Immunoperoxidase labelled antibody staining in differential diagnosis of central nervous system haemangioblastomas and central nervous system metastases of renal carcinomas.

Abstract

In the general laboratory these tumours present a diagnostic problem in that they are often histologically indistinguishable from central nervous system (CNS) metastases of renal clear cell carcinomas, as both entities are highly vascular with stromal clear cells, as seen by haematoxylin and eosin and reticulin stains, and both may show positivity in the stromal cells when stained with periodic Schiff reagent and variable positivity when stained for fat.' This difficulty is occasionally compounded by the coexistence of haemangioblastomas and renal carcinomas in patients with the von Hippel-Lindau syndrome. We used a range of immunoperoxidase labelled antibodies to address this problem of differential diagnosis of the two entities.

Immunoreactivity of CD10 and inhibin alpha in differentiating hemangioblastoma of central nervous system from metastatic clear cell renal cell carcinoma

“…Immunoreactivity in the stromal cells includes: NSE, Leu M1, glial fibrillary acidic protein, hormone receptor, vimentin, vascular endothelial growth factor, rennin, and erythropoietin. 1,2,6,[22][23][24][25] In early reports, stromal cells of hemangioblastoma are invariably negative for EMA and cytokeratin. Currently, an immunohistochemical panel of markers comprising of NSE and CD10 and inhibin alpha in hemangioblastoma and renal cell carcinoma S-M Jung and T Kuo EMA provides the most valuable means of discriminating hemangioblastoma from clear cell renal cell carcinoma.…”

“…In the majority of cases of hemangioblastoma, NSE is positive and EMA is negative, where the opposite is seen in cases of clear cell renal cell carcinoma. 2,5 However, NSE is not a specific marker and the presence of weak cytoplasmic staining in some renal cell carcinomas weakened this distinction. 5 Recently, inhibin A was demonstrated to be a useful marker in distinguishing hemangioblastoma from metastatic clear cell renal cell carcinoma.…”

“…1 The differential diagnosis between hemangioblastoma and metastatic clear cell renal cell carcinoma to the central nervous system can be difficult because striking morphologic similarities exist between them, in addition to the association between von HippelLindau disease and clear cell renal cell carcinoma. [1][2][3] Studies have shown that loss of von Hippel-Lindau tumor suppressor gene on chromosome 3 is found in familial and sporadic cerebellar hemangioblastoma as well as clear cell renal cell carcinoma. 4 However, since the clinical course and management of these two diseases are totally different, it is important to distinguish hemangioblastoma from metastatic clear cell renal cell carcinoma.…”

“…In most of the cases, the renal cell carcinomas showed immunopositive for epithelial membranous antigen (EMA) and immunonegative for neuron-specific enolase (NSE), while the hemangioblastoma showed immunopositive for NSE and immunonegative for EMA. 2,[5][6][7] The previous reports presented uniformly effectiveness of EMA in this distinction. 2,5 However, equivocal results with neoplasms staining for both markers or failure to stain for either marker could happen.…”

“…2,[5][6][7] The previous reports presented uniformly effectiveness of EMA in this distinction. 2,5 However, equivocal results with neoplasms staining for both markers or failure to stain for either marker could happen. Therefore, further research for methods to differentiate these two entities is necessary.…”