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ANNUAL MEETING ABSTRACTS 233A including all mature teratoma components, IMP3 may serve as a potential tissue biomarker to distinguish metastatic teratoma from its benign mimickers, especially in the setting of status post chemotherapy for germ cell tumors. 984 Clear Cell Papillary Renal Cell Carcinoma and XP11.2 Translocation- Associated Renal Cell Carcinoma Are Derived from Distal Nephron Tubules and Proximal-Tubules Respectively. PL Zhang, MB Amin. William Beaumont Hospital, Royal Oak, MI. Background: Clear cell papillary renal cell carcinoma (CCP-RCC) and XP11.2 translocation-associated renal cell carcinoma (XP-TC) are two recently described variants of RCC, but their origin as to which portion of renal tubules they arise from remains unclear. Kidney injury molecule-1 (KIM-1) is a type I transmembranous protein and specific injury marker of proximal tubules. Previous studies have demonstrated that KIM-1 is upregulated in proximal tubule derived RCC (clear cell RCC and papillary RCC) but negative in distal nephron tubule derived tumors (chromophobe RCC and oncocytoma). We attempted to determine the origin of CCP-RCC and XP-TC using KIM-1 expression. Since KIM-1 has a phagocytotic function in injured proximal tubules, we also investigated for correlation with CD68 expression, which is a phagocytic transmembrane glycoprotein, mainly present in macrophages. Design: The study included three group of RCC. Group 1 had 16 cases which included both clear cell RCC and papillary RCC (KIM-1 positive control group), Group 2 consisted of 11 cases of CCP-RCC (CK7 positive/P504S negative) and Group 3 had 11 cases of XP-TC (TFE-3 positive). Tumors were immunohistochemically stained for KIM-1 (AKG7 monoclonal antibody, JB Bonventre’s lab, Brigham and Women’s Hospital, Boston) and CD68 (KP1 clone, Dako Cytomation) and staining intensity was graded from 0 to 3+. Results: KIM-1 showed membranous and/or cytoplasmic staining in all group 1 cases (16/16; 5 with 1+, 7 with 2+ and 4 with 3+ staining). None of group 2, CCP-RCC cases (0/11) expressed KIM-1. In contrast, all group 3, XP-TC cases (11/11) revealed positive KIM-1 expression (1 with 1+, 7 with 2+ and 3 with 3+ staining), suggesting origin from proximal tubules. The cytoplasmic expression of CD68 was present all group 1 cases (16/16, 5 with 1+, 7 with 2+ and 4 with 3+ staining), absent in all group When compared with radiology images the 3 involved veins were large primary 2 cases (0/11); and present in 9/10 group 3 cases (2 with 1+, 7 with 2+ and 1 with 3+ tributaries of the MRV. staining, 1 case was not available). Conclusions: 1) Sinus involvement is not routinely mentioned by radiologists 2) Sinus Conclusions: Using KIM-1 as a differentiation marker, the negative staining in CCP- involvement is usually detectable by CT/MRI (9/12) when present 3) Unrecognized RCC suggests derivation from distal nephron tubules and positive staining in XP-TC sinus invasion by radiologists may lead to overestimate of tumor size and understaging suggests derivation from proximal tubules. CD68 expression closely mirrored KIM-1 that can be corrected by education on pathologic features of RCC 4) Discrepant MRV expression both in extent and intensity. The expression of CD68 in RCC subtypes involvement by radiologists versus pathologists affecting the left kidney is due to is a novel finding and in our opinion this CD68 expression most likely represents a differing definitions of what constitutes the MRV. functional relationship with KIM-1, and may not necessarily have a real diagnostic utility; although this finding needs further evaluation. Gynecologic & Obstetrics 985 Venous Invasion in Renal Cell Carcinoma: Preoperative Imaging- Gross Correlation. 986 Secretory Cell Expansion of the Fallopian Tube Epithelium May CX Zhao, KO Ojemakinde, A Bhalodia, M Heldmann, D Elmajian, SM Bonsib. Louisiana Represent an Initial Cellular Change in Pelvic Serous Carcinogenesis. State University Health Sciences Center-Shreveport, Shreveport. N AbuShahin, L Xiang, O Fadare, B Kong, W Zheng. University of Arizona Collage Background: Renal sinus vein (SV) invasion is the principal invasive pathway for most of Medicine, Tucson; Vanderbilt University School of Medicine, Nashville, TN; Qilu renal cell carcinomas(RCC). Emphasis on nephron sparing surgery requires accurate Hospital, Shandong University, Jinan, Shandong, China. preoperative imaging to optimize surgical strategies. Computed tomography (CT) and Background: The distal fallopian tube is a common site of origin for tubal intraepithelial magnetic resonance imaging (MRI) are the most sensitive studies for preoperative carcinoma and pelvic serous carcinoma in high-risk women (i.e BRCA mutation carriers imaging of RCC. Their accuracy in imaging sinus involvement in