Immunohistochemical analysis of mucinous tubular and spindle cell carcinoma and papillary renal cell carcinoma of the kidney - Significant immunophenotypic overlap warrants diagnostic caution
Immunohistochemical analysis of mucinous tubular and spindle cell carcinoma and papillary renal cell carcinoma of the kidney - Significant immunophenotypic overlap warrants diagnostic caution
复制标题
DOI：
10.1097/01.pas.0000180443.94645.50
复制
发表时间：
2006-01-01
影响因子：
5.6
通讯作者：
Amin, MB
中科院分区：
文献类型：
--
作者：
Paner, GP;Srigley, JR;Amin, MB
黏液性管状和梭形细胞癌是一种罕见的肾细胞癌，最近被描述为独特的亚型，可能与更常见的乳头状肾细胞癌有一些形态学相似之处，特别是嗜碱性（1型）肿瘤，具有突出的固体生长模式。肿瘤边界、致密的管状结构、局灶性乳头状形成、粘液产生和泡沫细胞（在乳头状肾细胞癌和粘液性管状和梭形细胞癌中可见的特征）以及梭形细胞形态，导致一些病例被送到我们这里咨询可能的肉瘤样乳头状肾细胞癌的问题。在这项研究中，组织微阵列与一式三份的样品，每个来自27个粘液性管状和梭形细胞癌和20个乳头状肾细胞癌，以模拟肾活检标本的经验。从免疫组织化学（IHC）数据，发表在当代文献中，一个面板组成的α-甲酰基辅酶A消旋酶（AMACR），细胞角蛋白7（CK 7），上皮膜抗原（EMA），肾细胞癌标志物（RCC Ma），CD 10，高分子量细胞角蛋白（HMWK），和c-kit的设计，以测试其在鉴别诊断的效用。粘液性管状和梭形细胞癌的免疫反应性为AMACR 93%，CK 7 81%，EMA 95%，RCC Ma 7%，CD 10 15%，HMWK 15%，c-kit 5%;乳头状肾细胞癌的免疫反应性为AMACR 95%，CK 7 65%，EMA 88%，RCC Ma 25%，CD 10 80%，HWMK 15%，c-kit 18%。这项迄今为止对粘液性管状和梭形细胞癌的IHC进行的最大规模研究消除了AMACR对RCC亚型中乳头状肾细胞癌的特异性。由于我们的研究显示近曲小管相关标记物AMACR在这些肿瘤中的表达，远端肾单位的粘液性小管和梭形细胞癌的组织发生仍然存在争议。因此，在以致密管状生长为主的肿瘤和局灶性乳头状结构中，仔细注意低级别梭形细胞群的存在可能有助于区分粘液性管状癌和梭形细胞癌，因为乳头状肾细胞癌的关键免疫组化染色也在这种亚型的肾细胞癌中表达。
Mucinous tubular and spindle cell carcinoma, a rare, recently described distinctive subtype of renal cell carcinoma, may have some morphologic similarities to the more common papillary renal cell carcinoma, particularly the basophilic (type 1) tumors with prominent solid growth pattern. Tumor circumscription, compact tubular architecture, focal papillations, mucin production and foam cells (features seen in both papillary renal cell carcinoma and mucinous tubular and spindle cell carcinoma), as well as spindle cell morphology, have resulted in some cases sent to us in consultation with a question of possible sarcomatoid papillary renal cell carcinoma. In this study, tissue microarrays with triplicate samples each from 27 mucinous tubular and spindle cell carcinomas and 20 papillary renal cell carcinomas were created to simulate experience in renal biopsy specimens. From immumohistochemistry (IHC) data, published in the contemporary literature, a panel consisting of alpha-methylacyl-CoA racemase (AMACR), cytokeratin 7 (CK7), epithelial membrane antigen (EMA), renal cell carcinoma marker (RCC Ma), CD 10, high molecular weight cytokeratin (HMWK), and c-kit was designed to test its utility in differential diagnosis. The immunoreactivity in mucinous tubular and spindle cell carcinoma was AMACR 93%, CK7 81%, EMA 95%, RCC Ma 7%, CD 10 15%, HMWK 15%, and c-kit 5% and in papillary renal cell carcinoma was AMACR 95%, CK7 65%, EMA 88%, RCC Ma 25%, CD10 80%, HWMK 15%, and c-kit 18%. This largest study to date on IHC of mucinous tubular and spindle cell carcinoma dispels the specificity of AMACR for papillary renal cell carcinoma among the RCC subtypes. The histogenesis of mucinous tubular and spindle cell carcinoma from the distal nephron continues to be debatable, as our study showed the expression of the proximal convoluted tubule-related marker AMACR among these tumors. Thus, in tumors with predominant compact tubular growth and focal papillary architectures, careful attention to the presence of a low-grade spindle cell population may be helpful in the distinction of mucinous tubular and spindle cell carcinoma, as the key immunohistochemical stains for papillary renal cell carcinoma are also expressed in this subtype of renal cell carcinoma.