Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
Virchows Archiv Aims and scope Submit manuscript

Abstract

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 Müllerian 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 Müllerian 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12

Similar content being viewed by others

References

  1. Abaitua J, Val Bernal JF (1975) Hamartoma leiomyomatoso renal del adulto. Segundo caso de la literatura. Arch Es Urol 26:601–612

    Google Scholar 

  2. Adsay NV, Conlon KC, Zee SY, Brennan MF, Klimstra DS (2002) Intraductal papillary-mucinous neoplasms of the pancreas: an analysis of in situ and invasive carcinomas in 28 patients. Cancer 94:62–77

    Article  PubMed  Google Scholar 

  3. Adsay NV, Eble JN, Srigley JR, Jones EC, Grignon DJ (2000) Mixed epithelial and stromal tumor of the kidney. Am J Surg Pathol 24:958–970

    Article  CAS  PubMed  Google Scholar 

  4. Adsay NV, Longnecker DS, Klimstra DS (2000) Pancreatic tumors with cystic dilatation of the ducts: intraductal papillary mucinous neoplasms and intraductal oncocytic papillary neoplasms. Semin Diagn Pathol 17:16–30

    CAS  PubMed  Google Scholar 

  5. Antonescu C, Bisceglia M, Reuter V, Rosai J (1997) Sarcomatous transformation of cystic nephromas. Mod Pathol 10:391A

    Google Scholar 

  6. Argani P, Faria PA, Epstein JI, Reuter VE, Perlman EJ, Beckwith JB, Ladanyi M (2000) Primary renal synovial sarcoma. Molecular and morphologic delineation of an entity previously included among embryonal sarcomas of the kidney. Am J Surg Pathol 24:1087–1096

    Article  CAS  PubMed  Google Scholar 

  7. Argani P, Beckwith JB (2000) Metanephric stromal tumor. Report of 31 cases of a distinctive pediatric renal neoplasm. Am J Surg Pathol 24:917–926

    Article  CAS  PubMed  Google Scholar 

  8. Arroyo MR, Green DM, Perlman EJ, Beckwith JB, Argani P (2001) The spectrum of metanephric adenofibroma and related lesions. Clinicopathologic study of 25 cases from the National Wilms Tumor Study Group Pathology Center. Am J Surg Pathol 25:433–444

    Article  CAS  PubMed  Google Scholar 

  9. Beiko DT, Nickel JC, Boag AH, Srigley JR (2001) Benign mixed epithelial stromal tumor of the kidney of possible Müllerian origin. J Urol 166:1381–1382

    Article  CAS  PubMed  Google Scholar 

  10. Bennington JL, Beckwith JB (1983) Atlas of tumor pathology. Tumors of the kidney, renal pelvis, and ureter. Second series, Fascicle 12, 1975, Reprinted 1983. Armed Forces Institute of Pathology, Washington, D.C., pp 84–85

  11. Bisceglia M, Bacchi CE (2003) Mixed epithelial-stromal tumor of the kidney in adults: two cases from the Arkadi M. Rywlin slide seminars. Adv Anat Pathol 10:223–233

    Article  CAS  PubMed  Google Scholar 

  12. Bisceglia M, Carosi I, Vairo M, Zaffarano L, Bisceglia M, Creti G (2000) Congenital mesoblastic nephroma: report of a case with review of the most significant literature. Pathol Res Pract 196:199–204

    CAS  PubMed  Google Scholar 

  13. Block NL, Grabstald HG, Melamed MR (1973) Congenital mesoblastic nephroma (leiomyomatous hamartoma): first adult case. J Urol 110:380–383

    CAS  PubMed  Google Scholar 

  14. Bluebond-Langner R, Pinto PA, Argani P, Chan TY, Halushka M, Jarrett TW (2002) Adult presentation of metanephric stromal tumor. J Urol 168:1482–1483

    Article  CAS  PubMed  Google Scholar 

  15. Bouvier R, Beurlet J, Roux MG (1996) Mesoblastic nephroma in adults. Apropos of a case and review of the literature. Arch Anat Cytol Pathol 44:37–41

