Expression of PAX2 and Renal Cell Carcinoma Antigen in Mucoepidermoid Carcinoma

Yunguang Liu, MD, PhD, Richard T. Cheney, MD, Angela Omilian, PhD, Carl Morrison, MD, Bo Xu, MD, PhD

Abstract


Clear cell renal cell carcinoma (CCRCC) is the most common metastatic clear cell tumor in the head and neck. The most common primary tumor of the head and neck with clear cell morphology is mucoepidermoid carcinoma (MEC). The distinction between MEC with clear cells (CMEC) and metastatic CCRCC can be challenging in a small biopsy specimen. Expression of PAX2 and renal cell carcinoma antigen (RCCma) has been widely used to aid of diagnosis for both primary and metastatic RCC. The aim of this study is to evaluate the utility of expression of PAX2 and RCCma between CMEC and metastatic CCRCC in a clinical setting using tissue microarrays (TMAs). In primary CCRCC, the nuclear immunoreactivity for PAX2 was found in 47 of 120 cases (39%), and the membranous staining pattern for RCCma was revealed in 69 of 120 cases (58%). The immunostain profiles of metastatic RCC showed positive staining for PAX2 in 21 of 94 cases (22%) and RCCma in 19 cases (20%), respectively. Two of six cases (33%) of metastatic RCC to the head and neck region display immunoreactivity for either PAX2 or RCCma. For MEC, positive membranous and cytoplasmic staining of RCCma was found in 3 of 23 cases (13%), and diffuse cytoplasmic reactivity for PAX2 was noted in 19 cases (83%). However, none of MEC showed nuclear reactivity that is specific for PAX2. Results of our study suggest that although PAX2 and RCCma are relatively specific for CCRCC, one should be cautious when interpreting the results of RCCma and PAX2 expression in the setting of CMEC versus metastatic CCRCC, particularly in a biopsy specimen. Clinicopathologic correlation combined with histomorphology and a panel of immunohistochemical markers is essential to render correct diagnosis.

[N A J Med Sci. 2012;5(4):203-207.]



Keywords


mucoepidermoid carcinoma, clear cell renal cell carcinoma, PAX2, RCCma, differential diagnoses

Full Text:

PDF

References


Spiro RH. Salivary neoplasms: overview of a 35-year experience with 2,807 patients. Head Neck Surg. 1986; 8(3):177-184.

Lopes MA, Kowalski LP, da Cunha Santos G, Paes de Almeida O. A clinicopathologic study of 196 intraoral minor salivary gland tumours. J Oral Pathol Med. 1999; 28(6):264-267.

Luna MA. Salivary mucoepidermoid carcinoma: revisited. Adv Anat Pathol. 2006;13(6):293-307.

Goode RK and EI-Naggar AK. Mucoepidermoid carcinoma. In: Barnes L, Eveson JW, Reichart P, et al eds. World Health Organization classification of tumor. Pathology & Genetics of Head and Neck tumors. Lyon: IARC Press, 2005:219-220.

Ellis GL, Auclair PL. Tumor of the salivary gland. AFIP Atlas of tumor pathology, ed. Washington, DC: ARP Press, 2008: Vol. 9.

Gokden N, Mukunyadzi P, James JD, Gokden M. Diagnostic utility of renal cell carcinoma marker in cytopathology. Appl Immunohistochem Mol Morphol. 2003;11(2):116-119.

McGregor DK, Khurana KK, Cao C, et al. Diagnosing primary and metastatic renal cell carcinoma: the use of the monoclonal antibody 'Renal Cell Carcinoma Marker'. Am J Surg Pathol. 2001;25(12):1485-1492.

Bakshi N, Kunju LP, Giordano T, Shah RB. Expression of renal cell carcinoma antigen (RCC) in renal epithelial and nonrenal tumors: diagnostic Implications. Appl Immunohistochem Mol Morphol. 2007;15(3):310-315.

Rothenpieler UW and Dressler GR. Pax-2 is required for mesenchyme-to-epithelium conversion during kidney development. Development. 1993;119(3):711-720.

Gokden N, Gokden M, Phan DC, McKenney JK. The utility of PAX-2 in distinguishing metastatic clear cell renal cell carcinoma from its morphologic mimics: an immunohistochemical study with comparison to renal cell carcinoma marker. Am J Surg Pathol. 2008;32(10):1462-1467.

Xu B, Thong N, Tan D, Khoury T. Expression of thyroid transcription factor-1 in colorectal carcinoma. Appl Immunohistochem Mol Morphol 2010;18(3):244-249.

Ficarra G, Pierleoni L, and Panzoni E. Metastatic renal cell carcinoma involving Wharton's duct: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;81(5):580-583.

Kohli M and Schaefer R. Management of solitary palatal metastasis from renal cell carcinoma. Nat Clin Pract Urol. 2006;3(7):392-396; quiz following 396.

Torres-Carranza E, Garcia-Peria A, Infante-Cossio P, Belmonte-Caro R, Loizaga-Iriondo JM, Gutierrez-Perez JL. Airway obstruction due to metastatic renal cell carcinoma to the tongue. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(3):e76-78.

Sastre J, Naval L, Munoz M, Gamallo C, Diaz FJ. Metastatic renal cell carcinoma to the mandible. Otolaryngol Head Neck Surg. 2005; 132(4): 663-664.

Sabo R, Sela M, Sabo G, Herskovitz P, Feinmesser R. Metastatic hypernephroma to the head and neck: unusual case reports and review of the literature. J Otolaryngol. 2001;30(3):140-144.

Seijas BP, Franco FL, Sastre RM, García AA, López-Cedrún Cembranos JL. Metastatic renal cell carcinoma presenting as a parotid tumor. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99(5):554-557.

Ankem MK, Hartanto VH, Han KR, et al. Metastatic renal cell carcinoma presenting as an oral tumor. Can J Urol. 2001; 8(3):1295-1296.

Pan CC, Chen PC, and Ho DM. The diagnostic utility of MOC31, BerEP4, RCC marker and CD10 in the classification of renal cell carcinoma and renal oncocytoma: an immunohistochemical analysis of 328 cases. Histopathology. 2004; 45(5):452-459.

Koga F, Kawano K, Honda M, et al. Sarcomatoid renal cell carcinoma with scant carcinomatous components. Int J Urol. 2000; 7(2):58-60; discussion 61.

Avery AK, Beckstead J, Renshaw AA, Corless CL. Use of antibodies to RCC and CD10 in the differential diagnosis of renal neoplasms. Am J Surg Pathol. 2000; 24(2):203-210.


Refbacks

  • There are currently no refbacks.