Genitourinary PAX8
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174A ANNUAL MEETING ABSTRACTS RMC and 19/21 (90%) of CDC cases. In contrast, 31/34 (91%) UUC were negative for Genitourinary PAX8. p63: p63 was positive in 7/12 (58%) RMC and in 3/21 (14%) CDC. Staining was focal in 6/7 RMC and strong in 4/7. Almost all (97%) UUC were p63 positive 767 Histopathologic Features of Bilateral Renal Cell Carcinomas: A (moderate/strong and multifocal/diffuse in 80% of cases). The one p63 negative UUC Study of 24 Cases was a microinvasive high grade tumor and was also negative for PAX8. J Abdelsayed, JY Ro, LD Truong, AG Ayala, SS Shen. The Methodist Hospital and Weill Conclusions: We suggest a binary panel of PAX8 and p63 as an aid in the differential Medical College of Cornell University, Houston, TX. diagnosis of high grade renal sinus epithelial neoplasms. (PAX8+/p63+) profile Background: The incidence of bilateral renal cell carcinoma (bRCC) has been reported supported the dx of RMC with a sensitivity of 58.3% and specificity of 89%. (PAX8+/ to vary from 1.5% to 11%. Clear understanding of the clinicopathologic features of p63-) profile supported the diagnosis of CDC with a sensitivity of 85.7% and a specificity bRCCs including the distinction between synchronous and metachronous tumors has of 89%. Finally (PAX8-/p63+) profile supported the diagnosis of UUC with a sensitivity important implications in patients’ management and follow up. The purpose of this study of 88% and a specificity of 100%. The concomitant expression of p63 and PAX8 in RMC is to summarize the clinicopathologic features of bRCCs and compare them with those seen in our study further suggests an intermediate phenotype between renal tubular and of unilateral renal cell carcinomas (uRCCs). a urothelial differentiation in RMC. Design: Of the 1230 patients treated at our hospital for RCC from 1990 to 2006, 24 (2.0%) were found to have bRCCs. The clinicopathologic features of these patients 770 PAX-8 Expression in Urothelial Neoplasia – An Immunohistochemical were reviewed and compared with those of unilateral RCCs. Study of 236 Cases Results: There were no significant differences in gender or age (59.7 vs. 60.3 years) R Albadine, L Schultz, DA Fajardo, R Sharma, PB Illei, S Jadallah, JI Epstein, GJ between patients with bRCCs or uRCCs. Of the 24 bRCCs, 13 were synchronous and Netto. Johns Hopkins University, Baltimore, MD. 11 were metachronous tumors (with an average of 22.6 months after 1st tumor). Three Background: PAX-8 is a transcription factor crucial for lineage commitment in thyroid, patients had Von Hippel Lindau (VHL) syndrome. Overall, 21 of 24 bRCCs (87.5%) Mullerian duct and nephric development. For its role in ontogenesis and oncogenesis had the same histology, while in 3 patients with metachronous tumors, the 1st tumor was in the genitourinary tract, PAX-8 has recently gained great utility as a marker of renal a clear RCC, and the contralateral tumor was a papillary RCC. The incidence of clear and ovarian lineage. In the current study, we investigate PAX-8 expression in a large cell, papillary, and chromophobe RCC was 54.1%, 41.6%, and 4.2% respectively for cohort of invasive and non-invasive urothelial neoplasms of upper and lower urinary bilateral RCC, compared to 77.2%, 15.2%, and 5.6% for unilateral RCC. Six of 13 pts tract, to further validate its utility in resolving the differential diagnosis of urothelial with synchronous tumors died within an average time of 22.6 month, contrasting with vs renal differentiation. 2 of 11 patients with metachronous tumors died at an average time of 102.8 month. Design: Tissue microarrays (TMA) were constructed from archival tissues of urothelial Conclusions: In this series, the incidence of bilateral RCC was 2.0%. VHL disease neoplasms retrieved from our institution (1985-2005). The cohort of 236 tumors included accounted for 14.2% of bRCC. The incidence of papillary RCC in patients with bRCC 200 bladder tumors: 6 Papillary Urothelial Neoplasm of Low Malignant Potential was much higher than in patients with uRCCs (41.6% vs. 15.0%). Our study also (PUNLMP), 43 non-invasive urothelial carcinoma (10 high grade) and 151 invasive indicates that patients with synchronous tumors have worse survival than patients with urothelial carcinoma (UrCa). The cohort also included 36 urothelial carcinoma of the metachronous tumors. upper urinary tract (UUC), including 2 non-invasive tumors. Triplicate tumor samples were spotted from each case. Immunohistochemistry for PAX-8 was performed using 768 Unique Morphologic Characteristics of High Grade Urothelial standard protocol and appropriate controls. Tumors were evaluated for extent of nuclear Carcinoma with Fibroblast Growth Factor Receptor-3 (FGFR3) Gene staining, categorized as focal (<25%), multifocal (25-75%) or diffuse (>75%) and Mutations assigned an incremental 0 to 3+ intensity score. The UUC subset of the cohort was further HA Al-Ahmadie, O Lin, GV Iyer, A Heguy, A Gopalan, SW Fine, SK Tickoo, AJ Hanrahan, evaluated for p63 immunostaining (NeoMarkers), using a similar approach. DF Bajorin, VE Reuter, DB Solit, MI Milowsky. Memorial Sloan-Kettering Cancer Results: Overall, 224/236 (95%) of urothelial neoplasms were negative for PAX-8. All Center, New York, NY. 6 (100%) PUNLMP and 151 (100%) invasive UrCa of the bladder were negative for Background: FGFR3 gene mutations in urothelial carcinoma (UC) demonstrate a PAX-8. PAX-8 staining was encountered in 7/43 (16%) non-invasive bladder UrCa. predilection for low grade and low stage tumors. Mutations in high grade UC are less In UUC, 3 (8%) invasive tumors were positive for PAX-8, all with weak/moderate common, however, as a receptor tyrosine kinase; FGFR3 may represent a potential intensity (1+/2+). Both cases of non-invasive UUC were negative for the PAX-8. p63 therapeutic target. We analyzed a large cohort of high grade UC for FGFR3 gene was positive in 33/36 (92%) UUC. The 3 negative cases included 2 non-invasive and mutational status and histopathologic characteristics. 1 pT1 tumor and all were also negative for PAX-8. Design: DNA extraction, whole genome amplification and Sanger Sequencing for Conclusions: For all practical purposes, urothelial neoplasms of the bladder lack PAX-8 FGFR3 gene mutations in exons 7, 10 and 15 was performed on frozen tumor and expression. All invasive UrCa of bladder origin were negative for PAX-8. Although normal tissue samples from 137 cystectomy specimens with invasive or refractory high rare PAX-8 positivity was encountered in non invasive tumors, their urothelial nature grade UC. All putative mutations were confirmed by a second PCR and sequencing is evident by their architecture. In UUC, where the differential diagnosis includes RCC, reaction, in parallel with amplification and sequencing of matched normal tissue DNA. PAX-8 was rarely expressed by invasive UUC (8%), the urothelial nature of the latter Detailed morphologic assessment of all cases was undertaken, including slides from subset of cases can be resolved by their co-expression of p63. corresponding transurethral resections when necessary. Results: FGFR3 gene mutations were detected in 16 of 137 (12%) cases (pTa, 1; pT1, 771 mTOR Pathway Alterations in Chromophobe Renal Cell Carcinoma 5; pT2, 4; pT3, 6). All were confirmed somatic missense mutations including S249C (RCC) (9), R248C (3), G370C (2), S371C (1) and Y373C (1). Besides the invasive component, R Albadine, L Schultz, J Hicks, AM Demarzo, P Argani, M Carducci, R Pili, GJ Netto. 15 of 16 FGFR3-mutated tumors (94%) displayed a distinct non invasive papillary Johns Hopkins University, Baltimore. component characterized by long, slender branching papillary formations, lined by Background: Dysregulation of mTOR pathway has been demonstrated in several polygonal cells with distinct cell borders and clear to eosinophilic cytoplasm. The types of malignancies. mTOR pathway activation interacts with effectors of cell cycle nuclei were variable in size with vesicular chromatin and irregular “wrinkled” nuclear progression and ultimately regulates protein translation and cell proliferation. Tumor membrane attaining a “koilocytoid” appearance. In 10 cases (63%), a component of hypoxia modulates mTOR pathway through HIF1α accumulation. Agents targeting low grade morphology was also demonstrable. mTOR are in various stages of clinical development. Here, we assess the status of Conclusions: 1. We confirmed that FGFR3 gene mutations are present in a small but several mTOR pathway components in Chormophobe RCC. significant proportion of high grade UC. 2. FGFR3 gene mutations confer unique Design: Standard immunohistochemical analysis was performed for PTEN, phos Akt, histopathologic features. 3. Identification of these histopathologic features may help p27, c-MYC, 4-EBP1, phos S6, and HIF1α using tissue microarrays constructed from to select patients for targeted therapy. 33 primary Chormophobe RCC (60% pT1 and 40% pT2-3) treated at our hospital (2004- 2006). Triplicate tumor samples and paired benign renal tissue controls were spotted 769 PAX8 (+)/p63 (+) Immunostaining Pattern in Renal Medullary in every case. Nuclear and or cytoplasmic expression was assessed for each marker as Carcinoma (RMC): An Intermediate Phenotype between Urothelial the percentage of positive cells (extent) and intensity of staining. A final H-score was Carcinoma of Upper Urinary Tract (UUC) and Collecting Ducts Carcinoma calculated in each tumor as the product of intensity x extent, and was correlated with (CDC) clinico-pathological parameters. R Albadine, L Schultz, A Billis, H Ellwood, DE Baydar, A Garvin, JI Epstein, P Argani, Results: In our cohort, M:F ratio was 1.13 and mean age at diagnosis was 59.7 years. G Netto. Johns Hopkins University, Baltimore; UNICAMP State University, Campinas, Mean tumor size was 4.7 cm. Three cases had multifocal disease. Mean length of Brazil; Hacettepe, Ankara, Turkey. follow-up was 28 months (range: 2-61). A 97% disease free survival rate was observed Background: Renal Medullary carcinoma (RMC) is a rare highly aggressive tumor during follow up.