Utility of MMP-1, p53, E-Cadherin, and Collagen IV Immunohistochemical Stains in the Differential Diagnosis of Adenomas With Misplaced Epithelium versus Adenomas With Invasive Adenocarcinoma

Context.—The World Health Organization classification of renal tumors synthesizes morphologic, immunohistochemical, and molecular findings to define more than 40 tumor types. Of these, clear cell (conventional) renal cell carcinoma is the most common malignant tumor in adults and—with the exception of some rare tumors—the most deadly. The diagnosis of clear cell renal cell carcinoma on morphologic grounds alone is generally straightforward, but challenging cases are not infrequent. A misdiagnosis of clear cell renal cell carcinoma has clinical consequences, particularly in the current era of targeted therapies. Objective.—To highlight morphologic mimics of clear cell renal cell carcinoma and provide strategies to help differentiate clear cell renal cell carcinoma from other renal tumors and lesions. The role of the pathologist in guiding treatment for renal malignancies will be emphasized to stress the importance of proper tumor classification in patient management. Data Sources.—Published literature and personal experience. Conclusions.—In challenging cases, submission of additional tissue is often an inexpensive and effective way to facilitate a correct diagnosis. If immunohistochemical stains are to be used, it is best to use a panel of markers, as no one marker is specific for a given renal tumor subtype. Selection of limited markers, based on a specific differential diagnosis, can be as useful as a large panel in reaching a definitive diagnosis. For renal tumors, both the presence and absence of immunoreactivity and the pattern of labeling (membranous, cytoplasmic, diffuse, focal) are important when interpreting the results of immunohistochemical stains.

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Oncocytic Renal Neoplasms on Resections and Core Biopsies: Our Approach to This Challenging Differential Diagnosis

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2017-0240-ra ◽

2017 ◽

Vol 141 (10) ◽

pp. 1336-1341 ◽

Cited By ~ 6

Author(s):

Angela Wu

Keyword(s):

Differential Diagnosis ◽

Low Grade ◽

Renal Neoplasms ◽

Immunohistochemical Stains

Distinguishing oncocytomas from their malignant mimics is very challenging. This review highlights our approach to classifying low-grade oncocytic tumors on both resections and biopsies. We also discuss how we use immunohistochemical stains in this challenging differential diagnosis.

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Atypical Polypoid Adenomyoma of the Uterus. An Immunohistochemical Study of a Case

Tumori Journal ◽

10.1177/030089168907500322 ◽

1989 ◽

Vol 75 (3) ◽

pp. 292-295 ◽

Cited By ~ 7

Author(s):

Silvana Di Palma ◽

Donatella Santini ◽

Giuseppe Martinelli

Keyword(s):

Differential Diagnosis ◽

Stromal Cells ◽

Immunohistochemical Study ◽

Invasive Adenocarcinoma ◽

S 100 ◽

Atypical Polypoid Adenomyoma

We studied one case of atypical polypoid adenomyoma of the uterus immunohistochemically using antisera against keratins, vimentin, S-100 protein, desmin and actin. The stromal cells were reactive with anti-actin and antidesmin antibodies suggesting a muscular phenotype and confirming previous ultrastructural data. Immunohistochemical investigations have proved to be useful in differential diagnosis of APA with invasive adenocarcinoma, adenosarcoma and adenofibroma of the endometrium.

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Differential diagnosis of primary benign vascular tumors and/or tumor-like lesions of the kidney: immunohistochemical stains should not be restricted to vascular and pan cytokeratin markers

Virchows Archiv ◽

10.1007/s00428-013-1379-3 ◽

2013 ◽

Vol 462 (3) ◽

pp. 365-367 ◽

Cited By ~ 11

Author(s):

Jérôme Verine

Keyword(s):

Differential Diagnosis ◽

Vascular Tumors ◽

Tumor Like Lesions ◽

Immunohistochemical Stains

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Adenoma with pseudoinvasion – A crucial differential diagnosis for invasive adenocarcinoma

Gastroenterología y Hepatología ◽

10.1016/j.gastrohep.2015.12.005 ◽

2017 ◽

Vol 40 (2) ◽

pp. 96-98 ◽

Cited By ~ 1

Author(s):

Maria João Ferreira da Silva ◽

Rolando Pinho ◽

Xiaogang Wen ◽

David Tente ◽

Sónia Leite ◽

...

Keyword(s):

Differential Diagnosis ◽

Invasive Adenocarcinoma

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Next-generation sequencing facilitates differentiating between multiple primary lung cancer and intrapulmonary metastasis: a case series

Diagnostic Pathology ◽

10.1186/s13000-021-01083-6 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Changjiang Liu ◽

Chengang Liu ◽

Xiao Zou ◽

Lin Shao ◽

Ying Sun ◽

...

