Transcription factor E3-rearranged renal cell carcinoma (TFE3-RCC) has heterogenous morphologic and immunohistochemical (IHC) features.131 pathologists with genitourinary expertise were invited in an online survey containing 23 questions assessing their experience on TFE3-RCC diagnostic work-up.
Fifty (38%) participants completed the survey. 46 of 50 participants reported multiple patterns, most commonly papillary pattern (almost always 9/46, 19.5%; frequently 29/46, 63%). Large epithelioid cells with abundant cytoplasm were the most encountered cytologic feature, with either clear (almost always 10/50, 20%; frequently 34/50, 68%) or eosinophilic (almost always 4/49, 8%; frequently 28/49, 57%) cytology. Strong (3+) or diffuse (>75% of tumour cells) nuclear TFE3 IHC expression was considered diagnostic by 13/46 (28%) and 12/47 (26%) participants, respectively. Main TFE3 IHC issues were the low specificity (16/42, 38%), unreliable staining performance (15/42, 36%) and background staining (12/42, 29%). Most preferred IHC assays other than TFE3, cathepsin K and pancytokeratin were melan A (44/50, 88%), HMB45 (43/50, 86%), carbonic anhydrase IX (41/50, 82%) and CK7 (32/50, 64%). Cut-off for positive TFE3 fluorescent in situ hybridisation (FISH) was preferably 10% (9/50, 18%), although significant variation in cut-off values was present. 23/48 (48%) participants required TFE3 FISH testing to confirm TFE3-RCC regardless of the histomorphologic and IHC assessment. 28/50 (56%) participants would request additional molecular studies other than FISH assay in selected cases, whereas 3/50 participants use additional molecular cases in all cases when TFE3-RCC is in the differential.Optimal diagnostic approach on TFE3-RCC is impacted by IHC and/or FISH assay preferences as well as their conflicting interpretation methods.
Journal of clinical pathology. 2021 Jan 29 [Epub ahead of print]
Mahmut Akgul, Sean R Williamson, Dilek Ertoy, Pedram Argani, Sounak Gupta, Anna Caliò, Victor Reuter, Satish Tickoo, Hikmat A Al-Ahmadie, George J Netto, Ondrej Hes, Michelle S Hirsch, Brett Delahunt, Rohit Mehra, Stephanie Skala, Adeboye O Osunkoya, Lara Harik, Priya Rao, Ankur R Sangoi, Maya Nourieh, Debra L Zynger, Steven Cristopher Smith, Tipu Nazeer, Berrak Gumuskaya, Ibrahim Kulac, Francesca Khani, Maria S Tretiakova, Funda Vakar-Lopez, Guliz Barkan, Vincent Molinié, Virginie Verkarre, Qiu Rao, Lorand Kis, Angel Panizo, Ted Farzaneh, Martin J Magers, Joseph Sanfrancesco, Carmen Perrino, Dibson Gondim, Ronald Araneta, Jeffrey S So, Jae Y Ro, Matthew Wasco, Omar Hameed, Antonio Lopez-Beltran, Hemamali Samaratunga, Sara E Wobker, Jonathan Melamed, Liang Cheng, Muhammad T Idrees
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