for 13 years by computed tomography (CT). To the best of our knowledge, this is the first report of image findings of MEST of the kidney over a follow-up period longer than 10 years.
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Affiliation(s)
- Kensuke Domae
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Yasutaka Ichikawa
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Makiko Kubooka
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Motonori Nagata
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Masaki Ishida
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Kakuya Kitagawa
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Satoru Masui
- Department of Urology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Yuna Hattori
- Department of Urology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Yuko Yoshio
- Department of Urology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Katsunori Uchida
- Department of Oncologic Pathology and Diagnostic Pathology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Tomoko Ogawa
- Department of Breast Surgery, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
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9
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Alrumayyan M, Raveendran L, Lawson KA, Finelli A. Cystic Renal Masses: Old and New Paradigms. Urol Clin North Am 2023; 50:227-238. [PMID: 36948669 DOI: 10.1016/j.ucl.2023.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Cystic renal masses describe a spectrum of lesions with benign and/or malignant features. Cystic renal masses are most often identified incidentally with the Bosniak classification system stratifying their malignant potential. Solid enhancing components most often represent clear cell renal cell carcinoma yet display an indolent natural history relative to pure solid renal masses. This has led to an increased adoption of active surveillance as a management strategy in those who are poor surgical candidates. This article provides a contemporary overview of historical and emerging clinical paradigms in the diagnosis and management of this distinct clinical entity.
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Affiliation(s)
- Majed Alrumayyan
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Lucshman Raveendran
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Keith A Lawson
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
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10
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Kalinowski P, Kalinowski T, Kucharz J, Kamecki H, Adamowicz B, Sikora K, Podgórska J, Demkow T. Mixed epithelial and stromal tumor of the kidney: A case report. Oncol Lett 2023; 25:25. [PMID: 36478902 PMCID: PMC9713829 DOI: 10.3892/ol.2022.13611] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/20/2022] [Indexed: 11/24/2022] Open
Abstract
Mixed epithelial and stromal tumor (MEST) is a rare neoplasm of the kidney, affecting mostly women at menopausal age. While few cases of malignant transformation have been described in the literature, MEST is usually considered a benign tumor with minimal risk of local recurrence or distance metastases. The current study presents a case of a 18-year old male patient with a cystic tumor of the left kidney incidentally diagnosed on magnetic resonance imaging of the heart performed for other reasons. The patient underwent a partial nephrectomy, with perioperative course being uneventful. The pathology report revealed MEST of the kidney. No local recurrence nor disease progression have been observed in the patient during the one-year follow-up period. The present case report is evidence that may help in developing guidelines on the management of patients with benign renal masses.
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Affiliation(s)
- Piotr Kalinowski
- Department of Medical Studies, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Tomasz Kalinowski
- Department of Urogenital Cancer, Maria Skłodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Jakub Kucharz
- Department of Urogenital Cancer, Maria Skłodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Hubert Kamecki
- Department of Urogenital Cancer, Maria Skłodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Bernard Adamowicz
- Department of Urogenital Cancer, Maria Skłodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Krzysztof Sikora
- Department of Pathology and Laboratory Diagnostics, Maria Skłodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Joanna Podgórska
- Department of Radiology, Maria Skłodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Tomasz Demkow
- Department of Urogenital Cancer, Maria Skłodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
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11
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Kozaka K, Takahashi H, Inoue A, Graham RPD, Boyum JH, Heiken JP, Takahashi N. Mucinous cystic neoplasms of the liver with biliary prolapse. Jpn J Radiol 2022; 41:409-416. [PMID: 36401061 PMCID: PMC10066120 DOI: 10.1007/s11604-022-01361-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/02/2022] [Indexed: 11/21/2022]
Abstract
Abstract
Objectives
To describe the prevalence, clinical and radiological findings of biliary prolapse in pathologically proven mucinous cystic neoplasm of the liver (MCN-L).
Methods
Thirty-four patients, all female with median age 50 years (range, 14–82), with histologically confirmed MCN-L were enrolled. Median tumor size was 9 cm (range, 2–21 cm). Fifty-seven examinations (17 ultrasound, 25 CT, and 15 MR) among 34 MCN-Ls were reviewed. Two radiologists retrospectively assessed images for tumor location, size and other morphological features of the tumor, presence of biliary prolapse and upstream bile duct dilatation. Ultrasound, CT, and MR were assessed separately. Clinical features were evaluated. Clinical and radiological characteristics of MCN-L with and without biliary prolapse were compared.
Results
15% (5/34) of MCN-Ls showed biliary prolapse confirmed at pathology. None of MCN-Ls were associated with invasive carcinoma. Patients with biliary prolapse were significantly younger than those without (median 27 years [22–56] vs. median 51 years [14–82], p = 0.03). MCN-Ls with biliary prolapse were significantly smaller than those without (median 6.4 cm [2.2–7.5] vs. median 9.6 cm [3.1–21], p = 0.01). The upstream bile duct was dilated more frequently in MCN-Ls with biliary prolapse (100% vs. 38%, p = 0.02). Jaundice was significantly more common in MCN-Ls with biliary prolapse (80 vs 3%, p = 0.0005). Other clinical or radiological features were not significantly different between two groups.
Conclusions
Biliary prolapse was found in 15% of MCN-Ls. MCN-Ls with biliary prolapse were significantly smaller and were more commonly associated with upstream bile duct dilation and jaundice than those without biliary prolapse.
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12
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Karasavvidou F, Mitrakas L, Tzika S, Zachos I, Anagnostou A, Tzortzis V. Mixed epithelial and stromal tumor—adult cystic nephroma of the kidney: a case report with immunohistochemical analysis. J Surg Case Rep 2022; 2022:rjac387. [PMID: 36105648 PMCID: PMC9467513 DOI: 10.1093/jscr/rjac387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/06/2022] [Indexed: 11/23/2022] Open
Abstract
The mixed epithelial and stromal tumor family of kidney contain neoplasms with biphasic epithelial and stromal component. According to the 2016 World Health Organization Classification, they encompasses a spectrum of tumors ranging from predominantly cystic tumors (adult cystic nephroma) to tumors that are variably solid (Mixed epithelial and stromal tumor-MESTs). We present the case of a 20-year-old woman with an adult cystic nephroma which was verified by immunohistochemical examination.
