Value of alpha-methylacyl-CoA racemase immunochemistry for predicting neoplastic progression in Barrett's oesophagus
HISTOPATHOLOGY
Authors: Kastelein, Florine; Biermann, Katharina; Steyerberg, Ewout W.; Verheij, Joanne; Kalisvaart, Marit; Looijenga, Leendert H. J.; Stoop, Hans A.; Walter, Laurens; Kuipers, Ernst J.; Spaander, Manon C. W.; Bruno, Marco J.
Abstract
AimTo investigate the value of -methylacyl-CoA racemase (AMACR) immunohistochemistry for predicting neoplastic progression in Barrett's oesophagus (BO). Methods and resultsWe conducted a case-control study within a prospective cohort of 720 BO patients. Patients who developed high-grade dysplasia or oesophageal adenocarcinoma were classified as cases, and patients without neoplastic progression as controls. AMACR expression was determined by immunohistochemistry in 12127 biopsies from 635 patients, and was scored independently by two expert pathologists. Relative risks adjusted for age, gender, BO length and oesophagitis (RRa) were calculated in log-linear models. During a median follow-up of 6.6years, 49 patients (8%) developed high-grade dysplasia or oesophageal adenocarcinoma. Although mild AMACR expression was associated with a trend towards an increased risk of neoplastic progression (RRa 1.6, 95% CI 0.9-3.1), the risk was especially elevated with strong AMACR expression (RRa 4.8, 95% CI 1.9-12.6). The positive predictive value of strong AMACR expression was slightly higher than that of low-grade dysplasia (22% versus 15%); the negative predictive value was slightly lower (91% versus 93%). ConclusionsStrong AMACR expression is associated with an increased risk of neoplastic progression in BO. However, AMACR expression appears to be a less powerful predictor for neoplastic progression than low-grade dysplasia.
Metanephric adenoma: the utility of immunohistochemical and cytogenetic analyses in differential diagnosis, including solid variant papillary renal cell carcinoma and epithelial-predominant nephroblastoma
MODERN PATHOLOGY
Authors: Kinney, Stephanie N.; Eble, John N.; Hes, Ondrej; Williamson, Sean R.; Grignon, David J.; Wang, Mingsheng; Zhang, Shaobo; Baldrige, Lee Ann; Martignoni, Guido; Brunelli, Matteo; Wang, Lisha; Comperat, Eva; Fan, Rong; Montironi, Rodolfo; MacLennan, Gregory T.; Cheng, Liang
Abstract
Metanephric adenoma is a benign renal neoplasm that overlaps in morphology with the solid variant of papillary renal cell carcinoma and epithelial-predominant nephroblastoma. To aid in resolving this differential diagnosis, we investigated the utility of immunohistochemical and molecular analyses in distinguishing between these entities; the first study, to our knowledge, to use a combined approach in analyzing all three tumors. We analyzed 37 tumors originally diagnosed as metanephric adenomas (2 of which we reclassified as papillary renal cell carcinomas), 13 solid variant papillary renal cell carcinomas, and 20 epithelial-predominant nephroblastomas using a combination of immunohistochemistry and fluorescence in situ hybridization (FISH) assessing for trisomy of chromosomes 7 and 17 and loss of Y. Immunohistochemical staining was performed for CK7, AMACR, WT1, and CD57. The combination of CK7-, AMACR-, WT1+, and CD57+ was considered characteristic of metanephric adenoma. Most of the tumors originally diagnosed as metanephric adenomas (31/37) showed the expected staining pattern of metanephric adenoma (CK7-, AMACR-, WT1+, and CD57+). Of the six tumors with discordant immunophenotype, two tumors were reclassified as papillary renal cell carcinoma after cytogenetic workup. It is recommended that all adult cases histologically resembling metanephric adenoma have WT1, CD57, CK7, and AMACR immunohistochemical staining performed. If the staining pattern is characteristic for metanephric adenoma (CK7-, AMACR-, WT1+, and CD57+, including membranous staining), then no other diagnostic tests are indicated. However, if there is a different immunostaining pattern, then we recommend FISH analysis.