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LETTER TO EDITOR  
Year : 2015  |  Volume : 58  |  Issue : 1  |  Page : 124-125
Sacrococcygeal teratoma with ectopic immature renal tissue


Department of Pathology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India

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Date of Web Publication11-Feb-2015
 

How to cite this article:
DasGupta S, Ghosh R, Das RN, Chatterjee U. Sacrococcygeal teratoma with ectopic immature renal tissue. Indian J Pathol Microbiol 2015;58:124-5

How to cite this URL:
DasGupta S, Ghosh R, Das RN, Chatterjee U. Sacrococcygeal teratoma with ectopic immature renal tissue. Indian J Pathol Microbiol [serial online] 2015 [cited 2019 Nov 22];58:124-5. Available from: http://www.ijpmonline.org/text.asp?2015/58/1/124/151214


Editor,

The occurrence of renal tissue in sacrococcygreal teratomas has rarely been reported in the literature. Sacrococcygeal teratoma is a rare childhood tumor with an incidence of one in 35,000-40,000 births. Extra-renal presence of structures consistent with ectopic immature renal tissues (EIRTs) have rarely been reported, both in teratomas or unassociated with a teratoma. [1] A broad nomenclature has been used for these unusual findings: EIRT, mesonephric remnant tissue, hamartoma with primitive renal tissue, extrarenal nephrogenic rests, extrarenal nephrogenic blastema, heterotopic nephrogenic rests, ectopic nephrogenic rests and extrarenal nephroblastomatosis. [2],[3] From a histological standpoint, EIRTs are generally described as aggregates of blastemal tissues, tubules and occasional glomeruli with a variable amount of admixed fibrous stroma.

A full term baby girl, born at 38 weeks of gestation, was noted to have a lump at the base of the spine. She presented to the outpatient department at 9 months of age. Her ultrasound scans and magnetic resonance imaging showed a large sacrococcygeal mass with an intrapelvic component showing solid and cystic areas. The mass was removed along with the coccyx. The alpha-fetoprotein (AFP) values were marginally raised, and human chorionic gonadotrophin values were within normal limits. Grossly, the mass measured 10 cm across with solid and cystic areas. Microscopic examination showed the presence of varying admixture of tissues. There was skin with appendages, glial tissue, bone, cartilage along with colonic and respiratory epithelium. In addition, immature neural tissue was noted with presence of neuroblastic foci [[Figure 1]a and b]. In focal areas, there was the presence of renal tissue in the form of immature glomeruli, tubules and blastemal components [[Figure 1]c and d]. A diagnosis of immature teratoma with the rare finding of the renal differentiation was made.
Figure 1: (a) Low power view showing neuroglia and skin with appendages (H and E, ×40). (b) Immature neuroglia with presence of rosettes (H and E, ×100). (c) Low power view of immature renal tissue with blastema and glomeruli (H and E, ×40). (d) Higher power view showing tubular and glomerular differentiation (H and E, ×100)


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Ectopic immature renal tissue probably represents metanephric remnants displaced during embryonic development. Its peculiar presence in the lumbosacral region, in cases of spinal dysraphism, supports the hypothesis that neural tube abnormalities may interfere with migration and morphogenesis of bystander renal tissue. [4],[5]

The strict similarity of ectopic immature renal structures to the foci of perilobar and intralobar nephrogenic rests/nephroblastomatosis occasionally found in neonatal kidneys and recognized potential source of nephroblastoma, could be a matter of concern and diagnostic uncertainty. [6] Generally, nephrogenic rests tend to form expanding, spherical nodules, surrounded by a fibrous pseudocapsule while EIRT usually consists of small multiple microscopic nests and islets. From a cytological point of view, only frank atypia is a reliable characteristic of nephroblastoma, since high mitotic rates and moderate pleomorphism are also found in EIRT. Therefore, if the immature renal tissue in a teratoma lacks obvious features of malignancy it should be considered as an "immature component," in analogy with the more common primitive neuroectodermal component of immature teratomas. In fact, it has been also proposed that areas reminiscent of nephroblastoma present in teratomas should be reported as nephroblastoma-like, when it involves half or more of a microscopic field seen with a ×4 objective, and as an immature component when smaller. [7] Glomerular differentiation can also pose a diagnostic problem with yolk sac tumor with  Schiller-Duval Bodies More Details in cases of mixed germ cell tumours. Serum AFP levels and staining for AFP can be useful in such cases, however, bearing in mind small elevations, which can be associated with the presence of gut or respiratory epithelium in teratomas.

Ectopic immature renal tissue, without an associated teratoma in the pediatric age group does not usually have a sinister prognosis. A diligent follow-up protocol seems to be adequate for their management. However, immature renal tissue, when encountered within a teratoma necessitates a closer attention. Presence of atypia or other features of malignancy portends the possibility of a nephroblastoma, whereas if such features are lacking, EIRT should be considered likewise to any other immature embryonal-type components.

 
   References Top

1.
Willis RA. The structure of teratomata. J Pathol Bacteriol 1935;40:1-36.  Back to cited text no. 1
    
2.
Goldberg J, Drut R. Ectopic immature renal tissue. Report of two cases. Pathol Res Pract 1984;179:115-23.  Back to cited text no. 2
    
3.
Ducos R, Warrier RP, MacKenzie F, Evans B. Ectopic immature renal tissue in an infant with undescended testis. Am J Pediatr Hematol Oncol 1986;8:264-6.  Back to cited text no. 3
    
4.
Abrahams JM, Pawel BR, Duhaime AC, Sutton LN, Schut L. Extrarenal nephroblastic proliferation in spinal dysraphism. A report of 4 cases. Pediatr Neurosurg 1999;31:40-4.  Back to cited text no. 4
    
5.
Jain D, Sharma MC, Sarkar C, Rishi A, Suri V, Garg A, et al. Spinal teratoma with renal differentiation - A rare phenomenon: Report of two patients. Clin Neurol Neurosurg 2008;110:265-9.  Back to cited text no. 5
    
6.
Murphy WM, Grignon DJ, Perlman EJ. Atlas of Tumor Pathology. Tumors of the Kidney, Bladder, and Related Urinary Structures. 4 th series, Fascicle 1. Washington: Armed Forces Institute of Pathology; 2004.  Back to cited text no. 6
    
7.
Michael H, Hull MT, Foster RS, Sweeney CJ, Ulbright TM. Nephroblastoma-like tumors in patients with testicular germ cell tumors. Am J Surg Pathol 1998;22:1107-14.  Back to cited text no. 7
    

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Correspondence Address:
Dr. Shatavisha DasGupta
15A/7, East Road, Santoshpur, Kolkata - 700 075, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.151214

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