What are the other Names for this Condition? (Also known as/Synonyms)
- Renal Cortical Adenoma
- Renal Papillary Adenoma
What is Papillary Adenoma of Kidney? (Definition/Background Information)
- Papillary Adenoma of Kidney is a tumor of the kidney that is generally diagnosed in adults. It is usually considered to be a low-grade neoplasm
- Numerous risk factors have been identified for Papillary Adenoma of Kidney that include kidney disease, genetic disorders, such as von Hippel-Lindau syndrome, and chronic urinary dialysis
- The cause of tumor formation is believed to be due to genetic factors and several chromosomal abnormalities have been identified
- The signs and symptoms of Papillary Adenoma of Kidney depend upon the size of the tumors. The tumor arises from the kidney cortex (outer portion of kidney). Based on WHO classification, tumors over 1 cm in size may be malignant in nature. Large tumors can potentially cause chronic kidney failure
- Typically, a surgical excision of Papillary Adenoma of Kidney with its entire removal is the preferred treatment. The prognosis is excellent for small benign tumors on their complete removal
- However, the prognosis of larger Renal Papillary Adenomas depends on a variety of factors including the histological pattern, tumor stage, and health status of the affected individual
Who gets Papillary Adenoma of Kidney? (Age and Sex Distribution)
- Papillary Adenoma of Kidney tumors are usually seen in adults. The incidence of the tumor increases with age
- According to research studies based on autopsy studies, 10% of the cases are observed in individuals between 20-40 years; 40% of the cases, in those between 70-90 years
- Both males and females are affected and no predilection is noted
- No specific ethnic or racial preference is seen
What are the Risk Factors for Papillary Adenoma of Kidney? (Predisposing Factors)
The following risk factors have been noted for Papillary Adenoma of Kidney:
- Chronic pyelonephritis
- A variety of vascular kidney diseases
- Long-term hemodialysis
- Acquired cystic kidney disease (in 35% of the cases)
- Von Hippel-Lindau syndrome
- Many tumors are associated with papillary renal cell carcinomas
It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.
Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.
What are the Causes of Papillary Adenoma of Kidney? (Etiology)
The exact cause of Papillary Adenoma of Kidney formation is unknown. However, the following genetic abnormalities have been noted on studying the tumor:
- Additions on chromosomes 7, 12, 16, 17, and 20
- Some tumors may show loss of chromosome Y
In general, it is known that cancers form when normal, healthy cells begin transforming into abnormal cells - these cancer cells grow and divide uncontrollably (and lose their ability to die), resulting in the formation of a mass or a tumor.
- The transformation of normally healthy cells into cancerous cells may be the result of genetic mutations. Mutations allow the cancer cells to grow and multiply uncontrollably to form new cancer cells
- These tumors can invade nearby tissues and adjoining body organs, and even metastasize and spread to other regions of the body
What are the Signs and Symptoms of Papillary Adenoma of Kidney?
The signs and symptoms of Papillary Adenoma of Kidney depend on the size and location of the tumor. It can also vary from one individual to another. In general, small tumors are asymptomatic and large tumors can cause signs and symptoms. The kidney symptoms may be caused due to mass effect (presence of bulky tumors).
According to WHO classification:
- Tumors less than 0.5 cm are usually benign
- Those up to 1 cm with tubulopapillary architecture are probably benign
- Those less than 1 cm in size with solid growth pattern or with clear cells are likely to be malignant
- Tumors over 1 cm are most likely malignant
The signs and symptoms of Papillary Adenoma of Kidney may include the following:
- The tumors are mostly asymptomatic and slow-growing
- The tumor arises from renal tubular epithelium present in the cortex of the kidney
- Majority tumors are less than 0.5 cm and well-circumscribed
- Some tumors may be associated with urinary tract infections, blood in urine, increased blood pressure, and flank pain
- Large tumors can severely affect the functioning of the kidney that is involved. Tumors growing to larger sizes can cause compression of adjoining organs and structures
How is Papillary Adenoma of Kidney Diagnosed?