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Affiliation(s)
- Foteini Karasavvidou
- Department of Pathology and Cytology, Faculty of Medicine-School of Health Sciences-University of Thessaly, University Hospital of Larissa , Larissa , Greece
| | - Lampros Mitrakas
- Department of Urology, Faculty of Medicine-School of Health Sciences-University of Thessaly, University Hospital of Larissa , Larissa , Greece
| | - Styliani Tzika
- Department of Pathology and Cytology, Faculty of Medicine-School of Health Sciences-University of Thessaly, University Hospital of Larissa , Larissa , Greece
| | - Ioannis Zachos
- Department of Urology, Faculty of Medicine-School of Health Sciences-University of Thessaly, University Hospital of Larissa , Larissa , Greece
| | - Athanasios Anagnostou
- Department of Urology, Faculty of Medicine-School of Health Sciences-University of Thessaly, University Hospital of Larissa , Larissa , Greece
| | - Vassilios Tzortzis
- Department of Urology, Faculty of Medicine-School of Health Sciences-University of Thessaly, University Hospital of Larissa , Larissa , Greece
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13
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Maeba K, Kanki A, Watanabe H, Yamamoto A, Fujimoto Y, Yoshiyuki M, Tamada T. Mixed epithelial and stromal tumor of the kidney composed mainly of solid components: A case report. Acta Radiol Open 2022; 11:20584601221103019. [PMID: 35794967 PMCID: PMC9251983 DOI: 10.1177/20584601221103019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
Mixed epithelial and stromal tumor (MEST) is a relatively rare lesion of mixed epithelial and mesenchymal origin, consisting of epithelial components that form cysts and stromal cells that are positive for estrogen and progesterone receptors. The present case was a 54-year-old female who presented with hematuria. Abdominal ultrasonography revealed a 41 x 30 mm tumor in the right kidney, with the tumor protruding outward in the direction of the renal pelvis. Dynamic contrast-enhanced computed tomography and magnetic resonance imaging confirmed a solid tumor in the right kidney that showed gradual contrast enhancement and contained a central non-enhancing area with the appearance of a cystic component. Based on the imaging findings, the provisional diagnosis was papillary renal cell carcinoma or angiomyolipoma with epithelial cysts. Right nephrectomy was performed and the tumor was confirmed histopathologically as MEST. We report a very rare case of MEST that was composed mainly of solid components.
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Affiliation(s)
- Kiyoka Maeba
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Akihiko Kanki
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | | | - Akira Yamamoto
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Yasuto Fujimoto
- Department of Pathology, Kawasaki Medical School, Kurashiki, Japan
| | - Miyaji Yoshiyuki
- Department of Urology, Kawasaki Medical School, Kurashiki, Japan
| | - Tsutomu Tamada
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Japan
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14
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Chen J, Liu H, Li M, Liu W, Masokano IB, Pei Y, Li W. Differentiating the clinical and computed tomography imaging features of mixed epithelial and stromal tumors of the kidney to establish a treatment plan. J Appl Clin Med Phys 2021; 23:e13486. [PMID: 34861098 PMCID: PMC8803287 DOI: 10.1002/acm2.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/18/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To differentiate the clinical features and computed tomography imaging features in the two types of mixed epithelial and stromal tumor of the kidney (MESTK) and to establish a treatment plan for the MESTK types. Methods Seventeen patients who underwent multidetector computed tomography (MDCT) before surgery and had a pathological diagnosis of MESTK were enrolled. Their clinical information (R.E.N.A.L. nephrometry score (R.E.N.A.L.‐NS), radical nephrectomy (RN), partial nephrectomy (PN), etc.) were collected. The radiological features included renal sinus fat invagination (SFI), maximal diameter (MD), capsule and septa of the tumor, etc., were also analyzed. They were divided into two types according to the MDsolid/MDtumor ratio (solid type with >60%; cystic type with ≤60%). An independent‐sample t‐test and Fisher exact test were used to assess the differences between the two groups. Results MESTKs demonstrated a variable multi‐septate cystic and solid components with a delayed enhancement. There were nine patients for solid type and eight patients for cystic type. Compared with solid type, the lesions in cystic type have larger MD (81.00 ± 37.91 vs. 41.22 ± 24.19, p = 0.020), higher R.E.N.A.L.‐NS (10.03 ± 0.50 vs. 8.95 ± 1.26, p < 0.001), higher RN (75.00% vs. 22.22%, p = 0.015), larger SFI (87.5% vs. 33.3%, p = 0.05), more septa (100% vs. 0%, p < 0.001), and more capsule (100% vs. 11.1%, p < 0.001). Conclusion Cystic type MESTK has more hazardous features (such as larger MD, higher R.E.N.A.L.‐NS, more RN, greater SFI, multiple septa) compared with solid type, suggesting that RN is more suitable for cystic type and PN for solid type.
