Clear Papillary Cell Research Articles

Case report: Papillary mesothelioma of the peritoneum with foamy cell lining

A 34-year-old female, with a history of continued asbestos exposure, presented with a papillary peritoneal mesothelioma with a diffuse, prominent clear foamy cell change, with microvacuolation in its papillary lining, that expressed cytokeratins 7, 5/6 and calretinin as well as nuclear WT-1 and apical membrane staining for thrombomodulin, podoplanin D2-40 and HBME-1. In contrast, lining cells were CD68 negative. Foamy cell change has been reported in isolated cases as solid cords but not as a diffuse change in the mesothelial papillary lining. This phenomenon prompts differential diagnoses with abdominal and renal papillary clear cell tumours, which were discarded after a characteristic mesothelial immunophenotype was demonstrated.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/4679576081031834.

Expression of Parafibromin in Clear Cell Papillary Renal Cell Carcinoma

Clear cell papillary renal cell carcinoma (CCPRCC) is a low-grade renal cell neoplasm. In this study, we investigated the expression of parafibromin, CK7, and RCC marker (RCC-Ma) in this tumor by immunohistochemistry in a group of CCPRCC. Twenty cases of CCPRCC were stained for parafibromin and showed diffuse and strong nuclear positivity for this marker. In addition the cases of CCPRCC were stained for CK7 and RCC-Ma, respectively, and the majority of tumors were positive for cytoplasmic staining of CK7 and negative for RCC-Ma. This unique staining pattern can be useful in the differential diagnosis from conventional clear cell renal cell carcinomas, which have a higher positivity rate for RCC-Ma, but largely negative for CK7 and parafibromin, and papillary renal cell carcinomas, which are usually positive for CK7 and RCC-Ma but are largely negative for parafibromin.

CD133 Staining Detects Acute Kidney Injury and Differentiates Clear Cell Papillary Renal Cell Carcinoma from Other Renal Tumors

CD133 has recently been characterized as a progenitor cell marker in the kidney. However, the expression of this marker has not been thoroughly investigated in kidney injury and variants of renal tumors for pathology practice. We quantified CD133 expression in kidney biopsies from patients with acute renal failure and compared staining intensity with serum creatinine levels. CD133 expression levels were also evaluated in several subtypes of renal neoplasms. Normal adult renal parenchyma showed CD133 expression in parietal epithelium and in less than 5% of the epithelial cells in proximal and distal nephron tubules. However, CD133 was diffusely upregulated in the injured proximal and distal tubular epithelium and the CD133 expression scores in renal tubules were significantly correlated with serum creatinine levels. Amongst the renal tumors, CD133 was diffusely expressed in clear cell papillary renal cell carcinoma but was only focally present in other types of renal tumors. In summary, CD133 is a useful marker to detect renal tubular injury and to differentiate clear cell papillary renal cell carcinoma from other tumor types.

Urine screening by Seldi-Tof, followed by biomarker identification, in a Brazilian cohort of patients with Renal Cell Carcinoma (RCC)

To screen proteins/peptides in urine of Renal Cell Carcinoma (RCC) patients by SELDI-TOF (Surface Enhanced Laser Desorption Ionization - Time of Flight) in search of possible biomarkers. Sixty-one urines samples from Clear Cell RCC and Papillary RCC were compared to 29 samples of control urine on CM10 chip. Mass analysis was performed in a ProteinChip Reader PCS 4,000 (Ciphergen Biosystems, Fremont, CA) with the software Ciphergen Express 3.0. All chips were read at low and at high laser energy. For statistical analysis the urine samples were clustered according to the histological classification (Clear Cell and Papillary Carcinoma). For identification urine was loaded on a SDS PAGE gel and bands of most interest were excised, trypsinized and identified by MS/MS. Databank searches were performed in Swiss-Prot database using the MASCOT search algorithm and in Profound. Proteins that were identified from urine of controls included immunoglobulin light chains, albumin, secreted and transmembrane 1 precursor (protein K12), mannan-binding lectin-associated serine protease-2 (MASP-2) and vitelline membrane outer layer 1 isoform 1. Identification of immunoglobulins and isoforms of albumin are quite common by proteomics and therefore cannot be considered as possible molecular markers. K12 and MASP-2 play important physiological roles, while vitellite membrane outer layer 1 role is unknown since it was never purified in humans. The down expression of Protein K-12 and MASP-2 make them good candidates for RCC urine marker and should be validated in a bigger cohort including the other less common histological RCC subtypes.