    CAS  PubMed  Google Scholar 

  16. Bruet A, Fingerhut A, Felsenheld C, Laffrat I, Mathe C, Fendler JP (1989) Le nephroma mésoblastique congenital de l’adulte. Ann Urol (Paris) 23:27–29

    Google Scholar 

  17. Caturelli E, Bisceglia M, Villani MR, de Maio G and Siena DA (1998) CA 19–9 production by a cystadenoma with mesenchymal stroma of the common hepatic duct: a case report. Liver 18:221–224

    CAS  PubMed  Google Scholar 

  18. Cerilli LA (2003) Mucinous tumor of the pancreas: Corpora albicans-like structures within the ovarian stroma. Int J Surg Pathol 11:219

    PubMed  Google Scholar 

  19. Clement PB (1987) Histology of the ovary. Am J Surg Pathol 11:277–303

    CAS  PubMed  Google Scholar 

  20. Compagno J, Oertel JE (1978) Mucinous cystic neoplasms of the pancreas with overt and latent malignancy (cystadenocarcinoma and cystadenoma). A clinicopathologic study of 41 cases. Am J Clin Pathol 69:573–580

    CAS  PubMed  Google Scholar 

  21. Devaney K, Goodman ZD, Ishak KG (1994) Hepatobiliary cystadenoma and cystadenocarcinoma. A light microscopic and immunohistochemical study of 70 patients. Am J Surg Pathol 18:1078–1091

    CAS  PubMed  Google Scholar 

  22. Pierson CR, Schober MS, Wallis T, Sarkar FH, Sorensen PHB, Eble JN, Srigley JR, Jones EC, Grignon DJ, Adsay V (2002) Mixed epithelial and stromal tumor of the kidney lacks the genetic alterations of cellular congenital mesoblastic nephroma. Hum Pathol 32:513–520

    Article  Google Scholar 

  23. Chandeck K, Cerrud L, Hernandez L (1992) Nefroma mesoblastico congenito en el adulto (primer caso de tumor en adulto mayor de 40 aňos). Rev Med Panama 17:50–56

    CAS  PubMed  Google Scholar 

  24. Davila RM, Kissane JM, Crouch EC (1992) Multilocular renal cyst. Immunohistochemical and lectin-binding study. Am J Surg Pathol 16:508–514

    CAS  PubMed  Google Scholar 

  25. Désligneres S, Flam T, Vacher-Lavenu MC, Debré B (1992) Le nephroma mésoblastique cellulaire ou atypique à forme partiellement kystique. A propos d’une observation chez une femme de 27 ans. J Urol 98:138–147

    Google Scholar 

  26. Durham JR, Bostwick DG, Farrow GM, Ohorodnik JM (1992) Mesoblastic nephroma of adulthood. Report of three cases. Am J Surg Pathol 17:1029–1038

    Google Scholar 

  27. Eble JN, Bonsib SM (1998) Extensively cystic renal neoplasms: cystic nephroma, cystic partially differentiated nephroblastoma, multilocular cystic renal cell carcinoma, and cystic hamartoma of renal pelvis. Semin Diagn Pathol 15:2–20

    CAS  PubMed  Google Scholar 

  28. Eichhorn JH, Young RH, Clement PB, Scully RE (2002) Mesodermal (Müllerian) adenosarcoma of the ovary. A clinicopathologic analysis of 40 cases and a review of the literature. Am J Surg Pathol 26:1243–1258

    Article  PubMed  Google Scholar 

  29. el Mrini M, Debbagh A, Hafiani M, Aboutaieb R, Bennani S, Beljelloun S (1998) Tumeur de Bolande de l’adulte: à propos d’un cas. Prog Urol 8:95–98

    PubMed  Google Scholar 

  30. Freeby JA, Fishman EK, Marshall FF, Henneberry JM (1997) Mesoblastic nephroma in an adult: spiral CT appearance. Abdom Imaging 22:439–440

    Article  CAS  PubMed  Google Scholar 

  31. Ganick DJ, Gilbert EF, Beckwith JB, Kiviat N (1981) Congenital cystic mesoblastic nephroma. Hum Pathol 12:1039–1043

    CAS  PubMed  Google Scholar 

  32. Gonzales Moran MA, Salas Valien JS, Suarez Vilela D, Rodriguez Lopez JA, Garcia Diez F (1993) Nefroma mesoblastico congenito en el adulto: studio inmunohistoquimico. Arch Espanoles Urol 46:56–59