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Affiliation(s)
- Juan Chen
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hui Liu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Mengsi Li
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenguang Liu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ismail Bilal Masokano
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yigang Pei
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Postdoctoral Fellow, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenzheng Li
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
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15
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Lobo J, Ohashi R, Helmchen BM, Rupp NJ, Rüschoff JH, Moch H. The Morphological Spectrum of Papillary Renal Cell Carcinoma and Prevalence of Provisional/Emerging Renal Tumor Entities with Papillary Growth. Biomedicines 2021; 9:1418. [PMID: 34680535 PMCID: PMC8533532 DOI: 10.3390/biomedicines9101418] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 12/11/2022] Open
Abstract
Renal cell carcinoma (RCC) represents a heterogeneous disease, encompassing an increasing number of tumor subtypes. Post-2016, the World Health Organization (WHO) classification recognized that the spectrum of papillary renal cell carcinoma is evolving and has long surpassed the dichotomic simplistic "type 1 versus type 2" classification. The differential diagnosis of pRCC includes several new provisional/emerging entities with papillary growth. Type 2 tumors have been cleared out of several confounding entities, now regarded as independent tumors with specific clinical and molecular backgrounds. In this work we describe the prevalence and characteristics of emerging papillary tumor entities in two renal tumor cohorts (one consisting of consecutive papillary tumors from a single institute, the other consisting of consultation cases from several centers). After a review of 154 consecutive pRCC cases, 58% remained type 1 pRCC, and 34% type 2 pRCC. Papillary renal neoplasm with reversed polarity (1.3%), biphasic hyalinizing psammomatous RCC (1.3%), and biphasic squamoid/alveolar RCC (4.5%) were rare. Among 281 consultation cases, 121 (43%) tumors had a dominant papillary growth (most frequently MiT family translocation RCCs, mucinous tubular and spindle cell carcinoma and clear cell papillary RCC). Our data confirm that the spectrum of RCCs with papillary growth represents a major diagnostical challenge, frequently requiring a second expert opinion. Papillary renal neoplasm with reversed polarity, biphasic hyalinizing psammomatous RCC, and biphasic squamoid/alveolar RCC are rarely sent out for a second opinion, but correct classification and knowledge of these variants will improve our understanding of the clinical behavior of renal tumors with papillary growth.
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Affiliation(s)
- João Lobo
- Department of Pathology, Portuguese Oncology Institute of Porto (IPOP), R. Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal;
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto.CCC), R. Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
- Department of Pathology and Molecular Immunology, ICBAS—School of Medicine and Biomedical Sciences, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira 228, 4050-513 Porto, Portugal
| | - Riuko Ohashi
- Histopathology Core Facility, Faculty of Medicine, Niigata University, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata 951-8510, Japan;
- Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata 951-8510, Japan
| | - Birgit M. Helmchen
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland; (B.M.H.); (N.J.R.); (J.H.R.)
| | - Niels J. Rupp
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland; (B.M.H.); (N.J.R.); (J.H.R.)
| | - Jan H. Rüschoff
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland; (B.M.H.); (N.J.R.); (J.H.R.)
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland; (B.M.H.); (N.J.R.); (J.H.R.)
- Faculty of Medicine, University of Zurich, Rämistrasse 71, 8006 Zurich, Switzerland
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16
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Ma W, Jiang H, Zhang Y, Zhang J, Jiang H. Acute abdominal pain induced by renal leiomyoma in a young patient: a case report. J Int Med Res 2021; 49:3000605211032802. [PMID: 34311602 PMCID: PMC8320583 DOI: 10.1177/03000605211032802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Renal leiomyoma is a rare benign mesenchymal tumor of the kidney that predominantly originates from the renal capsule or pelvis. However, because of its nonspecific clinical and imaging features, renal leiomyoma remains poorly characterized and may even lead to radical or partial nephrectomy on the basis of preoperative suspicion of renal carcinoma. We herein present a case involving a 12-year-old boy with acute abdominal pain who was diagnosed with renal leiomyoma based on both clinical imaging and histopathological examination. One year after radical nephrectomy, the patient recovered to good condition. This case demonstrates that the comprehensive application of imaging and histology are essential for early clinical diagnosis and effective treatment of renal leiomyoma.
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Affiliation(s)
- Weina Ma
- Department of Hematology, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Huali Jiang
- Department of Cardiovascularology, Tungwah Hospital of Sun Yat-sen University, Dongguan, China
| | - Yunzhen Zhang
- Department of Urology, Tungwah Hospital of Sun Yat-sen University, Dongguan, China
| | - Jian Zhang
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University; State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, Guangzhou, China.,Guangzhou Medical University, Guangzhou, China
| | - Hualong Jiang
- Department of Urology, Tungwah Hospital of Sun Yat-sen University, Dongguan, China
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17
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Rathi N, Shah SN, Przybycin CG. A Bosniak IV Cystic Renal Mass with Mixed Epithelial and Stromal Tumor Features. Urology 2021; 159:8-9. [PMID: 34224777 DOI: 10.1016/j.urology.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/02/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Nityam Rathi
- Medical Student, Cleveland Clinic Lerner College of Medicine, EC-10 Cleveland Clinic, 9501 Euclid Ave, Cleveland, OH 44195.
| | - Shetal N Shah
- Abdominal Imaging Section and Dept. of Nuclear Medicine, Imaging Institute, Cleveland Clinic, Mailcode JB-3, 9500 Euclid Avenue, Cleveland, Ohio 44131.
| | - Christopher G Przybycin
- Robert J Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Mailcode L25, 9500 Euclid Avenue, Cleveland, Ohio 44195.
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18
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Martínez-Corral ME, Núñez-Otero JJ, Toucedo-Caamaño V, García-Acuña SM, García-Figueiras R, García-Freire C. Mixed epithelial and stromal tumor of the kidney. Actas Urol Esp 2021; 45:412-415. [PMID: 34088442 DOI: 10.1016/j.acuroe.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/02/2021] [Indexed: 11/17/2022]
Affiliation(s)
- M E Martínez-Corral
- Servicio de Urología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
| | - J J Núñez-Otero
- Servicio de Urología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - V Toucedo-Caamaño
- Servicio de Urología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - S M García-Acuña
- Servicio de Anatomía Patológica, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - R García-Figueiras
- Servicio de Radiodiagnóstico, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - C García-Freire
- Servicio de Urología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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19
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Martínez-Corral M, Núñez-Otero J, Toucedo-Caamaño V, García-Acuña S, García-Figueiras R, García-Freire C. Mixed epithelial and stromal tumor of the kidney. Actas Urol Esp 2021. [PMID: 33685665 DOI: 10.1016/j.acuro.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Magnelli LL, Metra B, Falzarano SM, Grajo JR. A MEST up classification? Review of the re-classification of mixed epithelial and stromal tumor and adult cystic nephroma for the abdominal radiologist. Abdom Radiol (NY) 2021; 46:696-702. [PMID: 32757072 DOI: 10.1007/s00261-020-02687-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/18/2020] [Accepted: 07/25/2020] [Indexed: 12/16/2022]
Abstract
Mixed epithelial and stromal tumor (MEST) and the tumor formerly known as adult cystic nephroma (ACN) are uncommon renal tumors that have historically been described as separate entities in terms of histologic and imaging findings. However, these entities share many epidemiologic, radiologic, and pathologic features. While recent surgical and pathological literature has supported classifying MEST and ACN within the same tumor family, most radiologists and radiology texts continue to describe MEST and ACN as separate entities.
