Imaging of mixed epithelial and stromal tumor of the kidney: A case report and review of the literature

BACKGROUND Mixed epithelial and stromal tumors of the kidney (MESTKs) are a rare entity (about a hundred cases reported).They occur almost exclusively in postmenopausal women,with only seven cases reported in men.As this entity is very rare,little is known on its imaging features,especially magnetic resonance imaging (MRI) findings.In women,at MRI,the cystic component shows T1 hypointensity and T2 hyperintensity,while the solid component shows T1 hyperintensity and T2 hypointensity.CASE SUMMARY We report the computed tomography (CT) and MRI findings of MESTK in a 19- year-old male adolescent.To our knowledge,this case report is the first report of MRI findings of MESTK in male adolescents.The patient was admitted to Subei People's Hospital (Jiangsu Province,China) in July 2017 after a renal mass on the left side was detected by ultrasound during a clinical examination.Blood tests were all normal.Non-enhanced CT showed a round,well-circumscribed complex mass,approximately 45 mm × 40 mm in size.MRI revealed a clear wellcircumscribed mass with a mixed arrangement of solid and cystic components.On T2 weighted images,some hypointensities were found in the solid areas.After contrast enhancement,moderate or mild enhancement was found in the solid component,which increased with time.A radical left nephrectomy was performed.The pathology analysis revealed a mixed epithelial and stromal tumor.The patient had no imaging findings of recurrence or metastasis at 12 months following surgery.CONCLUSION The possibility of MESTK should be considered in male adolescents.MRI can provide useful information for the preoperative diagnosis.

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.

Mixed epithelial endocrine neoplasms of the colon and rectum–An evolution over time:A systematic review

BACKGROUND Mixed tumors of the colon and rectum,composed of a combination of epithelial and endocrine elements of benign and malignant potential are rare neoplasms.These can occur anywhere in the gastrointestinal tract and are often diagnosed incidentally.Though they have been a well-documented entity in the pancreas,where the exocrine-endocrine mixed tumors have been known for a while,recognition and accurate diagnosis of these tumors in the colon and rectum,to date,remains a challenge.This is further compounded by the different terminologies that have been attributed to these lesions over the years adding to increased confusion and misclassification.Therefore,dedicated literature reviews of these lesions in the colon and rectum are inconsistent and are predominantly limited to case reports and case series of limited case numbers.Though,most of these tumors are high grade and of advanced stage,intermediate and low grade lesions of these mixed tumors are also increasingly been reported.There are no established independent consensus based guidelines for the therapeutic patient management of these unique lesions.AIM To provide a comprehensive targeted literature review of these complex mixed tumors in the colon and rectum that chronicles the evolution over time with summarization of historical perspectives of terminology and to further our understanding regarding their pathogenesis including genomic landscape,clinicoradiological features,pathology,treatment,prognosis,the current status of the management of the primary lesions,their recurrences and metastases.METHODS A comprehensive review of the published English literature was conducted using the search engines PubMed,MEDLINE and GOOGLE scholar.The following search terms[“mixed tumors colon”OR mixed endocrine/neuroendocrine tumor/neoplasm/lesion colon OR adenocarcinoma and endocrine/neuroendocrine tumor colon OR mixed adenocarcinoma and endocrine/neuroendocrine carcinoma colon OR Amphicrine tumors OR Collision tumors]were used.Eligibility criteria were defined and all potential relevant items,including full articles and/or abstracts were independently reviewed,assessed and agreed upon items were selected for in-depth analysis.RESULTS In total 237 full articles/abstracts documents were considered for eligibility of which 45 articles were illegible resulting in a total of 192 articles that were assessed for eligibility of which 139 have been selected for reference in this current review.This seminal manuscript is a one stop article that provides a detailed outlook on the evolution over time with summarization of historical perspectives,nomenclature,clinicoradiological features,pathology,treatment,prognosis and the current status of the management of both the primary lesions,their recurrences and metastases.Gaps in knowledge have also been identified and discussed.An important outcome of this manuscript is the justified proposal for a new,simple,clinically relevant,non-ambiguous terminology for these lesions to be referred to as mixed epithelial endocrine neoplasms(MEENs).CONCLUSION MEEN of the colon and rectum are poorly understood rare entities that encompass an extensive range of heterogeneous tumors with a wide variety of combinations leading to tumors of high,intermediate or low grade malignant potential.This proposed new revised terminology of MEEN will solve the biggest hurdle of confusion and misclassification that plagues these rare unique colorectal neoplasms thus facilitating the future design of multi institutional prospective randomized controlled clinical trials to develop and evaluate newer therapeutic strategies that are recommended for continued improved understanding and personal optimization of clinical management of these unique colorectal neoplasms.

