The diagnostic utility of carbonic anhydrase IX, α-methylacyl-coenzyme A racemase, and BSND in classifying renal cell carcinoma: an immunohistochemical study

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Renal cell carcinoma (RCC), the most common malignant renal epithelial tumor, has three main subtypes – clear cell renal cell carcinoma (cc-RCC), papillary renal cell carcinoma (pp-RCC), and chromophobe renal cell carcinoma (cp-RCC). These subtypes have overlapping cytoarchitectural features, especially in inadequate tissue samples. As each subtype has a different course and prognosis, it is important to classify them accurately using novel biomarkers.


The objective of this study was to evaluate the diagnostic ability of carbonic anhydrase IX (CA IX), α-methylacyl-coenzyme A racemase (AMACR), and Bartter-syndrome, type-4a Sensorineural-deafness & renal dysfunction (BSND) expression in differentiating the three main types of RCC – cc-RCC, pp-RCC, and cp-RCC.

Patients and methods

Immunohistochemical expressions of CA IX, AMACR, and BSND were assessed in 50 paraffin blocks from patients with RCC.


CA IX was significantly positive in cases of cc-RCC (P<0.001); AMACR was significantly positive in pp-RCC (P<0.001); and BSND expression was significantly positive (P<0.001) in cp-RCC.


An immunohistochemical panel of the three markers AMACR, CA IX, and BSND could differentiate between the three main subtypes of RCC with high sensitivity and specificity.

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