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21
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Tatsuya S, Hirotaka A, Yuki A, Akiko T, Masahiro H, Shigeo O, Shuji M, Ryuichi M, Mototsugu O, Masahiro J. Radiologic features of mixed epithelial and stromal tumors of the kidney: Hyperattenuating on unenhanced computed tomography and T2-hypointensity on magnetic resonance imaging. Radiol Case Rep 2021; 16:858-862. [PMID: 33552340 PMCID: PMC7850961 DOI: 10.1016/j.radcr.2021.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 11/30/2022] Open
Abstract
In the 2016 World Health Organization renal tumor classification, the mixed epithelial and stromal tumor family was introduced as a new entity. This family encompasses a spectrum of tumors, ranging from predominantly cystic tumors (adult cystic nephromas) to tumors that are variably solid (mixed epithelial and stromal tumors). The majority of previous studies incorporating “mixed epithelial and stromal tumor” in the titles were actually reports of imaging findings of adult cystic nephroma. Thus, the solid component of mixed epithelial and stromal tumors has not been well evaluated. In this study, we present 2 cases of mixed epithelial and stromal tumors, as defined by the 2016 World Health Organization classification, showing a predominantly solid component. The characteristic findings of the solid component of these tumors were T2-hypointensity on magnetic resonance imaging and hyperattenuation on unenhanced computed tomography. Angiomyolipoma with epithelial cysts and epithelioid angiomyolipoma should be considered in the differential diagnosis of mixed epithelial and stromal tumors.
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Affiliation(s)
- Suzuki Tatsuya
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Akita Hirotaka
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Arita Yuki
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Tomiyama Akiko
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hashimoto Masahiro
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Okuda Shigeo
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Mikami Shuji
- Department of Diagnostic Pathology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Mizuno Ryuichi
- Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Oya Mototsugu
- Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Jinzaki Masahiro
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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22
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Sawamura M, Sawa N, Yamanouchi M, Ikuma D, Sekine A, Mizuno H, Suwabe T, Hoshino J, Kono K, Kinowaki K, Ohashi K, Nagashima Y, Ubara Y. Renal epithelial and stromal tumor with a multiple cystic lesion localized in the upper portion of the right kidney. CEN Case Rep 2020; 10:230-235. [PMID: 33145653 PMCID: PMC8019406 DOI: 10.1007/s13730-020-00548-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/15/2020] [Indexed: 11/28/2022] Open
Abstract
A 60-year-old Japanese woman was admitted because of the polycystic mass with right flank pain localized in the upper portion of the right kidney. Right nephrectomy was performed because the mass lesion had continuously increased in size over the past 10 years. A surgical specimen showed histology consistent with a mixed epithelial and stromal tumor, which is closely related to multilocular cystic nephroma, and was diagnosed by a defined capsule between the cystic mass lesion and normal renal tissue by CT and MRI, and histology. Localized renal cystic disease that does not have a capsule was excluded from differential diagnosis.
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Affiliation(s)
- Masato Sawamura
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.
| | - Naoki Sawa
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Masayuki Yamanouchi
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Daisuke Ikuma
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Akinari Sekine
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Hiroki Mizuno
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Tatsuya Suwabe
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Junichi Hoshino
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Yoji Nagashima
- Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, 1C-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan. .,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
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23
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Withey SJ, Verma H, Prezzi D. Multimodality Assessment of Cystic Renal Masses. Semin Ultrasound CT MR 2020; 41:334-343. [DOI: 10.1053/j.sult.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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24
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Galatola R, Stanzione A, Sirignano C, Mainolfi C, Guadagno E, Carlomagno N, Insabato L, Santangelo M, Maurea S. Giant Epithelioid Angiomyolipoma: An Imaging-related Differential Diagnosis Among Fat-containing Renal Masses. Clin Genitourin Cancer 2019; 18:e5-e9. [PMID: 31786119 DOI: 10.1016/j.clgc.2019.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Roberta Galatola
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
| | - Cesare Sirignano
- Istituto di Biostrutture e Bioimmagini, Consiglio Nazionale delle Ricerche, Naples, Italy
| | - Ciro Mainolfi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Elia Guadagno
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Nicola Carlomagno
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Luigi Insabato
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Michele Santangelo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Simone Maurea
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
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25
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Ye J, Xu Q, Zheng J, Wang SA, Wu YW, Cai JH, Yuan H. Imaging of mixed epithelial and stromal tumor of the kidney: A case report and review of the literature. World J Clin Cases 2019; 7:2580-2586. [PMID: 31559296 PMCID: PMC6745317 DOI: 10.12998/wjcc.v7.i17.2580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/11/2019] [Accepted: 07/27/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Mixed epithelial and stromal tumors of the kidney (MESTKs) are a rare entity (about a hundred cases reported). They occur almost exclusively in postmenopausal women, with only seven cases reported in men. As this entity is very rare, little is known on its imaging features, especially magnetic resonance imaging (MRI) findings. In women, at MRI, the cystic component shows T1 hypointensity and T2 hyperintensity, while the solid component shows T1 hyperintensity and T2 hypointensity.
