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Exploring Novel Markers in the Diagnosis of Hemangioblastoma versus Metastatic Renal Cell Carcinoma
Author(s) -
Rivera Andreana Laura,
Takei Hidehiro,
Ro Jae Y,
Shen Steven,
Zhai Jim,
Powell Suzanne Z
Publication year - 2007
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.21.5.a392
Subject(s) - renal cell carcinoma , pathology , medicine , immunohistochemistry , clear cell , staining , chromophobe cell , metastatic carcinoma , stain , stromal cell , carcinoma
Background: Hemangioblastomas (HB) account for nearly a tenth of all posterior fossa neoplasms. HB must be differentiated from renal cell carcinoma (RCC), as the distinction between these lesions dictates the management of these patients. Currently inhibin A and RCC marker have been used in the diagnosis of HB and metastatic RCC, both with inconsistent results. PAX‐2 has been an immunohistochemical (IHC) stain of interest in the diagnosis of RCC. D2–40 and Fli‐1 are IHC stains which have recently gained interest in the diagnosis of lesions with lymphatic or vascular origin. To our knowledge, no recent studies have compared the staining patterns of PAX‐2, D2–40, and Fli‐1 in HB and metastatic RCCs. Design: 14 cerebellar HB and 17 metastatic clear cell RCCs to the brain were selected. All cases were stained with RCC, inhibin A, PAX‐2, D2–40, and Fli‐1 immunomarkers. Results: RCC immunomarker was positive in 29% of RCCs and no HB. Inhibin A staining was positive in 94% of HB and 12% of RCCs. Pax2 was positive in 71% of RCCs and 6% of HB. D2–40 was weakly positive in 36% of HB and no RCCs. Weak Fli‐1 expression was noted in the endothelium in the RCCs. 71% of HB showed Fli‐1 positivity with staining in the endothelium, as well as, stromal cells. Conclusion: In the differentiation of HB and metastatic RCC, D2–40 and RCC marker proved to be poor markers with less than 50% of HB and RCCs showing positive staining. PAX‐2 was superior to RCC marker in the diagnosis of metastatic RCC. Overall, inhibin A still stained a higher percentage of HB than D2–40 or Fli‐1. However, with their distinct nuclear staining Fli‐1 and PAX‐2, along with inhibin A, may prove to be more useful and consistent stains in the diagnosis of HB versus RCC.