Differentiating Intrarenal Ectopic Adrenal Tissue From Renal Cell Carcinoma in the Kidney

Background. Adrenal rest (AR) is the presence of ectopic adrenal cortical tissue, often identified incidentally during autopsy (20% of postmortem examination). In the kidney, AR can be found in 6% of the general population. Ectopic adrenal tissue is of no functional significance but may in some cases, pose a diagnostic challenge for the pathologist, especially in the context of renal clear cell renal cell carcinoma (RCC) and small needle biopsies. Aim. To investigate the utility of immunohistochemical stains in distinguishing AR from RCC. Methods. Archival cases of AR, in our institution, were reviewed and compared with a cohort of RCC cases using a panel of immunohistochemical stains, including PAX2, PAX8, calretinin, and inhibin. Results. Nine of 10 (90%) cases of AR showed positive staining for inhibin and negative staining for calretinin, PAX2 and PAX8. One AR case was positive for PAX2 and PAX8 in addition to inhibin. All (100%) RCC cases were positive for PAX2 and PAX8, but negative for inhibin and calretinin. Conclusions. A panel of PAX2, PAX8 and inhibin may be useful markers for distinguishing AR from RCC. Calretinin was noncontributory in our study.

[1]  K. Iczkowski,et al.  Immunohistochemical distinction of metastases of renal cell carcinoma to the adrenal from primary adrenal nodules, including oncocytic tumor , 2015, Virchows Archiv.

[2]  Yan Zhang,et al.  Ectopic cortisol-producing adrenocortical adenoma in the renal hilum: histopathological features and steroidogenic enzyme profile. , 2014, International journal of clinical and experimental pathology.

[3]  L. Erickson.  Atlas of Endocrine Pathology , 2014 .

[4]  T. Jardetzky,et al.  Inhibin α-Subunit N Terminus Interacts with Activin Type IB Receptor to Disrupt Activin Signaling* , 2012, The Journal of Biological Chemistry.

[5]  Wei-ping Liu,et al.  Comparison of Immunohistochemical Markers in the Differential Diagnosis of Adrenocortical Tumors: Immunohistochemical Analysis of Adrenocortical Tumors , 2007, Applied immunohistochemistry & molecular morphology : AIMM.

[6]  L. Browning,et al.  D2-40 is a sensitive and specific marker in differentiating primary adrenal cortical tumours from both metastatic clear cell renal cell carcinoma and phaeochromocytoma , 2007, Journal of Clinical Pathology.

[7]  M. Bouchard,et al.  Pax2 and Pax8 Regulate Branching Morphogenesis and Nephron Differentiation in the Developing Kidney , 2007 .

[8]  W. Sellers,et al.  Lineage dependency and lineage-survival oncogenes in human cancer , 2006, Nature Reviews Cancer.

[9]  M. Mansukhani,et al.  PAX2: a reliable marker for nephrogenic adenoma , 2006, Modern Pathology.

[10]  R. Hoda,et al.  Rosai and Ackerman???s Surgical Pathology , 2004 .

[11]  Wenxin Zheng,et al.  Inhibin Immunohistochemical Staining: A Practical Approach for the Surgical Pathologist in the Diagnoses of Ovarian Sex Cord-Stromal Tumors , 2003, Advances in anatomic pathology.

[12]  K. Okoń,et al.  Adrenal rest presenting as a renal cyst. A case report. , 2003, Polish journal of pathology : official journal of the Polish Society of Pathologists.

[13]  M. Busslinger,et al.  Nephric lineage specification by Pax2 and Pax8. , 2002, Genes & development.

[14]  G. Krupitza,et al.  Derivation of nephrogenic adenomas from renal tubular cells in kidney-transplant recipients. , 2002, The New England journal of medicine.

[15]  N. Ordóñez.  Role of immunohistochemistry in distinguishing epithelial peritoneal mesotheliomas from peritoneal and ovarian serous carcinomas. , 1998, The American journal of surgical pathology.

[16]  P. Maxwell,et al.  Immunohistochemical staining of normal, hyperplastic, and neoplastic adrenal cortex with a monoclonal antibody against alpha inhibin. , 1998, Journal of clinical pathology.

[17]  G. D. Vita,et al.  Expression of the RET/PTC1 oncogene impairs the activity of TTF-1 and Pax-8 thyroid transcription factors. , 1998, Cell growth & differentiation : the molecular biology journal of the American Association for Cancer Research.

[18]  G. Viale,et al.  Calretinin: a novel immunocytochemical marker for mesothelioma. , 1996, The American journal of surgical pathology.

[19]  S. Mundlos,et al.  PAX8, a human paired box gene: isolation and expression in developing thyroid, kidney and Wilms' tumors. , 1992, Development.

[20]  M. Eccles,et al.  Expression of the PAX2 gene in human fetal kidney and Wilms' tumor. , 1992, Cell growth & differentiation : the molecular biology journal of the American Association for Cancer Research.

[21]  G. Dressler,et al.  Pax-2 is a DNA-binding protein expressed in embryonic kidney and Wilms tumor. , 1992, Proceedings of the National Academy of Sciences of the United States of America.

[22]  E. Carafoli.  Intracellular calcium homeostasis. , 1987, Annual review of biochemistry.