IMMUNOHISTOCHEMICAL, SEROLOGICAL AND MOLECULAR PROFILE OF CELIAC DISEASE IN KASHMIRI POPULATION - A PROSPECTIVE STUDY AT TERTIARY CARE HOSPITAL

Abstract

Background: Renal cell carcinoma (RCC) is the third most common cancer of the genitourinary tract and the most lethal urologic cancer, accounting for approximately 2% of adult malignancies and 90-95% of neoplasms arising from the kidney. The staining pattern is nuclear for PAX2, PAX8, and TFE3; combined nuclear and cytoplasm stain for S100A and S100P: and cytoplasmic/cell membrane stain for other markers. All major types of renal tumors express cytokeratin 18 (CK18) , whereas CK20 is negative in all of them.

Objectives: (i) To study the histopathological spectrum of renal tumors. (ii) To confirm the diagnosis by immunohistochemistry (IHC) . (iii) To study the distribution of renal tumors according to age and gender.

Methods: This study was conducted in the Department of Pathology at Sher-i-Kashmir Institute of Medical Sciences (SKIMS) , Srinagar. It was a prospective study of 1 & ½ years from September 2017 to March 2019. The study was conducted after taking permission from SKIMS Ethical Committee. Complete clinical details, examination findings, and radiological investigations of all patients were studied. Both excised specimen and renal biopsies were included. The excised tissue specimens were processed routinely and stained with Haematoxylin and Eosin and examined special stains, and immunohistochemistry was performed as required.

Results: Out of a total of 62 biopsies received, 82.3% were large biopsies while only 17.7% were small biopsies. The mean age in the small biopsy group was 44.8+11.52 years, and that in the large biopsy, the mean age was 42.7+13.99 years. There were 72.7% clear cell type RCC, 18.2% papillary type RCC, and 9.1% chromophobe RCC in small biopsies; whereas in large biopsies, 82.4% were clear cell type RCC, 11.8% were papillary type RCC, 3.9% were chromophobe RCC, and 2% were sarcomatoid RCC on histopathology.43.1% of tumors were in the middle pole, 33.3% in the upper pole, and 23.5% in the lower pole.60.8% tumors were 5-19cm, 31.4% were sized <5cm while as >10cm 7.8% tumors. As per Furhman’s grade, 54.9% had Grade II, 33.3% had grade III, 7.8% had grade I, while 3.9% had grade IV.88.2% of patients had N0 involved, 11.8% had N1 lymph nodes involved.47.1% had stage II tumours, 35.3% with stage I, 11.8% with stage III, and 5.9% with stage IV. On immunohistochemistry, there were 55.6% positive on PAX2, 88.0% were positive on CD10, 61.1% were positive on Vimitin, 66.7%, 83.3%, 22.2% were positive on CK, EMA, and CK7.

Conclusion: The common diagnostic situations that call for immunohistochemical staining are differential diagnoses of renal versus nonrenal neoplasms, histologic subtyping of renal cell carcinoma, diagnosis of rare primary renal neoplasms, diagnosis of renal neoplasms in small core-biopsy specimens, diagnosis of possible metastatic renal carcinomas, and less frequently, molecular prognostication.