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DUX4 Immunohistochemistry Is a Highly Sensitive and Specific Marker for CIC-DUX4 Fusion-positive Round Cell Tumor.

对CIC-DUX4融合基因阳性的圆细胞肿瘤而言DUX4是一种高度敏感和特异的免疫组织化学标记物

Siegele B,Roberts J,Black JO,Rudzinski E,Vargas SO,Galambos C

Abstract

The histologic differential diagnosis of pediatric and adult round cell tumors is vast and includes the recently recognized entity CIC-DUX4 fusion-positive round cell tumor. The diagnosis of CIC-DUX4 tumor can be suggested by light microscopic and immunohistochemical features, but currently, definitive diagnosis requires ancillary genetic testing such as conventional karyotyping, fluorescence in situ hybridization, or molecular methods. We sought to determine whether DUX4 expression would serve as a fusion-specific immunohistochemical marker distinguishing CIC-DUX4 tumor from potential histologic mimics. A cohort of CIC-DUX4 fusion-positive round cell tumors harboring t(4;19)(q35;q13) and t(10;19)(q26;q13) translocations was designed, with additional inclusion of a case with a translocation confirmed to involve the CIC gene without delineation of the partner. Round cell tumors with potentially overlapping histologic features were also collected. Staining with a monoclonal antibody raised against the C-terminus of the DUX4 protein was applied to all cases. DUX4 immunohistochemistry exhibited diffuse, crisp, strong nuclear staining in all CIC-DUX4 fusion-positive round cell tumors (5/5, 100% sensitivity), and exhibited negative staining in nuclei of all of the other tested round cell tumors, including 20 Ewing sarcomas, 1 Ewing-like sarcoma, 11 alveolar rhabdomyosarcomas, 9 embryonal rhabdomyosarcomas, 12 synovial sarcomas, 7 desmoplastic small round cell tumors, 3 malignant rhabdoid tumors, 9 neuroblastomas, and 4 clear cell sarcomas (0/76, 100% specificity). Thus, in our experience, DUX4 immunostaining distinguishes CIC-DUX4 tumors from other round cell mimics. We recommend its use when CIC-DUX4 fusion-positive round cell tumor enters the histologic differential diagnosis.

摘要

儿童和成人圆细胞肿瘤的组织学鉴别诊断非常广,其中包括最近发现的CIC-DUX4融合基因阳性的圆细胞肿瘤。CIC-DUX4肿瘤可以通过光镜和免疫组化特征诊断,但是现在需要基因检测辅助才能明确诊断,比如常规的染色体核型分析、荧光原位杂交或者分子学手段。我们希望通过实验来确定DUX4的表达能否作为融合基因阳性圆细胞肿瘤的特异性性免疫组化标记物,以鉴别CIC-DUX4融合基因阳性肿瘤和可能存在的组织学类似肿瘤。我们收集了一系列包含有t(4;19)(q35;q13) 和 t(10;19)(q26;q13)易位基因并且CIC-DUX4融合基因阳性的圆细胞肿瘤,其中一例确定含有CIC基因而没有DUX4。我们也收集了可能带有相同组织学特征的圆细胞肿瘤。所有肿瘤的DUX4蛋白C末端都被单克隆抗体标记。所有CIC-DUX4融合基因阳性的圆细胞肿瘤(5/5,敏感性100%)DUX4免疫组化都显示弥漫强阳性的核着色,其余圆细胞肿瘤——包括20例尤文肉瘤,1例尤文样肉瘤,11例腺泡状横纹肌肉瘤,9例胚胎性横纹肌肉瘤,12例滑膜肉瘤,7例促结缔组织增生型小圆细胞肿瘤,3例恶性横纹肌样肿瘤,9例神经母细胞瘤和4例透明细胞肉瘤(0/76,特异性100%)——核着色都呈阴性。因此,根据我们的经验,DUX4免疫染色能够区分CIC-DUX4融合基因阳性肿瘤和其它类似的圆细胞肿瘤。当CIC-DUX4融合基因阳性的圆细胞肿瘤进行组织学鉴别诊断的时候,我们建议做DUX4免疫染色。

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