Is immunohistochemical expression of GATA3 helpful in the differential diagnosis of transformed mycosis fungoides and primary cutaneous CD30-positive T cell lymphoproliferative disorders?
Is immunohistochemical expression of GATA3 helpful in the differential diagnosis of transformed mycosis fungoides and primary cutaneous CD30-positive T cell lymphoproliferative disorders?
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DOI：
10.1007/s00428-021-03056-y
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发表时间：
2021-02-18
期刊：
影响因子：
3.5
通讯作者：
Torres-Cabala, Carlos A.
中科院分区：
文献类型：
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作者：
Collins, Katrina;Gu, Jun;Torres-Cabala, Carlos A.
蕈样真菌病伴大细胞转化（MFLCT）很难与原发性皮肤CD30+ T细胞淋巴增生性疾病（PC CD30+ LPD）区分，尤其是原发性皮肤间变性大细胞淋巴瘤（PC- alcl）。这种诊断区分对于适当的患者管理至关重要。有人提出，GATA3可用于区分这两个实体。我们确定了2002年至2019年在我院诊断的25例MFLCT和24例PC CD30+ LPD（包括淋巴瘤样丘疹病（n=14）， PC- alcl （n=6）和CD30+ LPD，未另行说明（n=4））。对存档标本切片进行染色，免疫组化评价GATA3的表达，并比较皮肤CD30+ T细胞lpd之间的差异。大多数MFLCT队列患者的表皮T细胞中GATA3表达强烈，弥漫性表达范围为0 - 100%（平均53.20%），其中15/25例（60%）的GATA3表达大于50%，而PC CD30+ LPD组的表皮T细胞中GATA3表达不稳定，中度表达范围为0 - 60%（平均23.26%），5/6例（83%）的GATA3表达小于40% （p =0.003）。计算的敏感性和特异性分别为56%和74%，阳性预测值和阴性预测值分别为70%和61%。根据阳性细胞的百分比染色，使用50%作为表达的截止值，GATA3可能是区分MFLCT与PC CD30+ lpd（包括PC- alcl）的有用免疫组织化学标记物。
Mycosis fungoides with large cell transformation (MFLCT) can be difficult to distinguish from primary cutaneous CD30+ T cell lymphoproliferative disorders (PC CD30+ LPD), especially primary cutaneous anaplastic large cell lymphoma (PC-ALCL). This diagnostic distinction is critical for appropriate patient management. GATA3 has been proposed to be useful in the discrimination between these two entities. We identified 25 cases of MFLCT and 24 cases of PC CD30+ LPDs (including lymphomatoid papulosis (n=14), PC-ALCL (n=6), and CD30+ LPD, not otherwise specified (n=4)) diagnosed at our institution from 2002 to 2019. Sections from archived specimens were stained to evaluate for GATA3 expression by immunohistochemistry and compared among cutaneous CD30+ T cell LPDs. The majority of the MFLCT cohort had strong, diffuse expression of GATA3 ranging from 0 to 100% of dermal T cells (mean 53.20%) with 15/25 cases (60%) showing GATA3 expression greater than 50%, while the PC CD30+ LPD group showed variable, moderate GATA3 labeling ranging from 0 to 60% of dermal T cells (mean 23.26%), with 5/6 cases (83%) showing GATA3 expression less than 40% (p =0.003). The calculated sensitivity and specificity were 56% and 74%, while positive and negative predictive values were 70% and 61%, respectively. Based on the percent staining of positive cells, using 50% as a cutoff value for expression, GATA3 might be a useful immunohistochemical marker to discriminate MFLCT from PC CD30+ LPDs, including PC-ALCL.