Successful management of a mixed epithelial and stromal renal tumor masquerading as lower pole renal cyst:A laparoscopic deroofing approach

Background:Renal cysts are common in clinical practice,but some may harbor rare pathological entities such as mixed epithelial and stromal tumors(MEST).Imaging studies are crucial for accurate diagnosis.While laparoscopic deroofing is an established approach for symptomatic renal cysts,encountering MEST within a cyst is uncommon.Case Presentation:We present the case of a 37-year-old female who presented with persistent left flank pain.Imaging revealed a large renal cyst in the lower pole of the left kidney,classified as Bosniak 2.Despite analgesia,the patient's symptoms persisted,leading to a laparoscopic deroofing procedure.Histopathological examination postprocedure revealed a MEST.The patient reported complete resolution of symptoms at the 3-month follow-up.Conclusion:This unique case presents the successful identification and surgical management of a MEST masquerading as a lower pole renal cyst through laparoscopic deroofing.It also contributes to the existing literature by highlighting the importance of considering rare pathological entities in the evaluation of renal cysts and the value of laparoscopic techniques in their management.

肾混合性上皮间质肿瘤4例报道及文献复习

目的探讨肾混合性上皮间质肿瘤(m ixed ep ithelial and strom al tumor of the k idney,MESTK)的临床病理学特点、免疫表型和鉴别诊断。方法运用光镜和免疫组化方法分析4例MESTK,并复习有关文献。结果女性3例、男性1例,平均发病年龄为39岁。临床表现为腰痛、肉眼或镜下血尿。巨检肿瘤境界清楚,呈实性。镜检以不等量增生、囊性扩张腺上皮与不同排列方式的梭形细胞间质混合组成为特征。免疫表型为梭形细胞vim entin(3/3)、desm in(2/4)、SMA(3/4)、ER(2/3)、PR(3/3)呈阳性表达,不表达CD34(0/3)、S-100蛋白(0/2)、HMB45(0/2);上皮细胞CKpan(4/4)、EMA(4/4)呈阳性表达。结论MESTK是一种少见的肾良性混合性肿瘤,其诊断主要依靠组织病理学和免疫组化标记。

肾混合性上皮间质肿瘤的临床病理

目的探讨肾混合性上皮间质肿瘤（MESTK）的病理学特点及其鉴别诊断。方法应用光镜和免疫组化方法分析3例MESTK,并复习相关文献。结果3例MESTK患者中,女性2例,男性1例,平均发病年龄为20岁。大体检查示肿瘤边界清,切面呈囊实性。光镜下显示肿瘤由上皮样细胞和梭形细胞混合而成,两种细胞成分均分化良好,无明显异型性及病理性核分裂相。免疫组化检测示上皮样细胞呈CK阳性反应。梭形细胞呈Vimentin、SMA、actin、PgR或ER及WT-1阳性反应。随访25-29个月,3例患者均未发现肿瘤复发及转移。结论MESTK是一种罕见的肾混合性肿瘤,患者预后良好。

肾混合性上皮间质瘤临床诊治分析

目的：对肾混合性上皮间质瘤（MESTK）病例进行回顾性分析，探讨肾混合性上皮间质肿瘤（MESTK）的临床特点及诊治体会。方法回顾性分析2003年1月-2015年7月收治的13例MESTK患者的临床资料。其中，男性2例，女性11例；年龄15～57岁，平均38岁。所有患者均行影像学检查，计算机体层摄影（CT）主要表现为多呈无壁结节的多房囊性改变，均行手术治疗。结果13例MESTK患者，其中4例行开放根治性肾切除术，包括1例因巨大肿瘤术前先行肾动脉栓塞术，3例行后腹腔镜下根治性肾切除术，4例行后腹腔镜下肾部分切除术，2例行腹腔镜下肾部分切除术。13例患者均成功随访，随访时间5～159个月，其中1例患者术后24个月复发，再次手术，目前继续随访中，其余患者未见复发及转移。结论 MESTK临床少见，临床表现缺乏特异性，误诊率高。CT上多呈无壁结节的多房囊性改变及延迟强化，术中冰冻病理有助于鉴别肿瘤良恶性，治疗以完整切除肿瘤为原则，保留肾单位手术安全有效，鉴于少数MESTK有一定复发及恶变倾向，术后需密切随访。

