The utility of using immunohistochemistry in the differentiation of metastatic, cutaneous clear cell renal cell carcinoma and clear cell hidradenoma

Moises J Velez; Courtney L Thomas; Jason Stratton; Wilma Bergfeld; Joshua Weaver

doi:10.1111/cup.12946

The utility of using immunohistochemistry in the differentiation of metastatic, cutaneous clear cell renal cell carcinoma and clear cell hidradenoma

J Cutan Pathol. 2017 Jul;44(7):612-615. doi: 10.1111/cup.12946. Epub 2017 May 16.

Authors

Moises J Velez¹, Courtney L Thomas¹, Jason Stratton², Wilma Bergfeld³, Joshua Weaver¹

Affiliations

¹ Department of Pathology, Summa Akron City Hospital, Akron, Ohio.
² Clinical and Surgical Pathology, Dermatopathology, Regional Medical Laboratory, Tulsa, Oklahoma.
³ Department of Pathology and Dermatopathology, Cleveland Clinic, Cleveland, Ohio.

PMID: 28374447
DOI: 10.1111/cup.12946

Abstract

Background: Clear cell hidradenoma and cutaneous clear cell renal cell carcinoma (CCRCC) overlap morphologically. The distinction may be difficult in a patient with a history of CCRCC, presenting with a cutaneous nodule, potentially leading to an erroneous diagnosis. We investigated the usefulness of napsin A and paired box gene 8 (PAX-8) with previously studied markers epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), vimentin and cluster of differentiation marker 10 (CD10) in differentiating CCRCC from hidradenoma.

Methods: We evaluated hidradenomas and cutaneous CCRCCs for immunohistochemical expression of napsin A, PAX-8, EMA, CEA, vimentin and CD10.

Results: PAX-8 was expressed in all CCRCCs (8/8) while negative in hidradenomas. Napsin A was negative in both hidradenomas (0/12) and CCRCCs (0/10). EMA showed membranous reactivity in 11 of 12 hidradenomas and 8 of 10 CCRCCs; and highlighted ductal epithelium in 1 of 12 hidradenomas and cystic areas in 4 of 10 CCRCCs. CD10 showed ductal expression in 3 of 12 hidradenomas and membranous staining in 8 of 9 CCRCCs. CEA highlighted ductal epithelium in 11 of 12 hidradenomas while absent in CCRCCs (0/10). Vimentin highlighted neoplastic cells in 8 of 8 CCRCCs and failed to stain the hidradenomas (0/12).

Conclusion: A conservative immunohistochemical panel including PAX-8, vimentin and CEA allow for easy distinction of CCRCC from hidradenoma, whereas napsin A added no additional value.

Keywords: PAX-8; clear cell hidradenoma; clear cell renal cell carcinoma; hidradenoma; napsin A; renal cell carcinoma.