PAX2: a reliable marker for nephrogenic adenoma

Tong, Guo‐Xia; Melamed, Jonathan; Mansukhani, Mahesh; Memeo, Lorenzo; Hernández, Osvaldo; Deng, Fang−Ming; Chiriboga, Luis; Waisman, Jerry

doi:10.1038/modpathol.3800535

Cited by 97 publications

(80 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Renal cell carcinoma 12,13 and NA 1,9 are positive for PAX2, whereas prostate adenocarcinoma and urothelial carcinoma are negative. 9 The epithelial cells of the fallopian tube, uterus, cervix, and papillary serous carcinoma of the ovary are positive for PAX2, 14 but these cells rarely appear in urine. Therefore, it is conceivable that PAX2 positive cells in urine may include normal renal tubular cells, NA cells, and cells from renal cell carcinoma.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Nephrogenic adenoma identified on urine cytology using PAX‐2 immunostaining

Herlitz

Tong

Hamele‐Bena

et al. 2007

Diagnostic Cytopathology

Self Cite

View full text Add to dashboard Cite

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...

show abstract

Section: Discussionmentioning

confidence: 99%

“…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. …”

mentioning

confidence: 99%

Nephrogenic adenoma identified on urine cytology using PAX‐2 immunostaining

Herlitz

Tong

Hamele‐Bena

et al. 2007

Diagnostic Cytopathology

Self Cite

View full text Add to dashboard Cite

show abstract

“…6 The significance of PAX2 in renal development has been confirmed both in experimental animal models and in patients with spontaneous PAX2 mutations. [7][8][9][10] In addition, PAX2 is detected in renal cell carcinomas, 11 Wilms' tumors, 12,13 and nephrogenic adenomas 14,15 and is proposed to be a specific marker in identification of lesions of renal origin.…”

mentioning

confidence: 99%

Expression of PAX2 in papillary serous carcinoma of the ovary: immunohistochemical evidence of fallopian tube or secondary Müllerian system origin?

et al. 2007

Self Cite

View full text Add to dashboard Cite

PAX2 is a urogenital developmental transcription factor expressed in the Wolffian ducts, developing kidneys, and Mü llerian ducts during embryonic stage. Its function in renal development is well documented and its clinical application in the diagnosis of lesions of renal origin has been reported recently. However, information on its role in the Mü llerian-derived genital tract is sparse. In this study, we investigated the expression of PAX2 in human female genital tract using immunohistochemistry. We demonstrated that PAX2 was expressed specifically in the epithelial cells of fallopian tube, endometrial and endocervical glands, but not in the stromal tissues in these areas. PAX2 was detected in secondary Mü llerian structures in the ovary, such as endometriotic and endosalpingiotic glands and rete ovarii, but not in ovarian surface epithelium, surface epithelium-derived inclusion cysts, stroma, or sex-cord-derived structures such as follicles, oocytes, and corpus luteum. In addition, PAX2 was detected in 67% of ovarian papillary serous carcinomas (N ¼ 36) but rarely in peritoneal malignant mesotheliomas, with two exceptions (N ¼ 54). Interestingly, the two PAX2-positive 'peritoneal malignant mesotheliomas' were from female patients and were positive for estrogen receptor. The significance of expression of PAX2 and estrogen receptor in these cases is under investigation. Taken together, we suggest that PAX2 is a novel Mü llerian-specific epithelial marker when used in proper clinical settings. Identification of PAX2 in the majority of papillary serous carcinomas of the ovary but not in the ovarian surface epithelium or epithelium-derived inclusion cysts suggests that this malignant epithelial tumor may be directly derived from the primary or secondary Mü llerian epithelium in or surrounding the ovary, rather than from the surface epithelium or its derivatives.

show abstract

“…[4][5][6][7][8] Several studies have shown that PAX2 and PAX8 are expressed in nearly 100% of nephrogenic adenomas [9][10][11][12] and are helpful markers when the diagnosis of nephrogenic adenoma is difficult. In this study, we corroborated the frequent expression of PAX2 (93%) and PAX8 (100%) in our series of nephrogenic adenomas and identified a flat pattern associated with other traditional nephrogenic adenoma patterns that extended along the adjacent urothelium.…”

Section: Modern Pathology (2013) 26 792-798mentioning

confidence: 99%

“…[4][5][6][7][8] The transcription factors PAX2 and PAX8 (paired box genes) are crucial proteins during the embryonic and fetal development of several organs, particularly intermediate mesoderm and Mü llerian-derived tissues, and are expressed in nearly 100% of nephrogenic adenomas in some series. [9][10][11][12] Tong et al 13 have shown that urothelial cells from the upper genitourinary tract are PAX8 positive, whereas urinary bladder urothelium lacks PAX8 expression.…”

mentioning

confidence: 99%

Flat pattern of nephrogenic adenoma: previously unrecognized pattern unveiled using PAX2 and PAX8 immunohistochemistry

et al. 2013

View full text Add to dashboard Cite

Nephrogenic adenoma is a benign lesion of the urinary tract, particularly the urinary bladder. It is a gross and microscopic mimicker of urothelial neoplasm or metastatic carcinoma. Several histological patterns (tubular, tubulocystic, polypoid, papillary, fibromyxoid) have been recognized, but a flat pattern has not been described. Histologically, nephrogenic adenoma consists of tubules, cysts or papillae lined by flat to polygonal cells with frequent hobnail appearance. The stroma is often edematous or has a granulation tissue-like appearance with acute or chronic inflammation. By immunohistochemistry, nephrogenic adenomas are positive for renal epithelial markers CK7, CD10 and alpha-methylacyl-coenzyme A racemase, and negative for bladder urothelium or prostate markers. Recent studies have shown that nephrogenic adenomas are positive for PAX2 and PAX8. We encountered an interesting case of tubular nephrogenic adenoma with adjacent areas suspicious of flat urothelial atypia. Immunohistochemistry for PAX2 and PAX8 were positive in these areas, unveiling a flat pattern of nephrogenic adenoma. This case prompted us to study 15 cases of nephrogenic adenoma to determine additional instances of flat pattern and to assess the value of PAX2 and PAX8 immunoreactivity to diagnose nephrogenic adenoma. PAX2 and PAX8 immunostaining was positive in 14/15 and 15/15 cases, respectively. The flat pattern was present at least focally adjacent to tubular, polypoid and papillary areas, in 8/ 15 cases of nephrogenic adenoma. In conclusion, the flat pattern is a common finding in nephrogenic adenomas, but easily under recognized by morphologic examination and may be confused with flat urothelial lesions with atypia. Immunostains for PAX2 and PAX8 are useful in the detection of nephrogenic adenomas and particularly unveil those nephrogenic adenomas with flat pattern.

show abstract

PAX2: a reliable marker for nephrogenic adenoma

Cited by 97 publications

References 41 publications

Nephrogenic adenoma identified on urine cytology using PAX‐2 immunostaining

Nephrogenic adenoma identified on urine cytology using PAX‐2 immunostaining

Expression of PAX2 in papillary serous carcinoma of the ovary: immunohistochemical evidence of fallopian tube or secondary Müllerian system origin?

Flat pattern of nephrogenic adenoma: previously unrecognized pattern unveiled using PAX2 and PAX8 immunohistochemistry

Contact Info

Product

Resources

About