Advances in Anatomic Pathology:
doi: 10.1097/PAP.0b013e31824dafb3
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Sangoi, Ankur R. MD*,†; McKenney, Jesse K. MD

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*Department of Pathology, El Camino Hospital, Mountain View, CA

Department of Pathology, Stanford University Medical Center, Stanford, CA

The authors have no funding or conflicts of interest to disclose.

We thank Dr Liszka and colleagues’ kind acknowledgment of our review article1 on diagnosing metastatic clear cell renal carcinoma (CC-RCC). Regarding the section on differentiating primary pancreatic adenocarcinoma (PDAC) exhibiting clear cell change from metastatic CC-RCC, we fully agree that the literature on MUC1 expression in CC-RCC is challenging to interpret, and is complicated by the fact studies use “MUC1” (also known as CD227 and polymorphic urinary mucin) and “EMA” interchangeably.2,3 This is significant given the well-recognized immunoreactivity of CC-RCC with EMA. As such, in conjunction with the current data by Dr Liszka and colleagues and their cited references, we fully concur with their conclusion that MUC1 should not be utilized as a marker to distinguish PDAC from metastatic CC-RCC. Although RCC monoclonal antibody appears to be a reliable marker for CC-RCC (100% specificity versus PDAC, n=21),4–7 additional studies are still needed. Although PAX8 immunoreactivity in PDAC remains infrequent and typically patchy/weak (9%, n=53),8–11 recognition of this occasional staining in PDAC remains critical and highlights the need for additional novel markers and, most importantly, very close clinical/imaging correlation.

Ankur R. Sangoi, MD*†, Jesse K. McKenney, MD†

*Department of Pathology, El Camino Hospital, Mountain View, CA

†Department of Pathology, Stanford University Medical Center, Stanford, CA

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1. Sangoi AR, Karamchandani J, Kim J, et al. The use of immunohistochemistry in the diagnosis of metastatic clear cell renal cell carcinoma: a review of PAX-8, PAX-2, hKIM-1, RCCma, and CD10. Adv Anat Pathol. 2010;17:377–393

2. Leroy X, Zerimech F, Zini L, et al. MUC1 expression is correlated with nuclear grade and tumor progression in pT1 renal clear cell carcinoma. Am J Clin Pathol. 2002;118:47–51

3. Langner C, Ratschek M, Rehak P, et al. Expression of MUC1 (EMA) and E-cadherin in renal cell carcinoma: a systematic immunohistochemical analysis of 188 cases. Mod Pathol. 2004;17:180–188

4. Bakshi N, Kunju LP, Giordano T, et al. Expression of renal cell carcinoma antigen (RCC) in renal epithelial and nonrenal tumors: diagnostic implications. Appl Immunohistochem Mol Morphol. 2007;15:310–315

5. 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;25:1485–1492

6. Pan CC, Chen PC, Tsay SH, et al. Differential immunoprofiles of hepatocellular carcinoma, renal cell carcinoma, and adrenocortical carcinoma: a systemic immunohistochemical survey using tissue array technique. Appl Immunohistochem Mol Morphol. 2005;13:347–352

7. Yoshida SO, Imam A. Monoclonal antibody to a proximal nephrogenic renal antigen: immunohistochemical analysis of formalin-fixed, paraffin-embedded human renal cell carcinomas. Cancer Res. 1989;49:1802–1809

8. Laury AR, Perets R, Piao H, et al. A comprehensive analysis of PAX8 expression in human epithelial tumors. Am J Surg Pathol. 2011;35:816–826

9. Ozcan A, Shen SS, Hamilton C, et al. PAX 8 expression in non-neoplastic tissues, primary tumors, and metastatic tumors: a comprehensive immunohistochemical study. Mod Pathol. 2011;24:751–764

10. Sangoi AR, West RB, Bonventre JV, et al. Exploring the specificity of putative renal cell carcinoma markers in non-renal tissues and neoplasms from various organ systems: a tissue microarray study of 501 cases. Mod Pathol. 2010;23(suppl 1):216A

11. Tacha D, Zhou D, Cheng L. Expression of PAX8 in normal and neoplastic tissues: a comprehensive immunohistochemical study. Appl Immunohistochem Mol Morphol. 2011;19:293–299

© 2012 Lippincott Williams & Wilkins, Inc.


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