Clear cell papillary cystadenocarcinoma of the epididymis: a case report and immunohistochemistry of markers for renal cell carcinoma.

Neoplasms of the epididymis are uncommon, and malignant tumors are extremely rare. We report a case of clear cell papillary cystadenocarcinoma of the epididymis presenting with a long history of painless scrotal mass on the left side. Immunohistochemical markers for clear cell renal cell carcinoma (RCC) were examined to distinguish between clear cell papillary cystadenocarcinoma of the epididymis and metastatic clear cell renal cell carcinoma. The present case was positive for cytokeratin-7, PAX2, vinculin, vimentin and carbonic anhydrase IX. Expression of CD10 was focally observed. In contrast, no immunoreactivities for α-methylacyl-CoA racemase, RCC marker, glutathione S-transferase α or C-KIT were detected. The immunophenotypic profile of clear cell papillary cystadenocarcinoma of the epididymis closely resembles that of clear cell papillary RCC, although the immunohistochemical markers tested in this study are useful to make a differential diagnosis between clear cell papillary cystadenocarcinoma of the epididymis and metastatic clear cell RCC.

Renal Cortical Tumors: Use of Multiphasic Contrast-enhanced MR Imaging to Differentiate Benign and Malignant Histologic Subtypes

To investigate the use of quantitative multiphasic contrast material-enhanced magnetic resonance (MR) imaging in differentiating between common benign and malignant histologic subtypes of renal cortical tumors. The institutional review board waived informed consent and approved this retrospective HIPAA-compliant study of 138 patients who underwent preoperative contrast-enhanced MR imaging during the period of January 2004-December 2008. At surgery, 152 renal tumors were identified (77 clear cell, 22 papillary, 18 chromophobe, and 10 unclassified carcinomas; 16 oncocytomas; nine angiomyolipomas). Three readers independently identified and measured the most-enhanced area in each tumor and placed corresponding regions of interest in similar positions on images from the precontrast, corticomedullary, nephrographic, and excretory phases. The percentage change in signal intensity (%SI change) between precontrast imaging and each postcontrast phase was calculated. Interreader agreement was evaluated by using the overall concordance correlation coefficient (OCC). A linear mixed-effects model was used to estimate and compare the trajectories of the means of log %SI change across all phases between the six histologic subtypes. Interreader agreement was substantial to almost perfect (OCC, 0.77-0.88). The %SI change differed significantly between clear cell carcinomas and papillary and chromophobe carcinomas in all phases of enhancement (P < .0001-.0120). In addition, %SI change was significantly higher in angiomyolipomas than in clear cell carcinomas, but only in the corticomedullary phase (P = .0231). Enhancement did not differ significantly between clear cell carcinoma and oncocytoma in any phase (P = .2081-.6000). Quantitative multiphase contrast-enhanced MR imaging offers a widely available, reproducible method to characterize several histologic subtypes of renal cortical tumors, although it does not aid differentiation between clear cell carcinomas and oncocytomas.

Primary Bilateral Seminal Vesicle Carcinoma

With no more than 60 reported cases, tumors of the seminal vesicles are rare. Because of poor and nonspecific symptoms diagnosis is often very difficult. This report presents a case of a 56-year-old man with right renal agenesis and intermittent hematospermia and bilateral cystic masses of the seminal vesicles. Transrectal biopsies of the cystic lesion revealed a papillary clear cell adenocarcinoma. The patient underwent radical prostatectomy and pelvic lymphoadenectomy. Lymph node metastases were found on histological examination. The patient received 4 cycles of chemotherapy and pelvic radiotherapy. He remains disease free 21 months after surgery. Radiological imaging in patients with hematospermia and hematuria will allow disease detection at earlier stages. Immunohistochemistry and histomorphology can be used for differential diagnosis. Surgery with clear margins offers the best chance to cure. Hormonal and radio-chemotherapy have a role as adjuvant and palliative treatment.

