PAX8 Reliably Distinguishes Ovarian Serous Tumors From Malignant Mesothelioma
PAX8 Reliably Distinguishes Ovarian Serous Tumors From Malignant Mesothelioma
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DOI：
10.1097/pas.0b013e3181da7687
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发表时间：
2010-05-01
影响因子：
5.6
通讯作者：
Hirsch, Michelle S.
中科院分区：
文献类型：
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作者：
Laury, Anna R.;Hornick, Jason L.;Hirsch, Michelle S.
卵巢浆液性肿瘤可与恶性间皮瘤在形态学上重叠。这种区别在临床上很重要，但大多数研究未能确定可靠区分这两种肿瘤类型的免疫染色。最近，转录因子PAX8被证明是一个敏感且相对特异性的缪勒管肿瘤标志物。此外，一些研究表明，与浆液性卵巢肿瘤相比，h-caldesmon对间皮瘤具有敏感性和特异性。本研究的目的是评估PAX8和h-caldesmon的表达是否可以成功区分间皮瘤和浆液性卵巢肿瘤。采用PAX8和h-caldesmon抗体对254例卵巢浆液性肿瘤和50例卵巢间皮肿瘤的档案组织进行免疫组化。PAX8和h-caldesmon的核和细胞质免疫反应性分别为阳性。99%的高级别浆液性卵巢癌和所有（100%）低级别卵巢癌和浆液性交界性肿瘤均有PAX8染色；然而，只有74%的病例（188/254）在50%以上的肿瘤细胞中呈弥漫性阳性，且强度由强到弱不等。所有胸膜恶性间皮瘤均无PAX8反应。然而，2/23（9%）腹膜恶性间皮瘤显示局灶性和/或弱PAX8染色；其余病例为阴性。2例分化良好的乳头状间皮瘤和1例多囊间皮瘤均有PAX8染色。除1例胸膜恶性间皮瘤呈斑片状免疫反应外，所有浆液性肿瘤和间皮瘤中H-caldesmon均为阴性。与腹膜和胸膜恶性间皮瘤相比，强PAX8染色对卵巢浆液性肿瘤具有高度特异性（P < 0.00001）。3例“非侵袭性”间皮瘤中PAX8的弱染色对PAX8在鉴别诊断中的应用提出了质疑。基于这项研究，h-caldesmon不是间皮瘤的有用标记物。
Ovarian serous neoplasms can have morphologic overlap with malignant mesothelioma. The distinction is clinically important, yet most studies have failed to identify immunostains that reliably distinguish these 2 tumor types. Recently, transcription factor PAX8 was shown to be a sensitive and relatively specific marker for Mullerian tumors. In addition, some studies suggest that h-caldesmon is sensitive and specific for mesothelioma when compared with serous ovarian tumors. The goal of this study was to evaluate whether PAX8 and h-caldesmon expression can successfully distinguish mesothelioma from serous ovarian tumors. Immunohistochemistry was carried out using PAX8 and h-caldesmon antibodies on archival tissue from 254 ovarian serous tumors and 50 mesothelial tumors. Nuclear and cytoplasmic immunoreactivity were considered positive for PAX8 and h-caldesmon, respectively. PAX8 staining was present in 99% of high-grade serous ovarian carcinomas and all (100%) low-grade ovarian carcinomas and serous borderline tumors; however, only 74% of these cases (188/254) were diffusely positive in more than 50% of tumors cells, and intensity ranged from strong to weak. None of the pleural malignant mesotheliomas were reactive with PAX8. However, 2/23 (9%) peritoneal malignant mesotheliomas showed focal and/or weak staining for PAX8; the remaining cases were negative. Two well-differentiated papillary mesotheliomas and 1 multicystic mesothelioma each showed some staining for PAX8. h-caldesmon was negative in all serous neoplasms and all mesothelial neoplasms, except 1 pleural malignant mesothelioma which showed patchy immunoreactivity. Strong PAX8 staining is highly specific (P < 0.00001) for ovarian serous tumors when compared with malignant mesotheliomas of the peritoneum and pleura. The presence of weak staining for PAX8 in the 3 "noninvasive" mesotheliomas questions the use for PAX8 in this differential diagnosis. On the basis of this study, h-caldesmon is not a useful marker for mesothelioma.