md-medicaldata

Authors

 

Tanja Lakić ^1,2, Aleksandra Ilić ^1,2, Željka Vrekić ³, Aleksandra Fejsa-Levakov ^1,2, Bosiljka Krajnović ⁴, Radosav Radosavkić<sup>1,2

1</sup>Clinical Center of Vojvodina, Novi Sad, Serbia
²University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
³Faculty of Pharmacy, Novi Sad, Serbia
⁴Institute for lung diseases of Vojvodina, Sremska Kamenica

 

UDK: 616.61-006.03

The paper was received / Rad primljen: 08.04.2021.

Accepted / Rad prihvaćen: 07.06.2021.

 

Correspondence to:

Dr Aleksandra Ilić
Hajduk Veljkova 3, 21000 Novi Sad
+381 69 1452582
e-mail: aleksandra.m.ilic@mf.uns.ac.rs

 

 

Abstract

 

 

Introduction: Intrarenal ectopic adrenal tissue is rare asymptomatic and non-functionalfinding in adults that accounts approximately 1% of adult population. It occurs as aembryological development disorder due to fragmentation and scattering of adrenal cells to kidney and other anatomic sites, as well. Case report: We are presenting a 78-years-old female patient who was reported to Urology Clinic of Clinical Center of Vojvodina due to surgical treatment of right ureter tumor. In addition tothe previously diagnosed ureteral high grade urothelial carcinoma, detailed histopathological examination revealed another lesion in renal parenchyma composed of nested clear cells with mild to moderate nuclear atypia and pleomorphism. Because of suspected well differentiated clear cell renal cell carcinoma, immunohistochemical (IHC) stainings were done to determine the origin of the clear cells. IHC results (inhibin+, calretinin+, Melan A+, RCC-, PAX8-) supported the diagnosis of ectopic adrenal nest- choristoma of the kidney. Conclusion:Ectopic adrenal tissue is usually reported in the pediatric population, whereas it is rarely found in the adults. Because of the great morphological similarities but completely different biological origin and treatment, in order to avoid misdiagnosing, pathologists should be careful and use additional immunohistochemical stainings in the case of finding light cell lesions in the kidney.

 

 

 

Keywords:

ectopic adrenal tissue, renal choristoma, clear cell renal cell carcinoma, inhibin, RCC

 

 

 

Sažetak

Uvod: Ektopično tkivo nadbubrežne žlezde u bubregu je asimptomatska, afunkcionalna promena  koja je veoma retka kod odraslih čineći oko 1% svih nalaza u odrasloj populaciji. Nastaje usled poremećaja embriološkog razvoja kada dolazi do fragmentacije i rasipanja, lutanja nadbubrežnih ćelija do bubrega i drugih anatomskih lokalizacija. Prikaz slučaja: Prikazujemo 78-godišnju pacijentkinju koja je primljena na Kliniku za urologiju Kliničkog centra Vojvodine zbog planiranog hirurškog lečenja tumora desnog uretera. Uz prethodno dijagnostikovani visoko gradusni urotelni karcinom uretera, detaljan histopatološki pregled otkrio je još jednu leziju u bubrežnom parenhimu sastavljenu od gnezda svetlih ćelija sa blagom do umerenom nuklearnom atipijom i pleomorfizmom. Zbog sumnje na dobro diferentovani svetloćelijski karcinom bubrega, tražena su dodatna imunohistohemijska (IHC) bojenja kako bi se utvrdilo poreklo pomenutih svetlih ćelija. Rezultati imunohistohemijske analize (inhibin +, calretinin +, Melan A +, RCC-, PAX8-) išli su u prilog dijagnoze ektopičnog adrenalnog tkiva, odnosno horistoma bubrega. Zaključak: Ektopično nadbubrežno tkivo obično se javlja u pedijatrijskoj populaciji, dok su kod odraslih ovi nalazi vrlo retki. Zbog značajnih morfoloških sličnosti ali potpuno različitog biološkog porekla i lečenja, u cilju izbegavanja pogrešnog dijagnostikovanja patolozi bi trebalo da budu oprezni i da koriste dodatna imunohistohemijska bojenja u slučaju pronalaženja svetloćelijskih promena u bubrežnom parenhimu.

 

 

 

Ključne reči:

ektopično tkivo nadbubrega, horistom bubrega, svetloćelijski karcinom bubrega, inhibin, RCC

 

 

 

 

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