Velez Moises J, Thomas Courtney L, Stratton Jason, Bergfeld Wilma, Weaver Joshua
Department of Pathology, Summa Akron City Hospital, Akron, Ohio.
Clinical and Surgical Pathology, Dermatopathology, Regional Medical Laboratory, Tulsa, Oklahoma.
J Cutan Pathol. 2017 Jul;44(7):612-615. doi: 10.1111/cup.12946. Epub 2017 May 16.
Clear cell hidradenoma and cutaneous clear cell renal cell carcinoma (CCRCC) overlap morphologically. The distinction may be difficult in a patient with a history of CCRCC, presenting with a cutaneous nodule, potentially leading to an erroneous diagnosis. We investigated the usefulness of napsin A and paired box gene 8 (PAX-8) with previously studied markers epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), vimentin and cluster of differentiation marker 10 (CD10) in differentiating CCRCC from hidradenoma.
We evaluated hidradenomas and cutaneous CCRCCs for immunohistochemical expression of napsin A, PAX-8, EMA, CEA, vimentin and CD10.
PAX-8 was expressed in all CCRCCs (8/8) while negative in hidradenomas. Napsin A was negative in both hidradenomas (0/12) and CCRCCs (0/10). EMA showed membranous reactivity in 11 of 12 hidradenomas and 8 of 10 CCRCCs; and highlighted ductal epithelium in 1 of 12 hidradenomas and cystic areas in 4 of 10 CCRCCs. CD10 showed ductal expression in 3 of 12 hidradenomas and membranous staining in 8 of 9 CCRCCs. CEA highlighted ductal epithelium in 11 of 12 hidradenomas while absent in CCRCCs (0/10). Vimentin highlighted neoplastic cells in 8 of 8 CCRCCs and failed to stain the hidradenomas (0/12).
A conservative immunohistochemical panel including PAX-8, vimentin and CEA allow for easy distinction of CCRCC from hidradenoma, whereas napsin A added no additional value.
透明细胞汗腺瘤与皮肤透明细胞肾细胞癌（CCRCC）在形态学上存在重叠。对于有CCRCC病史且出现皮肤结节的患者，两者的鉴别可能困难，这可能导致错误诊断。我们研究了天冬氨酸内肽酶A（napsin A）和配对盒基因8（PAX - 8）与先前研究的标志物上皮膜抗原（EMA）、癌胚抗原（CEA）、波形蛋白和分化簇标志物10（CD10）在区分CCRCC与汗腺瘤方面的作用。
我们评估了汗腺瘤和皮肤CCRCC中天冬氨酸内肽酶A、PAX - 8、EMA、CEA、波形蛋白和CD10的免疫组化表达情况。
PAX - 8在所有CCRCC中均表达（8/8），而在汗腺瘤中呈阴性。天冬氨酸内肽酶A在汗腺瘤（0/12）和CCRCC（0/10）中均为阴性。EMA在12例汗腺瘤中的11例以及10例CCRCC中的8例显示膜反应性；在12例汗腺瘤中的1例突出显示导管上皮，在10例CCRCC中的4例突出显示囊性区域。CD10在12例汗腺瘤中的3例显示导管表达，在9例CCRCC中的8例显示膜染色。CEA在12例汗腺瘤中的11例突出显示导管上皮，而在CCRCC中不存在（0/10）。波形蛋白在8例CCRCC中的8例突出显示肿瘤细胞，而汗腺瘤未染色（0/12）。
包括PAX - 8、波形蛋白和CEA的保守免疫组化组合可轻松区分CCRCC与汗腺瘤，而天冬氨酸内肽酶A没有额外价值。
