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TFE3-Fusion Variant Analysis Defines Specific Clinicopathologic Associations Among Xp11 Translocation Cancers.

通过TFE-3融合变异体分析确定Xp11易位癌之间独特的临床病理相关性

Argani P,Zhong M,Reuter VE,Fallon JT,Epstein JI,Netto GJ,Antonescu CR

Abstract

Xp11 translocation cancers include Xp11 translocation renal cell carcinoma (RCC), Xp11 translocation perivascular epithelioid cell tumor (PEComa), and melanotic Xp11 translocation renal cancer. In Xp11 translocation cancers, oncogenic activation of TFE3 is driven by the fusion of TFE3 with a number of different gene partners; however, the impact of individual fusion variant on specific clinicopathologic features of Xp11 translocation cancers has not been well defined. In this study, we analyze 60 Xp11 translocation cancers by fluorescence in situ hybridization using custom bacterial artificial chromosome probes to establish their TFE3 fusion gene partner. In 5 cases RNA sequencing was also used to further characterize the fusion transcripts. The 60 Xp11 translocation cancers included 47 Xp11 translocation RCC, 8 Xp11 translocation PEComas, and 5 melanotic Xp11 translocation renal cancers. A fusion partner was identified in 53/60 (88%) cases, including 18 SFPQ (PSF), 16 PRCC, 12 ASPSCR1 (ASPL), 6 NONO, and 1 DVL2. We provide the first morphologic description of the NONO-TFE3 RCC, which frequently demonstrates subnuclear vacuoles leading to distinctive suprabasal nuclear palisading. Similar subnuclear vacuolization was also characteristic of SFPQ-TFE3 RCC, creating overlapping features with clear cell papillary RCC. We also describe the first RCC with a DVL2-TFE3 gene fusion, in addition to an extrarenal pigmented PEComa with a NONO-TFE3 gene fusion. Furthermore, among neoplasms with the SFPQ-TFE3, NONO-TFE3, DVL2-TFE3, and ASPL-TFE3 gene fusions, the RCCs are almost always PAX8 positive, cathepsin K negative by immunohistochemistry, whereas the mesenchymal counterparts (Xp11 translocation PEComas, melanotic Xp11 translocation renal cancers, and alveolar soft part sarcoma) are PAX8 negative, cathepsin K positive. These findings support the concept that despite an identical gene fusion, the RCCs are distinct from the corresponding mesenchymal neoplasms, perhaps due to the cellular context in which the translocation occurs. We corroborate prior data showing that the PRCC-TFE3 RCCs are the only known Xp11 translocation RCC molecular subtype that are consistently cathepsin K positive. In summary, our data expand further the clinicopathologic features of cancers with specific TFE3 gene fusions and should allow for more meaningful clinicopathologic associations to be drawn.

摘要

Xp11易位癌包括Xp11易位性肾细胞癌(RCC)Xp11易位性血管周上皮样细胞肿瘤(PEComa)以及色素性Xp11易位肾癌。在Xp易位癌中,TFE3与一些不同基因伴侣融合,从而激活TFE3致癌基因;然而不同的融合变异体对Xp11易位癌临床病理特点的影响尚不清楚。本研究作者使用定制的细菌人工染色体探针来建立TFE3融合基因伴侣,采用原位荧光杂交对60Xp11易位癌进行分析。5例通过RNA测序进一步分析其融合转录体的特点。60Xp11易位癌包括47Xp11易位性RCC8Xp11易位性PEComa以及5例色素性Xp11易位肾癌。60例病例中有53例(88%)确定了融合基因伴侣,包括18SFPQPSF)、16PRCC12ASPSCR1ASPL)、6NONO1DVL2。作者首次阐述了NONO-TFE3融合RCC的形态学特点,常出现核下空泡,形成基底层上方细胞核栅栏状排列的特征性结构。类似的核下空泡在SFPQ-TFE3融合RCC也可见到,与透明细胞乳头状RCC的形态特点亦有重叠。另外作者还首次描述了DVL2-TFE融合RCC1NONO-TFE3融合的肾外色素性PEComa。此外,免疫组化表明SFPQ-TFE3NONO-TFE3DVL2-TFE3ASPL-TFE3基因融合的肿瘤通常PAX8阳性、cathepsin K阴性,而Xp11易位性PEComa、色素性Xp11易位肾癌及腺泡状软组织肉瘤中PAX8阴性、cathepsin K阳性。这些结果表明尽管基因融合相同,但是RCCs表现却与类似的间叶组织肿瘤不同,这可能由易位发生的细胞环境不同导致的。作者亦证实了之前的研究结果:PRCC-TFE3融合的 RCC是目前唯一已知的持续表达cathepsin K Xp11易位性RCC。总之,本研究进一步扩展了TFE3基因融合性癌的临床病理特点,同时阐述了更有意义的临床病理相关性。

 

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