肾混合性上皮间质瘤1例报告并文献复习

目的 :探讨肾混合性上皮间质瘤 (MESTK)的临床及病理学特征。方法 :回顾性分析 1例MESTK患者的诊治情况 ,并复习有关文献探讨其临床特征。结果 :MESTK常见于成年女性 ,大多由实性或伴囊性成分混合而成。组织学上以不等量增生的腺上皮和不同排列方式的梭形细胞间质混合组成为特征 ,尤以瘤性梭形细胞间质增生为主体 ,形似平滑肌原性肿瘤。结论 :MESTK为一种独立的肾良性肿瘤 。

青少年肾混合性上皮间质肿瘤1例并文献复习

目的探讨青少年肾混合性上皮间质肿瘤(mixed epithelial and stromal tumor of the kidney,MESTK)的临床病理学特征,提高对此罕见疾病的认识。方法对1例MESTK(17岁)的临床病理学特征及免疫表型,并复习相关文献,综合分析青少年MESTK的临床及病理特征。结果患者女性,17岁,临床表现为先天性会阴部液体外溢。镜下见肿瘤呈结节状生长,肿瘤由上皮和间质两种成分构成,腺上皮细胞呈柱状或纤毛柱状;腺体周围间质细胞丰富似卵巢样,远离腺体的梭性细胞呈束状平滑肌样分化。免疫表型:上皮细胞CK7、vimentin阳性,间质细胞SMA、vimentin、ER、PR均阳性,远离腺体的间质细胞desmin阳性。结论 MESTK是一种罕见的肾脏良性肿瘤,多见于围绝经期女性,亦可发生于青少年,且与激素使用史无关,需与发生于青少年具有双向分化的肾肿瘤相鉴别。

男性肾混合性上皮间质瘤1例

患者男，49岁，主因“体检发现左肾肿物5月余”人院，自述平素无背部酸痛，无尿痛、尿频、尿急及肉眼血尿；否认药物长期应用史。CT：左肾下极类椭圆形肿块，约57mm×38mm，内见点条状高密度影，增强后呈轻度强化（图1A）。静脉肾盂造影（图1B）：左肾下组肾盏见局限性充盈缺损。影像学提示：左肾下极肿瘤，考虑为囊性肾细胞癌合并出血。遂行左肾肿物切除术。术后病理诊断（图1C）：肾混合性上皮间质瘤（mixedepi-thelial and stromal tumor of the kidney，MESTK）。随访24个月，未见肿瘤复发。

肾脏混合性上皮间质瘤的CT诊断和鉴别诊断

目的探讨肾脏混合型上皮间质瘤的CT诊断与鉴别诊断价值。方法回顾性分析2003年1月~2014年8月山东省菏泽市立医院经手术和病理确诊的3例肾脏混合性上皮间质瘤的CT表现,并复习有关病例报道。结果 3例均呈不规则肿块形,边界清楚,2例呈多囊状,囊壁呈实性密度,囊内密度较均匀,1例呈单囊状,囊壁不均匀,呈实性密度。增强扫描囊内无强化,囊壁呈中度强化,延迟扫描强化幅度无明显下降。结论 CT扫描对肾脏混合性上皮间质瘤具有较高的诊断价值。

肾混合性上皮和间质肿瘤5例临床病理分析

目的探讨肾混合性上皮和间质肿瘤(mixed epithelial and stromal tumor of the kidney,MESTK)临床病理特征。方法收集5例MESTK的临床资料及随访结果,采用HE染色及免疫组织化学染色,观察组织学特征及免疫组织化学特点,并复习相关文献。结果5例均为女性,年龄44~62岁,平均51.2岁。临床表现主要为腰背部疼痛及血尿,影像学检查提示肾脏囊实性占位。病理大体表现为肾脏界线清楚的囊实性肿瘤,多位于肾中极;组织学特征:肿瘤由上皮和间质成分混合构成,上皮排列成小管、微囊、大囊、乳头等结构,间质由梭形细胞组成,疏密不一,可见卵巢样间质、间质水肿及慢性炎症细胞浸润,上皮及间质细胞均未见明显异型性。免疫组织化学:上皮细胞表达广谱细胞角蛋白(CK_(pan))、CK7、PAX-8、P504S,间质细胞大多表达结蛋白(desmin)、平滑肌肌动蛋白(SMA)、雌激素受体(ER)、孕激素受体(PR)、CD10,Ki-67增殖指数低。结论MESTK是一种罕见的良性肾脏肿瘤,好发于围绝经期女性,影像学检查常误诊为囊性肾癌,有独特的病理组织学和免疫组织化学表现,肿物完整切除后,预后良好。

