Xp11 / TFE3 Translocation Carcinoma of the Kidney
Differential Diagnosis
- Translocation carcinoma should be considered in the following situations
- Any clear or papillary renal carcinoma in a patient under 35
- Any carcinoma combining papillary with clear cell features
- Any carcinoma with nests of cells with voluminous cytoplasm
- Any carcinoma with large numbers of psammoma bodies
- Immunohistochemistry can be useful in such cases
- FISH or PCR may be required to make the diagnosis
Immunohistochemistry for the differential diagnosis of renal translocation carcinomas
| CD10 | Racemase | CK7 | EMA | CD117 | |
|---|---|---|---|---|---|
| Translocation Ca | >90% | >90% | neg | neg | neg |
| Clear Cell Ca | >90% | 0-20% | neg | >90% | neg |
| Papillary Ca | >90% | >90% | >90% | >90% | neg |
| Chromophobe Ca | neg | neg | >90% | >90% | >90% |
| Xp11 Translocation Renal Cell Carcinoma | Clear Cell Tubulopapillary Renal Cell Carcinoma |
|---|---|
| Frequently occurs under age 20 | Mean age 60 |
| Typically high grade nuclear features | Low grade nuclear features |
| Voluminous cytoplasm | Moderate amount of clear cytoplasm |
| TPE3 immunostain or FISH positive in >80% | Lacks Xp11 translocations |
| CK7 and other keratins negative to weak, CD10 pos, Racemase/AMACR pos | CK7 strong pos, CD10 neg, Racemase/AMACR neg |
