Banet N,Gown AM,Shih IeM,Kay Li Q,Roden RB,Nucci MR,Cheng L,Przybycin CG,Nasseri-Nik N,Wu LS,Netto GJ,Ronnett BM,Vang R
Abstract
Immunohistochemical expression of GATA-3 is seen predominantly in non-neoplastic bladder and breast epithelium and their respective carcinomas; however, data on expression in normal and lesional trophoblastic tissues are limited. Immunohistochemical staining for GATA-3 was assessed in a range of normal/lesional trophoblastic tissues and tumors in the differential diagnosis (n=445), including nonmolar products of conceptions/second and third trimester placentas/ectopic pregnancies, hydatidiform moles, placental site nodules, normal/exaggerated implantation sites, choriocarcinomas, epithelioid trophoblastic tumors, placental site trophoblastic tumors, atypical smooth muscle tumors (including leiomyosarcoma), and cervical and pulmonary squamous cell carcinomas. The extent of expression (0 to 4+) and intensity (weak to strong) were recorded. All cases with developing trophoblast/non-neoplastic trophoblastic proliferation and 81% of trophoblastic neoplasms were positive. Of all non-neoplastic trophoblast cell types, expression was observed in cytotrophoblast in 89% of cases, syncytiotrophoblast in 50%, intermediate trophoblast in 100%, and villous trophoblastic columns in 100%. Increasing gestational age was associated with a decrease in extent/intensity of expression in non-neoplastic cytotrophoblast and syncytiotrophoblast, whereas intermediate trophoblast maintained diffuse and strong expression from early to late gestation (P<0.0001). Eighty-nine percent of normal/exaggerated implantation sites showed 3+ or 4+ expression, whereas staining in 55% of placental site nodules was 1+ or 2+. Staining for GATA-3 was present in 78% of choriocarcinomas, 95% of epithelioid trophoblastic tumors, and 71% of placental site trophoblastic tumors. Although the number of choriocarcinomas and placental site trophoblastic tumors that showed a spectrum of expression ranging from negative to diffuse was relatively evenly distributed, 81% of epithelioid trophoblastic tumors had 3+ or 4+ staining. None of the atypical smooth muscle tumors and 3% of squamous cell carcinomas were positive, all of which exhibited weak staining. We conclude that GATA-3 is frequently expressed in normal and lesional trophoblastic tissues. It is also differentially expressed in intermediate trophoblast and cytotrophoblast/syncytiotrophoblast, which varies according to time during pregnancy. This study expands the spectrum of neoplasms known to express GATA-3. Thus, recognition of expression in trophoblastic tumors is important, because it can present a diagnostic pitfall in the assessment of suspected metastatic bladder or breast carcinomas involving the gynecologic tract. In the evaluation of diagnostically problematic tumors for which trophoblastic neoplasms are in the differential diagnosis, such as leiomyosarcoma and squamous cell carcinoma, GATA-3 can be included as part of an immunohistochemical panel particularly when other trophoblastic markers are either not available or yield ambiguous results.
摘要
GATA-3免疫组化表达主要见于非肿瘤性膀胱和乳腺上皮及其相应的癌;而在正常和病变滋养层组织中表达的数据有限。
本文在一系列正常/病变滋养层组织及需鉴别诊断的肿瘤(n=445)中评估GATA-3免疫组化染色,包括非葡萄胎妊娠/第二和第三孕期胎盘/异位妊娠,葡萄胎,胎盘部位结节,正常/超常种植部位,绒毛膜癌,上皮样滋养细胞肿瘤,胎盘部位滋养细胞肿瘤,非典型平滑肌肿瘤(包括平滑肌肉瘤)及宫颈和肺鳞状细胞癌。记录表达程度(0-4+)和强度(弱-强)。
所有伴滋养层形成/非肿瘤性滋养细胞增生的病例和81%滋养细胞肿瘤阳性。所有非肿瘤性滋养细胞类型中,89%病例中的细胞滋养层细胞,50%病例中的合体滋养层细胞,100%病例中的中间滋养层细胞及100%病例中的绒毛滋养层细胞可见表达。孕龄增加与非肿瘤性细胞滋养层细胞和合体滋养层细胞中表达程度/强度降低有关,而中间滋养层细胞从孕早期到晚期维持弥漫强表达(p<0.0001)。89%的正常/超常种植部位呈3+或4+表达,而55%的胎盘部位结节染色为1+或2+。78%的绒毛膜癌,95%的上皮样滋养细胞肿瘤和71%的胎盘部位滋养细胞肿瘤可见GATA-3染色。虽然呈现从阴性到弥漫表达的绒毛膜癌和胎盘部位滋养细胞肿瘤的数量相对平均分布,但81%的上皮样滋养细胞肿瘤显示3+或4+染色。非典型平滑肌肿瘤不表达,3%的鳞状细胞癌弱阳性染色。
我们推断GATA3常表达于正常和病变滋养层组织。也区别表达于中间滋养层细胞和细胞滋养层细胞/合体滋养层细胞,依据妊娠时间不同而有不同表达。本研究扩展了GATA-3表达的已知肿瘤谱。
综上,识别滋养层肿瘤GATA-3表达相当重要,因为评估累犯女性生殖道的可疑转移性膀胱癌或乳腺癌时可能存在诊断陷阱。在评估诊断疑难的肿瘤,而滋养细胞肿瘤作为鉴别诊断时,如平滑肌肉瘤和鳞状细胞癌,GATA-3可作为免疫组化套餐中的一部分,特别是当其他滋养细胞标记缺乏或结果模糊时。
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