Mixed Epithelial And Stromal Tumor Of The Kidney Research Articles

Differentiating the clinical and computed tomography imaging features of mixed epithelial and stromal tumors of the kidney to establish a treatment plan.

ObjectiveTo differentiate the clinical features and computed tomography imaging features in the two types of mixed epithelial and stromal tumor of the kidney (MESTK) and to establish a treatment plan for the MESTK types.MethodsSeventeen patients who underwent multidetector computed tomography (MDCT) before surgery and had a pathological diagnosis of MESTK were enrolled. Their clinical information (R.E.N.A.L. nephrometry score (R.E.N.A.L.‐NS), radical nephrectomy (RN), partial nephrectomy (PN), etc.) were collected. The radiological features included renal sinus fat invagination (SFI), maximal diameter (MD), capsule and septa of the tumor, etc., were also analyzed. They were divided into two types according to the MDsolid/MDtumor ratio (solid type with >60%; cystic type with ≤60%). An independent‐sample t‐test and Fisher exact test were used to assess the differences between the two groups.ResultsMESTKs demonstrated a variable multi‐septate cystic and solid components with a delayed enhancement. There were nine patients for solid type and eight patients for cystic type. Compared with solid type, the lesions in cystic type have larger MD (81.00 ± 37.91 vs. 41.22 ± 24.19, p = 0.020), higher R.E.N.A.L.‐NS (10.03 ± 0.50 vs. 8.95 ± 1.26, p < 0.001), higher RN (75.00% vs. 22.22%, p = 0.015), larger SFI (87.5% vs. 33.3%, p = 0.05), more septa (100% vs. 0%, p < 0.001), and more capsule (100% vs. 11.1%, p < 0.001).ConclusionCystic type MESTK has more hazardous features (such as larger MD, higher R.E.N.A.L.‐NS, more RN, greater SFI, multiple septa) compared with solid type, suggesting that RN is more suitable for cystic type and PN for solid type.

Pattern of Tumor-Infiltrating Lymphocytes in Mixed Epithelial and Stromal Tumor of the Kidney: A Review of Five Cases.

Mixed epithelial and stromal tumor of the kidney (MESTK), a benign rare tumor with malignant transformation potential, is thought to be derived from fetal or immature cells originating from the mesonephric and Müllerian ducts. However, due to its rarity, little is known about the anti-tumor immune responses in MESTK. Herein, we present five cases of MESTK and evaluate the population of tumor-infiltrating lymphocytes (TILs) using a freshly obtained MESTK sample. Microscopically, TILs were scattered or clustered in large aggregates in the stroma in all five cases; furthermore, three cases exhibited heavy, large lymphocytic aggregates with no well-organized tertiary lymphoid structures with germinal centers. Flow cytometric analysis of TILs in one freshly obtained MESTK sample revealed that >40% of CD3+ T cells were effector memory Fas+CD28− γδ T cells expressing high levels of programmed cell death protein 1 and inducible T-cell co-stimulator, but low levels of CD44 and CD27. Most αß T cells exhibited a naïve phenotype. Additionally, we detected many activated class-switched CD21+CD27+ B cells as well as CD11chighIgMhigh marginal zone B-like and CD27−CD21−CD23− immunoglobulin (Ig)DhighIgMlow age-associated B-like cells. Collectively, for the first time, we report the immune microenvironment pattern of MESTK to oncogenic stress.

Papillary renal cell carcinoma with prominent spindle cell stroma - tumor mimicking mixed epithelial and stromal tumor of the kidney: Clinicopathologic, morphologic, immunohistochemical and molecular genetic analysis of 6 cases

Papillary renal cell carcinoma (PRCC) is currently a well-studied type of RCC. In addition to PRCC type 1, there are a number of other subtypes and variants of PRCCs which have been reported. We describe a series of 6 PRCCs with papillary, micropapillary and/or tubulopapillary architecture and prominent spindle cell stroma, resembling stroma in mixed epithelial and stromal tumor of the kidney (MESTK) or sarcomatoid RCC.Clinicopathologic, morphologic, immunohistochemical and molecular features were analyzed.All patients were males with an age range of 44–98 years (mean 65.3, median 65.5 years). Tumor size ranged from 2.4–11.4 cm (mean 5.8, median 4.5 cm). Follow-up data were available for 4 patients, ranging from 3 to 96 months (mean 42.75, median 36 months). Epithelial cells were mostly cylindrical with eosinophilic cytoplasm, showing nuclear grade 2 and 3 (ISUP/WHO).In all cases, loose to compact prominent stroma composed of spindle cells, without malignant mesenchymal heterologous elements was detected. No atypical mitoses were found, while typical mitoses were rare in both epithelial and stromal components.Epithelial cells were positive for CK7, AMACR, and vimentin in all cases, while negative for TFE3, HMB45, desmin, CD34, and actin. The stroma was positive for vimentin, actin and focally for CD34, while negative for CK7, AMACR, TFE3, HMB45, and desmin. Estrogen and progesterone receptors were completely negative. FH and SDHB expression was retained in all analyzable cases. Proliferative index was barely detectable in stromal component and low in epithelial component, ranging 0 to 5% positive stained cells/high power field.Copy number variation was variable with no distinct pattern. No mutations in CDKN2A, BAP1, MET were detected.PRCC with MESTK-like features is a distinct variant of PRCC mimicking MESTK. Our findings add to the body of literature on ever expanding variants of PRCCs. Both epithelial and stromal components lacked true Müllerian features, which was also proven by immunohistochemistry.