Keyword(s):

Lung Cancer ◽

Differential Diagnosis ◽

Primary Lung Cancer ◽

Invasive Adenocarcinoma ◽

Free Survival ◽

Multiple Primary ◽

Minimally Invasive Adenocarcinoma ◽

The Right ◽

Generation Sequencing

Abstract Background In lung cancer management, differential diagnosis between multiple primary lung cancer (MPLC) and intrapulmonary metastasis (IMP) is a critical point that is of direct therapeutic and clinical importance. However, this process often suffers from absence of a gold standard, resulting in equivocal cases. Herein, we present a series of three cases, in which genomic alteration patterns revealed by next-generation sequencing (NGS) facilitated the differential diagnosis between MPLC and IMP. Case presentation Case 1 was a 57-year-old female with two separate lesions in the upper lobe and the lower lobe of left lung, which were both histopathologically determined as T2aN0M0 adenocarcinomas. NGS identified an EGFR L858R in one lesion and an EGFR 20 exon insertion in the other one, suggestive of double primary malignancies. The patient underwent wedge resections and received an adjuvant treatment of icotinib and chemotherapy. She had a disease-free survival (DFS) of 19 months and counting. Case 2 was a 55-year-old female with multiple small lesions in both lungs. Histopathological examinations of resected lesions from right upper lobe revealed three subtypes: atypical adenomatous hyperplasia of alveolar epithelium, adenocarcinomas in situ and minimally invasive adenocarcinoma. NGS identified two different BRAF driver mutations G466E and V600_K601delinsE in two lesions of adenocarcinoma in situ, and a BRAF K601E in a lesion of minimally invasive adenocarcinoma. Case 3, a 68-year-old male, had the right upper lobe lesion histophathologically classified as a stage T3NxM0 mixed adenoneuroendocrine carcinoma and the left upper lobe lesion as a stage T1aN0M0 adenocarcinoma. NGS performed with different loci of surgical tissues revealed a rare sensitizing EGFR mutation G719A shared by the right upper lobe lesion and lymph node, and two EGFR mutations L861Q and G719S in left upper lobe lesion. The patient received icotinib treatment postoperatively and achieved a stable disease with a progression-free survival of 5 months. Conclusion Our cases provide evidence for utility of NGS in facilitating diagnosis and treatment decisions.

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Immunohistochemical Expression of HBME-1, E-cadherin, and CD56 in the Differential Diagnosis of Thyroid Nodules

Medicina ◽

10.3390/medicina48100074 ◽

2012 ◽

Vol 48 (10) ◽

pp. 74 ◽

Cited By ~ 1

Author(s):

Arturs Ozolins ◽

Zenons Narbuts ◽

Ilze Strumfa ◽

Guna Volanska ◽

Kaspars Stepanovs ◽

...

Keyword(s):

Differential Diagnosis ◽

Follicular Carcinoma ◽

Needle Aspiration ◽

Thyroid Tumors ◽

Papillary Thyroid ◽

Thyroid Carcinomas ◽

Diagnostic Potential ◽

Ancillary Test ◽

Benign Thyroid ◽

E Cadherin

Background and Objective. Distinction between benign and malignant thyroid tumors is essential for proper clinical management. The aim of this study was to evaluate the diagnostic potential of a set of 3 molecular markers in the differential diagnosis of thyroid tumors. Material and Methods. Immunohistochemistry for HBME-1, E-cadherin (E-CAD), and CD56 was carried out in 36 follicular adenomas, 77 colloid goiters, 36 papillary thyroid carcinomas, and 14 follicular carcinomas. Sixty-eight thyroid fine needle aspiration (FNA) cases confirmed by subsequent surgical resection specimens were selected. Immunocytochemistry for HBME-1, E-CAD, and CD56 was performed in these cases, including 25 papillary thyroid carcinomas, 1 follicular carcinoma, 22 follicular adenomas, and 20 colloid goiters. Results. PTC was characterized by a decreased expression of E-CAD and CD56 contrary to the surrounding benign thyroid tissues. There was no HBME-1 expression in benign thyroid tissues, but it was high in papillary thyroid carcinomas and weak in follicular adenomas. The expression of E-CAD and CD56 was significantly higher in follicular adenomas than in the surrounding thyroid tissues. Analyzing the FNA material, HBME-1 expression was documented in 96% of papillary thyroid carcinomas, but there was no expression in the benign lesions. E-CAD and CD56 expression was significantly weakened in papillary thyroid carcinomas, but enhanced in follicular adenomas. Conclusions. HBME-1 was found only in malignant lesions and can be considered the most sensitive, specific single marker in papillary thyroid carcinomas. CD56 and E-CAD can assist in the decision-making on the benign and malignant nature of the nodule. Immunocytochemistry is of value as an ancillary test to enhance the diagnostic accuracy of thyroid FNA samples.

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