    Google Scholar 

  33. Hennigar RA, Beckwith JB (1992) Nephrogenic adenofibroma. A novel kidney tumor of young people. Am J Surg Pathol 16:325–334

    CAS  PubMed  Google Scholar 

  34. Hirota S, Hase M, Matsumoto S, Fukuda T, Fujii M, Sugimoto K, Sugimura K, Hanioka K (2000) Cystic hamartoma of the renal pelvis: imaging features. Radiat Med 18:139–142

    CAS  PubMed  Google Scholar 

  35. Horie Y, Ikawa S, Kadowaki K, Minagawa Y, Kigawa J, Terakawa N (1995) Lipoadenofibroma of the uterine corpus. Report of a new variant of adenofibroma (benign Müllerian mixed tumor). Arch Pathol Lab Med 119:274–276

    Google Scholar 

  36. Iraqi A, Meziane EM, Sqalli S, Morchid A, Gueraoui M (1984) Histogenetic aspects of mesoblastic nephroma. Apropos of a case in an adult. Arch Anat Cytol Pathol 32:249–252

    CAS  PubMed  Google Scholar 

  37. Ishiguro H, Kato K, Kishimoto T, Nagai Y, Takahashi T, Sasano H, Ishikura H (2003) Expression of steroidogenic enzymes by luteinizing cells in the ovarian-type stroma of a mucin-producing cystic tumour of the pancreas. Histopathology 43:97–98

    CAS  PubMed  Google Scholar 

  38. Jones MW, Lefkowitz M (1995) Adenosarcoma of the uterine cervix: A clinicopathological study of 12 cases. Int J Gynecol Pathol 14:223–229

    CAS  PubMed  Google Scholar 

  39. Joshi VV, Beckwith JB (1989) Multilocular cyst of the kidney (cystic nephroma) and cystic, partially differentiated nephroblastoma. Cancer 64:466–479

    CAS  PubMed  Google Scholar 

  40. Kerner H, Munichor M (1997) Papillary cystadenofibroma of the vagina. Histopathology 30:84–86

    Article  CAS  PubMed  Google Scholar 

  41. Kim DH, Sohn JH, Lee MC, Lee G, Yoon GS, Hashimoto H, Sonobe H, Ro JY (2000) Primary synovial sarcoma of the kidney. Am J Surg Pathol 24:1097–1104

    Article  CAS  PubMed  Google Scholar 

  42. Kleist B, Lorenz G, Dietrich H, Klebingat KJ (1998) Mesoblastic nephroma in adults. Pathologe 19:226–229

    Article  CAS  PubMed  Google Scholar 

  43. Levin NP, Damjanov I, Depilis VJ (1982) Mesoblastic nephroma in an adult patient: recurrence 21 years after removal of the primary lesion. Cancer 49:573–577

    CAS  PubMed  Google Scholar 

  44. Madewell JE, Goldman SM, Davis CJ, Hartman DS, Feigin DS, Lichtenstein JE (1983) Multilocular cystic nephroma. A radiographic-pathologic correlation of 58 patients. Radiology 146:309–321

    CAS  PubMed  Google Scholar 

  45. Mahalati K, Sahin A, Ozen H, Bozdogan O, Cila A, Ruacan S (1994) Mesoblastic nephroma in adults: a clinical case. Bull Cancer 81:928–930

    CAS  PubMed  Google Scholar 

  46. Mensch LS, Trainer TD, Plante MK (1999) Cystic hamartoma of the pelvis: a rare pathologic entity. Mod Pathol 12:417–421

    CAS  PubMed  Google Scholar 

  47. Michal M, Syrucek M (1998) Benign mixed epithelial and stromal tumour of the kidney. Pathol Res Pract 194:445–448

    CAS  PubMed  Google Scholar 

  48. Michal M (2000) Benign mixed epithelial and stromal tumor of the kidney. Pathol Res Pract 196:275–276

    CAS  PubMed  Google Scholar 

  49. Mourra N, Balladur P, Parc R, Flejou J-F (2003) Intrasplenic mucinous cystadenoma with mesenchymal stroma arising in pancreatic heterotopia. Histopathology 42:616–617