V2152 SIMULTANEOUS NATIVE KIDNEY AND ALLOGRAFT LAPAROSCOPIC NEPHRECTOMY FOR SINCRONOUS TUMOR

You have accessJournal of UrologySingle Port Surgery1 Apr 2012V2152 SIMULTANEOUS NATIVE KIDNEY AND ALLOGRAFT LAPAROSCOPIC NEPHRECTOMY FOR SINCRONOUS TUMOR Antonio Alcaraz, Mireia Musquera, Laura Izquierdo, Eduardo Garcia-Cruz, Alexandru Ciudin, and Lluis Peri Antonio AlcarazAntonio Alcaraz Barcelona, Spain More articles by this author , Mireia MusqueraMireia Musquera Barcelona, Spain More articles by this author , Laura IzquierdoLaura Izquierdo Barcelona, Spain More articles by this author , Eduardo Garcia-CruzEduardo Garcia-Cruz Barcelona, Spain More articles by this author , Alexandru CiudinAlexandru Ciudin Barcelona, Spain More articles by this author , and Lluis PeriLluis Peri Barcelona, Spain More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2324AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopy is not a common technique to be used in kidney allograft surgery due to the fibrosis that surround the kidney and difficults surgical maneuvers. We present our experience with a laparoscopic simultaneous native kidney nephrectomy and trasplantectomy. METHODS We present a 55 years old female with 2 previous kidney trasplantations who was diagnosed of a tumor in the left native kidney and a second one in the allograft during the study for a third kidney trasplantation. The CT Scan confirmed a 2 cm solid lesion in both the native kidney and the allograft and a 2.7 cm paraaortic adenophaty. A laparoscopic surgery was indicated. The patient was placed in right decubitus position and 3 abdominal trocars were placed (one trocar of 5 mm and 2 of 10mm). A left nephrectomy is performed following the same steps as usual. After sectioning the vascular pedicle, the native kidney is removed from the operative field. Then, we proceed with the paraortic adenopaty ressection by using blunt dissection and the Ligasure. Finally, the transplantectomy is performed. The allograft artery is localized following the native ureter. After having sectioned the artery, the renal vein is identified and sectioned between hem-o-loks. Then, the remaining kidney attachments are liberated using the Ligasure. Through a Gibson incision a 15 mm bag is placed, and the three surgical samples are wrapped and removed. RESULTS Operative time was 165 minutes with an estimated blood loss of 200 cc. The pathological report showed a 2 cm type I papillary clear cell renal carcinoma in the native kidney and a 2,2 cm chromophobe renal cell carcinoma in the allograft. The lymph node was a metastasis from the native kidney tumor. CONCLUSIONS Laparoscopy is a feasible approach to perform a nephrectomy and a trasplantectomy, allowing a single incision to remove both pieces. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e869 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Antonio Alcaraz Barcelona, Spain More articles by this author Mireia Musquera Barcelona, Spain More articles by this author Laura Izquierdo Barcelona, Spain More articles by this author Eduardo Garcia-Cruz Barcelona, Spain More articles by this author Alexandru Ciudin Barcelona, Spain More articles by this author Lluis Peri Barcelona, Spain More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

An analysis of five clear cell papillary cystadenomas of mesosalpinx and broad ligament: four associated with von Hippel‐Lindau disease and one aggressive sporadic type

Clear cell papillary cystadenoma (CCPC) is associated with von Hippel-Lindau disease (VHLD), but rarely involves mesosalpinx and broad ligament (M/BL). This study provides new data about its behaviour and immunophenotype. We performed an analysis of four benign cases of CCPC of M/BL with either characteristic clinical features or genetic markers [loss of heterozygosity (LOH)] of VHLD in patients ranging from 24 to 36 years and a sporadic case in a 52-year-old presenting with peritoneal metastases. All CCPCs were papillary but had solid and tubular areas. Haemorrhage, thrombosis and scarring were constant features and related to an unusual pattern of sub-epithelial vascularity. All clear or oxyphilic cells co-expressed cytokeratin 7 (CK7), CAM5.2 and vimentin, with strong apical CD10 and nuclear paired box gene 2 (PAX2) immunoreactivity. Three cases also showed positivity for VHL40, epithelial membrane antigen (EMA), Wilms' tumour suppressor gene (WT-1) and cancer antigen 125 (CA125) but only one expressed renal cell carcinoma (RCC) antigen. Vascular plexus overexpressed nuclear and cytoplasmic WT-1. The VHLD-associated cases appeared to be benign, but the sporadic case exhibited a low malignant potential. CCPCs show histological and immunophenotypical similarities with the recently reported clear cell papillary RCC, although the previously unreported apical CD10 and nuclear PAX2 expression may be related to their mesonephric origin. CCPC has a distinctive sub-epithelial vascular pattern that is consistent with its pathogenesis.

