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- Title
Nephrogenic Adenoma Intermixed With Urothelial Carcinoma: A Potential Mimic of Divergent Glandular Differentiation, Variant Morphology, or Invasion.
- Authors
Kryvenko, Oleksandr N.; Wasco, Matthew J.; Williamson, Sean R.
- Abstract
Context.-- Nephrogenic adenoma (NA) is a common urinary tract lesion typically associated with urothelial disruption, leading to implantation of shed renal tubular cells. NA may demonstrate a spectrum of architectural and cytologic features mimicking urothelial carcinoma (UC), adenocarcinoma (including clear cell adenocarcinoma and prostatic adenocarcinoma), and invasion. However, admixed UC and NA has not been described. Objective.-- To describe cases where the NA was intimately intermixed with UC, potentially mimicking variant differentiation or invasion. Design.-- In 3 health care systems we identified specimens of NA and UC intimately intermixed with each other to the extent that they could mimic a spectrum of one lesion. We assessed patterns of NA and clinical implications of misdiagnosing NA as glandular differentiation of UC. Results.-- There were 4 women and 29 men (median age, 72 years; range, 31-89 years). Twenty-four patients had transurethral resections, 3 had biopsies, and 6 had major resections. Fourteen had noninvasive high-grade papillary UC, 6 had carcinoma in situ, and 11 had invasive high-grade UC. In 2 patients, NA developed in a papillary urothelial neoplasm with extensive denudation. Three patients had fibromyxoid NA infiltrated by invasive UC. Classical NA (n = 30) had tubulopapillary (n = 18), pure tubular (n = 7), or pure papillary architecture (n = 5). In 1 lesion, NA was present in muscularis propria, and 2 lesions involved adventitia. NA could have been misdiagnosed as invasion in 17 of 22 (77%) noninvasive tumors or higher stage in 19 of 33 (58%). Conclusions.-- NA can be intermingled with high-grade UC, expanding the spectrum of entities that must be considered in the differential diagnosis, as it may mimic glandular or tubular differentiation, invasion, and a higher stage of disease. Misinterpretation of NA in such a setting may incorrectly convey a more aggressive biological potential of cancer to clinicians.
- Subjects
EPITHELIAL cell tumors; ADENOCARCINOMA; CANCER invasiveness; KIDNEY tubules; ADENOMA; TRANSURETHRAL resection of bladder; TRANSITIONAL cell carcinoma
- Publication
Archives of Pathology & Laboratory Medicine, 2023, Vol 147, Issue 5, p552
- ISSN
0003-9985
- Publication type
Article
- DOI
10.5858/arpa.2021-0620-OA