Departments of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Am J Surg Pathol. 2011 Jul;35(7):949-61. doi: 10.1097/PAS.0b013e31821e25cd.
Multiple therapeutic options for renal tumors that are now available have put pathologists under increasing pressure to render diagnosis on limited material. Results on biopsies by hematoxylin and eosin (H&E) have historically not been encouraging. Currently, multiple immunohistochemical markers with differential expression in these renal tumors are available. We studied the utility of such markers on needle biopsies that were obtained ex vivo. After nephrectomy, two 18-guage cores were obtained and processed routinely. Expressions of carbonic anhydrase (CA) IX, CD117, α-methylacyl-CoA racemase (AMACR), cytokeratin 7 (CK7), and CD10 were evaluated. Results, with or without immunostaining, were compared with the final nephrectomy diagnosis. We studied 145 tumors, including 119 renal cell carcinomas (83 clear cell, 18 papillary, 14 chromophobe, and 4 type unclassified), 11 oncocytomas, and 15 miscellaneous tumors. Adequate evaluable material was present in 123 (85%) cases. In such biopsies, 81% of cases were correctly classified by H&E alone, with correct diagnosis in 90% of cases in the most common tumor subtypes (clear cell, papillary and chromophobe renal cell carcinoma, and oncocytoma). By adding immunostains, the accuracy was 90% overall and 99% among the 4 most common subtypes. The following extent and patterns of immuneexpression were highly useful in the diagnoses: diffuse, membranous CAIX expression in clear cell renal cell carcinoma, diffuse positivity for AMACR in papillary renal cell carcinoma, distinct peripheral cytoplasmic accentuation for CD117 in chromophobe renal cell carcinoma, widespread and intense positivity for CK7 in chromophobe and papillary renal cell carcinoma, and diffuse membranous reactivity in clear cell and patchy/luminal in papillary renal cell carcinoma for CD10. In conclusion, utilizing immunostains improves classification of renal tumors on needle biopsy, which may be of particular help for pathologists with limited experience. Both extent and patterns must be considered for a definitive diagnosis.
目前，针对这些肾肿瘤，有多种具有不同表达的免疫组化标志物可供选择。我们研究了这些标志物在离体获得的肾肿瘤穿刺活检中的应用。肾切除术后，获取两个 18 号活检针芯，并进行常规处理。评估碳酸酐酶（CA）IX、CD117、α-甲基酰基辅酶 A 消旋酶（AMACR）、细胞角蛋白 7（CK7）和 CD10 的表达。有无免疫组化染色的结果与肾切除术后的最终诊断进行比较。我们研究了 145 例肿瘤，包括 119 例肾细胞癌（83 例透明细胞癌、18 例乳头状癌、14 例嫌色细胞癌和 4 例未分类）、11 例嗜酸细胞瘤和 15 例其他肿瘤。在 123 例（85%）可评估的病例中，有足够的评估材料。在这些活检中，81%的病例仅通过 H&E 单独分类，90%的最常见肿瘤亚型（透明细胞癌、乳头状癌和嫌色细胞癌、嗜酸细胞瘤）的诊断正确。通过添加免疫组化染色，整体准确率为 90%，在 4 种最常见的亚型中准确率为 99%。以下免疫表达的范围和模式在诊断中非常有用：透明细胞肾细胞癌中弥漫性、膜性 CAIX 表达，乳头状肾细胞癌中弥漫性 AMACR 阳性，嫌色细胞肾细胞癌中明显的外周细胞质突出的 CD117，广泛和强烈的 CK7 阳性在嫌色细胞癌和乳头状肾细胞癌中，CD10 在透明细胞癌中呈弥漫性膜反应，在乳头状肾细胞癌中呈斑片状/管腔反应。总之，免疫组化染色可提高肾肿瘤穿刺活检的分类，对于经验有限的病理学家可能特别有帮助。必须考虑范围和模式来进行明确诊断。
