Clinicopathological characteristics and prognosis of papillary renal neoplasm with reverse polarity
Objective To summarize the clinical and pathological characteristics,treatment methods,and prognosis of papillary renal neoplasm with reverse polarity(PRNRP).Methods The clinical and pathological data of six pathologically confirmed PRNRP patients admitted to Renji Hospital affiliated with Shanghai Jiaotong University School of Medicine from August 2022 to August 2023 were retrospectively analyzed.Among them,three were male and three were female,with an average age of(55.3±10.5)years old.All six cases were incidentally discovered during health examinations.Preoperative contrast-enhanced CT scans showed tumors with cortical phase manifestations of uneven enhancement,avascularity,and indistinct borders,with CT values of(85.6±18.7)HU.In the corticomedullary phase,the CT values showed mild elevation,with an average of(94.3±4.7)HU.In the delayed phase,the tumor boundaries were clear,and the enhancement degree was significantly lower than that of the surrounding renal cortex and medulla,with a tumor CT value of(86.3±11.9)HU.The pseudocapsule of the tumor was not clearly displayed on contrast-enhanced CT scans.All cases underwent partial nephrectomy,including two cases of robot-assisted laparoscopic partial nephrectomy and four cases of laparoscopic partial nephrectomy.Results Postoperative pathological measurements revealed a maximum tumor diameter ranging from 6 to 15 mm,with an average diameter of(11.0±3.5)mm.All six cases were classified as pT1aN0M0 stage.Microscopically,the tumors exhibited branching papillary structures with eosinophilic cytoplasm,and the tumor cells displayed low-grade nuclei located at the top of the cytoplasm and away from the basal membrane.Immunohistochemical analysis showed diffuse strong positivity for GATA3 and CK7,while CA-Ⅸexpression was negative.The median follow-up time after surgery was 10(9,13)months,and no tumor recurrence or metastasis was observed.Conclusions PRNRP is a rare,low-grade malignant papillary renal tumor.Contrast-enhanced CT scan has characteristic features of avascularity.Pathological morphological features are low-grade nuclei located at the top of the cytoplasm and far away from the basal membrane,forming a"reverse polarity".The immunophenotype shows positive expression of GATA3 and CK7.Partial nephrectomy is the recommended treatment approach,and the postoperative prognosis is favorable.
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