Differential Immunoprofiles of Hepatocellular Carcinoma, Renal Cell Carcinoma, and Adrenocortical Carcinoma: A Systemic Immunohistochemical Survey Using Tissue Array Technique

Department of Pathology, National Yang-Ming University, Taipei Veterans General Hospital, Taiwan.
Applied immunohistochemistry & molecular morphology: AIMM / official publication of the Society for Applied Immunohistochemistry (Impact Factor: 2.01). 01/2006; 13(4):347-52. DOI: 10.1097/01.pai.0000146525.72531.19
Source: PubMed


The differential diagnoses of hepatocellular carcinoma (HCC), renal cell carcinoma (RCC), and adrenocortical carcinoma (ACC) are sometimes difficult due to their overlapping histologic features. Immunohistochemistry is a helpful adjunct in supporting the histologic diagnosis. In this study, the authors used the tissue array technique to systemically analyze the efficacy of different immunohistochemical panels in discerning these neoplasms. Immunohistochemical stains were performed on a total of 895 tumors (including 170 HCCs, 176 RCCs, and 40 ACCs) using monoclonal antibodies against hepatocyte antigen (HPA), CD10, RCC marker, vimentin, alpha-inhibin, keratins (KL-1, CAM 5.2, 7, and 20), epithelial membrane antigen, and polyclonal antibodies against carcinoembryonic antigen (pCEA) and alpha-fetoprotein, and antibodies Melan-A (A103), MOC31, and BG8. HPA immunostain alone detected 85.9% of HCCs, and the addition of canalicular pattern of pCEA and CD10 immunostains raised the sensitivity to 94.7%. RCC marker was positive in 54.5% of RCCs but was negative in all non-RCC tumors. Using positive CD10 and negative HPA and pCEA together with RCC marker increased the sensitivity to 74.4%. Immunoreactivity for alpha-inhibin and A103 could be detected in 67.5% and 55% of ACCs, respectively. When the two antibodies were combined, 82.5% of ACCs were labeled. Proper selection of immunohistochemical stains aid in the differential diagnosis of the three neoplasms. Using the tissue array technique, the authors also showed an effective model for comprehensive antibody testing.

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    • "Sarcomatoid renal cell carcinoma or hepatocellular carcinoma with sarcomatoid dedifferentiation both may show morphologically similar appearance with clear and eosinophilic cytoplasm. However, positive staining of CD56, inhibin, Melan-A, synaptophysin, calretinin and negative staining of pan-cytokeratin, EMA, Hepar-1 in adrenocortical sarcomatoid carcinoma may be of help in the differential diagnosis [17,18]. A primary retroperitoneal sarcoma such as liposarcoma, rhabdomyosarcoma, or malignant peripheral nerve sheet tumor also needs to be excluded by careful histological and immunohistochemical analysis. "
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