少见的肾脏肿块（新加免疫组化公布）

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楼主发表于 2010-05-27 20:05|举报|关注(3)
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姓名：	×××	性别：	男	年龄：	65
标本名称：	左肾脏
简要病史：	肉眼血尿两天，影像学提示左肾脏占位。手术切除肾脏，发现腹主动脉旁有核桃大肿块，临床怀疑为肿大淋巴结。
肉眼检查：	左肾脏肿大，切面以肾盂为中心有4X4cm不规则灰白区，质硬，与正常肾组织无明显界限。腹主动脉旁肿块切面同肾脏。取材：1.肾被膜处；2.病变与正常组织交界处；3.灰白病变处；4.腹主动脉旁肿块。

应金老师的提议，我们加做了HMB45,CD10,遗憾的是我科室没有Calponin。结果如图，请各位老师点评。

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本帖最后由于 2010-06-05 16:27:00 编辑

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: 许春雷

×参考诊断

集合管癌

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61 楼发表于2010-05-27 21:29:00举报|引用
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粘液小管梭形细胞肿瘤

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: 嫁人就嫁灰太狼，学习要上华夏网。

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62 楼发表于2010-06-01 09:04:00举报|引用
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以下是引用xljin8在2010-6-1 7:01:00的发言：

非常好的病例，恶性肿瘤诊断基本确定，关键在于组织学类型。根据形态学特点：细胞形态比较一致性，似上皮样细胞，细胞质透亮，无明显的多形性和高核分裂活性。肿瘤细胞与肾小球兼容性好。诊断还有考虑成人型肾脏透明细胞肉瘤等。

支持!!

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63 楼发表于2010-06-01 10:19:00举报|引用
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猜两个：透明细胞肉瘤；上皮样Pecoma.期待结果

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64 楼发表于2010-06-01 23:29:00举报|引用
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我们做了CKpan,CK7,CK20,Wimentin,EMA,CD68,S-100,CD34,P63,CD34,CEA共11项，图片背景偏黄是照相缘故。对于各种抗体的表达及强弱，请各位老师点评，并据此免疫组化对病变进行分析。谢谢！

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: 许春雷

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65 楼发表于2010-06-01 23:47:00举报|引用
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接上页

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: 许春雷

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66 楼发表于2010-06-02 20:14:00举报|引用
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本帖最后由于 2010-06-02 20:36:00 编辑

1）p63+ -- 集合管癌？
2）肌上皮癌？转移性或原发性？
3) IHC再标记：HMB-45、Calponin、CD10 WT-1
4）参考 Am J Surg Pathol 最新文献，少数集合管癌 p63可阳性（14%）


Albadine R, Schultz L, Illei P, Ertoy D, Hicks J, Sharma R, Epstein JI, Netto GJ.
PAX8 (+)/p63 (-) Immunostaining Pattern in Renal Collecting Duct Carcinoma (CDC):

A Useful Immunoprofile in the Differential Diagnosis of CDC Versus Urothelial

Carcinoma of Upper Urinary Tract.  Am J Surg Pathol. 2010 May 11. [Epub ahead of print]

Departments of *Pathology double daggerUrology section signOncology, Johns

Hopkins University, Baltimore, MD daggerDepartment of Oncology, Hacettepe

University, Ankara, Turkey.BACKGROUND: Collecting duct carcinoma (CDC) is a relatively 
rare but aggressive type of renal malignancy with variable morphologic features. 
One of the World Health Organization diagnostic criteria for CDC is the exclusion of 
urothelial carcinoma of renal pelvis from the differential diagnosis. PAX8 is a novel

