Abstract
In recent years, renal epithelial tumors have been among the fastest reclassifying tumors, requiring updates to the tumor classification system. Nonetheless, immunohistochemistry (IHC) remains the most widely used tool for renal epithelial tumors. In this proposal, we aimed to create the most efficient IHC panel for categorizing the diverse subtypes of renal tumors, and to find out more specific immunohistochemical results in each subtype or each antibody. A total of 214 renal tumors were analyzed using 10 possible IHC markers to differentiate subtypes, including three major renal cell carcinoma (RCC) subtypes, clear-cell type (50 cases), papillary type (50 cases), and chromophobe type (20 cases), and minor subtypes (MiT RCC, 13 cases; collecting duct carcinoma, 5 cases; and oncocytoma, 10 cases). A triple immunomarker (cytokeratin 7 (CK7)-carbonic anhydrase IX (CAIX)- alpha-methylacyl-CoA racemase (AMACR)) panel is useful in particular high-grade clear-cell tumors. If IHC remains ambiguous, the use of an adjunctive panel can be suggested, including CD10, epithelial membrane antigen, cathepsin K, c-kit, hepatocyte nuclear factor 1-β, and E-cadherin. For an efficient immunohistochemical strategy for subtyping of RCC, we conclude that the CK7-CAIX-AMACR panel is the best primary choice for screening subtyping.
Highlights
For cancer diagnosis, immunohistochemistry (IHC) results often serve as valuable diagnostic tools when staining is positive
Eosinophilic tumors can be seen in papillary renal cell carcinoma (RCC) (PRCC), clear-cell renal cell carcinoma (CCRCC), chromophobe RCC (ChRCC), eosinophilic variants, renal oncocytoma (RO), and acquired cystic disease RCC (ACD-RCC) [1,2,3,4,5,6,7]
Carbonic anhydrase IX (CAIX) was diffusely and intensively stained with a box pattern in all CCRCC, which can play a role in a pathognomonic marker (Figure 1B)
Summary
Immunohistochemistry (IHC) results often serve as valuable diagnostic tools when staining is positive. When using IHC to subtype renal cell carcinoma (RCC), both positive and negative staining of key immunomarkers are comparatively important. RCC subtypes include clear-cell tumors, such as clear-cell carcinoma (ccRCC), chromophobe RCC (ChRCC), clear-cell papillary RCC (CCPRCC), and microphthalmos translocation family RCC Eosinophilic tumors can be seen in papillary RCC (PRCC), CCRCC, ChRCC, eosinophilic variants, renal oncocytoma (RO), and acquired cystic disease RCC (ACD-RCC) [1,2,3,4,5,6,7]. Ancillary triage of RCC tumors is mandatory except for tumors with very typical histological findings, as overlapping morphology is common and each subtype has a different prognosis. Routine histological results can frequently overlap between similar subtypes. More definitive immunohistochemical panels are required for cardinal subtyping
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