Tariq Naima, Mamoon Nadira, Haroon Asna, Ali Zafar, Ahmad Imran Nazir
Department of Pathology, Shifa International Hospital, Islamabad-Pakistan.
J Ayub Med Coll Abbottabad. 2018 Jul-Sep;30(3):325-332.
Renal cell carcinoma (RCC), accounts for 2-3% of all new cancers diagnosed. Most renal tumours have characteristic histological features, which help in their sub classification. However, some cases do show overlapping morphology which pose a diagnostic challenge for the pathologists. Tumour ancillary studies such as immunohistochemistry (IHC) may play a significant role in segregation of these tumours. This study was undertaken to determine the role of IHC in diagnosing these tumours.
December 2015. It was carried out in histopathology laboratory of Shifa International Hospital, Islamabad. A total of fifty-five (n=55) nephrectomy specimens having RCC subtypes were included. A specific morphological diagnosis was rendered in each case on H&E.. A panel of six immunohistochemical markers CK7, CD10, CD117, CA IX, AMACR and Vimentin was then applied in each case and a final diagnosis considering both morphology and IHC was given. Statistical analysis was done using SPSS version 20.0. Mean and SD were calculated for quantitative variables where as frequencies and percentages were calculated for qualitative variables.
Out of a total of 55 cases, 36 (65.55%) were males whereas 19 (34.5%) were females. The mean age of patients was 54.04±14.40 years. Clear cell RCC comprised 70.9% (n=39), Papillary RCC 14.5% (n=8), Chromophobe RCC 10.9% (n=6) and clear cell papillary RCC 3.6% (n=2) of cases on morphology. After application of IHC stains in all cases, 83.6% (n=46) of cases were found to have correct diagnosis on H& E. However, 16.4% (n=9) of cases could not be correctly diagnosed on morphology alone and it was in these cases that IHC played a major role in reaching a final diagnosis.
Although most RCC subtypes display a characteristic morphology on H&E, in a significant proportion of the cases there are considerable overlapping morphological features. Our study shows that a correct diagnosis cannot be made on H & E alone in a notable number of cases. Therefore, IHC should be applied in all cases to reach a final diagnosis, which has both prognostic and therapeutic implications.
肾细胞癌（RCC）占所有新诊断癌症的2%-3%。大多数肾肿瘤具有特征性的组织学特征，这有助于对其进行亚分类。然而，一些病例确实表现出形态学上的重叠，这给病理学家带来了诊断挑战。肿瘤辅助研究如免疫组织化学（IHC）可能在这些肿瘤的鉴别中发挥重要作用。本研究旨在确定免疫组织化学在诊断这些肿瘤中的作用。
2015年12月。研究在伊斯兰堡希法国际医院的组织病理学实验室进行。共纳入55例具有肾细胞癌亚型的肾切除标本。每例标本在苏木精-伊红（H&E）染色切片上做出特定的形态学诊断。然后对每例标本应用一组六种免疫组织化学标志物，即细胞角蛋白7（CK7）、CD10、CD117、碳酸酐酶IX（CA IX）、α-甲基酰基辅酶A消旋酶（AMACR）和波形蛋白，并结合形态学和免疫组织化学结果做出最终诊断。使用SPSS 20.0版进行统计分析。对定量变量计算均值和标准差，对定性变量计算频率和百分比。
55例病例中，男性36例（65.55%），女性19例（34.5%）。患者的平均年龄为54.04±14.40岁。形态学诊断显示，透明细胞肾细胞癌占70.9%（n=39），乳头状肾细胞癌占14.5%（n=8），嫌色性肾细胞癌占10.9%（n=6），透明细胞乳头状肾细胞癌占3.6%（n=2）。对所有病例应用免疫组织化学染色后，发现83.6%（n=46）的病例在H&E染色切片上诊断正确。然而，16.4%（n=9）的病例仅靠形态学无法正确诊断，正是在这些病例中，免疫组织化学在做出最终诊断中发挥了主要作用。
虽然大多数肾细胞癌亚型在H&E染色切片上显示出特征性形态，但在相当一部分病例中存在明显的形态学重叠特征。我们的研究表明，在相当数量的病例中仅靠H&E染色无法做出正确诊断。因此，应在所有病例中应用免疫组织化学以做出最终诊断，这对预后和治疗都有影响。