lineage restricted transcription factor expressed in renal tubules. We investigated the 
expression pattern of PAX8 in CDC and its utility, in combination with p63, in resolving 
the differential diagnosis of CDC versus upper tract urothelial carcinoma (UUC). 
DESIGN: Archival tissues from 21 CDC and 34 UUC were retrieved from our institutional 
files. Immunohistochemistry for PAX8 and p63 were performed on routine and tissue 
microarray sections using standard immunohistochemistry protocol. Intensity of nuclear 
staining was evaluated for each marker and assigned an incremental 0, 1+, 2+, and 3+ score. Extent 
of staining was categorized as focal (<25%), nonfocal (25% to 75%), or diffuse (>75%). 
RESULTS: CDC: All 21 (100%) CDC were positive for PAX8. Intensity of expression 
was moderate to strong (2+/3+) in 19 cases (90%). Extent of staining was diffuse 
in 13 of 21 tumors. The p63 was positive in 3 of 21 (14%) CDC cases (PAX8+/p63+). 
UUC: The 34 UUC included 5 pT1, 4 pT2, and 25 pT3/pT4 tumors.Thirty-one of 34 (91.2%) 
UUC were negative for PAX8, whereas 33 of 34 (97%) were p63 positive. Staining 
intensity was moderate in 15 cases (44%), of which 12 were nonfocal or diffuse. 
The unique p63-negative UUC was a pT1 tumor that was also negative for PAX8 (PAX8-/p63-).
CONCLUSIONS: We propose the use of the combination of PAX8 and p63 in the diagnosis of poorly 
differentiated renal sinus epithelial neoplasms where the differential diagnosis includes 
CDC versus UUC.The immunoprofile of PAX8+/p63- supports the diagnosis of CDC with a sensitivity 
of 85.7% and a specificity of 100%. In contrast, a (PAX8-/p63+) profile supports the diagnosis 
of UUC with a sensitivity of 88.2% and a specificity of 100%. The inverse PAX8/p63 expression 
seen in CDC and UUC supports a renal tubular rather than an urothelial differentiation in CDC 
given the nephric lineage restriction f PAX8.

1）p63+ -- 集合管癌？
2）肌上皮癌？转移性或原发性？
3) IHC再标记：HMB-45、Calponin、CD10 WT-1
4）参考 Am J Surg Pathol 最新文献，少数集合管癌 p63可阳性（14%）


Albadine R, Schultz L, Illei P, Ertoy D, Hicks J, Sharma R, Epstein JI, Netto GJ.
PAX8 (+)/p63 (-) Immunostaining Pattern in Renal Collecting Duct Carcinoma (CDC):

A Useful Immunoprofile in the Differential Diagnosis of CDC Versus Urothelial

Carcinoma of Upper Urinary Tract.  Am J Surg Pathol. 2010 May 11. [Epub ahead of print]

Departments of *Pathology double daggerUrology section signOncology, Johns

Hopkins University, Baltimore, MD daggerDepartment of Oncology, Hacettepe

University, Ankara, Turkey.BACKGROUND: Collecting duct carcinoma (CDC) is a relatively 
rare but aggressive type of renal malignancy with variable morphologic features. 
One of the World Health Organization diagnostic criteria for CDC is the exclusion of 
urothelial carcinoma of renal pelvis from the differential diagnosis. PAX8 is a novel

lineage restricted transcription factor expressed in renal tubules. We investigated the 
expression pattern of PAX8 in CDC and its utility, in combination with p63, in resolving 
the differential diagnosis of CDC versus upper tract urothelial carcinoma (UUC). 
DESIGN: Archival tissues from 21 CDC and 34 UUC were retrieved from our institutional 
files. Immunohistochemistry for PAX8 and p63 were performed on routine and tissue 
microarray sections using standard immunohistochemistry protocol. Intensity of nuclear 
staining was evaluated for each marker and assigned an incremental 0, 1+, 2+, and 3+ score. Extent 
of staining was categorized as focal (<25%), nonfocal (25% to 75%), or diffuse (>75%). 
RESULTS: CDC: All 21 (100%) CDC were positive for PAX8. Intensity of expression 
was moderate to strong (2+/3+) in 19 cases (90%). Extent of staining was diffuse 
in 13 of 21 tumors. The p63 was positive in 3 of 21 (14%) CDC cases (PAX8+/p63+). 
UUC: The 34 UUC included 5 pT1, 4 pT2, and 25 pT3/pT4 tumors.Thirty-one of 34 (91.2%) 
UUC were negative for PAX8, whereas 33 of 34 (97%) were p63 positive. Staining 
intensity was moderate in 15 cases (44%), of which 12 were nonfocal or diffuse. 
The unique p63-negative UUC was a pT1 tumor that was also negative for PAX8 (PAX8-/p63-).
CONCLUSIONS: We propose the use of the combination of PAX8 and p63 in the diagnosis of poorly 
differentiated renal sinus epithelial neoplasms where the differential diagnosis includes 
CDC versus UUC.The immunoprofile of PAX8+/p63- supports the diagnosis of CDC with a sensitivity 
of 85.7% and a specificity of 100%. In contrast, a (PAX8-/p63+) profile supports the diagnosis 
of UUC with a sensitivity of 88.2% and a specificity of 100%. The inverse PAX8/p63 expression 
seen in CDC and UUC supports a renal tubular rather than an urothelial differentiation in CDC 
given the nephric lineage restriction f PAX8.