    CAS  PubMed  Google Scholar 

  50. Murphy WM, Beckwith JB, Farrow GM (1994) Tumors of the kidney, bladder and related urinary structures. In: Rosai J, Sobin LH (eds) Atlas of tumor pathology, vol 11. Washington D.C.: Armed Forces Institute of Pathology, pp 55–67

  51. Ogawa O, Okumura K, Taniguchi T, Nakagawa T (1989) A case of giant renal hamartoma considered as congenital mesoblastic nephroma of adult. Hinyokika Kio 35:1749–1753

    CAS  Google Scholar 

  52. Pawade J, Soosay GN, Delprado W, Parkinson MC, Rode J (1993) Cystic hamartoma of the renal pelvis. Am J Surg Pathol 17:1169–1175

    CAS  PubMed  Google Scholar 

  53. Payne F, Rollandson TP, Sivridis E (1992) Adenomyolipoma of the endometrium: a hamartoma? Histopathology 20:357–359

    CAS  PubMed  Google Scholar 

  54. Pierson CR, Schober MS, Wallis T, Sarkar FH, Sorensen PH, Eble JN, Srigley JR, Jones EC, Grignon DJ, Adsay V (2001) Mixed epithelial and stromal tumor of the kidney lacks the genetic alterations of cellular congenital mesoblastic nephroma. Hum Pathol 32:513–520

    Article  CAS  PubMed  Google Scholar 

  55. Prats Lopez J, Palou Redorta J, Morote Robles J, Martinez Perez E, Ruiz Marcellan C (1988) Leiomyomatous renal hamartoma in an adult. Eur Urol 14:80–82

    PubMed  Google Scholar 

  56. Reeves G (2002) The ovarian cortex and medulla have their specific stromal component. A passionate review: 40 years of theory and practice. Patologia 40:7–25

    Google Scholar 

  57. Rubin BP, Chen CJ, Morgan TW, Xiao S, Grier HE, Kozakewich HP, Perez-Atayde AR, Fletcher JA (1998) Congenital mesoblastic nephroma t(12;15) is associated with ETV6-NTRK3 gene fusion: cytogenetic and molecular relationship to congenital (infantile) fibrosarcoma. Am J Pathol 154:1451–1458

    Google Scholar 

  58. Shek TWH, Luk ISC, Peh WCG, Chan KL (1999) Metanephric adenofibroma. Report of a case and review of the literature. Am J Surg Pathol 23:727–733

    Article  CAS  PubMed  Google Scholar 

  59. Smida L, Taief YL, Rebai T (1989) Mesoblastic nephroma. Unusual renal tumor in adults. Apropos of a case. J Urol 95:423–426

    CAS  Google Scholar 

  60. Steele R, Daroca PJ, Hill S, Reed RJ, Thomas R (1994) Multilocular renal cyst (cystic nephroma) with Müllerian-like stroma. Urology 43:549–553

    Article  CAS  PubMed  Google Scholar 

  61. Svec A, Hes O, Michal M, Zachoval R (2001) Malignant mixed epithelial and stromal tumor of the kidney. Virchows Arch 439:700–702

    CAS  PubMed  Google Scholar 

  62. Terai A, Terachi T, Machida S (1985) Case of adult renal hamartoma resembling congenital mesoblastic nephroma. Hinyokika Kiyo 31:2219–2223

    CAS  PubMed  Google Scholar 

  63. Thompson LD, Becker RC, Przygodzki RM, Adair CF, Heffess CS (1999) Mucinous cystic neoplasm (mucinous cystadenocarcinoma of low-grade malignant potential) of the pancreas: a clinicopathologic study of 130 cases. Am J Surg Pathol 23:1–16

    Article  CAS  PubMed  Google Scholar 

  64. Trillo A (1990) Adult variant of congenital mesoblastic nephroma. Arch Pathol Lab Med 114:533–555

    Google Scholar 

  65. Truong LD, Williams R, Ngo T, Cawood C, Chevez-Barrios P, Awalt HL, Brown RW, Younes M, Ro JY (1998) Adult mesoblastic nephroma. Expansion of the morphologic spectrum and review of literature. Am J Surg Pathol 22:827–839