CASE SUMMARY We report the computed tomography (CT) and MRI findings of MESTK in a 19-year-old male adolescent. To our knowledge, this case report is the first report of MRI findings of MESTK in male adolescents. The patient was admitted to Subei People's Hospital (Jiangsu Province, China) in July 2017 after a renal mass on the left side was detected by ultrasound during a clinical examination. Blood tests were all normal. Non-enhanced CT showed a round, well-circumscribed complex mass, approximately 45 mm × 40 mm in size. MRI revealed a clear well-circumscribed mass with a mixed arrangement of solid and cystic components. On T2 weighted images, some hypointensities were found in the solid areas. After contrast enhancement, moderate or mild enhancement was found in the solid component, which increased with time. A radical left nephrectomy was performed. The pathology analysis revealed a mixed epithelial and stromal tumor. The patient had no imaging findings of recurrence or metastasis at 12 months following surgery.
CONCLUSION The possibility of MESTK should be considered in male adolescents. MRI can provide useful information for the preoperative diagnosis.
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Affiliation(s)
- Jing Ye
- Department of Medical Imaging, Clinic Medical School, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou 225000, Jiangsu Province, China
| | - Qing Xu
- Department of Medical Imaging, Clinic Medical School, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou 225000, Jiangsu Province, China
| | - Jing Zheng
- Department of Medical Imaging, Clinic Medical School, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou 225000, Jiangsu Province, China
| | - Shou-An Wang
- Department of Medical Imaging, Clinic Medical School, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou 225000, Jiangsu Province, China
| | - Ya-Wei Wu
- Department of Medical Imaging, Clinic Medical School, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou 225000, Jiangsu Province, China
| | - Jun-Hui Cai
- Dalian Medical University, Dalian 116000, Liaoning Province, China
| | - Hu Yuan
- Dalian Medical University, Dalian 116000, Liaoning Province, China
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26
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Salvatori F, Macchini M, Misericordia M, Paci E, Giovagnoni A, Candelari R. A simple cyst is not always simply a cyst: A case of cystic recurrence after nephrectomy for tubulocystic renal cell carcinoma and literature review. Urologia 2019; 87:119-124. [PMID: 31441383 DOI: 10.1177/0391560319870091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tubulocystic renal cell carcinoma is a rare subtype of renal tumor according to the 2016 World Health Organization, and less than 100 cases have been documented up to date in literature. The imaging features are not well known and to the best of our knowledge, there is not a radiology description of recurrence from tubulocystic renal cell carcinoma in the literature. We describe the case of a 70-year-old man with unusual cystic lesions in the left hypochondrium 11 years after a nephrectomy for tubulocystic renal cell carcinoma on the same side, and we report a review of the clinical characteristics of metastatic tubulocystic renal cell carcinoma.
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Affiliation(s)
- Fabio Salvatori
- School of Radiology, Università Politecnica delle Marche, Ancona, Italy
| | - Marco Macchini
- Interventional Radiology, Azienda Ospedaliera Universitaria-Ospedali Riuniti di Ancona, Ancona, Italy
| | - Marco Misericordia
- Department of Radiology, Azienda Ospedaliera Universitaria-Ospedali Riuniti di Ancona, Ancona, Italy
| | - Enrico Paci
- Interventional Radiology, Azienda Ospedaliera Universitaria-Ospedali Riuniti di Ancona, Ancona, Italy
| | - Andrea Giovagnoni
- Department of Radiology, Azienda Ospedaliera Universitaria-Ospedali Riuniti di Ancona, Ancona, Italy
| | - Roberto Candelari
- Interventional Radiology, Azienda Ospedaliera Universitaria-Ospedali Riuniti di Ancona, Ancona, Italy
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Mixed epithelial and stromal tumour with extension to vesicoureteric junction. Asian J Urol 2019; 6:302-304. [PMID: 31297324 PMCID: PMC6595157 DOI: 10.1016/j.ajur.2018.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 12/03/2017] [Accepted: 01/02/2018] [Indexed: 11/21/2022] Open
Abstract
Mixed epithelial and stromal tumour (MEST) is an uncommon renal tumour with a tendency to protrude into the collecting system. We present a 50-year-old woman with a renal tumour extending up to the vesicoureteric junction (VUJ) who was suspected to have an upper tract transitional cell carcinoma for which a nephroureterectomy was performed. Histopathologic examination revealed a MEST arising from the kidney and extending up to the VUJ. To the best of our knowledge, this is the first report of a renal MEST with extension to the VUJ.
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Stanzione A, Santangelo M, De Rosa F, Ponsiglione A, Peluso G, Insabato L, Imbriaco M. Giant leiomyoma of the renal capsule: CT and MR imaging features with pathologic correlations. MEMO - MAGAZINE OF EUROPEAN MEDICAL ONCOLOGY 2019. [DOI: 10.1007/s12254-019-0505-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Imaging of Unusual Renal Tumors. Curr Urol Rep 2019; 20:5. [PMID: 30663008 DOI: 10.1007/s11934-019-0867-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW Renal masses are a wide entity and a common finding in clinical practice. Detection of these masses has increased in the last years, yet mortality rates have slightly decreased. RECENT FINDINGS According to the World Health Organization classification, there are 8 types, 51 subtypes, and a lot more subsequent subclassifications of renal tumors. Histopathological analysis should always be assessed for final diagnosis of theses tumors. However, imaging can be an important diagnostic guidance. The most common diagnoses of renal tumor are clear cell carcinoma, papillary renal cell carcinoma, angiomyolipoma, and transitional cell carcinoma. Nonetheless, a considerable variety of particular tumors can arise from the kidney, challenging the expertise of radiologists and urologists on this subject. The awareness of these unusual entities is vital for professionals working at a complex medical facility with greater volume of patients. We hereby present uncommon renal tumors and its pathological and radiological features.
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Arif-Tiwari H, Kalb BT, Bisla JK, Martin DR. Classification and Diagnosis of Cystic Renal Tumors: Role of MR Imaging Versus Contrast-Enhanced Ultrasound. Magn Reson Imaging Clin N Am 2018; 27:33-44. [PMID: 30466911 DOI: 10.1016/j.mric.2018.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Superior soft tissue and contrast resolution of MR imaging benefits sensitivity to kidney cyst features and classification, which may have an impact on patient management and outcomes. Contrast-enhanced ultrasound (CEUS) may have nearly similar sensitivity for detection of cyst features yet is dependent on patient body habitus and adequacy of visualization windows for the kidneys, which does not have the same impact on MR imaging results. Both MR imaging and CEUS may provide superior kidney cyst assessment compared with contrast-enhanced CT; however, further research is needed, particularly for the identification of role of CEUS.