Clear Cell Papillary Renal Cell Carcinoma: A Report of 15 Cases Including Three Cases of Concurrent Other-Type Renal Cell Carcinomas

BackgroundClear cell papillary renal cell carcinoma (CCPRCC) is a recently established subtype of renal epithelial tumor. The aim of this study was to identify the diagnostic criteria of CCPRCC with an emphasis on immunohistochemical studies, and to report three cases with concurrent other-type renal cell carcinoma (RCC).MethodsA total of 515 RCC patients that consecutively underwent surgical resection at Seoul National University Hospital from 1 January 2010 to 31 December 2011 were screened. Each case was reviewed based on the histologic features and was evaluated immunohistochemically.ResultsA total of 15 CCPRCCs were identified, which composed 2.9% of the total RCCs. The mean age was 52 years, and the average tumor size was 1.65 cm. All 15 cases showed low nuclear grade, no lymph node metastasis and no distant metastasis. The CCPRCCs showed variable architectural patterns including cystic, trabecular, papillary, and acinar. All of the cases showed moderate to intense immunoreactivity for cytokeratin 7 (CK7). CD10 was negative or showed focal weak positivity. Three cases had concurrent other-type RCC, including a clear cell RCC and an acquired cystic disease-associated RCC.ConclusionsThe strong CK7 and negative or focal weak CD10 expression will be useful for the diagnosis of CCPRCC.

Clear Cell Papillary Renal Cell Carcinoma: A Novel Category of Renal Cell Neoplasm

Copyright: © 2012 Alexiev BA. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Clear cell Renal Cell Carcinoma (clear cell RCC) and papillary Renal Cell Carcinoma (papillary RCC) are the most common carcinomas of the renal tubular epithelium and distinguishing them from one another is important because they have different prognoses [1-3]. Although most of the time they can be distinguished easily in routine sections, occasionally, overlapping morphologic findings make classification difficult. Rarely, RCC are encountered in which there are areas of papillary architecture, but there are extensive populations of cells with clear cytoplasm [1-3]. In this situation, it is unclear whether they should be classified as clear cell RCC or papillary RCC. Recently, a distinctive tumor characterized by papillary architecture and composed entirely of clear cells has been described as arising in kidneys with or without end-stage renal disease and is designated as ‘‘Clear Cell Papillary Renal Cell Carcinoma’’ (CCPC) [1-3].

Molecular characterization of kidney cancer

Molecular profiling of renal cell carcinomas (RCCs) may improve the distinction between oncocytoma and malignant RCC subtypes and aid in early detection of metastasis. The hyaluronic acid (HA) family includes HA synthases (HAS1, HAS2, HAS3), hyaluronidases (HYAL-1, HYAL-2, HYAL-3, HYAL-4, PH20, HYAL-P1), and HA receptors (CD44s, CD44v, RHAMM). HA family members promote tumor growth and metastasis. The authors evaluated the expression of HA family members in kidney specimens. By using quantitative polymerase chain reaction, mRNA levels of 12 HA family members were measured in tumor specimens obtained from 86 consecutive patients undergoing nephrectomy; 80 of them also provided normal specimens. Mean and median follow-up were 15.2 ± 8.8 and 13.8 months. RCC specimens included clear cell RCC: 65; papillary: 10; chromophobe: 5; oncocytoma: 6; metastasis positive: 17. Median HAS1, CD44s, and RHAMM transcript levels were elevated 3- to 25-fold in clear cell RCC and papillary and chromophobe tumors when compared with normal tissues. HYAL-4, CD44s, and RHAMM levels were elevated 4- to 12-fold in clear cell RCC and papillary tumors when compared with oncocytomas; only HYAL-4 levels distinguished between chromophobe and oncocytoma (P = .009). CD44s and RHAMM levels were significantly higher in tumors <4 cm (510 ± 611 and 19.6 ± 20.8, respectively) when compared with oncocytoma (46.4 ± 20 and 3.8 ± 2.5; P ≤ .006). In univariate and multivariate analyses, CD44s (P < .0001), RHAMM (P < .0001), stage, tumor size, and/or renal vein involvement were significantly associated with metastasis. The combined CD44s + RHAMM marker had 82% sensitivity and 86% specificity to predict metastasis. CD44s and RHAMM levels distinguish between oncocytoma and RCC subtypes regardless of tumor size and are potential predictors of RCC metastasis.

