Nephrogenic adenoma mimicking carcinoma: A potential pitfall in cytodiagnosis

Henke, A.; Callaghan, Edward J.; Timmerman, Timothy G.; Hughes, Jonathan H.

doi:10.1002/(sici)1097-0339(200001)22:1<49::aid-dc13>3.0.co;2-j

Cited by 5 publications

(4 citation statements)

References 14 publications

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“…However, irregular nuclear contour and coarse chromatin can be seen in some cells, suggesting malignancy. [6][7][8]11 PAX2 is a developmental transcription factor and is expressed in limited tissue types. In the urogenital system, PAX2 is found in renal tubular cells and parietal cells of the Bowan's capsule in kidney.…”

Section: Discussionmentioning

confidence: 99%

“…However, the cytologic features of NA are less well defined and it contributes to false positive diagnoses in urine cytology. [6][7][8] In addition, NA may coexist with or develop after the treatment of malignant tumors of the urinary tract, thus further complicating the recognition of this benign lesion. Several immunohistochemical markers have been used to assist in the differential diagnosis of NA.…”

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confidence: 99%

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Nephrogenic adenoma identified on urine cytology using PAX‐2 immunostaining

Herlitz

Tong

Hamele‐Bena

et al. 2007

Diagnostic Cytopathology

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Urine cytology is a sensitive and specific method in detecting urothelial carcinoma of the urinary bladder, particularly the high-grade ones. However, the cytologic features of nonneoplastic lesions of the lower urinary tract, including nephrogenic adenoma, are nonspecific and may cause false positive diagnosis. Recent evidence has demonstrated that nephrogenic adenoma is a true ''nephrogenic'' lesion derived from the exfoliated and implanted renal tubular cells in the urinary tract. This has promoted the use of immunostaining of renal transcription factor PAX2 in tissue biopsies to differentiate nephrogenic adenoma from the common malignant tumors of the lower urinary tract. We report here that PAX2 immunostaining can also be used in urine cytology specimen to identify nephrogenic adenoma. Combination of PAX2 immunostaining and cytologic analysis may increase the accuracy in identifying this benign lesion in urine cytology specimen and therefore reduce unnecessary repeat cystoscopy and biopsy procedures. This may be a cost effective followup method for patients with an established diagnosis of nephrogenic adenoma. Diagn. Cytopathol. 2008;36:47-49. ' 2007 Wiley-Liss, Inc.Key Words: PAX2; nephrogenic adenoma; urine cytology Nephrogenic adenoma (NA) is an uncommon lesion of the urinary tract often associated with renal transplant, anatomic anomaly, or a history of traumatic injury of the urinary tract. 1 It was traditionally considered to be a metaplastic lesion of the urothelium. However, recent evidence has suggested that NA is a truly ''nephrogenic'' lesion derived from exfoliated and implanted renal tubular cells in the urinary tract. 2 The histologic features of NA are well described and the diagnoses in most cases are straightforward. 3-5 Urine cytology is frequently used to evaluate urinary bladder cancer and constitutes a large portion of cytology specimens. However, the cytologic features of NA are less well defined and it contributes to false positive diagnoses in urine cytology. [6][7][8] In addition, NA may coexist with or develop after the treatment of malignant tumors of the urinary tract, thus further complicating the recognition of this benign lesion. Several immunohistochemical markers have been used to assist in the differential diagnosis of NA. Recently, we reported that the renal transcription factor PAX2 is a reliable marker to distinguish NA from common carcinomas of the urinary tract on tissue sections. 9 We report here our experience utilizing PAX2 antibody in a urine cytology specimen for one NA case. Report of a CaseThe patient was a 69-year-old woman with end stage renal disease secondary to diabetes and hypertension who was on a waiting list for kidney transplant. A 3-cm tumor was noted on the right lateral wall of the urinary bladder during the pretransplant evaluation. The patient underwent a partial cystectomy and the tumor was reportedly resected completely. The histological diagnosis was lowgrade papillary urothelial carcinoma, which resulted in her subsequent removal from the tra...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Nephrogenic adenoma identified on urine cytology using PAX‐2 immunostaining

Herlitz

Tong

Hamele‐Bena

et al. 2007

Diagnostic Cytopathology

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“…4a and b). The clue is the absence of significant nuclear atypia 42. In line with current views on origin from renal tubular cells, immunostaining for the nuclear renal transcription factor PAX2 has been successfully utilized on a ThinPrep slide of urine to support a diagnosis of nephrogenic adenoma 43.…”

Section: Glandular Entitiesmentioning

confidence: 91%

Urine cytopathology: Challenges, pitfalls, and mimics

Thiryayi

Rana

2011

Diagnostic Cytopathology

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Urine cytopathology is a useful and noninvasive tool in the diagnosis and follow-up of urothelial neoplasia, which remains complementary to emerging molecular tests. These specimens may be challenging and there are numerous mimics and diagnostic pitfalls with which to contend. This review discusses these various entities and includes consideration of ancillary tests that may be useful in the diagnostic procedure.

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“…Invasive urothelial carcinoma is a perennial concern; urethral obstruction by nephrogenic adenoma may be radiographically suspicious for malignancy, and cytologic urine screening may yield abnormalities. 28,29 In addition, the presence of focal atypia, closely packed or solid tubules, and an infiltrative appearance within nephrogenic adenomas may confound the diagnosis. 20,28 In support of a diagnosis of nephrogenic adenoma, a circumscribed growth pattern, confinement to the lamina propria and urothelial surface, small lesional size, and the absence of mitoses and necrosis aid in the distinction.…”

Section: Differential Diagnosismentioning

confidence: 99%