The Role of RCC-Ma in Evaluating Primary and Metastatic Clear Cell Carcinomas in the Liver
DL Tunnell, MP Bronner. Cleveland Clinic, Cleveland, OH
Background: The differentiation between primary hepatocellular carcinoma (HCC) and metastatic renal or adrenocortical cell carcinoma (RCC, ACC) can be difficult. The neoplastic cytology and growth patterns can be indistinguishable. Immunohistochemistry for hepatocyte specific markers can be helpful but may not be definitive. The goal of this study was to evaluate RCC-Ma in primary HCC and hepatic metastases of RCC and ACC.
Design: From 1993-2007, thirty-two cases of hepatic metastases of RCC and seven of ACC were studied. Of the metastatic RCCs, 68% (22/32) were of the clear cell type, while none of the ACC metastases were clear cell tumors. Nine of the RCC cases also had available matched primary renal tumor, of which 77% (7/9) were clear cell type. Twenty-two cases of primary HCC were used as controls, 27% (6/22) of which were of clear cell morphology. Immunohistochemistry (IHC) for HepPar-1, CD10, polyclonal CEA and RCC-Ma were performed.
Results: The immunohistochemical results are indicated in the table.
|IHC Marker||HCC Primary||ACC hepatic mets||RCC hepatic mets||RCC primary|
|RCC-Ma||0% (0 of 22)||0% (0 of 7)||28% (9 of 32)*||66% (6 of 9)*|
|CD10 (non-canalicular)||0% (0 of 22)**||42% (3 of 7)***||90% (29 of 32)*||100% (9 of 9)*|
|Polyclonal CEA||27% (6 of 22)||0% (0 of 7)||0% (0 of 32)||0% (0 of 32)|
|HepPar1||72% (16 f 22)||0% (0 of 7)||3% (1 of 32)||0% (0 of 9)|
*Both primary and metastatic RCC demonstrated membranous and/or cytoplasmic staining with RCC-Ma and CD10. The CD10 cytoplasmic and membranous pattern in RCC was distinct from the **fine canalicular staining pattern present uniformly in liver. ***The staining pattern of CD10 in ACC was faintly cytoplasmic and also distinct from that in HCC and RCC.
Conclusions: RCC-Ma revealed a 66% sensitivity for primary RCC, which decreased to 28% in RCC hepatic metastases, whereas non-canalicular CD10 showed 90% sensitivity in hepatic metastases of RCC. The specificity for distinguishing metastatic RCC from primary HCC was 100% for RCC-Ma and 100% for CD10 (non-canalicular), as none of the 22 primary HCCs stained with RCC-Ma or had the cytoplasmic/membranous pattern of CD10. None of the markers was useful for distinguishing ACC from HCC. As a panel approach, these markers are diagnostically useful for distinguishing metastatic RCC from primary HCC.
Category: Liver & Pancreas
Tuesday, March 10, 2009 9:30 AM
Poster Session III # 176, Tuesday Morning