Adenomatoid tumors of the female and male genital tract. A comparative clinicopathologic and immunohistochemical analysis of 47 cases emphasizing their site-specific morphologic diversity

Abstract

Adenomatoid tumors (ATs) are uncommon benign mesothelial tumors with a predilection for the genital tract. We reviewed 47 ATs diagnosed at our institutions during 10-year period. Thirty tumors (64%) originated in the female (21 uterine, 8 tubal, and 1 ovarian) and 17 (36%) in the male (9 epididymal and 8 testicular) genital tract. The median age for females and males was 47.5 and 51 years, respectively. While 83% of tumors in females were incidental findings in resections for unrelated diseases, 94% of male lesions presented as clinical masses leading to surgery. The median size was 2, 1, and 0.5 cm for uterine, epididymo-testicular, and tubo-ovarian lesions, respectively. Architecturally, the microcystic/angiomatoid pattern was the most frequent (32/47; 68%), followed by combined microcystic/trabecular (26/47; 55%) and retiform/adenoid (15/47; 32%) pattern. The trabecular/solid (6%) and macrocystic (4%) patterns were uncommon. However, 57% of cases revealed ≥2 growth patterns. Taken by anatomic site, 20 of 21 uterine cases were at least focally microcystic but none was retiform. In contrast, the retiform pattern dominated in male genital tract tumors (12/17; 71%). Immunohistochemistry showed expression of calretinin (36/36) and D2-40 (30/30) and lack of CD34 (0/30) and PAX8 (0/32). GLUT-1 was expressed in 11/11 male genital tract tumors but in none of the microcystic uterine lesions. Estrogen and progesterone receptor expression was weak and focal (two and three uterine cases, respectively). None stained for the androgen receptor. Our study illustrates the great site-specific morphological diversity of ATs emphasizing their wide site-dependent differential diagnosis.

Adenomatoid Tumor of the Adrenal Gland in Young Woman: From Clinical and Radiological to Pathological Study

“…1 Tumor cells can form solid nests, but more often they form fenestrated channels or anastomosed tubules with variable size and form, located in the fibrous stroma in variable order. Tumor cells have significant vacuolisation, with eccentrically located nucleus (signet- ring cell).…”

“…1 Also, these tumors can occur in extra-genital organs and anatomic sites, including liver, intestinal mesentery, omentum, pancreas, heart, pleura, mediastinum, lymph nodes and adrenal glands. 2 Their occurrence in the adrenal glands is rare and unexpected, so a variety of differential diagnostic challenges both clinically and morphologically could be elicited.…”

Adenomatoid Tumor of the Uterus: An Incidental Finding

“…These tumor cells are strongly positive for cytokeratin, vimentin, calretinin and HMBE-1 (anti-human mesothelioma antibody), but do not express EMA, CEA [1,11,12]. One study found estrogen and progesterone receptor expression is weak and focal and none stained for the androgen receptor [13].…”

Value of Calretinin Immunostaining in Diagnostic Pathology

“…49 These findings indicate that, when used in conjunction with TTF-1 and/or napsin A, 2 markers that are highly sensitive and specific for lung adenocarcinomas, or PAX 8 and/or PAX 2, 2 renal cell carcinoma-associated markers that are absent in mesotheliomas, calretinin can assist in distinguishing epithelioid mesotheliomas from lung adenocarcinomas and renal cell carcinomas involving the pleura, respectively. 23,55,68 In addition to mesotheliomas, calretinin expression has been reported in adenomatoid tumors, which are rare benign mesothelial tumors that, even though they predominantly occur in the male and female genital organs, [69][70][71] may also arise in extragenital sites, including the pleura, 72,73 peritoneum, 74 intestinal mesentery, 75 omentum, 74 heart, 76 adrenal glands, 77,78 liver, 79,80 pancreas, 81 and mediastinum. 30,53 In contrast to epithelioid mesotheliomas, where it is generally accepted that calretinin is commonly expressed in the vast majority of cases (> 90%), some controversy exists in the literature regarding the frequency with which this marker is expressed in sarcomatoid mesotheliomas.…”

“…30,53 In contrast to epithelioid mesotheliomas, where it is generally accepted that calretinin is commonly expressed in the vast majority of cases (> 90%), some controversy exists in the literature regarding the frequency with which this marker is expressed in sarcomatoid mesotheliomas. 11,[69][70][71]78 The conclusion of these studies was that calretinin was a highly sensitive and specific marker for adenomatoid tumors that could be used to assist in establishing the differential diagnosis. 25,26,[54][55][56] The cause of these discrepancies is unclear as all of these studies used well-characterized calretinin polyclonal an-tibodies.…”