Abstract
OCT4 and SALL4 are transcription factors within a complex network that functions to maintain pluripotency in primitive stem cells and germ cells. Nuclear expression of OCT4 is widely cited as sensitive and specific for primary and metastatic germ cell tumors and is commonly used in the diagnosis of central nervous system (CNS) germinomas. Studies have failed to systematically examine the expression of OCT4 or SALL4 in diffuse large B-cell lymphoma (DLBCL), although this entity enters the morphologic differential diagnosis of some germ cell tumors. A retrospective review was conducted on 145 consecutive cases of DLBCL and testicular lymphoma to evaluate the prevalence of OCT4 and SALL4 expression. Nuclear OCT4 expression was present in 2/11 (18%) testicular DLBCLs and 6/134 (4.5%) nontesticular DLBCLs. Most OCT4 cases demonstrated moderate to strong expression in >50% of neoplastic cells. Rare, weak nuclear SALL4 expression was detected in only 3 nontesticular DLBCLs. Within the extratesticular DLBCL group, 2/6 (33%) primary CNS DLBCLs expressed nuclear OCT4. In addition, OCT4 DLBCL showed an overall predilection toward non-germinal center B-cell phenotype (7/8; 88%) and had a higher than expected rate of CD5 coexpression (4/8, 50%). These results are cautionary against using OCT4 as a sole marker of germ cell differentiation in testicular and extratesticular sites, especially in the CNS. The apparent associations of OCT4 expression with primary CNS DLBCL, non-germinal center B-cell phenotype, and CD5 coexpression raise the question of whether OCT4 expression in DLBCL may reflect more aggressive biology.
摘要
OCT4及SALL4是复杂调控系统中的转录因子,其功能在于维持原始干细胞及生殖细胞的多潜能性。核表达OCT4是原发及转移性生殖细胞肿瘤的敏感及特异性标记物,这已经得到了公认,通常也用于诊断中枢神经系统(CNS)生殖细胞瘤。在弥漫大B细胞淋巴瘤(DLBCL)中缺少关于OCT4及SALL4表达的系统性研究,尽管这组疾病已列入一些生殖细胞肿瘤的形态学鉴别诊断中。
本研究回顾分析了145例连续的DLBCL病例及睾丸淋巴瘤,评估OCT4及SALL4的表达情况。2/11(18%)睾丸DLBCLs及6/134(4.5%)非睾丸DLBCLs表现为OCT4核表达。大多数OCT4阳性病例表现为>50%肿瘤细胞中-强表达。仅在3例非睾丸DLBCLs中出现SALL4核的弱表达。在睾丸外DLBCL,2/6(33%)原发性CNS DLBCLs表达OCT4。另外,OCT4阳性DLBCL表现为较一致的非生发中心表型(7/8;88%)及超出预想的、较高的CD5共表达(4/8,50%)。
这些结果对OCT4在睾丸及睾丸外部位做为独有的生殖细胞分化标记物提出质疑。OCT4表达与原发性CNS DLBCL、非生发中心表型及CD5共表达相关的研究结果提示是否OCT4表达反映DLBCL更具侵袭性的生物学行为。
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