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Kidney: Papillary adenoma

Written2008-10Laurie J Eisengart, Ximing J Yang
Department of Pathology, Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
Updated2016-11Kelsey McIntyre, Michelle S. Hirsch
Department of Pathology, Brigham and Women's Hospital, Boston, MA. pdalcin@partners.org

(Note : for Links provided by Atlas : click)

Abstract

Abstract Review on Renal papillary adenoma, with data on clinics, and the genes involved.

Identity

ICD-Topo C649 KIDNEY
ICD-Morpho 8260/0 Papillary adenoma
Atlas_Id 5211
Phylum Urinary system:Kidney:Adult:Adenoma:Tubulopapillary adenoma
Other namesRenal papillary adenoma
Tubulo-papillary adenoma
Note Papillary adenomas are benign renal tumors that are, based on the 2016 WHO classification of renal tumors, low grade papillary neoplasms that are 15mm or fewer in diameter (Moch et al., 2016). This defining size for papillary adenoma was increased from 5mm in the prior WHO classification as metastases from these tumors are not observed in lesions that are ≤15mm.

Clinics and Pathology

Disease Renal papillary adenoma
Epidemiology Papillary adenomas are common. They have been reported in 7% of nephrectomy specimens and 10-40% of autopsy kidneys. In autopsy series, the lesions are more common in older patients (10% of patients <40 years; 40% in those >70 years) and in patients with end stage kidney disease. Papillary adenomas may be found more frequently in resected kidneys with papillary renal cell carcinoma, and in patients with hereditary RCC, renal vascular disease, end-stage renal disease or acquired cystic kidney disease.
Clinics Most renal papillary adenomas are discovered incidentally at nephrectomy for another disease. However, with better imaging more tumors may be identified preoperatively. Multiple, bilateral papillary adenomas are referred to as renal adenomatosis.
Pathology The current World Health Organization (WHO) classification of kidney tumors defines renal papillary adenomas as unencapsulated epithelial tumors lesions with a tubulo-papillary architecture measuring ≤ 15mm and of low nuclear grade (Eble et al., 2016). The tumors morphologically resemble PRCC with papillary to tubulopapillary architecture and CK7 expression. By definition, cytologic aypia and necrosis are absent (Fig. 1).
 
Figure 1: Histologically, papillary adenomas resemble low grade papillary RCC, but are < 15 mm in greatest dimension.
Treatment Although very little is typically done for small renal masses <2.0 cm, a core biopsy can be obtained to confirm the diagnosis of a papillary adenoma detected by imaging. Subsequent treatment options would typically include observation and cyoablation; surgery is less for papillary adenomas and is typically reserved for carcinomas.
Evolution It has been proposed that renal papillary adenomas are precursor lesions of papillary renal cell carcinoma. In addition to the epidemiologic association with PRCC (see above), papillary adenomas and PRCC show similar immunohistochemical expression of alpha-methylacyl-coenzyme A racemase ( AMACR ). Interestingly, papillary adenomas arising in the setting of acquired polycystic kidney disease do not show AMACR expression, suggesting a different biological mechanism for these neoplasms.
Prognosis Excellent for this benign lesion. Renal papillary adenomas theoretically have no metastatic potential.

Cytogenetics

Note Trisomy 7 and 17, and loss of the Y chromosome are common changes in papillary adenomas.There are no definitive cytogenetic differences between the small tumors classified as adenomas and PRCC.

Bibliography

 
Papillary adenoma.
Eble J, Delahunt B, Moch H, Martignoni G, Amin MB, Srigley JR, Argani P, Tan PH, Cheville J, Tickoo SK.
In: World Health Organization Classification of Tumours: Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs. Moch, H., Humphrey, P.A., Ulbright, T.M., Reuter, V.E. eds; IARC Press, Lyon 2016, 42-43.
 
Numerical chromosomal aberrations in papillary renal cortical tumors: relationship with histopathologic features.
Henke RP, Erbersdobler A.
Virchows Arch. 2002 Jun;440(6):604-9. Epub 2001 Sep 5.
PMID 12070600
 
Chromosomal gains and losses detected by comparative genomic hybridization and proliferation activity in renal cell carcinoma.
Kallio JP, Mahlamaki EH, Helin H, Karhu R, Kellokumpu-Lehtinen P, Tammela TL.
Scand J Urol Nephrol. 2004;38(3):225-30.
PMID 15204376
 
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PMID 1958590
 
Renal cancer: cytogenetic and molecular genetic aspects.
Meloni-Ehrig AM.
Am J Med Genet. 2002 Oct 30;115(3):164-72. (Review).
PMID 12407697
 
Genetic aberrations detected by comparative genomic hybridization are associated with clinical outcome in renal cell carcinoma.
Moch H, Presti JC Jr, Sauter G, Buchholz N, Jordan P, Mihatsch MJ, Waldman FM.
Cancer Res. 1996 Jan 1;56(1):27-30.
PMID 8548768
 
World Health Organization Classification of Tumours of the Urinary Systems and Male Genital Organs
Moch, H., Humphrey, P.A., Ulbright, T.M., Reuter, V.E. eds (4th edition); IARC Press, Lyon 2016; 11-76.
 
Analysis of kidney tumors by comparative genomic hybridization and conventional cytogenetics.
Rigola MA, Casadevall C, Bernues M, Caballin MR, Fuster C, Gelabert A, Egozcue J, Miro R.
Cancer Genet Cytogenet. 2002 Aug;137(1):49-53.
PMID 12377413
 
Management of the incidental renal mass.
Silverman SG, Israel GM, Herts BR, Richie JP.
Radiology. 2008 Oct;249(1):16-31.
PMID 18796665
 
Renal papillary adenoma--a putative precursor of papillary renal cell carcinoma.
Wang KL, Weinrach DM, Luan C, Han M, Lin F, Teh BT, Yang XJ.
Hum Pathol. 2007 Feb;38(2):239-46. Epub 2006 Oct 23.
PMID 17056094
 

Citation

This paper should be referenced as such :
McIntyre K, Hirsch MS
Kidney: Papillary adenom
Atlas Genet Cytogenet Oncol Haematol. in press
On line version : http://AtlasGeneticsOncology.org/Tumors/RenalPapilAdenomID5211.html
History of this paper:
Eisengart, LJ ; Yang, XJ. Kidney: Papillary adenoma. Atlas Genet Cytogenet Oncol Haematol. 2009;13(10):749-750.
http://documents.irevues.inist.fr/bitstream/handle/2042/44593/10-2008-RenalPapilAdenomID5211.pdf


Other genes implicated (Data extracted from papers in the Atlas) [ 1 ]

Genes LOX

External links

arrayMap Topo ( C64) arrayMap ((UZH-SIB Zurich)   [auto + random 100 samples .. if exist ]   [tabulated segments]
 
 
Other databaseICGC Data Portal - [RECA-CN] Renal cancer - CN
Disease databaseKidney: Papillary adenoma
REVIEW articlesautomatic search in PubMed
Last year articlesautomatic search in PubMed


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