Deavers Michael T, Malpica Anais, Liu Jinsong, Broaddus Russell, Silva Elvio G
Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Mod Pathol. 2003 Jun;16(6):584-90. doi: 10.1097/01.MP.0000073133.79591.A1.
Because ovarian sex cord-stromal tumors (SCST) are morphologically heterogeneous neoplasms that are relatively infrequently encountered, their diagnosis can be difficult. Immunohistochemical staining may be useful for establishing the diagnosis in problematic cases. We studied 53 ovarian SCSTs to characterize their immunohistochemical staining pattern: 17 adult granulosa cell tumors (AGCTs), 4 juvenile granulosa cell tumors (JGCTs), 3 sex cord tumors with annular tubules (SCTATs), 9 Sertoli-Leydig cell tumors (SLCTs), 10 fibromas, 5 fibrothecomas (FTs), and 5 thecomas. In 8 of the 53 cases, the tissue studied was from a metastatic site. The immunopanel included calretinin, inhibin, WT1, cytokeratin cocktail, epithelial membrane antigen (EMA), and cytokeratin 5/6 (CK5/6). The fibromas and FTs were also tested with CD10. The extent of staining was assessed in a semiquantitative fashion and ranked on a scale of 0 through 4+. All of the tumors, except for 1 metastatic SLCT, were positive for calretinin. Forty-five of the cases (85%) stained for inhibin; 1 metastatic AGCT, 3 fibromas, and 4 FTs were negative. WT1 was present in 39 tumors (74%), with expression most prominent in the SLCTs. The cytokeratin cocktail stained 23 of the 53 tumors (43%), whereas just 1 tumor was positive for EMA (1+ in a JGCT). All tumors were negative for CK5/6, and the 15 fibromas and FTs were negative for CD10. We conclude that because cytokeratin is frequently expressed by SCSTs, in particular by granulosa cell tumors, SLCTs, and SCTATs, the inclusion of EMA in a panel may help to exclude epithelial neoplasms. In addition, WT1, present in normal granulosa cells, is expressed by a majority of SCSTs. Finally, these results demonstrate that calretinin is at least as sensitive as inhibin for ovarian SCSTs overall and that it is more sensitive than inhibin for fibromas and FTs.
由于卵巢性索间质肿瘤（SCST）是形态学上异质性的肿瘤，相对少见，其诊断可能具有挑战性。免疫组化染色对于疑难病例的诊断可能有用。我们研究了53例卵巢SCST，以明确其免疫组化染色模式：17例成人颗粒细胞瘤（AGCT）、4例幼年型颗粒细胞瘤（JGCT）、3例环管状性索肿瘤（SCTAT）、9例支持-间质细胞瘤（SLCT）、10例纤维瘤、5例纤维卵泡膜瘤（FT）和5例卵泡膜瘤。53例中有8例的研究组织来自转移部位。免疫组化抗体组合包括钙视网膜蛋白、抑制素、WT1、细胞角蛋白混合抗体、上皮膜抗原（EMA）和细胞角蛋白5/6（CK5/6）。纤维瘤和FT还检测了CD10。以半定量方式评估染色程度，并按0至4+进行分级。除1例转移性SLCT外，所有肿瘤钙视网膜蛋白均呈阳性。45例（85%）抑制素染色阳性；1例转移性AGCT、3例纤维瘤和4例FT为阴性。39例肿瘤（74%）存在WT1，在SLCT中表达最显著。细胞角蛋白混合抗体在53例肿瘤中的23例（43%）呈阳性，而仅1例肿瘤EMA呈阳性（JGCT中为1+）。所有肿瘤CK5/6均为阴性，15例纤维瘤和FT CD10为阴性。我们得出结论，由于细胞角蛋白在SCST中经常表达，特别是在颗粒细胞瘤、SLCT和SCTAT中，抗体组合中加入EMA可能有助于排除上皮性肿瘤。此外，WT1存在于正常颗粒细胞中，大多数SCST表达WT1。最后，这些结果表明，总体而言，钙视网膜蛋白对卵巢SCST的敏感性至少与抑制素相同，对纤维瘤和FT的敏感性比抑制素更高。