AB181. Analysis of clinical and pathological features of mixed epithelial and stromal tumor of the kidney

ObjectiveTo study the histology and pathology clinical features, diagnosis, identification and treatment of mixed epithelial and stromal tumor of the kidney (MESTK).MethodsOne case of MESTK was reported. One patient’s clinical data with mixed epithelial and stromal tumor of the kidney in our department was reported. Male, 53 years old, physical examination found the left kidney cyst. B-ultrasonic, ultrasonic imaging and CT of the left kidney and upper lateral visible cysts, size 7.5×6.4×6.4 cm, and the adjacent in the renal sinus cyst space form, can be seen in the space limitations, involving the scope of 6.5×2.8×2.8 cm. Retrieve PubMed and domestic literature of CNKI database, reported a total of 160 cases, including malignant change in 12 cases of foreign literature, and their clinical data were reviewed.ResultsPatient with surgical treatment had complete resection of the tumor and ipsilateral kidney. The tumor consisted of multiple cystic and solid areas on gross examination, and intracapsular surface coating flat, cubic, hobnail and stratified epithelium, partial epithelial hyperplasia, have formed at the regional and ventricular papillary structures. Local tissue is at early invasive. Immunohistochemistry: Vimentin (+), CK7 (+), Pax8 (−), SAM partial (+), P504s weak (+), TFE3 partial (+), ER (−), PR (+), Ki67 <1% positive tumor cells. There was no evidence of recurrence and metastasis during the follow-up of 6 months.ConclusionsMESTK on domestic and foreign clinical is rare, and has non-specific clinical manifestations. Additionally, surgery is the main therapy for MESTK and there is the possibility of malignant and malignant lesions has no effective treatment.

Mixed Epithelial and Stromal Tumor of the Kidney: A Rare Case Report

Mixed epithelial and stromal tumor of the kidney (MESTK) is a rare kidney tumor that is composed of both epithelial and mesenchymal components with solid and cystic architecture. Up to the present, approximately 100 cases have been reported. It was introduced in the World Health Organization 2004 renal tumor classification. Here, we report a 49-year-old female with mixed epithelial and stromal tumor (MEST) in her kidney with no cystic components and no history of hormone use. J Med Cases. 2014;5(6):362-365 doi: http://dx.doi.o rg/10.14740/jmc1797 w

Mixed epithelial and stromal tumor of the kidney with endometrioid differentiation associated with pancreatic solid pseudopapillary tumor

Abstract Mixed epithelial and stromal tumor of the kidney (MESTK) is a benign cystic neoplasm. Pancreatic solid-pseudopapillary tumor (SPT) is a typically cystic carcinoma of low malignant potential. We describe a MESTK synchronous with a SPT in a female with an ovarian cystic corpus luteum. Glands showed endometrioid differentiation and the spindle cell stroma created complex leaflet-like structures similar to Mullerian adenofibroma. The SPT consisted of polygonal cells with a pseudopapillary pattern and a cystic area. Expression of estrogen and progesterone receptors in MESTK stromal cells and progesterone receptors in SPT provided a diagnostic clue, confirming the hormonal dependence in pathogenesis. Given that our MESTK is a polypoid tumor with endometrioid differentiation, the differential diagnosis with polypoid endometriosis is considered.

Mixed epithelial and stromal tumor of the kidney: report of eight cases and literature review

Mixed epithelial and stromal tumor of the kidney (MESTK) is the term given to a class of uncommon biphasic tumors of the kidney, with few reported cases. We describe eight cases of MESTK with detailed clinicopathological data and follow-up information. With this report, we hope to increase clinical awareness that MESTK should be considered as one of the possible diagnoses for cystic renal mass, especially in peri-menopausal women or those who receive hormone therapy. In addition, regular follow-up is necessary for the any cases with malignant potential.

