The utility of PAX-2 in distinguishing metastatic clear cell renal cell carcinoma from its morphologic mimics - An immunohistochemical study with comparison to renal cell carcinoma marker
The utility of PAX-2 in distinguishing metastatic clear cell renal cell carcinoma from its morphologic mimics - An immunohistochemical study with comparison to renal cell carcinoma marker
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DOI：
10.1097/pas.0b013e318176dba7
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发表时间：
2008-10-01
影响因子：
5.6
通讯作者：
MeKenney, Jesse K.
中科院分区：
文献类型：
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作者：
Gokden, Neriman;Gokden, Murat;MeKenney, Jesse K.
PAX-2是肾脏发育过程中表达的同源基因。虽然PAX-2的免疫组织化学表达已被描述在各种原发性肾细胞癌（RCC）亚型和转移性RCC，其特异性作为标志物的肾谱系在转移性设置尚未得到充分评价。此外，其效用尚未直接与在这种情况下最广泛使用的抗体，肾细胞癌标志物（RCCma）进行比较。我们研究了PAX-2在转移性透明细胞肾细胞癌（CCRCC）和各种可能与CC-RCC相似的透明细胞质非肾肿瘤中的表达。检索了27例转移到不同器官的CC-RCC和50例CC-RCC的形态学相似者的档案材料。对每例患者进行PAX-2和RCCmarz抗体免疫组化。对核染色（PAX-2）或膜染色（RCCma）进行半定量评分。27例转移性CC-RCC中有23例（85%）显示PAX-2的核免疫反应性，而27例中有19例（70%）发现RCCma反应性。转移性CG RCC的免疫学特征为PAX-2+/RCCma+：27例中的19例（70%），PAX-2+/ RCCma-：27例中的5例（19%），PAX-2-/RCCma+：27例中的2例（7%）和PAX-2-/RCCma-：27例中的1例（4%）。50例CC-RCC中有5例（10%）与PAX-2至少有灶性核反应，包括3例甲状旁腺癌中的1例（33 /0），7例卵巢透明细胞癌中的3例（43 /0）和1例附睾透明细胞乳头状囊腺瘤。在50个模拟物中的26个（52%）中鉴定出膜RCCma反应性。我们的结论是，PAX-2是一个有用的标志物，用于区分转移性CC-RCC从其潜在的形态学模拟，但必须谨慎使用在某些鉴别诊断设置，如甲状旁腺癌，卵巢透明细胞癌，透明细胞乳头状囊腺瘤的附睾显示表达PAX-2和RCCma。
PAX-2 is a homeogene expressed during kidney development. Although immunohistochemical expression of PAX-2 has been described in a variety of primary renal cell carcinoma (RCC) subtypes and in metastatic RCC, its specificity as a marker of renal lineage in a metastatic setting has not been fully evaluated. In addition, its utility has not been directly compared with the most widely used antibody in this setting, renal cell carcinoma marker (RCCma). We studied PAX-2 expression in metastatic clear cell renal cell carcinoma (CCRCC) and in a variety of nonrenal neoplasms with clear cytoplasm that may potentially mimic CC-RCC. Archival material from 27 CC-RCCs metastatic to various organs and 50 close morphologic mimics of CC-RCC were retrieved. Immunohistochemistry with PAX-2 and RCCmarz antibodies was performed on each case. Nuclear staining (PAX-2) or membranous staining (RCCma) was scored semiquantitatively. Twenty-three of 27 (85%) metastatic CC-RCCs showed nuclear immunoreactivity for PAX-2, whereas RCCma reactivity was found in 19 of 27 (70%). The immunoprofiles of the metastatic CG RCC were PAX-2+/RCCma+: 19 of 27 (70%), PAX-2+/ RCCma-: 5 of 27 (19%), PAX-2-/RCCma+: 2 of 27 (7%), and PAX-2-/RCCma-: 1 of 27 (4%). Five of the 50 mimics of CC-RCC (10%) had at least focal nuclear reactivity with PAX-2, including 1 of 3 parathyroid carcinomas (33 /0), 3 of 7 clear cell carcinomas of the ovary (43 /0), and the l clear cell papillary cystadenoma of the epididymis. Membranous RCCma reactivity was identified in 26 of the 50 mimics (52%). We conclude that PAX-2 is a useful marker for distinguishing metastatic CC-RCC from its potential morphologic mimics, but caution must be used in certain differential diagnostic settings where nonrenal tumors such as parathyroid carcinoma, ovarian clear cell carcinoma, and clear cell papillary cystadenoma of the epididymis were shown to express both PAX-2 and RCCma.