Clear Cell Papillary Renal Cell Carcinoma in the Bilateral Native Kidneys after 2 Years of Renal Transplantation: Report of a Case and Review of the Literature

Renal transplantation increases the probability of malignant tumors by about 2–4-fold overall with a much higher rate for renal epithelial malignancy. Renal tumors in renal transplant recipients are commonly conventional clear cell or papillary renal cell carcinoma. Clear cell papillary renal cell carcinoma is a recently described unique renal epithelial neoplasm with scant eosinophilic or moderate amount of clear cytoplasm and pyknotic small nuclei oriented commonly toward the apical surfaces. No such tumor has been reported in renal transplant recipients. In this paper, we describe a clear cell papillary renal cell carcinoma involving bilateral native kidneys in a patient who had received a renal transplant 2 years earlier. Clear cell papillary renal cell carcinoma commonly presents with low pathologic stage and lower Fuhrman grade and is clinically indolent. Additional cases are needed to evaluate the clinical behavior of this type of tumor in renal transplant recipients.

Clear Cell Carcinoma of the Conjunctiva

To describe a rare case of primary conjunctival clear cell carcinoma. The clinical history and pathologic findings were reviewed. An 82-year-old white man presented with a lesion on his right conjunctiva for 8 months. An excisional biopsy was performed with wide margins and mitomycin C. Pathologic examination showed a papillary clear cell carcinoma of the conjunctiva. The patient has been followed for 6 months without recurrence. Primary clear cell carcinoma, a variant of squamous cell carcinoma, can occur in the conjunctiva.

Oligoarray comparative genomic hybridization of renal cell tumors that developed in patients with acquired cystic renal disease

Renal cell carcinoma occurs at higher frequency in acquired cystic renal disease than in the general population. We have analyzed 4 tumors obtained from the kidneys of 2 patients with acquired cystic renal disease, including 2 conventional renal cell carcinomas and 2 acquired cystic renal disease-associated tumors, for genetic alterations. DNA changes were established by applying the 44K Agilent Oligonucleotide Array-Based CGH (Agilent Technologies, Waldbronn, Germany), and mutation of VHL gene was detected by direct sequencing of the tumor genome. DNA losses and mutation of the VHL gene, which are characteristic for conventional renal cell carcinomas, were seen in 2 of the tumors. The acquired cystic renal disease-associated eosinophilic-vacuolated cell tumor showed gain of chromosomes 3 and 16. No DNA alterations occurred in the papillary clear cell tumor. We suggest that not only the morphology but also the genetics of renal cell tumors associated with acquired cystic renal disease may differ from those occurring in the general population.

Difference between RAT and clear cell papillary renal cell carcinoma/clear renal cell carcinoma

