Mixed epithelial and stromal tumor of the kidney

N. Volkan Adsay, John Eble, John R. Srigley, Edward C. Jones, David Grignon

Research output: Contribution to journalArticle

197 Citations (Scopus)

Abstract

We describe the clinicopathologic features of 12 patients with a distinctive tumor of the kidney characterized by a mixture of epithelial and stromal elements that form solid and cystic growth patterns. Similar tumors were reported previously in the literature under various names, including adult mesoblastic nephroma. All but one of the patients were women. The only man had a long history of treatment with lupron and diethylstilbesterol. Seven of the women had histories of long-term oral estrogen use of whom six had undergone total abdominal hysterectomy and bilateral salpingo- oophorectomy several years prior, and the seventh patient had been using oral contraceptives for many years. Another woman had this operation but did not receive any hormone therapy. Ages ranged from 31 to 71 years (mean, 56 yrs). Six patients presented with symptoms, including pain and infections attributable to mass effect, and in six the tumor was detected incidentally. Grossly, the tumors were well-circumscribed (mean size, 6 cm; range, 3-12 cm) and consisted of solid and cystic components, most often in equal proportions but in variable distribution. Microscopically, the spindle cell component ranged in appearance from scar-like fibrous tissue to leiomyoma-like interlacing fascicles; usually there was a mixture of both. More cellular foci reminiscent of ovarian stroma or solitary fibrous tumor were also present. No blastema was present. Epithelial elements (composed of clusters of tubules with variable lining) were scattered amidst the spindle cells, and focally transformed into large cysts lined by cells with abundant pink cytoplasm and a hobnail appearance. Immature epithelial elements typical of Wilms' tumor were not present. Muscle markers (desmin and smooth muscle actin) were positive diffusely and strongly in the spindle cells of all tumors, whereas HMB-45 and CD34 were absent. Estrogen receptors were detected in the nuclei of spindle cells in seven tumors and progesterone receptors in three. The distinctive clinicopathologic characteristics of these lesions warrant their classification as a separate category of kidney tumor. We suggest the descriptive term 'mixed epithelial and stromal tumor' for this group until its nature and relationship to other kidney lesions are further clarified. Its preponderance in females with a history of long-term estrogen replacement and the history of long-term sex-steroid use in the only male patient, combined with the frequent content of estrogen and progesterone receptors in the spindle cells, suggest that the hormonal milieu plays a role in the evolution of these tumors. The clinical and pathologic parallels with mucinous cystic tumors of pancreas and liver raise the possibility of a common pathogenetic mechanism that may be linked to the periductal fetal mesenchyme. We think this entity is a benign composite neoplasm in which stroma and epithelium are both integral neoplastic components.

Original languageEnglish
Pages (from-to)958-970
Number of pages13
JournalAmerican Journal of Surgical Pathology
Volume24
Issue number7
DOIs
StatePublished - Jul 2000

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Kidney
Neoplasms
Progesterone Receptors
Estrogen Receptors
Mesoblastic Nephroma
Solitary Fibrous Tumors
Leuprolide
Estrogen Replacement Therapy
Desmin
Wilms Tumor
Leiomyoma
Ovariectomy
Mesoderm
Cellular Structures
Oral Contraceptives
Cell Nucleus
Hysterectomy
Names
Cicatrix
Smooth Muscle

Keywords

  • Biphasic
  • Cysts
  • Estrogen
  • Hormones
  • Kidney
  • Mixed tumor

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine

Cite this

Mixed epithelial and stromal tumor of the kidney. / Adsay, N. Volkan; Eble, John; Srigley, John R.; Jones, Edward C.; Grignon, David.

In: American Journal of Surgical Pathology, Vol. 24, No. 7, 07.2000, p. 958-970.

Research output: Contribution to journalArticle

Adsay, N. Volkan ; Eble, John ; Srigley, John R. ; Jones, Edward C. ; Grignon, David. / Mixed epithelial and stromal tumor of the kidney. In: American Journal of Surgical Pathology. 2000 ; Vol. 24, No. 7. pp. 958-970.
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