Mixed Epithelial and Stromal Tumor of Kidney: An Exceptional Renal Neoplasm in an 8-Year-Old Prepubertal Girl with Isolated Clitoral Hypertrophy

Mixed epithelial and stromal tumor of the kidney (MESTK) is a recently described rare kidney biphasic benign tumor composed of a mixture of stromal and epithelial structures [1]. It almost exclusiv...

Mixed Epithelial and Stromal Tumor of the Kidney: A Case Report

Mixed epithelial and stromal tumor of the kidney (MESTK) is a recently described rare neoplasm. Malignant transformation, recurrence and metastasis are rare, therefore histopathological distinction from other renal neoplasms, especially from renal cell carcinoma is important. Histologically the tumor is composed of biphasic components including cysts and tubules embedded in the spindle cell stroma. We report a case of a MESTK in 60-year-old postmenopousal woman who presented with an incidental solid renal mass but no urinary complaint.

A Case Report of a Renal Mixed Epithelial and Stromal Tumor in a Heterozygous S1P2 Receptor Deficient Mouse

We report a case of mixed epithelial and stromal tumor of the kidney (MESTK) in a 32-week-old heterozygous sphingosine 1-phosphate-2 (S1P2) receptor deficient female mouse. A white solid mass replacing the left kidney was observed at the left retroperitoneal wall. Histologically, the tumor mass consisted of dimorphic cellular components of epithelial and stromal cells. Epithelial cells formed various sized irregular-shaped tubular structures resembling renal tubules surrounded by stromal cells. Immunohistochemically, epithelial cells were positive for cytokeratin, while stromal cells showed positive immunoreactivity with alpha-smooth muscle actin as well as vimentin. Based on the morphological and immunohistochemical findings, this tumor was diagnosed as a MESTK.

Spontaneous Renal Mixed Epithelial and Stromal Tumor (MEST) in a Beagle

A mixed epithelial and stromal tumor (MEST) of the kidney was found in a 22-month-old female Marshall beagle. Histopathologically, this lesion was well demarcated and was composed of a mixture of epithelial and stromal elements. The epithelial elements, which contained columnar or ciliated columnar epithelia, had cystic and tubular growth patterns. The tubular lumina contained eosinophilic materials, which were positive for periodic acid Schiff and alcian blue (pH 2.5). Immunohistochemically, the epithelia were positively stained with proliferative cell nuclear antigen (PCNA) and showed co-expression of cytokeratin and vimentin. Morphologically, these proliferative ductal structures were suggestive of a primitive duct arising from the mesonephric or paramesonephric tubule. The stromal elements were characterized by proliferation of spindle cells embedded in a collagen-rich eosinophilic matrix. Additionally, stromal cells were positive for PCNA, vimentin and muscle markers (α-smooth muscle actin and desmin). Therefore, this lesion was ultimately diagnosed as a MEST of the kidney.

Mixed epithelial and stromal tumor of the kidney in a puerperal woman

Puerperal pyrexia is still rampant, especially in third world countries, and is usually due to puerperal sepsis, urinary tract infections, upper respiratory infection, and breast infection. Rarely, in third world countries like India, it may be due to tuberculosis, malaria, typhoid, and so on, which are also rampant in the general population. Mixed epithelial and stromal tumor of the kidney (MESTK) is a recently recognized subset of renal tumors composed mainly of smooth muscle cells in which epithelial structures are embedded. It usually occurs in middle aged and older women. In the present case report, a 36-year-old woman presented with puerperal pyrexia, possibly due to tuberculosis and with an incidental mixed epithelial and stromal tumor of the kidney causing complex ascitis and fever, which required nephrectomy that was followed by full recovery. This case report highlights the importance of keeping MESTK in mind even in younger women with asymptomatic renal mass. It also highlights the importance of keeping renal tumors in mind as a possibility and to perform proper investigations for adequate treatment and recovery.

A Mixed Epithelial and Stromal Tumor of the Kidney in a Ringtail Lemur (Lemur catta)

Primary renal tumors are rare neoplasms in nonhuman primates. This report describes a mixed epithelial and stromal tumor of the kidney (MESTK) in a 14.5-year-old female ringtail lemur. The well-demarcated, solid, and cystic mass was located in the pelvis of the left kidney and consisted histologically of both epithelial and mesenchymal components. The mesenchymal cells were arranged in fascicles around cysts lined by a well-differentiated epithelium. Neither the mesenchymal nor the epithelial parts showed significant nuclear atypia or mitotic figures. To our knowledge, only 1 similar case, classified as adenoleiomyofibromatous hamartoma, has been reported in a ringtail lemur. In humans this tumor affects predominantly perimenopausal women and can express estrogen and progesterone receptors. However, neither estrogen nor progesterone receptors could be identified by immunohistochemistry in the tumor of the present ringtail lemur. Therefore, a hormonal mechanism could not be demonstrated in this case.