We would like to thank Dr. Verine for his interest inour paper on renal angiomyoadenomatous tumors (RAT)[1] and for his letter to the editor [2]. Dr. Verine finds itunfortunate that we did not compare clear cell papillaryrenal cell carcinoma with RAT. In his view, clear cellpapillary renal cell carcinoma shares a lot of similaritieswith RAT, namely CK7, CA-IX, and CD10 immunohisto-chemical positivity and presence of clear cell snouts asshown in the paper of Tickoo et al. [3].We have several cases of clear cell papillary renalcell carcinoma in our files and we must state that thistype of carcinoma is so much different from RAT thatwe did not (and do not) consider it worth listing in thedifferential diagnosis of RAT. Just for mentioning a fewmajor differences between RAT and clear cell papillaryrenal cell carcinoma: RAT is not a papillary tumor at alland is not composed of clear cells either. When presentin RAT, clear cell areas comprise usually only a focalchange. Most of the RAT is usually a basophilic tumorgrowing as a solid lesion, composed of variouslycollapsed tubules. Immunohistochemistry does not playany practical role in the diagnosis of RAT as it sharesan identical immunohistochemical profile with severalentities (it is beyond the scope of this letter to discussthis matter in detail). The immunohistochemistry ofRATs was described in our paper [1]onlytocompletethe pathological features of this distinct entity. We furtherdo not see any similarity between the clear snouts of RATand those illustrated in the paper of Tickoo et al. [3]assuggested by Dr. Verine.Taking further into account the facts that RAT, incontrast to the cases of Tickoo et al. [3], has a typicalangioleiomyomatous stroma, typical capillary vascularity,and lacks the end-stage kidney background, we think thatthe difference between RAT and clear cell papillary renalcell carcinoma/clear renal cell carcinoma is like thatbetween the day and the night or like that between a ratand a hedgehog.In closing, we thank again Dr. Verine for his comments.References

CD98hc (SLC3A2), a novel marker in renal cell cancer

In a variety of malignant diseases, molecular targeting represents a therapeutic option, whereby, when compared with chemotherapy, fewer side effects are thought to be expected. Especially in renal cell cancer (RCC), tyrosine kinase-inhibitors have been established as useful and highly effective therapy. However, tyrosine kinase-inhibitors currently approved for RCC treatment lack single molecule specificity and bear a variety of side effects of the gastro-intestinal tract, skin, heart and haematopoietic system. Therefore, the identification of novel cell surface markers is sought, which might lead to novel diagnostic and therapeutic strategies in cancer. Paraffin-embedded RCCs from a well characterized tissue bank were immunohistochemically quantified for embryonic transmembrane antigen CD98hc (SLC3A2) expression and semi-quantitative analyses were correlated with subtype or grade of differentiation. We found increased CD98hc expression in different types of malign RCCs, among them clear cell (cc)RCC, papillary (p)RCC and chromophobe (ch)RCC, but lack of expression in the benign renal oncocytoma. Thereby, the extent of CD98hc expression directly complies with grade of malignancy. Furthermore, the more malignant type II pRCC significantly higher expressed CD98hc than the less malignant and more differentiated type I pRCC (type II 83.34%, type I 4.76% CD98hc positive, P < 0.00001; n = 51). The established marker for type I pRCC, Cytokreatin 7, showed 95.24% expression in type I and 26.67% expression in type II pRCC (P < 0.00001, n = 51). From these data, we conclude that CD98hc is expressed in RCCs, whereby the extent of expression is likely to correlate directly with grade of malignancy. In pRCCs, CD98hc might represent a novel and reliable marker for type II pRCC.

The Utility of PAX-2 in Distinguishing Metastatic Clear Cell Renal Cell Carcinoma From its Morphologic Mimics