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Narayanasamy S, Krishna S, Prasad Shanbhogue AK, Flood TA, Sadoughi N, Sathiadoss P, Schieda N. Contemporary update on imaging of cystic renal masses with histopathological correlation and emphasis on patient management. Clin Radiol 2018; 74:83-94. [PMID: 30314810 DOI: 10.1016/j.crad.2018.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/06/2018] [Indexed: 01/21/2023]
Abstract
This article presents an updated review of cystic renal mass imaging. Most cystic renal masses encountered incidentally are benign and can be diagnosed confidently on imaging and require no follow-up. Hyperattenuating masses discovered at unenhanced or single-phase enhanced computed tomography (CT) measuring between 20-70 HU are indeterminate and can be further investigated first by using ultrasound and, then with multi-phase CT or magnetic resonance imaging (MRI); as the majority represent haemorrhagic/proteinaceous cysts (HPCs). Dual-energy CT may improve differentiation between HPCs and masses by suppressing unwanted pseudo-enhancement observed with conventional CT. HPCs can be diagnosed confidently when measuring >70 HU at unenhanced CT or showing markedly increased signal on T1-weighted imaging. Although the Bosniak criteria remains the reference standard for diagnosis and classification of cystic renal masses, histopathological classification and current management has evolved: multilocular cystic renal cell carcinoma (RCC) has been reclassified as a cystic renal neoplasm of low malignant potential, few Bosniak 2F cystic masses progress radiologically during follow-up; RCC with predominantly cystic components are less aggressive than solid RCC; and Bosniak III cystic masses behave non-aggressively. These advances have led to an increase in non-radical management or surveillance of cystic renal masses including Bosniak 3 lesions. Tubulocystic RCC is a newly described entity with distinct imaging characteristics, resembling a pancreatic serous microcystadenoma. Other benign cystic masses including: mixed epithelial stromal tumours (MEST) are now considered in the spectrum of cystic nephroma and angiomyolipoma (AML) with epithelial cysts (AMLEC) resemble a fat-poor AML with cystic components.
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Affiliation(s)
- S Narayanasamy
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - S Krishna
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - A K Prasad Shanbhogue
- Department of Radiology, New York University School of Medicine, 660 First Avenue, New York, NY 10016, USA
| | - T A Flood
- Department of Anatomic Pathology, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - N Sadoughi
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - P Sathiadoss
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - N Schieda
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada.
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Honda Y, Nakamura Y, Goto K, Terada H, Sentani K, Yasui W, Sekino Y, Hayashi T, Teishima J, Matsubara A, Akagi M, Fuji T, Baba Y, Iida M, Awai K. Tubulocystic renal cell carcinoma: a review of literature focused on radiological findings for differential diagnosis. Abdom Radiol (NY) 2018; 43:1540-1545. [PMID: 29796844 DOI: 10.1007/s00261-018-1643-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Tubulocystic renal cell carcinoma (TC-RCC) has been classified as an independent subtype according to the 2016 World Health Organization (WHO) classification. It is a rare subtype that predominantly affects men. Although few in number, radiological imaging reports have suggested that TC-RCC is characterized by multilocular cystic lesions, which are categorized as the Bosniak classification II-IV, with signature pathological characteristics comprising numerous small cysts or a tubular structure. The Bosniak classification system facilitates patient management; however, the differentiation of cystic tumors exhibiting similar imaging findings remains impossible; in fact, the differentiation of multilocular cystic RCC, adult cystic nephroma, and mixed epithelial and stromal tumor remains challenging. This review aims to discuss TC-RCC with a focus on implications of radiological findings in the differential diagnosis of TC-RCC.
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Affiliation(s)
- Yukiko Honda
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan.
| | - Yuko Nakamura
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan
| | - Keisuke Goto
- Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan
| | - Hiroaki Terada
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan
| | - Kazuhiro Sentani
- Department of Molecular Pathology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan
| | - Wataru Yasui
- Department of Molecular Pathology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan
| | - Yohei Sekino
- Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan
- Department of Molecular Pathology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan
| | - Tetsutaro Hayashi
- Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan
| | - Jun Teishima
- Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan
| | - Akio Matsubara
- Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan
| | - Motonori Akagi
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan
| | - Tomoyo Fuji
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan
| | - Yasutaka Baba
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan
| | - Makoto Iida
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7340037, Japan
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34
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Ward RD, Remer EM. Cystic renal masses: An imaging update. Eur J Radiol 2018; 99:103-110. [DOI: 10.1016/j.ejrad.2017.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/16/2017] [Accepted: 12/19/2017] [Indexed: 01/20/2023]
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Farias JA, Laryea J, Gokden N, Kamel MH. Peritoneal seeding following incomplete resection of mixed epithelial stromal tumor of the kidney: First case report. Urol Ann 2016; 8:114-7. [PMID: 26834418 PMCID: PMC4719503 DOI: 10.4103/0974-7796.171493] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Mixed epithelial stromal tumor (MEST) is rare and typically benign renal cystic neoplasm that cannot be clinically distinguished from cystic renal cell carcinoma. Its mainstay course of diagnosis and treatment remains surgical excision. Recurrence and malignant transformation is rare but has previously been described. To our best knowledge, we present the first case of peritoneal seeding resulting in a paracolonic MEST following incomplete resection in a patient with benign MEST. This signifies a new pathological behavior for MEST, predominantly, a benign kidney tumor. In addition, documentation with more cases of MEST is needed to further understand its pathogenesis, clinical behavior, malignant potential, and optimal management.
