Abstract
Both clear cell renal carcinoma (ccRCC) and clear cell carcinoma of the ovary (CCOC) have a clear cytoplasmic morphological feature, hence it is difficult to identify metastatic ccRCC and CCOC by morphology alone. At present, there are no effective immunohistochemical markers to distinguish between these two tumors. Studies have shown that the clear cytoplasm of ccRCC is mainly caused by cholesterol-rich lipids in the cytoplasm, while that of CCOC is due to the accumulation of cytoplasmic glycogen. Objective: to hypothesize that the scavenger receptor class B-type 1 (SR-B1) protein responsible for HDL cholesterol uptake may be differentially expressed in ccRCC and CCOC, and high CD10 expression in the renal tubular epithelium may assist in distinguishing between ccRCC and CCOC. Methods: effective immunohistochemical markers were applied in 90 cases of renal clear cell carcinoma and 31 cases of ovarian cancer to distinguish between the two types of tumors.Result: SR-B1 and CD10 expression is significantly higher in ccRCC than CCOC. Both SR-B1 and CD10 exhibited focal weak-medium intensity staining in CCOC, and their staining extent and intensity were significantly lower than ccRCC. The sensitivity and specificity of SR-B1 for identifying ccRCC were 74.4% and 83.9%, respectively. The sensitivity and specificity of CD10 for identifying CCOC were 93.3% and 80.6%, respectively. The combined SR-B1( +) CD10( +) immunoprofile supports the diagnosis of ccRCC with a specificity of 93.5%. The combined SR-B1(-) CD10(-) immunoprofile supports the diagnosis of CCOC with a specificity of 93.3%. Conclusions: our findings demonstrate that the combination of SR-B1 and CD10 immunoprofiling is a valuable tool for differential diagnosis of ccRCC and CCOC.
Highlights
IntroductionClear cell renal cell carcinoma (ccRCC) is the most common malignant tumor of the renal parenchyma
Clear cell renal cell carcinoma is the most common malignant tumor of the renal parenchyma
A differential diagnosis is needed when metastasis occurs, but the latter has relatively specific immunohistochemical markers to assist in diagnosis (Fig. 2), such as melanin labeling S-100 and HMB45 positivity in PEComa (Fletcher et al 2013), TFE3 or TFEB positivity in MiT family translocation renal cell carcinoma (Moch et al 2016), TTF-1 and NapsinA positivity in fetal adenocarcinoma of the lung (Huang and Chen 2016), Inhibin A positivity and PAX8/PAX2 negativity in hemangioblastoma (Carney et al 2011), D2-40, CK5/6, Calretinin and WT-1 positivity in malignant mesothelioma (Travis et al 2015), and PAX8 and WT-1 positivity in serous carcinoma of the ovary (Kuhn and Ayhan 2018)
Summary
Clear cell renal cell carcinoma (ccRCC) is the most common malignant tumor of the renal parenchyma. Clear cell carcinoma of the ovary (CCOC) is characterized by resistance to conventional chemotherapy, early recurrence, and a poor prognosis (Gulec et al 2015; Sugiyama et al 2000) CCOC and ccRCC share morphological similarities such as a clear cytoplasm, and tubular, flaky or papillary structures. Both tumors express PAX8, a transcription factor normally expressed by cells of the nephric, thyroid, and Mullerian duct lineage (Köbel et al 2016) distinguishing between CCOC and metastatic ccRCC to the. The cytoplasmic transparency of ccRCC is mainly due to the large amount of cytoplasmic cholesterol ester (Gebhard et al 1987; Tosi et al 2004), while the clear cytoplasm of CCOC is more likely due to the accumulation of cytoplasmic glycogen (Tavassoli and Devilee 2003), suggesting that different energy metabolism characteristics may assist in a differential diagnosis
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