Atypical features of mixed epithelial and stromal tumour of kidney: a case report with histopathology correlation

Wei Li Se To; Aidi Aswadi   Halim Lim; Siti Kamariah  Che Mohamed; Mohd Nazli Kamarulzaman; Khairunisa Ahmad Affandi

doi:10.31436/ijohs.v7i1.414

Authors

Se To Wei Li Department of Radiology, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang, Malaysia.
Aidi Aswadi Halim Lim Department of Radiology, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang, Malaysia.
Siti Kamariah Che Mohamed Department of Radiology, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang, Malaysia.
Mohd Nazli Kamarulzaman Department of Surgery, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang, Malaysia.
Khairunisa Ahmad Affandi Department of Pathology, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang, Malaysia.

DOI:

https://doi.org/10.31436/ijohs.v7i1.414

Keywords:

cystic nephroma, mixed epithelial stromal tumour, renal carcinoma

Abstract

Adult cystic nephroma and mixed epithelial stromal tumours (MEST) are classified under the mixed epithelial and stromal tumour (MEST) family, which is a part of the 2016 World Health Organisation (WHO) renal tumour classification. They are rare, benign tumours which have similar imaging appearance as certain types of renal carcinoma. Hence, it is often regarded as malignant pre-operatively and histopathologically confirmed to be benign. We present a case of a 66-year-old lady who complains of gradual abdominal distension for 9 months, associated with loss of appetite, loss of weight and early satiety. Other than clinical findings that point towards ascites, the rest of her physical examination was unremarkable. Blood investigations including tumour markers were normal. Abdominal ultrasound and computed tomography (CT) showed a huge unilocular intra-abdominal cystic mass with enhancing solid component attached to the right kidney which was exerting significant mass effect to the surrounding structures. The patient developed impending abdominal compartment syndrome and underwent right nephrectomy with tumour excision. The final histopathological diagnosis revealed mixed epithelial and stromal tumour (MEST). The patient recovered well. Mixed epithelial stromal tumour (MEST) is a rare clinical entity. Ultrasound and CT imaging are the usual investigating modalities. Histopathological correlation is needed to reach the diagnosis. This case has an unusual and different radiological imaging appearance when compared to past literature and contributes an additional case to our collective knowledge of these lesions.

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