Metanephric adenoma: the utility of immunohistochemical and cytogenetic analyses in differential diagnosis, including solid variant papillary renal cell carcinoma and epithelial-predominant nephroblastoma
Metanephric adenoma: the utility of immunohistochemical and cytogenetic analyses in differential diagnosis, including solid variant papillary renal cell carcinoma and epithelial-predominant nephroblastoma
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DOI：
10.1038/modpathol.2015.81
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发表时间：
2015-09-01
期刊：
影响因子：
7.5
通讯作者：
Cheng, Liang
中科院分区：
文献类型：
--
作者：
Kinney, Stephanie N.;Eble, John N.;Cheng, Liang
后肾腺瘤是一种良性肾脏肿瘤，在形态上与乳头状肾细胞癌和上皮为主的肾母细胞瘤的实性变体重叠。为了帮助解决这一鉴别诊断，我们研究了免疫组织化学和分子分析在区分这些实体中的效用;据我们所知，这是第一项使用联合方法分析所有三种肿瘤的研究。我们分析了37例最初诊断为后肾腺瘤的肿瘤（其中2例我们重新分类为乳头状肾细胞癌），13例实体变异乳头状肾细胞癌，以及20例上皮为主的肾母细胞瘤，使用免疫组织化学和荧光原位杂交（FISH）相结合的方法评估7号和17号染色体的三体性以及Y染色体的缺失。对CK 7、AMACR、WT 1和CD 57进行免疫组织化学染色。CK 7-、AMACR-、WT 1+和CD 57+的组合被认为是后肾腺瘤的特征。最初诊断为后肾腺瘤的大多数肿瘤（31/37）显示出后肾腺瘤的预期染色模式（CK 7-、AMACR-、WT 1+和CD 57+）。免疫表型不一致的六个肿瘤中，两个肿瘤在细胞遗传学检查后被重新分类为乳头状肾细胞癌。建议所有组织学上类似后肾腺瘤的成人病例进行WT 1、CD 57、CK 7和AMACR免疫组化染色。如果染色模式是后肾腺瘤的特征（CK 7-、AMACR-、WT 1+和CD 57+，包括膜染色），则无需其他诊断试验。然而，如果有不同的免疫染色模式，那么我们建议FISH分析。
Metanephric adenoma is a benign renal neoplasm that overlaps in morphology with the solid variant of papillary renal cell carcinoma and epithelial-predominant nephroblastoma. To aid in resolving this differential diagnosis, we investigated the utility of immunohistochemical and molecular analyses in distinguishing between these entities; the first study, to our knowledge, to use a combined approach in analyzing all three tumors. We analyzed 37 tumors originally diagnosed as metanephric adenomas (2 of which we reclassified as papillary renal cell carcinomas), 13 solid variant papillary renal cell carcinomas, and 20 epithelial-predominant nephroblastomas using a combination of immunohistochemistry and fluorescence in situ hybridization (FISH) assessing for trisomy of chromosomes 7 and 17 and loss of Y. Immunohistochemical staining was performed for CK7, AMACR, WT1, and CD57. The combination of CK7-, AMACR-, WT1+, and CD57+ was considered characteristic of metanephric adenoma. Most of the tumors originally diagnosed as metanephric adenomas (31/37) showed the expected staining pattern of metanephric adenoma (CK7-, AMACR-, WT1+, and CD57+). Of the six tumors with discordant immunophenotype, two tumors were reclassified as papillary renal cell carcinoma after cytogenetic workup. It is recommended that all adult cases histologically resembling metanephric adenoma have WT1, CD57, CK7, and AMACR immunohistochemical staining performed. If the staining pattern is characteristic for metanephric adenoma (CK7-, AMACR-, WT1+, and CD57+, including membranous staining), then no other diagnostic tests are indicated. However, if there is a different immunostaining pattern, then we recommend FISH analysis.