The Study On Clinical Pathology And Molecular Genetics Of Renal Cell Carcinomas

Purpose To analyze and summarize the clinical pathologic features, immunophenotype of renal cell carcinomas(RCC),based on the new WHO classification of renal cell carcinoma, and discuss their value in the pathological diagnosis and differential diagnosis of renal cell carcinoma.Methods 114 cases of renal cell carcinoma were consecutively selected from archives of the Department of Pathology in Shiheizi University of medicine and People's hospital of Xingjiang Uygur Autonomous Region. The clinicopathology and immunophenotype of 114 cases RCC were studied by morphologic observation and immunchistochemistry assay based on the new WHO classification. The chromosomal 17 were detected by fluorescence in situ hybridization (FISH) in 3 cases of RCC, the karyotype of one case of RCC was indentied by G-banding.Results (1)The average age of 114 patients with RCC was 57.47 years(ranges from14~85 years) ,RCC is more common in males than females ( 1.92:1), 68 cases of RCC are arised in left renal, and 46 cases in right. (2) 114 cases RCC were reclassified into 5 subtypes: 76 cases ( 65.5 %) CCRCC, 11cases (9.6%) PRCC, 14 cases (12%)chrRCC, 11cases(9.6%)Xp11.2RCC, 2 cases(1.7%) undifferentiated renal carcinoma. (3)Immunostaining showed: the positive rate of CK ,CD10, Vim in CCRCC is 94.7%(72/76),94.7%(72/76),76.3%(58/76, respectively; the positive rate of AMACR in PRCC is 100%(11/11); The the positive rate of CD117,CD10 in chrRCC is 78.5%(11/14) , 14.2(2/14) ,respectively; in 11 case of Xp11.2 RCC,the positive rate of TFE3,AMACR,CD10,CK is 100%(11/11,100%(11/11),90.9%(10/11), 72.7% (8/11),respectively; the positive rate of CK,CD10,Vim in 2 cases of unRCC is 100%(2/2), 100%(2/2), 50%(1/2). The expression of CD10,CD117 is significantly different between CCRCC and chrRCC(χ2=46.9844 P=0.000;χ2=19.8052 P =0.000) . The expression of AMACR is significantly different between CCRCC and PRCC, CCRCC and Xp11.2RCC (χ2=19.6478 P=0.000 .χ2=19.6478 P=0.000). The positive rate of EGFR in RCC is 49.5% (56/114),the positive rate of MDM2 in CCRCC is 81.5%(62/76),the positive rate of P53 in unRCC,Xp11.2RCC,ASPS is100%(2/2),63.6%(7/11),88.3%(10/12) ,respectively.(4) All 3 cases of RCC were detected gain of chromosomal 17 by FISH, the G-banding karyotype shows chromosome lose.Conclusion (1) The new WHO classification is practical and progressive for clinical application. (2)The expressions of CD10, Vim, CD117 are helpful in the distinction of chrRCC from CCRCC; The expressions of AMACR, CK7 and Topoisomerase IIαare helpful in the distinction of PRCC from CCRCC. The expressions of AMACR,CD10,CK are helpful in the distinction of Xp11.2RCC from ASPS.MDM2 may play a role in developing of CCRCC. P53 gene may play a role in developing of Xp11.2RCC and ASPS. (3) The technique to isolate individual nuclei from paraffin-embedded tissue is useful to help FISH technique detect chromosome abnormalities.