Multicentric papillary renal cell carcinoma associated with renal adenomatosis

Abstract

A case of multicentric papillary renal cell carcinoma (RCC) associated with renal adenomatosis in the bilateral kidneys is reported. Bilateral multiple renal cysts in a 46-year-old man were pointed out incidentally by ultrasonography. Some of the left renal lesions were considered to be RCC, and left radical nephrectomy was performed accordingly. The left kidney was occupied by numerous solid nodules, which ranged from yellow to tan in color, and some of the large ones had foci of hemorrhage and necrosis. Microscopically, most of the tumors showed papillary RCC associated with renal adenoma, while others consisted only of adenomas. Ten months later, multiple lesions of the right kidney, which were initially considered to be multiple cysts, were found to have become enlarged and some of them were diagnosed as RCC. Thus, right radical nephrectomy was also performed, and these tumors showed the same features as the left renal tumors. The patient's familial history was not remarkable. The kidneys revealed various histological features, ranging from dysplastic to adenoma or carcinoma, including transitional or overlapping features between them. The findings suggest an adenoma-carcinoma sequence in papillary RCC. It is worth considering such entities.

Incidentally detected renal adenomatosis in a patient with urolithiasis

“…Therefore, we think that positivity of this molecule is not adequate per se to indicate the presence of carcinomatous transformation. Because of lack of some additional findings such as nuclear atypia, and solid areas defined by Kiyoshima et al [6] which might substantiate the diagnosis of carcinoma, we thought that the lesion with the greatest diameter might be accepted as a representative of adenoma. Therefore we spoke with the attending clinician, and expressed our opinion that it would be appropriate for us to accept the lesion with the greatest diameter as adenoma.…”

“…[1] Presence of multiple adenomas (≥5) is termed 'renal adenomatosis' which is seen quite rarely. [6] This term is firstly used by Syrjanen in 1979. [7] Very scarce number of cases have been reportedly associated with dialysis-related acquired renal cystic disease (ARCC) or chronic renal damage (Table 1).…”

“…Otherwise, association between adenomatosis, and papillary RCC have been mentioned in case reports. [4,[6][7][8][9][10]13] In some of these reports , concomitancy of oncocytic lesions has been also indicated. [9,10] Adenoma, and papillary RCC also share some common genetic anomalies.…”

“…Briefly, because of higher rates of concomitancy, multifocality, histological, and immunohistochemical similarities, and common genetic anomalies, some authors have indicated that adenomatosis, and papillary RCC might be an outcome of a common biological process, and adenomas can be considered as precancerous lesions. [3][4][5][6] In conclusion, rarely seen renal adenomatosis can develop on the ground of hydroneprosis secondary to urolithiasis. Clinical monitorization of the lesions larger than 5 mm in diameter just like low-grade papillary RCC seems to be appropriate for these tumors with variable reporting criteria.…”

“…However its incidence varies in different series (0.26-22.4%). [3,6] Though it can be observed in every age group, it can be detected in 10, and 40% of the patients younger than 40 or older than 70 years of age, respectively. In other words, its incidence increases with age.…”