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Ureters

Nephrogenic metaplasia / adenoma


Reviewers: Sean Williamson, M.D., (see Reviewers page)
Revised: 24 August 2012, last major update July 2012
Copyright: (c) 2002-2012, PathologyOutlines.com, Inc.

General
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● Rare, associated with stone or other irritation of the mucosa
● Nephrogenic adenoma: similar histologic findings, but presenting as a mass
● For nephrogenic adenoma, mean age 52 years, range 15 to 94 years (entire urinary tract), M/F = 2:1; ureter is rare site (4% of all urinary tract tumors, Mod Pathol 1995;8:722)

Micro description
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● Proliferation of tiny mucin-containing microcysts, medium-sized tubular structures (resembling renal tubules), and small exophytic papillary structures
● Lined by cuboidal cells similar to renal tubular epithelial cells
● Basement membrane around tubules may be appreciable but not prominent
● Tubules/cysts often have eosinophilic or basophilic secretion
● Generally mild cytologic atypia, characterized by enlarged vesicular nuclei and prominent nucleoli
● No mitotic figures
● May have transmural involvement and appear infiltrative, (Mod Pathol 2002;15:765, Am J Clin Pathol 1983;80:92)

Micro images
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Cross-section of ureter


Tiny microcystic structures superficially resembling signet ring cells and larger tubular structures in the lamina propria of the ureter


Higher magnification of microcysts surrounded by a thickened basement membrane


Small elongated tubular structures lying in a fibrous stroma


A cystically dilated tubule contains mucin and is lined by hobnail cells


Cytokeratin

Positive stains
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● CK7, AE1-AE3, mucin, PAX2, AMACR

Negative stains
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● CEA, p53, Ki-67 (<5%), p63, HMWCK (34betaE12)

Electron macroscopy description
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● Epithelial cells with sparse microvilli and thick basal lamina

Molecular description
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● In renal transplant patients with opposite sex donor, FISH reveals the donorís sex chromosomes within the lesion, suggesting implantation and proliferation of shed renal tubular cells into injured mucosa (N Engl J Med 2002;29:347)

Molecular images
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FISH and H&E in transplant patients

End of Ureters > Nephrogenic metaplasia / adenoma


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