Diagnostic Utility of SALL4 in Extragonadal Yolk Sac Tumors An Immunohistochemical Study of 59 Cases With Comparison to Placental-like Alkaline Phosphatase, Alpha-fetoprotein, and Glypican-3
Diagnostic Utility of SALL4 in Extragonadal Yolk Sac Tumors An Immunohistochemical Study of 59 Cases With Comparison to Placental-like Alkaline Phosphatase, Alpha-fetoprotein, and Glypican-3
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DOI：
10.1097/pas.0b013e3181ad25d5
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发表时间：
2009-10-01
影响因子：
5.6
通讯作者：
Cao, Dengfeng
中科院分区：
文献类型：
--
作者：
Wang, Fenghua;Liu, Aijun;Cao, Dengfeng
腺外卵黄囊肿瘤(原发和转移性)很少见，但属于恶性生殖细胞肿瘤。如果没有免疫组织化学标记物，性腺外肿块的病理诊断可能具有挑战性，但用于诊断这些肿瘤的标记物，如胎盘样碱性磷酸酶(PLAP)、甲胎蛋白(AFP)和Glypcan-3缺乏足够的敏感性和/或特异性。在早期对性腺生殖细胞肿瘤的研究中，SALL4已被确定为一种新的诊断标志，可用于诊断生殖细胞瘤和其他类型的原始生殖细胞肿瘤。在这里，我们通过免疫组织化学染色，研究了SALL4在59个性腺外囊肿(27个原发性骶尾部，15个原发性非骶尾部，17个转移性)中的诊断价值。我们还将SALL4与PLAP、AFP和Glypcan-3进行了比较。此外，我们对这些肿瘤进行了泛角蛋白、上皮膜抗原和OCT4的免疫组织化学染色。结果显示：59个卵巢均有较强的泛角蛋白染色(其中70%为肿瘤细胞，58个为90%的肿瘤细胞)，其中10个(17%)同时显示局灶性上皮膜抗原染色(3%的肿瘤细胞)。59个眼囊OCT4均为阴性。SALL4在59个月中均呈强阳性表达(54个月中肿瘤细胞90%以上，5个月中70%~85%)。59例中仅39例(66%)PLAP染色阳性，且多为局灶性染色(肿瘤细胞<30%)(28例)。AFP染色阳性者占绝大多数(56/59或95%)，而32例(54%)仅在30%以下的肿瘤细胞中染色。59个卵巢中，18个(30%)瘤细胞染色阳性，10个(17%)瘤细胞染色介于30%~60%之间。在59个卵巢中，PLAP、AFP和Glypcan-3的肿瘤细胞平均染色百分率分别为14%(0%~90%)、35%(0%~95%)和57%(1%~100%)，而SAL4的平均染色百分率为94%(70%~100%)(P<；0.001)。SALL4是否是比PLAP、AFP或GLYPICAN-3更敏感的性外囊肿标志物。
Extragonadal yolk sac tumors (YSTs; primary and metastatic) are rare but are malignant germ cell tumors. Pathologic diagnosis of extragonadal YSTs can be challenging Without immunohistochemical markers but markers used for diagnosing these tumors such as placental-like alkaline phosphatase (PLAP), alpha-fetoprotein (AFP), and glypican-3 lack adequate sensitivity and/or specificity. In earlier studies with gonadal germ cell tumors, SALL4 has been identified its a novel diagnostic marker for YSTs and other types of primitive germ cell tumors. Here, we investigated the diagnostic utility of SALL4 in 59 extragonadal YSTs (27 primary sacrococcygeal, 15 primary nonsacrococcygeal, and 17 metastatic) by immunohistochemical staining. We also compared SALL4 with PLAP, AFP, and glypican-3. In addition, we performed immunostains for pancytokeratin, epithelial membrane antigen, and OCT4 in these tumors. Our results showed that all 59 YSTs showed strong pancytokeratin staining (70% tumor cells in I case, > 90% tumor cells in 58) and 10 (17%) of them also showed focal epithelial membrane antigen staining ( < 3% tumor cells). All 59 YSTs were negative for OCT4. Strong SALL4 staining wits seen in all 59 YSTs (in more than 90% tumor cells in 54 and 70% to 85% tumor cells in 5 YSTs). Only 39 of 59 (66%) YSTs showed positive PLAP staining and the staining was often focal (in less than 30% tumor cells) (28 of 39 cases). Positive AFP staining wits seen in the vast majority of YSTs (56 of 59 or 95%); however, 32 (54%) YSTs showed staining in less than 30% tumor cells. Although all 59 YSTs showed positive glypican-3 staining, 18 (30%) showed staining in less than 30% tumor cells, and additional 10 (17%) showed staining in between 30% and 60% tumor cells. In these 59 YSTs, the mean percentage of tumor cells stained with PLAP was 14% (range: 0% to 90%), with AFP 35% (range 0% to 95%), and with glypican-3 57% (range: 1% to 100%), whereas the mean percentage Of tumor cells stained for SALL4 was 94% (range: 70% to 100%) (P < 0.001), Our results indicate that SALL4 is a novel sensitive (100% sensitivity) diagnostic marker for extragonadal YSTs. SALL4 is it more sensitive marker than PLAP, AFP, or glypican-3 for extragonadal YSTs.