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Am J Surg Pathol. 2013 Oct;37(10):1518-31. doi: 10.1097/PAS.0b013e318299f12e.

Renal tumors: diagnostic and prognostic biomarkers.

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*Department of Pathology, Singapore General Hospital, Singapore, Singapore †Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN §Laboratory of Pathology, National Cancer Institute, Bethesda ∥Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD ¶Memorial Sloan Kettering Cancer Center, New York, NY #Department of Pathology and Genomic Medicine, The Methodist Hospital and Weill Medical College of Cornell University, Houston, TX ‡Service d'Anatomie et Cytologie Pathologiques, CHU Pontchaillou, Rennes, France **Institute of Pathological Anatomy and Histopathology, Polytechnic University of the Marche Region, Ancona, Italy ††Karolinska Institute, Stockholm, Sweden ‡‡Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada §§Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand ∥∥Institute of Surgical Pathology, University of Zurich, Zurich, Switzerland.


The International Society of Urological Pathology convened a consensus conference on renal cancer, preceded by an online survey, to address issues relating to the diagnosis and reporting of renal neoplasia. In this report, the role of biomarkers in the diagnosis and assessment of prognosis of renal tumors is addressed. In particular we focused upon the use of immunohistochemical markers and the approach to specific differential diagnostic scenarios. We enquired whether cytogenetic and molecular tools were applied in practice and asked for views on the perceived prognostic role of biomarkers. Both the survey and conference voting results demonstrated a high degree of consensus in participants' responses regarding prognostic/predictive markers and molecular techniques, whereas it was apparent that biomarkers for these purposes remained outside the diagnostic realm pending clinical validation. Although no individual antibody or panel of antibodies reached consensus for classifying renal tumors, or for confirming renal metastatic disease, it was noted from the online survey that 87% of respondents used immunohistochemistry to subtype renal tumors sometimes or occasionally, and a majority (87%) used immunohistochemical markers (Pax 2 or Pax 8, renal cell carcinoma [RCC] marker, panel of pan-CK, CK7, vimentin, and CD10) in confirming the diagnosis of metastatic RCC. There was consensus that immunohistochemistry should be used for histologic subtyping and applied before reaching a diagnosis of unclassified RCC. At the conference, there was consensus that TFE3 and TFEB analysis ought to be requested when RCC was diagnosed in a young patient or when histologic appearances were suggestive of the translocation subtype; whereas Pax 2 and/or Pax 8 were considered to be the most useful markers in the diagnosis of a renal primary.

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