Вспомогательные тесты для классификации RCC

Renal cell carcinoma. Edited by Nizar M. Tannir, Oxford University Press, 2014

Иммуногистохимические окрашивания — полезное дополнение в диагностике и обследовании пациентов с RCC. Хотя большая часть RCC диагностируется без использования вспомогательной техники, иммуногистохимические окрашивания полезны в случаях, когда морфология не типична или в ограниченных образцах, например, пункционных и тонкоигольных аспирационных биопсиях.

Most RCC tumors stain for cytokeratin (CK) cocktail and epithelial membrane antigen (eMA), except for translocation RCC, which may be negative. CK7 is a specialized cytokeratin stain that is expressed in PRCC, ChRCC, tubulocystic RCC, CCPRCC, and MTSCC; it is typically negative in ccRCC. High-molecular-weight CK34Яe12 (HMWCK) and CK5/6 are positive in most CDCs. PAX gene proteins (PAX-2 and PAX-8) are expressed in most renal tumors and may be useful for identifying RCC in metastatic sites. However, these proteins are not specific as they are also expressed in primary tumors from other sites (such as ovary and thyroid). Vimentin is an intermediate filament that is expressed in most mesenchymal tumors but in few carcinomas. All RCCs, with the exception of ChRCC, express this marker, which is useful for distinction between ccRCC and ChRCC. Alpha-methylacyl-CoA racemase (AMACR) is a mitochondrial enzyme that is involved in the oxidation of fatty acids and is strongly expressed in PRCC and MTSCC. While it may be expressed in other RCCs, the expression is typically focal and less strong than in PRCC and MTSCC. CD10 is a cell surface glycoprotein that is typically expressed in ccRCC and PRCC, with less frequent expression in other RCCs. RCC antigen is a glycoprotein that is present on the brush border of proximal renal tubular epithelial cells and is expressed in ccRCC and PRCC. TFe-3/TFe-B are nuclear proteins that are overexpressed as a result of the specific translocation and accumulate in the nuclei of tumor cells in translocation RCC. These are highly specific markers and not expressed in any of the other RCCs.

Immunohistochemical profiles of the most common RCCs are as follows (Таблица 2.2): ccRCCs are positive for eMA, vimentin, RCC antigen, CD10, and carbonic anhydrase IX and negative for CK7 and AMACR. PRCCs and MTSCCs are positive for eMA, vimentin, RCC antigen, CK7, CD10, and AMACR. ChRCCs are positive for eMA, CK7, and CD117 and negative for vimetin, CD10, and RCC antigen. CDCs and medullary RCCs are positive for ulex europeaus lectin, HMWCK, CK7, p63, and vimentin and are negative for CD10 and RCC antigen. Xp11 translocation carcinomas are positive for TFe-3, CD10, and AMACR and negative for eMA, CK7, low-molecular-weight CK, and HMWCK.

Molecular testing for RCCs has not matured to the point of being part of the routine pathology evaluation.


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