Immunohistological Diagnosis of Primary and Metastatic Renal Cell Carcinoma Using Panel of Immunohistochemical Markers
A Single Centre Study
Keywords:
Immunohistochemistry, Renal Cell Carcinoma, Carbonic anhydrase, Cytokeratin -7
Abstract
Background: Tumour heterogeneity and lack of markers with high specificity makes diagnosis of renal cell carcinoma (RCC) challenging. The study was undertaken to evaluate panel of IHC markers to enable diagnosis and reproducible classification in primary and metastatic renal tumors. Methods: Descriptive Study wherein 100 cases of RCC and 25 trucut biopsies (20 metastatic and 5 primary renal tumors) were evaluated for morphology and immunostained by panel of immunohistochemical (IHC) markers consisting of CA-9, CD10, CK-7, AMACAR and TFE-3 with additional markers as required. Result: Morphologically tumors were grouped as clear cell and nonclear cell (eosinophilic and poorly differentiated). Clear cell RCCs (CCRCC), clear cell papillary RCC (CCPRCC) and multilocular cystic RCC (MCRNLMP) displayed strong statistical association of CA-9 immunostaining (p=50.00, x2-0.000). Inverse correlation was found between the intensity of the staining of CA-9 and tumor grade. (p=32.97, x2=0.000). CA-9 and CK-7 co-expression was evident in all cases of CCPRCC and MCRNLMP. Papillary RCC exhibited positive statistical correlation with CK-7 and AMACAR. E-cadherin and CD117 were required additionally to differentiate between oncocytoma and chromophobe RCC. CD10 and Pax 8 were most helpful in diagnosing metastatic RCCs Conclusion: IHC panel consisting of CA-9, CD10, CK7, AMACR and TFE3 helps triage RCCs with clear cell/eosinophilic cell / papillary/poorly differentiated pattern. In a setting of metastatic RCC, use of CD10 and Pax 8 together facilitate primary diagnosis of RCC when tissue available is limited.References
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20. Camparo P, Vasiliu V, Molinie V, et al. Renal translocation carcinomas: clinicopathologic, immunohistochemical, and geneexpression profiling analysis of 31 cases with a review of the literature. Am J Surg Pathol. 2008;32:656–670.
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2. Steven S. Shen, Luan D. Truong, Marina Scarpelli, Antonio Lopez-Beltran. Role of Immunohistochemistry in Diagnosing Renal Neoplasms. When Is It Really Useful? Arch Pathol Lab Med. 2012;136:410–417.
3. Gupta K, Miller JD, Li JZ, Russell MW, Charbonneau C. Epidemiologic and socioeconomic burden of metastatic renal cell carcinoma (mRCC): a literature review. Cancer Treat Rev. 2008;34:193–205.
4. John R. Srigley, Brett Delahunt, John N. Eble, et al The ISUP Renal Tumor Panel. The International Society of Urological Pathology (ISUP) Vancouver Classification of Renal Neoplasia. Am J Surg Pathol. 2013;37:1469–1489.
5. Moch H, Humphrey P, Ulbright TM, Reuter VE.WHO Classification of Tumours of the Urinary System and Male Genital Organs, Eur Urol. 2016 l;70:106-19.
6. Tickoo SK, Reuter VE. Differential diagnosis of renal tumors with papillary architecture. Adv Anat Pathol. 2011;18:120–132.
7. Truong LD, Shen SS. Immunohistochemical diagnosis of renal neoplasms. Arch Pathol Lab Med. 2011;135:92-109.
8. Naoto Kuroda, Azusa Tanaka ,Chisato Ohe , Yoji Nagashima. Recent advances of immunohistochemistry for diagnosis of renal tumors. Pathology International. 2013; 63:381-390.
9. Zhihong Zhao, Guixiang Liao, Yongqiang Li, Shulu Zhou, Hequn Zou, and Samitha Fernando. Prognostic Value of Carbonic Anhydrase IX Immunohistochemical Expression in Renal Cell Carcinoma: A Meta-Analysis of the Literature. PLoS One. 2014; 9(11): e114096.
10. Bhatnagar R, Alexiev BA. Renal-cell carcinomas in end-stage kidneys: a clinicopathological study with emphasis on clear-cell papillary renal-cell carcinoma and acquired cystic kidney disease associated carcinoma. Int J Surg Pathol. 2012;20:19–28.
11. Rohan SM, Xiao Y, Liang Y, et al. Clear-cell papillary renal cell carcinoma: molecular and immunohistochemical analysis with emphasis on the von Hippel-Lindau gene and hypoxia-inducible factor pathway-related proteins. Mod Pathol. 2011;24:1207–1220.
12. Elizabeth M. Genega, Musie Ghebremichael, Robert Najarian, et al. Carbonic Anhydrase IX Expression in Renal Neoplasms: Correlation with Tumor Type and Grade. Am J ClinPathol. 2010; 134: 873–879.
13. Alshenawy HA. Immunohistochemical panel for differentiating renal cell carcinoma with clear and papillary features. Pathol Oncol Res. 2015;21:893-9
14. Bui MH, Seligson D, Han KR, et al. Carbonic anhydrase IX is an independent predictor of survival in advanced renal clear cell carcinoma: implications for prognosis and therapy. Clin Cancer Res. 2003;9:802-811
15. Choueiri TK, Cheng S, Qu AQ, Pastorek J, Atkins MB, Signoretti S Carbonic anhydrase IX as a potential biomarker of efficacy in metastatic clear-cell renal cell carcinoma patients receiving sorafenib or placebo: analysis from the treatment approaches in renal cancer global evaluation trial (TARGET). Urol Oncol. 2013;31:1788-1793.
16. Adley BP, Papavero V, Sugimura J, Teh BT, Yang XJ. Diagnostic value of cytokeratin 7 and parvalbumin in differentiating chromophobe renal cell carcinoma from renal oncocytoma. Anal Quant CytolHistol. 2006;28:228–236.
17. Geramizadeh B, Ravanshad M, Rahsaz M. Useful markers for differential diagnosis of oncocytoma, chromophobe renal cell carcinoma and conventional renal cell carcinoma.Indian J PatholMicrobiol.2008;51:167-71.
18. Molinie´ V, Balaton A, Rotman S, et al. Alpha-methyl CoA racemase expression in renal cell carcinomas. Hum Pathol. 2006;37:698–703.
19. Lina Liu, Junqi Qian, Harpreet Singh, Isabelle Meiers, Xiaoge Zhou and David G. Bostwick. Immunohistochemical Anakysis of Chroophobe Renal cell carcinoma, Renal Oncocytoma, and Clear Cell Carcinoma An Optimal and Practical Panel for Differential Diagnosis. Arch Pathol Lab Med. 2007;131:1290–1297.
20. Camparo P, Vasiliu V, Molinie V, et al. Renal translocation carcinomas: clinicopathologic, immunohistochemical, and geneexpression profiling analysis of 31 cases with a review of the literature. Am J Surg Pathol. 2008;32:656–670.
21. Al-Ahmadie HA, Alden D, Fine SW, et al. Role of immunohistochemistry in the evaluation of needle core biopsies in adult renal cortical tumors: an ex vivo study. Am J Surg Pathol. 2011;35:949–961
22. Wenjuan Yu, Yuewei Wang, Yanxia Jiang, Wei Zhan and Yujun Li. Distinct immunophenotypes and prognostic factors in renal cell carcinoma with sarcomatoid differentiation: a systematic study of 19 immunohistochemical markers in 42 cases. BMC Cancer. 2017;17:293-97.
Published
2019-11-23
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