RCC has not been and/or those with a breast cancer history). It has recently been further defined at the investigated. cellular level, that the secretory cell as opposed to cililated cell of the fallopian tube is Design: Fifteen cases of RCC were retrospectively selected and staged by 2010 TNM the cell-of-origin of these cancers. However, under normal conditions, secretory and (3-pT1/2, 10-pT3a and 2-pT3b). The original radiology reports were obtained (11 ciliated cells are intimately admixed within the tubal epithelial lining. We hypothesized LSUHSC/4 outside hospitals). A radiologist with expertise in urologic imaging received that a change in ratio between tubal secretory and ciliated cells may represent one of a brief tutorial on sinus invasive properties of RCC and re-examined the CT/MRI images the early steps in the process of female pelvic serous carcinogenesis for sinus invovlement. These interpretations were correlated with RCC gross photos. Design: Cellular compositions (secretory versus ciliated) in fallopian tubal segments Results: The mean tumor sizes were 8.7, 8.9, and 8.2cm by original radiologist, expert (fimbriated end versus ampulla), secretory cell expansion (> 10 but < 30 cells in a radiologist and patholgosist gross examination, respectively. SV invasion was not row) and secretory cell outgrowth (≥ 30 cells in a row) were studied in 3 groups of mentioned in any original CT/MRI reports (0/15) but was present in 12/15 cases by patients: patients with benign gynecologic diseases (“no-risk”), “high-risk” patients pathology review. Upon re-review of CT/MRI by radiology expert following tutorial, as previously defined, and patients with “ovarian” high-grade serous carcinomas. The SV involvement was identified in 9/15. numbers of secretory and ciliated cells were counted by 2 methods: light microscopy RCC Tumor Stage Frequencies and immunostainings with PAX8 for secretory cells and tubulin for ciliated cells. The Interpretation pT1/2 pT3 ratio of cellular compositions was statistically compared among the 3 groups SV MRV Results: As compared with the “no risk” group, the numbers of tubal secretory cells Original Radiologist 14 0 1 Expert Radiologist 6 3 6 in the high-risk and cancer groups were increased by a factor of at least 2 and 4 Pathologist 3 3 9 respectively. The frequency of secretory cell expansion was 3 to 4-fold higher in the Main renal vein (MRV) involvement was noted in 6/15 cases by expert radiologist but high-risk and cancer groups, while the frequency of secretory cell outgrowth was 4-fold in 9/15 by patholgists. The 3 discrepant cases involved the left kidney. higher in the high-risk and 6-fold higher in the cancer group, respectively. Overall, immunohistochemistry with PAX8 and tubulin was more sensitive than morphologic evaluation for distinguishing the cell types. There was no significant difference between the tubal fimbriated end and ampulla regarding the number of secretory cells Conclusions: An increase in the number of secretory cells in fallopian tube epithelium may represent an early, morphologically identifiable event in the process of pelvic serous carcinogenesis, although the underlying molecular mechanism of secretory cell expansion or outgrowth and how they eventuate in cancers, remain unclear. 234A ANNUAL MEETING ABSTRACTS 987 Correlation of the Volume of Carcinomatous Component with the 989 EZH2 Expression Correlates with Increased Angiogenesis in Clinical Stage and Nodal Metastasis in Uterine Carcinosarcoma. Ovarian Carcinoma. Y Ahmed, H Nasser, M Al-Hajeili, T Kuntzman, B Albashiti, R Ali-Fehmi, P Mazzara, B Albashiti, A Sood, S Bandyopadhyay, A Semaan, A Munkarah, Y Hussein, Q Ahmed, L Fathallah. St John Providence Hospital and Medical Center, Detroit, MI; William R Morris, R Ali-Fehmi. Wayne State Universty, Detroit, MI; Henry Ford Hospital, Beaumont Hospital, Royal Oak, MI; Wayne State University, Detroit, MI. Detroit; MD Anderson Cancer Center, Houston, TX. Background: Carcinosarcoma (CS), also known as malignant mixed Müllerian tumor Background: We recently discovered EZH2, a polycomb repressor, to have substantially is an uncommon biphasic neoplasm composed of malignant epithelial and stromal increased expression in tumor endothelial cells. In this study, we examined the clinical components that can arise in any genital organ but most frequently in the uterus. and functional significance of EZH2 and its correlation with VEGF and angiogenesis Prognostic factors that influence the clinical outcome of the patient remain a matter in ovarian carcinoma. of controversy. However, the most important prognostic factor is the clinical stage at Design: Cell lines: Mouse ovarian endothelial cells (MOEC) were transfected with the the time of initial treatment. The objective
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