PAX-2 is a homeogene expressed during kidney development. Although immunohistochemical expression of PAX-2 has been described in a variety of primary renal cell carcinoma (RCC) subtypes and in metastatic RCC, its specificity as a marker of renal lineage in a metastatic setting has not been fully evaluated. In addition, its utility has not been directly compared with the most widely used antibody in this setting, renal cell carcinoma marker (RCCma). We studied PAX-2 expression in metastatic clear cell renal cell carcinoma (CC-RCC) and in a variety of nonrenal neoplasms with clear cytoplasm that may potentially mimic CC-RCC. Archival material from 27 CC-RCCs metastatic to various organs and 50 close morphologic mimics of CC-RCC were retrieved. Immunohistochemistry with PAX-2 and RCCmapi antibodies was performed on each case. Nuclear staining (PAX-2) or membranous staining (RCCma) was scored semiquantitatively. Twenty-three of 27 (85%) metastatic CC-RCCs showed nuclear immunoreactivity for PAX-2, whereas RCCma reactivity was found in 19 of 27 (70%). The immunoprofiles of the metastatic CC-RCC were PAX-2+/RCCma+: 19 of 27 (70%), PAX-2+/RCCma-: 5 of 27 (19%), PAX-2-/RCCma+: 2 of 27 (7%), and PAX-2-/RCCma-: 1 of 27 (4%). Five of the 50 mimics of CC-RCC (10%) had at least focal nuclear reactivity with PAX-2, including 1 of 3 parathyroid carcinomas (33%), 3 of 7 clear cell carcinomas of the ovary (43%), and the 1 clear cell papillary cystadenoma of the epididymis. Membranous RCCma reactivity was identified in 26 of the 50 mimics (52%). We conclude that PAX-2 is a useful marker for distinguishing metastatic CC-RCC from its potential morphologic mimics, but caution must be used in certain differential diagnostic settings where nonrenal tumors such as parathyroid carcinoma, ovarian clear cell carcinoma, and clear cell papillary cystadenoma of the epididymis were shown to express both PAX-2 and RCCma.

Blood Levels of Carbonic Anhydrase 9 Correlate with Clear Cell Renal Cell Carcinoma Activity

AbstractIntroductionBiomarkers for early detection of renal cell carcinoma (RCC) may help diagnose minimal residual disease in patients at risk for RCC, can guide anti-angiogenic therapy, or may help identify candidates for adjuvant treatment. In this study, we investigated whether blood levels of carbonic anhydrase 9 (CA9) correlate with RCC tumor burden and therefore disease activity.MethodsCA9 is a von Hippel–Lindau–hypoxia inducible factor target upregulated in clear cell RCC. We used an anti-CA9 antibody (M75)-based enzyme-linked immunosorbent assay test to measure CA9 levels in blood obtained before and after nephrectomy for clinically localized disease in patients with: (1) clear cell RCC, (2) papillary and chromophobe RCC or oncocytoma, or (3) benign kidney lesions, and we compared these samples to blood drawn from normal control individuals.ResultsWe observed a significant (p &lt; 0.006) decrease in the blood levels of CA9, after nephrectomy for localized disease, in the majority of patients with clear cell RCC (57%). In contrast, patients with nonclear cell RCC, benign disease, or those having undergone debulking nephrectomy for metastatic disease did not have a decrease in CA9 blood levels after nephrectomy. Preliminary longitudinal follow up measurements of CA9 levels in a small group of patients indicated that rising CA9 levels may correlate with disease progression.ConclusionsPlasma CA9 levels correlate with disease activity in a subset of clear cell RCC patients and should be considered in future multiplex RCC biomarker development algorithms.

Prognostic factors in women 45 years of age or younger with endometrial cancer

The purpose of this study was to conduct a clinical and pathologic review of endometrial cancers diagnosed in women aged younger than 45 years to better identify the prognostic factors for this subgroup of women. We retrospectively evaluated the clinical history, treatment, and follow-up of patients with histologically confirmed endometrial cancer treated in Faculty Hospital Nitra, Slovakia from 1993 to 2003. Data were abstracted regarding tumor histology, grade, age, parity, stage, diabetes, use of oral contraceptives, body mass index (BMI), and survival. One hundred seventy-three patients with endometrioid histology were divided into two groups: younger group (age <or=45 years, n = 20) and older group (age >45, n = 153). Patients with high-risk histology (clear cell or serous papillary) were excluded from the study. Twenty patients less than or equal to 45 years of age received treatment for endometrial cancer: stage I, 16 (80%); stage II, 2 (10%); stage III, 1 (5%); and stage IV, 1 (5%). Tumors were well differentiated in 12 (60%), moderately differentiated in 6 (30%), and poorly differentiated in 2 (10%). Age ranged from 28 to 45 years (mean 37), with mean BMI 35.8 +/- 9.4. At the end of study period, 17 (85%) were alive with no evidence of disease and 3 (15%) had died of recurrent disease. We conclude that patients less than or equal to 45 years of age have better survival compared to older patients. Deeper myometrial invasion was significantly associated with age greater than 45 years. Majority of young patients with endometrial cancer were obese and nulliparous.