摘要目的 探讨碳酸酐酶Ⅸ(CAⅨ)、PAX2及PAX8在不同类型肾上皮性肿瘤中的表达及临床病理意义.方法 采用免疫组织化学EnVision法对155例不同类型肾肿瘤及4例远处转移性透明细胞性肾癌进行CAⅨ、PAX2及PAX8的表达检测.选取96例癌旁肾组织、8例透明细胞性肝癌和2例皮肤透明细胞汗腺瘤作对照.结果 (1)CAⅨ在94.0％(63/67)的透明细胞性肾癌中表达,77.8％ (49/63)呈弥漫强阳性,在乳头状肾细胞癌、集合管癌和肾盂尿路上皮癌有不同程度表达,均呈灶状阳性,而在嫌色细胞癌、嗜酸细胞瘤和癌旁肾组织均不表达.4例远处转移性透明细胞性肾癌均为弥漫性强表达,CAⅨ在透明细胞性肾癌中的表达与组织学分级、临床分期、远处转移等无关(均P＞0.05).透明细胞性肝癌和透明细胞汗腺瘤呈灶状阳性.(2) PAX2在各种肾上皮性肿瘤以及透明细胞性肝癌和透明细胞汗腺瘤均有表达.(3) PAX8在各种肾上皮性肿瘤均高表达,肾盂尿路上皮癌低表达(4/10),而8例透明细胞性肝癌和2例透明细胞汗腺瘤均不表达.(4)CAⅨ对透明细胞性肾癌的诊断具有较高的敏感性和特异性；PAX2对肾源性肿瘤具有较高的敏感性,但特异性较差；PAX8对肾源性肿瘤具有较高的敏感性和特异性.结论 CAⅨ是透明细胞性肾癌高度敏感和特异的免疫标志物,可用于透明细胞性肾癌与其他类型肾上皮性肿瘤以及其他非肾源性透明细胞肿瘤的鉴别.PAX2对肾肿瘤的敏感性高,而特异性低；PAX8对肾源性上皮性肿瘤的判断具有重要意义.联合应用上述3种指标对肾上皮性肿瘤的诊断和鉴别诊断具有重要提示作用.

abstractsObjective To study the expression of carbonic anhydrase Ⅸ (CA Ⅸ),PAX2 and PAX8 in different types of renal epithelial tumor and their association with clinicopathologic characteristics.Methods Immunohistochemical study by EnVision method was performed in order to assess the expression of CAⅨ,PAX2 and PAX8 in 155 cases of renal cell carcinoma and4 cases of metastatic clear cell renal cell carcinoma (CCRCC).Ninety-six cases of non-neoplastic renal parenchymal tissue adjacent to CCRCC,8 cases of clear cell hepatocellular carcinoma and 2 cases of clear cell hidradenoma were used as controls.Results CAⅨ was commonly expressed in CCRCC (94.0％,63/67),of which 77.8％ (49/63) showed strong positivity.CAⅨ was focally positive in papillary renal cell carcinoma,collecting duct carcinoma and urothelial carcinoma of renal pelvis.It was negative in chromophobe renal cell carcinoma,oncocytoma and adjacent non-neoplastic renal tissue.CAⅨ was also strongly expressed in the 4 cases of metastatic CCRCC.Focal expression of CAⅨ was demonstrated in the 8 cases of clear cell hepatocellular carcinoma and 2 cases of clear cell hidradenoma.The expression of CAⅨ in CCRCC did not correlate with tumor grading,clinical staging and presence of distal metastasis.On the other hand,PAX2 showed positive expression in different types of renal epithelial tumor,clear cell hepatocellular carcinoma and clear cell hidradenoma in various degrees.In contrast,PAX8 was commonly expressed in all types of renal epithelial tumor,with the exception of urothelial carcinoma of renal pelvis.PAX8 was not expressed in clear cell hepatocellular carcinoma and clear cell hidradenoma.Regarding diagnosis of CCRCC,CAⅨ demonstrated high sensitivity and specificity.PAX2 showed high specificity but low sensitivity.PAX8 was sensitive and specific in the diagnosis of renal epithelial tumor.Conclusions CAⅨ is a useful immunohistochemical marker with high specificity and sensitivity in distinguishing CCRCC from other types of renal epithelial tumor and clear cell tumors of non-renal origin.PAX2 is a marker with high sensitivity and low specificity for diagnosis of renal epithelial tumors.PAX8 is typically expressed in renal epithelial tumors.The combined detection of CAⅨ,PAX2 and PAX8 is useful in the diagnosis and differential diagnosis of renal epithelial tumors.