肾脏罕见肿瘤8例临床分析并文献回顾

目的探讨特殊类型肾肿瘤的临床诊治特点。方法回顾性分析2014年1月-2019年12月上海交通大学附属第六人民医院收治的8例特殊类型肾肿瘤患者,其中男性3例,女性5例。3例患者入院前有血尿、腹部肿块等症状,5例患者为无症状体检时发现。总结8例特殊类型肾肿瘤的诊断、治疗、预后等特点。结果8例特殊类型肾肿瘤患者中良、恶性各4例,其中4例良性肾肿瘤分别为:混合性上皮和间质肿瘤、后肾腺瘤、成人型囊性肾瘤、血管周上皮样细胞分化肿瘤;4例恶性肾肿瘤为:去分化脂肪肉瘤、肾细胞癌肉瘤样变、MiT家族易位相关性肾细胞癌、低度恶性潜能的多房囊性肾细胞肿瘤。上述8例患者除肾细胞癌肉瘤样变患者治疗后出现转移,其余患者预后良好。结论8种特殊类型的肾肿瘤皆为罕见病例,目前临床上对于肾占位性病变的主要治疗手段为手术治疗。

富含脂肪成分的肾混合性上皮和间质肿瘤临床病理观察

目的探讨富含脂肪成分的肾混合性上皮间质肿瘤(MESTK)的临床病理特点,以期提高对该罕见疾病的认识。方法应用组织病理学及免疫组化方法观察1例肾混合性上皮和间质肿瘤的特点,并结合文献探讨其诊断与鉴别诊断。结果患者女性,35岁。经查体发现左肾盂实性占位。大体肿块呈分叶状,切面呈实性、灰白色,可见散在小囊腔。镜下肿瘤主要由上皮和间质成分构成,上皮成分由大小不一的被覆不同上皮的腺体组成,部分腺管扩张呈微囊,伴周围丰富的间质,间质成分为束状平滑肌样或卵巢间质样,并见多量脂肪细胞分布于其中。上皮和间质细胞均无明显异型性及核分裂象。免疫组化:上皮细胞CK广泛(+),小腺管区PAX-8局灶(+),间质细胞ER、PR、SMA、desmin和CD10(+)。结论 MESTK是一种罕见的肾肿瘤,具有独特的组织病理学特点,罕有多量脂肪细胞分布于间质内,此例为国内首次报道。需与肾其他富含脂肪成分、伴有囊性变或具有上皮和间质结构的肿瘤相鉴别。

肾混合性上皮间质肿瘤3例临床病理分析

目的探讨肾混合性上皮间质肿瘤(MESTK)的临床病理特点、鉴别诊断和生物学行为。方法报道3例MESTK的临床、病理组织学及免疫表型并复习相关文献。结果 3例MESTK中,男性2例,女性1例;均表现为肾区肿块,无肉眼血尿,其中1例有肾区疼痛。肿块大体均呈囊实性,切面灰白、灰黄色,质韧。镜下见上皮和间质成分,上皮可围成小管状或囊腔样;间质成分为不同形态的梭形细胞,异型性不明显,核分裂象少见,可呈束状平滑肌样或卵巢样排列;其中1例PR(+)。结论肾混合性上皮间质肿瘤较少见,具有上皮和间质两种成分,是一种独立的肾肿瘤,诊断主要依靠组织病理学和免疫组化标记,由于近年来出现复发病例和恶性病例报道,其生物学行为有待进一步观察。

