Kidney tumor - adult malignancies - Adenocarcinoma of renal pelvis

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Kidney tumor - adult malignancies

Adult renal cell carcinoma

Adenocarcinoma of renal pelvis

Reviewers: Sean Williamson, M.D. (see Reviewers page)
Revised: 5 June 2012, last major update June 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Rare neoplasm (1%) of renal pelvis originating from urothelium with pure glandular differentiation

Epidemiology
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● Most primary renal neoplasms of renal pelvis are urothelial carcinomas; urothelial carcinoma with glandular differentiation is more common than pure adenocarcinoma
● A link between adenocarcinoma and pyelitis glandularis/pyelitis cystica, secondary to chronic inflammation or renal stones, is controversial (Urology 2008;71:915, Clin Cancer Res 2007;13:6232)

Case reports
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● 35 year old woman with pseudomyxoma peritonei (Indian J Pathol Microbiol 2008;51:536)
● 41 year old man with tumor in horseshoe kidney (Hinyokika Kiyo 2002; 48:187)
● 48 year old woman whose tumor was CEA+ (Urology 2008;71:e7)
● 53 year old man with tumor in solitary pelvic kidney (Urology 1993; 41:292)
● 57 year old man with gross hematuria and flank pain (Case of Week #94)
● 65 year man with mucin secreting tumor (Arch Pathol Lab Med 1988;112:847)
● 76 year old man with 22 cm tumor (Hinyokika Kiyo 1997;43:727)
● With urothelial carcinoma in renal pelvis and bladder (Int J Urol 2004;11:1016)

Gross description
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● Large, infiltrating tumor, which fills dilated renal pelvis and calyces and invades adjacent renal parenchyma

Gross images
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Signet ring adenocarcinoma

Micro description
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● Subtypes are tubulovillous (72%), mucinous (22%) or papillary non-mucinous and non-intestinal (6%)
● Tubulovillous have worst prognosis (Arch Pathol Lab Med 1993;117:1156)
● Signet ring variant is rare, may be associated with collagenous spherulosis (Int J Surg Pathol 2005;13:375)

Micro images
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Signet ring cell adenocarcinoma:

Rhabdoid features and intracytoplasmic lumina

Signet ring cells

Superficial invasion by tumor cells

With goblet cell metaplasia

Mucin+ with PAS-Alcian Blue stain

Positive stains
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● Mucin stains: PAS, Alcian Blue, mucicarmine

Differential diagnosis
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● Urothelial carcinoma with glandular differentiation: shows admixture of typical urothelial carcinoma and glandular component
● Metastasis or direct extension: exclusion is critical (colorectal, stomach, breast, or others)

End of Kidney tumor - adult malignancies > Adult renal cell carcinoma > Adenocarcinoma of renal pelvis

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