Metanephric adenoma

The utility of immunohistochemical and cytogenetic analyses in differential diagnosis, including solid variant papillary renal cell carcinoma and epithelial-predominant nephroblastoma

Stephanie N. Kinney, John Eble, Ondrej Hes, Sean R. Williamson, David Grignon, Mingsheng Wang, Shaobo Zhang, Lee Ann Baldrige, Guido Martignoni, Matteo Brunelli, Lisha Wang, Eva Comperat, Rong Fan, Rodolfo Montironi, Gregory T. MacLennan, Liang Cheng

Research output: Contribution to journalArticle

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Abstract

Metanephric adenoma is a benign renal neoplasm that overlaps in morphology with the solid variant of papillary renal cell carcinoma and epithelial-predominant nephroblastoma. To aid in resolving this differential diagnosis, we investigated the utility of immunohistochemical and molecular analyses in distinguishing between these entities; the first study, to our knowledge, to use a combined approach in analyzing all three tumors. We analyzed 37 tumors originally diagnosed as metanephric adenomas (2 of which we reclassified as papillary renal cell carcinomas), 13 solid variant papillary renal cell carcinomas, and 20 epithelial-predominant nephroblastomas using a combination of immunohistochemistry and fluorescence in situ hybridization (FISH) assessing for trisomy of chromosomes 7 and 17 and loss of Y. Immunohistochemical staining was performed for CK7, AMACR, WT1, and CD57. The combination of CK7-, AMACR-, WT1+, and CD57+ was considered characteristic of metanephric adenoma. Most of the tumors originally diagnosed as metanephric adenomas (31/37) showed the expected staining pattern of metanephric adenoma (CK7-, AMACR-, WT1+, and CD57+). Of the six tumors with discordant immunophenotype, two tumors were reclassified as papillary renal cell carcinoma after cytogenetic workup. It is recommended that all adult cases histologically resembling metanephric adenoma have WT1, CD57, CK7, and AMACR immunohistochemical staining performed. If the staining pattern is characteristic for metanephric adenoma (CK7-, AMACR-, WT1+, and CD57+, including membranous staining), then no other diagnostic tests are indicated. However, if there is a different immunostaining pattern, then we recommend FISH analysis.

Original languageEnglish
Pages (from-to)1236-1248
Number of pages13
JournalModern Pathology
Volume28
Issue number9
DOIs
StatePublished - Sep 3 2015

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Wilms Tumor
Cytogenetic Analysis
Renal Cell Carcinoma
Adenoma
Differential Diagnosis
Staining and Labeling
Neoplasms
Fluorescence In Situ Hybridization
Chromosomes, Human, Pair 17
Chromosomes, Human, Pair 7
Kidney Neoplasms
Trisomy
Routine Diagnostic Tests
Cytogenetics
Immunohistochemistry

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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Metanephric adenoma : The utility of immunohistochemical and cytogenetic analyses in differential diagnosis, including solid variant papillary renal cell carcinoma and epithelial-predominant nephroblastoma. / Kinney, Stephanie N.; Eble, John; Hes, Ondrej; Williamson, Sean R.; Grignon, David; Wang, Mingsheng; Zhang, Shaobo; Baldrige, Lee Ann; Martignoni, Guido; Brunelli, Matteo; Wang, Lisha; Comperat, Eva; Fan, Rong; Montironi, Rodolfo; MacLennan, Gregory T.; Cheng, Liang.

In: Modern Pathology, Vol. 28, No. 9, 03.09.2015, p. 1236-1248.

Research output: Contribution to journalArticle

Kinney, Stephanie N. ; Eble, John ; Hes, Ondrej ; Williamson, Sean R. ; Grignon, David ; Wang, Mingsheng ; Zhang, Shaobo ; Baldrige, Lee Ann ; Martignoni, Guido ; Brunelli, Matteo ; Wang, Lisha ; Comperat, Eva ; Fan, Rong ; Montironi, Rodolfo ; MacLennan, Gregory T. ; Cheng, Liang. / Metanephric adenoma : The utility of immunohistochemical and cytogenetic analyses in differential diagnosis, including solid variant papillary renal cell carcinoma and epithelial-predominant nephroblastoma. In: Modern Pathology. 2015 ; Vol. 28, No. 9. pp. 1236-1248.
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abstract = "Metanephric adenoma is a benign renal neoplasm that overlaps in morphology with the solid variant of papillary renal cell carcinoma and epithelial-predominant nephroblastoma. To aid in resolving this differential diagnosis, we investigated the utility of immunohistochemical and molecular analyses in distinguishing between these entities; the first study, to our knowledge, to use a combined approach in analyzing all three tumors. We analyzed 37 tumors originally diagnosed as metanephric adenomas (2 of which we reclassified as papillary renal cell carcinomas), 13 solid variant papillary renal cell carcinomas, and 20 epithelial-predominant nephroblastomas using a combination of immunohistochemistry and fluorescence in situ hybridization (FISH) assessing for trisomy of chromosomes 7 and 17 and loss of Y. Immunohistochemical staining was performed for CK7, AMACR, WT1, and CD57. The combination of CK7-, AMACR-, WT1+, and CD57+ was considered characteristic of metanephric adenoma. Most of the tumors originally diagnosed as metanephric adenomas (31/37) showed the expected staining pattern of metanephric adenoma (CK7-, AMACR-, WT1+, and CD57+). Of the six tumors with discordant immunophenotype, two tumors were reclassified as papillary renal cell carcinoma after cytogenetic workup. It is recommended that all adult cases histologically resembling metanephric adenoma have WT1, CD57, CK7, and AMACR immunohistochemical staining performed. If the staining pattern is characteristic for metanephric adenoma (CK7-, AMACR-, WT1+, and CD57+, including membranous staining), then no other diagnostic tests are indicated. However, if there is a different immunostaining pattern, then we recommend FISH analysis.",
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AU - Williamson, Sean R.

AU - Grignon, David

AU - Wang, Mingsheng

AU - Zhang, Shaobo

AU - Baldrige, Lee Ann

AU - Martignoni, Guido

AU - Brunelli, Matteo

AU - Wang, Lisha

AU - Comperat, Eva

AU - Fan, Rong

AU - Montironi, Rodolfo

AU - MacLennan, Gregory T.

AU - Cheng, Liang

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