    Article  CAS  PubMed  Google Scholar 

  66. Tulbach A, Kardar AH, Akhtar M (1997) Mesoblastic nephroma in an adult. J Urol Pathol 6:67–73

    Google Scholar 

  67. Van Velden DJ, Schneider JW, Allen FJ (1990) A case of adult mesoblastic nephroma: ultrastructure and discussion of histogenesis. J Urol 143:1216–1219

    PubMed  Google Scholar 

  68. Weihing RR, Shintaku IP, Geller SA, Petrovic LM (1997) Hepatobiliary and pancreatic mucinous cystadenocarcinomas with mesenchymal stroma: analysis of estrogen receptors/progesterone receptors and expression of tumor-associated antigens. Mod Pathol 10:372–379

    CAS  PubMed  Google Scholar 

  69. Wenig BM, Albores-Saavedra J, Buetow PC, Heffess CS (1997) Pancreatic mucinous cystic neoplasm with sarcomatous stroma: a report of three cases. Am J Surg Pathol 21:70–80

    Article  CAS  PubMed  Google Scholar 

  70. Wigger HG (1975) Fetal mesenchymal hamartoma of the kidney. A tumor of secondary mesenchyme. Cancer 36:1002–1008

    CAS  PubMed  Google Scholar 

  71. Wong NA, Arnott ID, Pope I, Palmer KR, Garden OJ, Thomas JS, Piris J (2001) Hepatobiliary cystadenoma with mesenchymal stroma may mimic biliary smooth muscle neoplasms. Histopathology 39:34–36

    Google Scholar 

  72. Yavuz E, Tuzlali S, Iplikci A, Ilhan R (2001) Adenomyolipoma of the uterus: a case report. Pathology 33:96–100

    Article  CAS  PubMed  Google Scholar 

  73. Zamboni G, Scarpa A, Bogina G, Iacono C, Bassi C, Talamini G, Sessa F, Capella C, Solcia E, Rickaert F, Mariuzzi GM, Kloppel G (1999) Mucinous cystic tumors of the pancreas: clinicopathological features, prognosis, and relationship to other mucinous cystic tumors. Am J Surg Pathol 23:410–422

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Dr. P. Mukensnabl for the excellent photographic work. We are also most grateful to Richard Pocock and Mark Stott, Consultant Urologists in Exeter, for the extra clinical information on their patients.

Author information

Authors and Affiliations

  1. Sikl’s Department of Pathology, Laboratore Spec. Diagnostiky Medical Faculty Hospital, Charles University Hospital, Alej Svobody 80, 304 60 , Pilsen, Czech Republic

    Michal Michal, Ondrej Hes & Ludmila Boudova

  2. Department of Pathology, IRCCS-Ospedale “Casa Sollievo della Sofferenza” Viale Cappuccini, San Giovanni Rotondo, Italy

    Michele Bisceglia

  3. Department of Pathology, Royal Devon and Exeter Hospital, Exeter, UK

    Roderick H. W. Simpson

  4. The Western Australian Centre for Pathology and Medical Research, Nedlands, Australia

    Dominic V. Spagnolo

  5. Anatomic Pathology Unit, Ospedali Riuniti di Bergamo, Bergamo, Italy

    Alberto Parma

  6. Department of Urology, Charles University Hospital, Pilsen, Czech Republic

    Milan Hora

  7. Department of Urology, University Hospital Kralovske Vinohrady, Prague, Czech Republic

    Roman Zachoval

  8. Department of Pathology, The Ohio State University Hospital, Columbus, OH, USA

    Saul Suster

Authors
  1. Michal Michal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ondrej Hes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michele Bisceglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roderick H. W. Simpson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dominic V. Spagnolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alberto Parma
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ludmila Boudova
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Milan Hora
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Roman Zachoval
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Saul Suster
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michal Michal.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Michal, M., Hes, O., Bisceglia, M. et al. Mixed epithelial and stromal tumors of the kidney. A report of 22 cases. Virchows Arch 445, 359–367 (2004). https://doi.org/10.1007/s00428-004-1060-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00428-004-1060-y

Keywords

Search

Navigation