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Affiliation(s)
- Judy A Farias
- Department of Urology, University of Arkansas Medical Sciences, Little Rock, Arkansas, USA
| | - Jonathan Laryea
- Department of General Surgery, University of Arkansas Medical Sciences, Little Rock, Arkansas, USA
| | - Neriman Gokden
- Department of Pathology, University of Arkansas Medical Sciences, Little Rock, Arkansas, USA
| | - Mohamed H Kamel
- Department of Urology, University of Arkansas Medical Sciences, Little Rock, Arkansas, USA
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36
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Wood CG, Stromberg LJ, Harmath CB, Horowitz JM, Feng C, Hammond NA, Casalino DD, Goodhartz LA, Miller FH, Nikolaidis P. CT and MR imaging for evaluation of cystic renal lesions and diseases. Radiographics 2015; 35:125-41. [PMID: 25590393 DOI: 10.1148/rg.351130016] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Cystic renal lesions are commonly encountered in abdominal imaging. Although most cystic renal lesions are benign simple cysts, complex renal cysts, infectious cystic renal disease, and multifocal cystic renal disease are also common phenomena. The Bosniak classification system provides a useful means of categorizing cystic renal lesions but places less emphasis on their underlying pathophysiology. Cystic renal diseases can be categorized as focal, multifocal, or infectious lesions. Diseases that manifest with focal lesions, such as cystic renal cell carcinoma, mixed epithelial and stromal tumor, and cystic nephroma, are often difficult to differentiate but have differing implications for follow-up after resection. Multifocal cystic renal lesions can be categorized as acquired or heritable. Acquired entities, such as glomerulocystic kidney disease, lithium-induced nephrotoxicity, acquired cystic kidney disease, multicystic dysplastic kidney, and localized cystic renal disease, often have distinct imaging and clinical features that allow definitive diagnosis. Heritable diseases, such as autosomal dominant polycystic kidney disease, von Hippel-Lindau disease, and tuberous sclerosis, are usually easily identified and have various implications for patient management. Infectious diseases have varied imaging appearances, and the possibility of infection must not be overlooked when assessing a cystic renal lesion. A thorough understanding of the spectrum of cystic renal disease will allow the radiologist to make a more specific diagnosis and provide the clinician with optimal recommendations for further diagnostic testing and follow-up imaging.
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Affiliation(s)
- Cecil G Wood
- From the Department of Radiology, Northwestern Memorial Hospital, 676 N Saint Clair St, Suite 800, Chicago, IL 60611
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37
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Dell'Atti L. An Unusual Presentation of Cystic Nephroma in an Adult Man. Rare Tumors 2015; 7:5860. [PMID: 26266015 PMCID: PMC4508646 DOI: 10.4081/rt.2015.5860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/16/2015] [Accepted: 03/19/2015] [Indexed: 11/23/2022] Open
Abstract
Cystic nephroma (CN) is an uncommon, benign lesion of the kidney, whose clinical presentation is nonspecific with symptoms such as flack pain, hematuria and urinary tract infection. There are two peaks in the incidence of the tumor, with a bimodal distribution presenting in children between three months and two years, and in adults over 30-years of age. We report a case of CN in the middle part of the left kidney in a 66-year-old male that presented with a singular unilocular, well-circumscribed cyst containing numerous calcifications on the walls and with unremarkable thin or relatively thicker septa from the border with the renal parenchyma, but no solid components. Laparoscopic nephrectomy was performed. Images, histopathological and immunohistochemical features, that are potentially useful for refining this lesion, are discussed.
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Affiliation(s)
- Lucio Dell'Atti
- Department of Urology, University Hospital St. Anna , Ferrara, Italy
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38
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Podduturi V, Guileyardo JM. Mixed epithelial and stromal tumors of the kidney discovered incidentally at autopsy. Proc (Bayl Univ Med Cent) 2015; 28:224-6. [PMID: 25829661 DOI: 10.1080/08998280.2015.11929237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Mixed epithelial and stromal tumors (MEST) of the kidney are uncommon neoplasms that were added to the World Health Organization's renal tumor classification in 2004. These entities are biphasic and contain both epithelial and mesenchymal components. MEST most commonly occur in women. Presented are two cases of MEST incidentally discovered at autopsy.
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Affiliation(s)
- Varsha Podduturi
- Department of Pathology, Baylor University Medical Center at Dallas
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39
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Yoon JH. Primary renal carcinoid tumor: A rare cystic renal neoplasm. World J Radiol 2013; 5:328-333. [PMID: 24003360 PMCID: PMC3758502 DOI: 10.4329/wjr.v5.i8.328] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 05/22/2013] [Accepted: 08/01/2013] [Indexed: 02/06/2023] Open
Abstract
We present the case of a 21-year-old man with an incidentally detected cystic renal mass. A well-defined, solid mass measuring approximately 8 cm x 6 cm with a cystic component was identified in the left kidney by abdominal multidetector computed tomography (CT) and ultrasonography. The mass was well-enhanced on the corticomedullary CT phase and washout of enhancement occurred on the nephrographic phase. The mass contained peripheral wall and septal calcifications in the cystic component. The lesion was resected and diagnosed as a primary renal carcinoid tumor. Primary carcinoid tumors of the kidney are extremely rare. This case is notable because of the rarity of this neoplasm and its unique radiologic and pathologic findings. A review of previously reported cases in the literature is also presented.
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40
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Wang CJ, Lin YW, Xiang H, Fang DB, Jiang P, Shen BH. Mixed epithelial and stromal tumor of the kidney: report of eight cases and literature review. World J Surg Oncol 2013; 11:207. [PMID: 23958048 PMCID: PMC3765432 DOI: 10.1186/1477-7819-11-207] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 08/07/2013] [Indexed: 01/30/2023] Open
Abstract
Mixed epithelial and stromal tumor of the kidney (MESTK) is the term given to a class of uncommon biphasic tumors of the kidney, with few reported cases. We describe eight cases of MESTK with detailed clinicopathological data and follow-up information. With this report, we hope to increase clinical awareness that MESTK should be considered as one of the possible diagnoses for cystic renal mass, especially in peri-menopausal women or those who receive hormone therapy. In addition, regular follow-up is necessary for the any cases with malignant potential.
