Rao B Vishal, Regulavalasa Tejomayi, Fonseca Daphne, Murthy Sudha S, Sharma Rakesh, Raju K V V N, Rao T Subramanyeshwar, Sundaram Challa
Department of Pathology and Laboratory Medicine, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India.
Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India.
Urol Ann. 2020 Jul-Sep;12(3):236-240. doi: 10.4103/UA.UA_131_18. Epub 2020 Jun 10.
Morphological cocktails in renal cell carcinoma (RCC).
Minimal immunohistochemistry (IHC) panel to resolve the diagnosis of renal cell cacinoma (RCC) with morphological overlaps.
RCC is the most common malignancy in kidney accounting for 90% of all kidney cancers. Clear cell RCC is the most common histological type followed by papillary RCC. However, many of the RCCs show morphological cocktails which may pose diagnostic difficulties in small biopsies and even in the resection specimens. Accurate diagnosis has both prognostic and therapeutic implications; hence, correct differentiation is necessary.
This retrospective study includes all renal cell tumors diagnosed on core biopsies, radical and partial nephrectomies between January 2015 and September 2017 were studied. The demographic, clinical, and gross findings were noted. The cases that had morphological overlap among the subtypes were subjected to a panel of IHC markers, including CD10, CK7, alpha-methyl acyl-coenzymeA racemase (AMACR), and CD117.
There were 128 RCC in the study period, and morphological overlap was seen in 36 (27.9%) specimens including 13 core biopsies, 16 radical, and 7 partial nephrectomies. IHC resolved 35/36 (97.2%) cases rendering a diagnosis of clear cell (11), papillary (15), chromophobe (4), and oncocytoma (5). However, in one case where the provisional diagnosis was oncocytic tumor, all IHC markers were negative rendering IHC noncontributory.
Difficulty in diagnosis was encountered in many core biopsies, resection specimens which when subjected to IHC panel of CD10, CK7, AMACR, and CD117 helped in resolving the diagnosis of subtypes of RCC.
肾细胞癌（RCC）中的形态学混合表现。
采用最小免疫组化（IHC）组合来解决具有形态学重叠的肾细胞癌（RCC）的诊断问题。
RCC是肾脏最常见的恶性肿瘤，占所有肾癌的90%。透明细胞RCC是最常见的组织学类型，其次是乳头状RCC。然而，许多RCC表现出形态学混合表现，这可能在小活检甚至切除标本中造成诊断困难。准确诊断具有预后和治疗意义；因此，正确的鉴别诊断是必要的。
这项回顾性研究包括2015年1月至2017年9月间经芯针活检、根治性肾切除术和部分肾切除术诊断的所有肾细胞肿瘤。记录人口统计学、临床和大体检查结果。对各亚型间存在形态学重叠的病例进行一组免疫组化标记物检测，包括CD10、CK7、α-甲基酰基辅酶A消旋酶（AMACR）和CD117。
研究期间共有128例RCC，36例（27.9%）标本出现形态学重叠，包括13例芯针活检、16例根治性肾切除术和7例部分肾切除术。免疫组化明确了35/36（97.2%）例的诊断，诊断为透明细胞型（11例）、乳头状型（15例）、嫌色细胞型（4例）和嗜酸细胞瘤型（5例）。然而，在1例初步诊断为嗜酸细胞性肿瘤的病例中，所有免疫组化标记物均为阴性，免疫组化未能提供诊断帮助。
许多芯针活检和切除标本在诊断上存在困难，对其进行CD10、CK7、AMACR和CD117免疫组化组合检测有助于明确肾细胞癌亚型的诊断。
