Diagnostic Markers in the Differentiation of Gynecologic and Urological Clear Cell Carcinoma
RJ Wolsky, E Lengyel, AG Montag. University of Chicago, Chicago
Background: The clear cell carcinoma (CCC) phenotype includes tumors from various sites with optically clear cytoplasm containing glycogen or lipid. CCC of the gynecologic tract is relatively common, including ovary, endometrium, cervix and vagina in descending order. Although CCC of the bladder and urethra are rare, differentiation from direct extension of a gynecologic tumor is important for appropriate staging and therapy. The present study analyzes markers of potential utility in differentiating CCC of the gynecologic and genitourinary tract.
Design: With IRB approval, archival slides and blocks were retrieved and tissue microarrays were designed containing CCC tumors from ovary (20), endometrium (21), cervix (15), vagina (4) bladder (3), urethra (3), kidney (17) and control tissues. Five micron sections were stained using monoclonal antibodies to E cadherin, alpha methyl co-A racemase (P504S), mesothelin, PLAP, uroplakin, CD10, and cytokeratins (CK) 7, 19 and 20. Staining intensity was visually scored by two observers on a scale of 0 to 3. Statistical analysis was performed using the Fisher exact test.
Results: All 6 bladder and urethral tumors had strong expression of E cadherin (see table), significantly greater than gynecologic sites or kidney (p<.01 for all comparisons). P504S was absent or weak in all cervical and vaginal tumors, while strong in 4 of 6 bladder/urethral lesions (p<.01). Only 1 of 6 bladder and urethral tumors was strongly positive for CK19, significantly less than gynecologic sites (p<.05 for all comparisons). CK7 (2/17) was less commonly and CD10 (12/17) more commonly expressed in renal CCC than in all other sites (p<.001 and p<.005 respectively). Few tumors of any type expressed CK20. Urologic tumors rarely expressed uroplakin (1/6 and 1/16 respectively) and PLAP and mesothelin showed no significant difference among any of the comparisons.
|Stain intensity||0 to 1||2 to 3||0 to 1||2 to 3||0 to 1||2 to 3|