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Affiliation(s)
- Chao-jun Wang
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road 79, 310003 Hangzhou, Zhejiang Province, China.
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41
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Cystic renal neoplasms and renal neoplasms associated with cystic renal diseases in adults: cross-sectional imaging findings. J Comput Assist Tomogr 2013. [PMID: 23192202 DOI: 10.1097/rct.0b013e31826dba18] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cystic renal neoplasms in adults are a heterogeneous group of tumors with characteristic histogenesis, pathological findings, and variable biological profiles. They include disparate entities that are either biologically benign (lymphangioma, cystic nephroma, and mixed epithelial and stromal tumor) or malignant (cystic renal cell carcinoma, multilocular cystic renal cell carcinoma, and primary renal synovial sarcoma). Renal cystic diseases are characterized by cystic changes of the kidneys due to hereditary, developmental, or acquired etiology. Cystic renal diseases such as acquired cystic kidney disease, von Hippel-Lindau disease, and tuberous sclerosis are associated with the development of a wide spectrum of benign and malignant renal neoplasms. Most cystic renal tumors and cystic disease-associated renal neoplasms show characteristic cross-sectional imaging findings that permit accurate diagnosis. In addition, cross-sectional imaging is pivotal in the follow-up and surveillance of adult cystic tumors of the kidney.
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Abstract
The vast majority of primary renal masses represent clear cell or papillary renal cell carcinomas, angiomyolipomas, or transitional cell carcinomas. However, a number of more rare masses can also be encountered, many of which can be very difficult to differentiate from these more common entities based on their imaging features. These uncommon entities include metanephric adenoma, epithelioid angiomyolipoma, medullary renal cell carcinomas, multilocular cystic nephroma, hemangiopericytoma, hemangioma, leiomyoma, leiomyosarcoma, solitary fibrous tumor, renal plasmacytomas, and mixed epithelial and stromal tumors. In some cases, certain clinical and imaging features can allow one of these unusual entities to be placed in the differential diagnosis, including patient age, degree of tumor enhancement, presence of underlying sickle cell trait or sickle cell disease, the presence of a cystic component to the tumor, and tumor morphology. Even if a radiologist is unable to make a specific diagnosis, knowledge of these entities is important, as it allows radiologists to guide post-surgical follow-up, as well to understand the most common sites of metastatic disease.
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Affiliation(s)
- Siva P Raman
- Department of Radiology, Johns Hopkins University, JHOC 3251, 601 N. Caroline Street, Baltimore, MD 21287, USA.
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43
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Segmental multicystic dysplastic kidney in an adult: usefulness of enhanced CT in excretory phase. ABDOMINAL IMAGING 2012; 38:603-7. [PMID: 22782317 DOI: 10.1007/s00261-012-9938-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We present an adult case of segmental multicystic dysplastic kidney (SMCDK). The patient had a 10 × 6 cm oval-shaped mass consisting of a solid and multilocular cystic component at the right upper renal sinus. The solid component showed gradual and mild enhancement on dual-phase enhanced CT. Excretory-phase CT demonstrated the excretion of contrast medium into the septa and cysts. Dilation of the upper calices and renal pelvis and atretic renal pelvis in the mass were also clearly visualized in the excretory phase. The signal intensity of the solid component was slightly lower than that of the renal parenchyma on T2-weighted images and similar to that of the medulla on diffusion-weighted images. Right nephrectomy showed a multilocular cystic component within the renal sinus and some of the cysts contained blood. The renal pelvis of the upper moiety was blind, as suggested by CT. Microscopically, there were multiple non-communicating small cysts, as shown by CT, and the wall was lined with immature tubule-like cells. In addition, immature tubule-like cells were seen in the septa. Immature mesenchymal cells were seen around the cysts. The solid component mainly consisted of fibroconnective tissue with immature tubule-like cells. The pathological diagnosis was confirmed as SMCDK. Excretion of contrast media into the septum and cystic component might be a characteristic finding of SMCDK in addition to the finding of a multilocular cystic mass in the upper moiety with urinary tract abnormality.
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Sountoulides P, Koptsis M, Metaxa L, Theodosiou A, Kikidakis D, Filintatzi C, Paschalidis K. Mixed epithelial and stromal tumor of the kidney (MEST) simulating an upper tract TCC. Can Urol Assoc J 2012; 6:E23-6. [PMID: 22396379 DOI: 10.5489/cuaj.11042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We present a rare and interesting case of a mixed epithelial and stromal tumour (MEST) of the kidney. The case is unique as it involves a male patient with no history of hormonal therapy presenting with a filling defect in the renal collecting system and positive urine cytology. The patient was diagnosed with transitional cell carcinoma of the renal pelvis and subjected to nephroureterectomy, which revealed a solid tumour arising from the lower calyces and extending into the renal pelvis and upper ureter. Pathology revealed a MEST. The patient was disease-free at the 6-month follow-up.
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45
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Horikawa M, Shinmoto H, Kuroda K, Shiomi E, Soga S, Ito K, Tachi K, Katsurada Y, Simazaki H, Asano T, Kaji T. Mixed epithelial and stromal tumor of the kidney with polypoid component extending into renal pelvis and ureter. Acta Radiol Short Rep 2012; 1:10.1258_arsr.2011.110010. [PMID: 23986822 PMCID: PMC3738331 DOI: 10.1258/arsr.2011.110010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 11/24/2011] [Indexed: 11/18/2022] Open
Abstract
Mixed epithelial and stromal tumor (MEST) of the kidney is an unusual benign neoplasm that predominantly occurs in middle-aged females. It typically appears as a well-circumscribed multiseptate mass with solid components on computed tomography (CT) or magnetic resonance image (MRI), reflecting its characteristics of an admixture of stromal proliferation and epithelial cells consisting of multiple cysts. We present a rare case of 61-year-old woman with MEST, which manifested as a multilocular cystic mass with a polypoid component protruding into the renal pelvis and ureter. To our best knowledge, this is the first case of MEST extending into the ureter.
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46
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Affiliation(s)
- Cecil G Wood
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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