Renal tumors antibodies

Skinnider BP, Polpe AL, Hennigar RA, et al. Distribution of cy-tokeratins and vimentin in adult renal neoplasms and normal renal tissue potential utility of a cytokeratin antibody panel in the differential diagnosis of renal tumors. Am J Surg Pathol. 2005 29 747. 

Unwin, R. D., Hamden, P., Pappin, D., Rahman, D., Whelan, P., Craven, R. A., et al. (2003) Serological and proteomic evaluation of antibody responses in the identification of tumor antigens in renal cell carcinoma. Proteomics 3,45-55. 

There are several individual and serial case reports of patients with tumors and extrapyramidal features such as chorea, ballistic movements, and dystonia [35, 63-65]. Again, SCLC is the most common associated tumor, but renal cancer and lymphoma are also reported [65]. Patients with Hu or Ma antibodies can exhibit extrapyramidal symptoms as part of the multifocal CNS involvement [65, 66], whereas CRMP-5 is probably the most common antibody associated with paraneoplastic chorea. Coexisting neuronal antibodies are found in 50% of the CRMP-5 positive cases, and accompanying symptoms such as vision loss, LE, loss of smell or taste, and peripheral neuropathy are often present [65]. Movement disorders are uncommon in CRMP-5 positive patients in general, being a clinical feature in only 15% (subacute chorea in 11%) [30]. In some patients, paraneoplastic causation is strongly suspected even when no known onconeural antibody is detected [64, 65]. Individual patients have shown clinical improvement and decline in antibody levels after chemotherapy or methylprednisolone [65, 67]. 

Antibodies to these PEMs are directed to the apical membrane portions of secretory mammary cells surrounding milk fat globules (mol wt >250 kDa). They react with a variety of epithelial tumors, including mesotheliomas. Like keratin, these antibodies are also expressed on synovial sarcomas, epithelioid sarcomas, and chordomas. They are not as reactive with as wide a variety of tumors as antikeratins. For instance, they do not react with many endocrine tumors. However, they may recognize some renal-cell carcinomas and small-cell anaplastic carcinomas... 

OKT3, an immunosuppressive monoclonal antibody, can induce systemic vascular changes (leaky syndrome) and prerenal azotemia, presumably by stimulating the release of cytokines (e.g., tumor necrosis factor). These effects are seen more often in poorly hydrated patients. There is also evidence that OKT3 may induce a direct tubular toxicity, since significant numbers of patients developing renal insufficiency also exhibit enzymuria. 

D2-40, a clone of podoplanin, is a recently developed commercially available antibody directed against the M2A antigen, a 40,000-kD sialoglycoprotein associated with germ cells and lymphatic endothelium. Chu and colleagues evaluated 53 cases of mesothelioma, 28 cases of reactive pleural tissue, 30 cases of pulmonary adenocarcinoma, 35 cases of renal cell carcinoma, 26 cases of ovarian serous carcinoma, 16 cases of invasive breast carcinoma, 11 cases of prostatic adenocarcinoma, and 7 cases of urothelial carcinoma. The authors found D2-40 expression in 51 of 53 (96%) mesotheliomas, 27 of 28 (96%) reactive pleural tissues, and 17 of 26 (65%) ovarian serous carcinomas. They did not find D2-40 in the other tumors examined. The authors also observed that the neoplastic cells immunostained in a cell membrane distribution. 

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