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Diagnostic and Prognostic Role of Immunohistochemical Expression of Napsin-A Aspartic Peptidase in Clear Cell and Papillary Renal Cell Carcinoma: A Study Including 233 Primary and Metastatic Cases

Xu, Bin MD, PhD*; Abourbih, Samuel MD; Sircar, Kanishka MD; Kassouf, Wassim MD; Aprikian, Armen MD; Tanguay, Simon MD; Brimo, Fadi MD*

Applied Immunohistochemistry & Molecular Morphology:
doi: 10.1097/PAI.0b013e31828ef24e
Research Articles

Napsin-A aspartic peptidase (napsin-A) is an aspartic protease that is predominantly expressed in the proximal renal tubules and type II pneumocytes of the lung. Recently, napsin-A was reported to be present in a proportion of renal cell carcinomas (RCCs). However, the utilization of napsin-A immunohistochemistry as a routine diagnostic tool for RCC, and the correlation of the level of napsin-A expression with histologic features have not yet been established. In the current study, using tissue microarrays composed of primary and metastatic RCCs, napsin-A expression was demonstrated in 86 of 222 (39%) clear cell RCCs (CRCCs) and 16 of 21 (76%) papillary RCCs (PRCCs), with a strong and diffuse staining pattern observed in PRCCs and a relatively weak and focal positivity in CRCCs. Compared with primary CRCCs, a comparable proportion of metastatic CRCCs retained napsin-A expression (45/132, 34%), suggesting the potential utility of napsin-A in the evaluation of metastatic tumors. The expression of napsin-A was also found to be inversely correlated to aggressive local tumor characteristics, such as advanced pathologic stage and high Fuhrman nuclear grade. We conclude that napsin-A may be a valuable immunohistochemical marker in the diagnosis of RCCs, particularly PRCC.

Author Information

Departments of *Pathology

Urology, McGill University Health Center, Montreal, QC, Canada

Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX

The authors declare no conflict of interest.

Reprints: Fadi Brimo, MD, Department of Pathology, Montreal General Hospital, 1650 Cedar Avenue, Montreal, QC, Canada H3G 1A4 (e-mail:

Received December 20, 2012

Accepted February 24, 2013

© 2014 Lippincott Williams & Wilkins, Inc.