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p63 Immunohistochemistry Differentiates Salivary Gland Oncocytoma and Oncocytic Carcinoma from Metastatic Renal Cell Carcinoma

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Abstract

Metastatic renal cell carcinoma (RCC) can pose diagnostic challenges in the head and neck often resembling benign and malignant oncocytic lesions. Immunohistochemical panels have been reported to help with this differential but are not entirely specific or sensitive. We have noticed that p63 routinely stains salivary gland oncocytomas but not metastatic RCC. Nineteen oncocytomas, 9 cases of oncocytosis, 9 oncocytic carcinomas and 16 head and neck metastatic RCC were studied. Morphologic features evaluated were cytoplasmic character (clear versus oncocytic), Fuhrman nuclear grade, mitotic rate, growth pattern, presence of lumens/blood lakes and stromal characteristics. Tumors were stained with antibodies to p63, renal cell carcinoma marker (RCCm), CD10, and vimentin. Eight benign oncocytic tumors (29%) had clear cell features while 6 metastatic RCC (37%) had oncocytic features. Median Fuhrman nuclear grade was 2 in oncocytoma and oncocytosis and 3 both oncocytic carcinoma and metastatic RCC. Mitotic rates were only significantly different between benign oncocytic tumors and metastatic RCC. All oncocytomas had lumina compared to half of metastatic RCC, all of which also demonstrated blood lakes. Seven benign oncocytic tumors (25%) and 5 oncocytic carcinomas (56%) had RCC-like vascular stroma. All primary salivary gland tumors were positive for p63, predominately in basal cell-type distribution. None of the metastatic RCC was positive. RCCm was entirely specific but lacked sensitivity for metastatic RCC while CD10 and vimentin showed variable sensitivity and specificity. While clinical history and morphology usually are adequate, demonstration of p63 staining can definitively exclude metastatic RCC from the differential diagnosis of similar appearing tumors in salivary glands, namely oncocytoma and oncocytic carcinoma, with 100% specificity and sensitivity. While RCCm, CD10, and vimentin performed adequately, they were significantly less reliable than p63 with both false positives and false negatives.

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Acknowledgment

The authors would like to thank Ms. Kim Adams for help in preparation of this manuscript.

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Authors and Affiliations

  1. Department of Pathology, University of Michigan Medical Center, 1500 E. Medical Center Dr. Room 2G332 UH, Ann Arbor, MI, 48109-0054, USA

    Jonathan B. McHugh

  2. Department of Pathology, The Cleveland Clinic, Cleveland, USA

    Aaron P. Hoschar

  3. Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, USA

    Mari Dvorakova, Anil V. Parwani, E. Leon Barnes & Raja R. Seethala

Authors
  1. Jonathan B. McHugh
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  2. Aaron P. Hoschar
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  3. Mari Dvorakova
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  4. Anil V. Parwani
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  5. E. Leon Barnes
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  6. Raja R. Seethala
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Corresponding author

Correspondence to Jonathan B. McHugh.

Additional information

The results of this study were presented at the 96th Annual Meeting of the United States and Canadian Academy of Pathologists in San Diego, CA, March 2007.

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McHugh, J.B., Hoschar, A.P., Dvorakova, M. et al. p63 Immunohistochemistry Differentiates Salivary Gland Oncocytoma and Oncocytic Carcinoma from Metastatic Renal Cell Carcinoma. Head and Neck Pathol 1, 123–131 (2007). https://doi.org/10.1007/s12105-007-0031-4

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  • DOI: https://doi.org/10.1007/s12105-007-0031-4

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