Distal Tubular Hyperplasia: A Proposal for a Unique Form of Renal Tubular Proliferation Distinct From Papillary Adenoma. Am J Surg Pathol 2021 Apr 01;45(4):516-522
Date
02/10/2021Pubmed ID
33560656DOI
10.1097/PAS.0000000000001680Scopus ID
2-s2.0-85102905706 (requires institutional sign-in at Scopus site) 2 CitationsAbstract
We identified an unusual pattern of renal tubular proliferation associated with chronic renal disease, found in 23 patients, diffusely (n=12), or focally (n=11). Incidence was 5% of end-stage renal disease kidneys from one institution (8/177) and 7/23 patients with acquired cystic kidney disease-associated renal cell carcinoma from another. Most (19 patients) had 1 or more neoplasms including papillary (n=9), acquired cystic kidney disease (n=8), clear cell (n=4), or clear cell papillary (n=3) renal cell carcinoma. All (20 men, 3 women) had end-stage renal disease. The predominant pattern (n=18) was the indentation of chronic inflammation into renal tubules forming small polypoid structures; however, 5 had predominantly hyperplastic epithelium with less conspicuous inflammation. In 14 patients both patterns were appreciable, whereas the remainder had only the inflammatory pattern. Immunohistochemistry was positive for cytokeratin 7, high-molecular-weight cytokeratin, PAX8, and GATA3. Staining for alpha-methylacyl-CoA racemase was negative or weak, dramatically less intense than papillary neoplasms or proximal tubules. CD3 and CD20 showed a mixture of B and T lymphocytes in the inflammatory areas. Fluorescence in situ hybridization showed no trisomy 7 or 17 or loss of Y (n=9). We describe a previously uncharacterized form of renal tubular proliferation that differs from papillary adenoma (with weak or negative alpha-methylacyl-CoA racemase, lack of trisomy 7 or 17, and sometimes diffuse distribution). On the basis of consistent staining for high-molecular-weight cytokeratin and GATA3, we propose the name distal tubular hyperplasia for this process. Future studies will be helpful to assess preneoplastic potential and etiology.
Author List
Williamson SR, Al-Obaidy KI, Cheng L, Smith SC, Cox RM, McKenney JK, Gokden N, Phillips CL, Giannico GA, Gallan AJ, Przybycin CG, Grignon DJAuthor
Alexander J. Gallan MD Assistant Professor in the Pathology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdenomaAdult
Aged
Biomarkers, Tumor
Carcinoma, Renal Cell
Cell Proliferation
Diagnosis, Differential
Female
Humans
Hyperplasia
Immunohistochemistry
In Situ Hybridization, Fluorescence
Kidney Diseases, Cystic
Kidney Failure, Chronic
Kidney Neoplasms
Kidney Tubules
Male
Middle Aged
Precancerous Conditions
Predictive Value of Tests
United States
Young Adult
