Papillary renal neoplasm with reversed polarity: A case report of a rare renal tumor

Abstract

INTRODUCTION AND IMPORTANCE: Papillary Renal Neoplasm with Reversed Polarity (PRNRP) is a rare renal tumor first described in 2019. It is characterized by low-grade nuclei, eosinophilic cytoplasm, and an inverted nuclear arrangement. Unlike papillary renal cell carcinoma (PRCC), PRNRP frequently harbors KRAS mutations and lacks the typical trisomies of chromosomes 7 and 17. Histopathology and immunohistochemistry remain the gold standard for diagnosis. CASE PRESENTATION: A 52-year-old woman with Type 2 Diabetes Mellitus, hypertension, and chronic kidney disease presented with worsening renal function. Imaging revealed a Bosniak type IV cyst in the right kidney, raising suspicion for malignancy. She underwent a robotic partial nephrectomy, and histopathology confirmed PRNRP (pT1a, WHO/ISUP grade 1). The tumor was completely resected, and no recurrence or metastasis was noted. PRNRP poses diagnostic challenges due to its rarity and overlap with other renal tumors. It is often discovered incidentally, with imaging offering limited preoperative specificity. Histopathologic criteria include thin papillary structures, interstitial vitrification, eosinophilic cytoplasm, and nuclear reversal. PRNRP follows an indolent course, with no reported cases of recurrence or metastasis post-resection. CLINICAL DISCUSSION: Papillary Renal Neoplasm of Reversed Polarity (PRNRP) is a rare variant of renal cell carcinoma characterized by its distinct histological feature of reversed polarity, where the epithelial cells exhibit basally located nuclei and apical cytoplasm. This uncommon tumor type poses diagnostic challenges due to its overlapping features with other renal neoplasms, underscoring the importance of histopathological examination for accurate identification and management. CONCLUSION: Current treatment parallels renal cell carcinoma management, primarily surgical excision, with surveillance recommended for long-term follow-up. PRNRP is a distinct renal neoplasm with an excellent prognosis. Further research is needed to refine diagnostic criteria, understand molecular mechanisms, and optimize treatment strategies. Increased awareness among clinicians and pathologists can aid in accurate diagnosis and management.