title: Carcinomas of ovary and lung with clear cell features: can immunohistochemistry help in differential diagnosis?
abstract: Metastatic lung carcinomas with clear cell morphology can be confused with primary ovarian clear cell carcinomas. We performed immunohistochemical stains in 14 cases of non-small cell lung carcinomas with clear cell features and 14 cases of ovarian clear cell carcinomas using a panel of markers, including thyroid transcription factor 1 (TTF-1), carcinoembryonic antigen (CEA), Wilms tumor gene 1, octamer-binding transcription factor 4 (OCT-4), cancer antigen 125 (CA-125), estrogen receptor, and progesterone receptor. Among non-small cell lung carcinomas with clear cell features, 87.5% of adenocarcinomas (or 50% overall frequency in lung carcinomas) were positive for TTF-1, whereas none of the ovarian clear cell carcinomas were positive (P = 0.002). All 14 ovarian clear cell carcinomas stained for CA-125 as compared with 1 non-small cell lung carcinoma (P < 0.001). On the other hand, 85% of non-small cell lung carcinomas stained for CEA, whereas none of the ovarian clear cell carcinomas did (P < 0.001). Interestingly, 4 ovarian clear cell carcinomas (28%) showed positive staining for the germ cell marker OCT-4. Either lung or ovarian carcinomas stained for Wilms tumor gene 1, estrogen receptor, or progesterone receptor very infrequently; and the difference between the 2 groups was not statistically significant. Our results suggest that an immunohistochemical panel consisting of TTF-1, CEA, CA-125, and OCT-4 is helpful in distinguishing most pulmonary and ovarian carcinomas with clear cell features.
authors.affiliation: Department of Pathology, Stony Brook University Hospital, New York, NY, USA.
authors.forename: Nicole R
authors.initials: NR
authors.lastname: Howell
authors.forename: Wenxin
authors.initials: W
authors.lastname: Zheng
authors.forename: Liang
authors.initials: L
authors.lastname: Cheng
authors.forename: Carmen
authors.initials: C
authors.lastname: Tornos
authors.forename: Philip
authors.initials: P
authors.lastname: Kane
authors.forename: Michael
authors.initials: M
authors.lastname: Pearl
authors.forename: Eva
authors.initials: E
authors.lastname: Chalas
authors.forename: Sharon X
authors.initials: SX
authors.lastname: Liang
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000175:diagnosis* / Q000378:metabolism / Q000556:secondary; D000328:Adult; D014408:Biomarkers, Tumor / Q000378:metabolism; D018394:CA-125 Antigen / Q000235:genetics / Q000378:metabolism; D002272:Carcinoembryonic Antigen / Q000235:genetics / Q000378:metabolism; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D009687:Nuclear Proteins / Q000235:genetics / Q000378:metabolism; D050814:Octamer Transcription Factor-3 / Q000235:genetics / Q000378:metabolism; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000556:secondary; D000074482:Thyroid Nuclear Factor 1; D014157:Transcription Factors / Q000235:genetics / Q000378:metabolism
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D002272:Carcinoembryonic Antigen; C000614412:NKX2-1 protein, human; D009687:Nuclear Proteins; D050814:Octamer Transcription Factor-3; D000074482:Thyroid Nuclear Factor 1; D014157:Transcription Factors