Cytologic diagnosis of papillary renal neoplasm with reverse polarity

Cancer Cytopathol. 2025 Jan;133(1):e22903. doi: 10.1002/cncy.22903. Epub 2024 Sep 11.

Abstract

Background: Papillary renal neoplasm with reverse polarity is a recently recognized low-grade neoplasm with a favorable prognosis. To date, its cytologic features have not been well documented.

Methods: Two patients with papillary renal neoplasm with reverse polarity sampled by fine needle aspiration and core needle biopsy are described, one of whom is under active surveillance without clinical progression and the other is alive and well 16 years after partial nephrectomy.

Results: The cytologic features included a mix of papillae and dispersed cells with abundant oncocytic cytoplasm and round, bland nuclei apically displaced away from the papillary core. Immunohistochemistry showed positive staining for GATA3 in both cases. Molecular studies on one of the cases showed a KRAS p.G12V mutation.

Conclusions: The cytologic features of this distinctive, indolent neoplasm are important to recognize because patients with papillary renal neoplasm with reverse polarity may be excellent candidates for partial nephrectomy or even active surveillance.

Keywords: PRNRP; cytologic features; papillary renal neoplasm with reverse polarity.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Biopsy, Fine-Needle
  • Carcinoma, Papillary / diagnosis
  • Carcinoma, Papillary / pathology
  • Carcinoma, Papillary / surgery
  • Carcinoma, Renal Cell / diagnosis
  • Carcinoma, Renal Cell / pathology
  • Carcinoma, Renal Cell / surgery
  • Female
  • GATA3 Transcription Factor / analysis
  • GATA3 Transcription Factor / metabolism
  • Humans
  • Kidney Neoplasms* / diagnosis
  • Kidney Neoplasms* / pathology
  • Kidney Neoplasms* / surgery
  • Male
  • Middle Aged
  • Mutation
  • Nephrectomy
  • Proto-Oncogene Proteins p21(ras) / genetics

Substances

  • Proto-Oncogene Proteins p21(ras)
  • KRAS protein, human
  • GATA3 Transcription Factor
  • GATA3 protein, human