LAUSR

Nephrogenic adenomas are uncommon benign lesions that are typically cytologically bland, but degenerative and reactive changes may make it difficult to distinguish these lesions from malignant entities, such as urothelial carcinoma and prostatic adenocarcinoma. In this study, we explored whether napsin A, a sensitive marker for lung adenocarcinoma, may also have a role in distinguishing nephrogenic adenoma from other genitourinary lesions. Immunohistochemically, napsin A was expressed in all 43 nephrogenic adenomas (bladder 38, prostatic urethra 4, and ureter 1; mean positive tumor cells 72%, median 80%, range 15-100%) and showed regional variability in its expression pattern with a bias towards surface architectures (flat, papillary) compared to stromal architectures (tubular/glandular, microcystic). We also compared napsin A to other markers including PAX8, GATA3, p63 and 34BE12. While napsin A matched PAX8 in terms of its sensitivity for nephrogenic adenoma (100%), napsin A stained a lower percentage of tumor cells than PAX8 (72% vs 99%, p =1.0 x10-5). P63 was negative in all nephrogenic adenomas whereas GATA3 showed variable staining in 25 cases (58%). All 43 nephrogenic adenomas showed variable 34BE12 staining. Finally, we profiled napsin A expression among 401 genitourinary tumors on tissue microarrays (n=308) and full tissue blocks (N=93), and observed napsin A positivity in 37 tumors (9%) which included urothelial carcinomas with the glandular/microcystic component differentiation (in the glandular/microcystic component in 4/6), bladder adenocarcinomas (primary 4/4 and metastatic 3/3), urinary tract clear cell carcinomas (primary 8/9, 1/1 metastatic uterine primary) and some renal tumors (17/174). All 81 pure urothelial carcinomas and 53 prostatic acinar adenocarcinomas were negative for napsin A. Our study indicates that napsin A is a highly sensitive marker for nephrogenic adenoma and can serve as a useful addition in immunohistochemical panels seeking to distinguish it from pure urothelial carcinoma and prostatic acinar adenocarcinoma but not clear cell carcinoma or urothelial carcinoma with glandular differentiation.