Mixed epithelial and stromal tumor of the kidney in a 12‐year‐old girl

Mixed epithelial and stromal tumor of the kidney (MESTK) is a rare kidney neoplasm that almost exclusively occurs in perimenopausal women, and long-term estrogen replacement is relevant to its pathogenesis. Herein is described an atypical case of MESTK uncovered in a 12-year-old premenarcheal girl without a history of prior estrogen use. On surgical specimen it was found that the well-circumscribed tumor measuring 14 cm arose from the lower pole of the right kidney, showing solid and fibrous-cystic areas. Microscopically, it was composed both of epithelial structures similar to renal tubules and stroma comprising non-specific spindle cells. Some intratumoral tubules showed affinities to distal-nephron-specific lectins, and those immunoreactive for proximal-tubule-specific CD15 were also present. In addition, primitive ductal structures were reactive both for CD15 and lectins, but immature epithelial elements typical of nephroblastoma were absent. Spindle cells were positive for actin, desmin and vimentin, and expressed progesterone and estrogen receptors. The tumor was comparable with MESTK, although some epithelia were associated with the immunophenotype of proximal tubules. The patient was free of disease postoperatively for 40 months. In the present case, remnants of the primitive periductal mesenchyme might be promoted to neoplastic cells by a sex-steroid surge during puberty.

Mixed epithelial and stromal tumor of the kidney with cervical and intestinal differentiation

Dear Editors:Mixedepithelialandstromaltumorofthekidney(MESTK)has only recently been recognized as a rare benign tumorof the kidney which has distinct clinical and morphologi-cal characteristics. The name MESTK was first used byMichalandSyrucekin1998[1],andwasnewlyrecognizedin the recent WHO classification of the urinary system as adistinct entity [2].We report a unique case of MESTK which showed cer-vical and intestinal epithelial differentiation. To the best ofour knowledge, no such differentiation within MESTKhas ever been described in the literature [3, 4]. A 50-year-old woman presented with hematuria associated with painin the left flank. The patient had a 20-year history of tak-ing oral contraceptives. Computed tomography revealed a7 cm solid and cystic mass at the upper poles of the leftkidney. On thorough clinical check-up, no other tumorwas found in the patient. Under the diagnosis of renal tu-mor, the patient underwent total nephrectomy and adre-nalectomy. After surgery, no additional treatment wasgiven. Seven months after excision of the tumor, the pa-tient is without signs of recurrence and metastasis. Mac-roscopically, the tumor was localized in the upper part ofthe kidney. The tumor was 7 cm in diameter, well-circum-scribed, and composed of irregular mixtures of solid andcystic areas. The solid areas of the tumor were firm andgray-white on gross section. The cysts varied in size rang-ing from 0.5 to 2 cm in diameter. There were no signs ofinfiltrative growth into the surrounding renal parenchymaand the adjacent calyceal system.Histologically, the tumor was composed of a mixture ofepithelial elements that formed glands and cysts and stro-mal component formed mainly by spindle cells. The ep-ithelial component had a characteristic appearance both

Mixed epithelial and stromal tumors of the kidney. A report of 22 cases.

Mixed epithelial and stromal tumor of the kidney (MESTK) is a recently described subset of renal neoplasm that tends to occur in middle-aged and older women and is characterized by a distinctive histological appearance. To further characterize this lesion, we report the clinicopathological and immunohistochemical features of 22 additional cases from our institutional files. Grossly, the tumors ranged in size from 1 cm to 14 cm (mean 6.7 cm), were well circumscribed but unencapsulated, and showed a cystic cut surface. The tumors were composed of a spindle cell proliferation that resembled ovarian stroma, as well as an epithelial component lining the cystic structures, which usually consisted of flat to hobnailed cells typical of collecting-duct epithelium. Areas displaying features of Mullerian differentiation were also documented in 6 cases, including epithelium of endometrioid, tubal, clear cell and squamous cell type as well as one case showing an architecture that closely resembled Mullerian adenofibroma and adenosarcoma. Follow-up in 14 patients (average 4.4 years) showed no evidence of recurrence or metastasis. We believe these tumors represent the renal counterpart of similar mixed epithelial and stromal neoplasms occurring in the biliary tract and pancreas, which is also characterized by cystic structures lined by epithelium, admixed with ovarian-type stroma. The differential diagnosis for these tumors includes cystic nephroma and cystic partially differentiated nephroblastoma, which we believe to represent clinically and morphologically distinct entities from MESTK. In particular, the distinction from cystic nephroma in adult male patients is emphasized, and two cases of this entity are included in the study for comparison.