The diagnosis of Papillary Adenoma of Kidney may involve the following tests and procedures:
- Complete physical exam with evaluation of medical history
- Plain X-ray of the abdomen
- CT or CAT scan with contrast of the abdomen may show a tumor mass. This radiological procedure creates detailed 3-dimensional images of structures inside the body
- MRI scans of the abdomen: Magnetic resonance imaging (MRI) uses a magnetic field to create high-quality pictures of certain parts of the body, such as tissues, muscles, nerves, and bones. These high-quality pictures may reveal the presence of the tumor
- Ultrasound scan of the abdomen
- Urine analysis to check for the presence of blood cells
- Kidney function test
- Intravenous pyelogram (IVP): A dye is injected into the blood vessels and the image of kidney structure is obtained
- Vascular angiographic studies of the tumor
Invasive diagnostic procedures such as:
- Laparoscopy: A special device is inserted through a small hole into the abdomen, to visually examine it. If necessary, a tissue sample is obtained for further analysis. Exploration of the abdomen using a laparoscope is called ‘exploratory laparoscopy’
- Laparotomy: The abdomen is opened through an incision for examination, and if required, a biopsy sample obtained. Exploration of the abdomen using laparotomy procedure is called ‘exploratory laparotomy’
Although the above modalities can be used to make an initial diagnosis, a tissue biopsy of the tumor is necessary to make a definitive diagnosis to begin treatment. The tissue for diagnosis can be procured in multiple different ways which include:
- Fine needle aspiration (FNA) biopsy of the kidney tumor: A FNA biopsy may not be helpful, because one may not be able to visualize the different morphological areas of the tumor. Hence, a FNA biopsy as a diagnostic tool has certain limitations, and an open surgical biopsy is preferred
- Core biopsy of the kidney tumor
- Open biopsy of the kidney tumor
- A tissue biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
- Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
- Sometimes, the pathologist may perform special studies, which may include immunohistochemical stains, molecular testing, and very rarely, electron microscopic studies to assist in the diagnosis
A differential diagnosis, to eliminate other tumor types is considered, before arriving at a definitive diagnosis.
Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.
What are the possible Complications of Papillary Adenoma of Kidney?
The complications of Papillary Adenoma of Kidney may include:
- Stress and anxiety due to a concern of kidney cancer
- Chronic renal failure affecting kidney function if tumors are large is a potential complication
- If bleeding occurs in the tumor suddenly, it can cause retroperitoneal hemorrhage, which can result in large blood loss leading to severe shock. This is a potentially life-threatening complication requiring emergency care. In this situation, the signs and symptoms could be nausea, vomiting, back pain, sudden drop in blood pressure, and palpitations. This clinical condition is termed Wunderlich syndrome
- Some research indicate that Renal Papillary Adenoma can transform into a carcinoma (malignant transformation). Hence, long-term vigilance for any such transformation is necessary
- Damage to the muscles, vital nerves, and blood vessels, during surgery
- Post-surgical infection at the wound site is a potential complication
How is Papillary Adenoma of Kidney Treated?
The treatment measures for Papillary Adenoma of Kidney typically involves surgical intervention with complete excision. This can also help reduce the chances of tumor recurrence.
The surgical treatment methods may include:
- Endoscopic surgery
- Nephron-sparing surgery
- Partial or complete nephrectomy
- Tumor embolization is a possible treatment option. Here the blood supply to the tumor is blocked resulting in its shrinkage or death
A partial or complete nephrectomy may be considered, when large-sized tumors are noted in the kidneys.
- A kidney dialysis may be required, if the kidney function is severely compromised due to renal failure
- Prompt diagnosis and emergency treatment of any abdominal (retroperitoneal) bleeding due to the tumor should be immediately considered
- In case of malignancy, additional treatment measures including chemotherapy and radiation therapy may be necessary, based on assessment of the healthcare provider
- Postoperative care is important: A minimum activity level is ensured, until the surgical wound heals
- Long-term follow-up care with regular screening may be recommended by the healthcare provider
How can Papillary Adenoma of Kidney be Prevented?
- Current medical research has not established a method of preventing Papillary Adenoma of Kidney
- Regular medical screening at periodic intervals with tests and physical examinations are strongly recommended
What is the Prognosis of Papillary Adenoma of Kidney? (Outcomes/Resolutions)
The prognosis of Papillary Adenoma of Kidney depends upon the size of the tumor, severity of the signs and symptoms, and histological pattern. It also depends upon the overall health of the individual and response to therapy.
- Typically, in most of the cases, the prognosis is good, since it is usually a benign tumor
- In case of a malignant transformation, the prognosis may depend upon several factors including the stage of the tumor and overall health of the individual
Additional and Relevant Useful Information for Papillary Adenoma of Kidney:
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