肾脏混合性上皮间质肿瘤的影像表现及文献回顾

目的:探讨肾脏混合性上皮间质肿瘤(MESTK)的影像及病理特点。方法:结合文献,回顾性分析经手术病理证实的4例肾脏混合性上皮间质肿瘤(MESTK)患者的CT和MRI资料。结果:4例患者的主要CT和MRI表现:肾实质内囊实性肿块,边界清楚,可突入肾盂内,增强扫描呈轻度强化。病理检查:肿瘤均由上皮和间质成分共同构成,上皮细胞呈立方状、柱状和鞋钉样,可见明确的胃肠道上皮细胞分化;间质成分主要由梭形细胞构成,可见特征性的呈束状分布的平滑肌组织。结论:肾脏混合性上皮间质肿瘤的主要表现为肾实质内囊实性肿块,其影像表现无明显特征性,与其它肾脏良恶性肿瘤的鉴别比较困难。

肾混合性上皮和间质肿瘤临床病理观察

目的探讨肾混合性上皮和间质肿瘤(mixed epithelial and stromal tumor of the kidney,MESTK)的临床病理特征和诊断要点。方法分析1例MESTK的临床病理资料,观察其组织学形态及免疫表型特征,并复习相关文献。结果患者,女性,61岁。肾占位术后标本病理检查结果示:肿瘤大体为多个囊腔和实性区域构成,镜下呈双向分化,主要由上皮和间质成分组成,两种成分相互交织存在,上皮由大囊、微囊和小管形成,囊壁被覆扁平、立方或高柱状上皮细胞,部分上皮具有苗勒细胞分化可能,间质呈粘液样改变。未见明显核分裂像和异形性。免疫组化表型:肿瘤上皮细胞表达CK、vimentin,肿瘤间质细胞表达desmin、ER、PR、SMA,而α-inhibin及CR表达阴性。结论MESTK是一种罕见的良性的混合性肿瘤,可能具有一定的恶性潜能,具有较为独特的上皮和间质的组织病理学特点(上皮成分是由大囊,微囊及小管组成,间质粘液样变性),应与肾脏其他囊性及双向分化的肿瘤相鉴别。

肾脏混合性上皮和间质肿瘤、囊性肾癌MSCT表现及其鉴别诊断

目的分析肾脏混合性上皮和间质肿瘤(MESTK)、囊性肾癌(CRCC)多层螺旋CT(MSCT)影像表现及其鉴别诊断。方法选取本院2017年3月至2018年12月收治的8例MESTK和16例CRCC患者作为研究对象,分析MESTK、CRCC的MSCT表现及MSCT检查鉴别诊断MESTK、CRCC的灵敏性、特异性、准确性。结果MSCT检查诊断MESTK、CRCC的灵敏性为75.00%,特异性为81.25%,准确性为79.17%。8例MESTK患者均为单侧病变,均为囊实性病变,Bosniak分型:Ⅲ型6例,Ⅳ型2例。增强扫描显示分隔及壁延迟强化,囊性部分不强化,实性部分呈轻或中度强化。16例CRCC患者中,7例透明细胞癌囊变,边缘毛躁,Bosniak分型均为ⅡF型;增强扫描,囊壁及间隔呈轻中度强化;9例多房性透明细胞性肾细胞癌,Bosniak分型:Ⅲ型8例,Ⅳ型1例;增强扫描呈不同程度强化,实质期强化减弱。结论MSCT可有效显示MESTK、CRCC的影像学特点,通过分析肿瘤实性成分多少、间隔形态及增强方式可为有效鉴别MESTK、CRCC,为临床提供可靠的依据。

肾混合性上皮和间质肿瘤临床病理观察

目的探讨肾混合性上皮和间质肿瘤的临病理特点和免疫表型。方法对1例肾混合性上皮和间质肿瘤的临床、病理组织学及免疫表型进行观察并复习文献。结果患者女性，49岁，左腰部不适1年余。B超与CT检查均显示左肾下极实性肿物，行左侧肾切除术。大体见位于肾下极肿物18cm×12cm×8cm，切面呈黄白色结节状，与肾实质分界清，质韧。镜下肿瘤构成复杂。散在的微囊和小管内衬单层或复层立方上皮，区域形成粗大的乳头状结构。间质细胞密集区与稀疏区交替存在，细胞呈短梭形或卵圆形。上皮细胞CKpan和Vimentin（＋），间质细胞ER、PR、Actins和Desmin（＋）。结论肾混合性上皮和问质肿瘤是一种少见的良性肿瘤。组织学上以不等量增生的腺上皮和不同排列方式的梭形细胞问质成分混合构成为特征，是一种独立的肾疾病，手术切除预后良好。