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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Am+J+Surg+Pathol
2013 ; 37
(12
): 1824-30
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Amylase ?-1A (AMY1A): a novel immunohistochemical marker to differentiate
chromophobe renal cell carcinoma from benign oncocytoma
#MMPMID24225843
Jain S
; Roy S
; Amin M
; Acquafondata M
; Yin M
; Laframboise W
; Bastacky S
; Pantanowitz L
; Dhir R
; Parwani A
Am J Surg Pathol
2013[Dec]; 37
(12
): 1824-30
PMID24225843
show ga
Chromophobe renal cell carcinoma (ChRCC) and oncocytoma present with a perplexing
overlap of morphologic and immunohistochemical features. ChRCC have deletions in
the 1p21.1 region including the amylase ?-1A gene (AMY1A). No such deletions are
found in oncocytoma. Instead, oncocytomas shared other deletions on chromosome 1:
1p31.3, 1q25.2, and 1q44. We performed AMY1A immunostaining on 75 oncocytomas (57
tissue microarray [TMA] cores, 18 whole slides) and 54 ChRCCs (20 TMA cores, 34
whole slides). Staining was assessed using the H-score method. The intensity was
graded as follows: no staining=0, weak=1, moderate=2, and strong=3. The AMY1A
immunostain preferentially stained the distal tubules and collecting ducts of
normal kidney. All oncocytomas (100%) expressed AMY1A with an H-score that varied
from 100 to 300 (mean 205). Mild to moderate heterogeneity in staining intensity
was noted within a given oncocytoma. For oncocytomas, 87% (65/75) cases had
H-scores of at least 120 with a mean score of 221. Notably, the 13% (10/75) of
oncocytoma cases that had an H-score of 100 were derived from the TMA. A total of
87% (47/54) of the ChRCC cases were negative for the AMY1A immunostain. Of the
ChRCC cases, 4% (2/54) showed very weak cytoplasmic staining (H-score of 70
each), which was less than the lowest H-score of oncocytoma cases. All 5 cases of
ChRCC, which showed an H-score of 100 or more, were referred to as eosinophilic
variants of ChRCC. Three of these 5 cases showed a very nondescript, diffuse
staining of the cytoplasm. Two of these 5 cases showed an H-score of 130. We
think that as the staining pattern of these 2 cases is similar to that of
oncocytoma, they should be put in a category of renal oncocytic neoplasms
favoring oncocytoma. This result shows that AMY1A staining could be very helpful
in further classifying even a subset of the eosinophilic variants of ChRCC. The
difference between ChRCC and oncocytoma was statistically significant (? test,
P<0.0001). All cases of clear cell RCC and papillary RCC were negative for AMY1A
expression. Overall, sensitivity and specificity of AMY1A staining for oncocytoma
was 100% (95% confidence interval, 0.95-1.00) and 96.75% (95% confidence
interval, 0.93-0.99), respectively. Similarly, the sensitivity and specificity
for distinguishing oncocytoma from ChRCC was 100% (95% confidence interval,
0.95-1.00) and 90.74% (95% confidence interval, 0.80-0.97), respectively. These
data show that the novel marker AMY1A can be of great diagnostic utility when
trying to differentiate ChRCC (classic and eosinophilic variant) and oncocytoma.
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