Immunohistochemical Diagnosis of Renal Neoplasms
Immunohistochemical Diagnosis of Renal Neoplasms
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DOI：
10.1043/2010-0478-rar.1
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发表时间：
2011-01-01
影响因子：
4.6
通讯作者：
Shen, Steven S.
中科院分区：
文献类型：
--
作者：
Truong, Luan D.;Shen, Steven S.
背景-肾肿瘤的组织学诊断通常通过常规光学显微镜是直接的。然而，免疫标记物在几种情况下可能是必不可少的，包括区分肾和非肾肿瘤，肾细胞癌(RCC)的亚型，以及诊断罕见类型的肾肿瘤或小活检标本中的转移性肾癌。目的：全面回顾免疫标记物对肾肿瘤的诊断作用。设计：本综述基于已发表的文献和个人经验。结论：下列标记物可能在不同的诊断环境中具有诊断价值：细胞角蛋白、波形蛋白、α-甲基酰基辅酶A消旋酶、碳水解酶IX、PAX2、PAX8、RCC标记物、CD10、E-钙粘蛋白、肾脏特异性蛋白、白蛋白、claudin-7、claudin-8、claudin-7、claudin-8、claudin-7。S100A1、CD82、CD117、TFE3、血栓调节蛋白、Uroplakin III、P63和S100P。细胞角蛋白由肾细胞癌统一表达，尽管在某些亚型中数量有限，需要广谱的抗CK抗体，包括低分子和高分子细胞角蛋白。Pax2和PAX8是肾肿瘤的敏感和相对特异的标记物，无论是哪种亚型。CD10和RCC标记物对近端肾小管来源的肿瘤敏感，包括透明细胞和乳头状肾细胞癌。肾脏特异性钙粘素、小白蛋白、claudin-7和claudin-8是肾单位远端肿瘤的敏感标记物，包括嫌色肾细胞癌和嗜酸细胞瘤。CK7和α-甲基酰基辅酶A消旋酶是乳头状肾细胞癌的敏感标志物，TFE3的表达对Xp11易位肾细胞癌的诊断具有重要意义。S100A1和CD82可能有助于嫌色肾细胞癌和嗜酸细胞瘤的鉴别诊断。血栓调节蛋白、Uroplakin III、P63和S100P是尿路上皮癌的有用标志物。与高分子细胞角蛋白、PAX2和PAX8一起，它们可以帮助区分肾盆腔尿路上皮癌和集合管RCC。肉瘤样肾细胞癌的敏感标记物仍不可用。免疫标记物最常用于诊断转移性肾细胞癌。与原发肾细胞癌相比，上述标记物在转移性肾细胞癌中的表达频率和弥漫性较低。认识到这些标记物的可变敏感性和特异性，重要的是在诊断小组中至少包括CD10、RCC标记物、PAX2和PAX8。(ARCH Pathol Lab Med.2011；135：92-109)
Context.-Histologic diagnosis of renal neoplasm is usually straightforward by routine light microscopy. However, immunomarkers may be essential in several contexts, including differentiating renal from nonrenal neoplasms, subtyping of renal cell carcinoma (RCC), and diagnosing rare types of renal neoplasms or metastatic RCC in small biopsy specimens.Objective.-To provide a comprehensive review of the diagnostic utility of immunomarkers for renal neoplasms.Design.-This review is based on published literature and personal experience.Conclusions.-The following markers may have diagnostic utility in various diagnostic contexts: cytokeratins, vimentin, alpha-methylacyl coenzyme A racemase, carbonic anhydrase IX, PAX2, PAX8, RCC marker, CD10, E-cadherin, kidney-specific cadherin, parvalbumin, claudin-7, claudin-8, S100A1, CD82, CD117, TFE3, thrombomodulin, uroplakin III, p63, and S100P. Cytokeratins are uniformly expressed by RCC, albeit in a somewhat limited amount in some subtypes, requiring broad-spectrum anti-CK antibodies, including both low and high-molecular-weight cytokeratins. PAX2 and PAX8 are sensitive and relatively specific markers for renal neoplasm, regardless of subtype. CD10 and RCC marker are sensitive to renal cell neoplasms derived from proximal tubules, including clear cell and papillary RCCs. Kidney-specific cadherin, parvalbumin, claudin-7, and claudin-8 are sensitive markers for renal neoplasms from distal portions of the nephron, including chromophobe RCC and oncocytoma. CK7 and alpha-methylacyl coenzyme A racemase are sensitive markers for papillary RCC; TFE3 expression is essential in confirming the diagnosis of Xp11 translocation RCC. The potentially difficult differential diagnosis between chromophobe RCC and oncocytoma may be facilitated by S100A1 and CD82. Thrombomodulin, uroplakin III, p63, and S100P are useful markers for urothelial carcinoma. Together with high molecular-weight cytokeratins, PAX2, and PAX8, they can help differentiate renal pelvic urothelial carcinoma from collecting duct RCC. A sensitive marker for sarcomatoid RCC is still not available. Immunomarkers are most often used for diagnosing metastatic RCC. Compared with primary RCC, expression of the above-mentioned markers is often less frequent and less diffuse in the metastatic setting. Recognizing the variable sensitivity and specificity of these markers, it is important to include at least CD10, RCC marker, PAX2, and PAX8 in the diagnostic panel. (Arch Pathol Lab Med. 2011;135:92-109)