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卵巢胚胎性癌的形态学、免疫组织化学和荧光原位杂交研究,并与卵黄囊瘤的实体型变体和未成熟畸胎瘤进行比较。

Morphologic, immunohistochemical, and fluorescence in situ hybridization study of ovarian embryonal carcinoma with comparison to solid variant of yolk sac tumor and immature teratoma.

机构信息

Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.

出版信息

Hum Pathol. 2010 May;41(5):716-23. doi: 10.1016/j.humpath.2009.10.016. Epub 2010 Jan 21.

Abstract

The prognosis and therapy for malignant ovarian germ cell tumors including embryonal carcinoma differ from those of other categories of ovarian tumors, making accurate diagnosis imperative for patient care. Because of its rarity, the protein markers and genomic alterations typifying primary ovarian embryonal carcinoma have not been fully characterized. The present study aims to establish a set of sensitive and specific protein markers useful for the diagnosis and delineation of ovarian embryonal carcinoma. Chromosomal 12p anomalies were analyzed by dual-color fluorescence in situ hybridization. In a series of 6 ovarian mixed germ cell tumors with a component of embryonal carcinomas, OCT4, CD30, SOX2, and glypican 3 expressions were analyzed immunohistochemically on formalin-fixed paraffin-embedded tissue specimens. The results were compared to 4 cases of mixed germ cell tumor that were originally mistaken for embryonal carcinoma. OCT4 marked the nuclei of 6 cases, among which 5 cases also showed glypican 3 expression indicative of an admixed yolk sac tumor component. SOX2 was positive in only 3 cases of embryonal carcinoma. In 1 case of mixed germ cell tumor containing embryonal carcinoma, embryoid bodies from a component of polyembryoma were demonstrated to be both OCT4 and CD30 positive. Two cases originally classified as embryonal carcinoma were OCT4 and CD30 negative and showed glypican 3 positivity. They were reclassified as solid variant of yolk sac tumor. Two other cases originally classified as embryonal carcinoma were OCT4 positive and CD30 negative and were classified as immature teratoma with neuroectodermal differentiation based on the immunohistochemical findings as well as morphologic features and were diagnosed as immature teratoma. Chromosome 12p alterations were identified in 5 of 6 cases of embryonal carcinomas. In summary, a panel of immunostains is more useful than a single biomarker in the differential diagnosis of ovarian germ cell tumors. Chromosome 12p fluorescence in situ hybridization combined with OCT4, CD30, and glypican 3 immunostains is useful in confirming the diagnosis of ovarian embryonal carcinoma.

摘要

包括胚胎癌在内的恶性卵巢生殖细胞肿瘤的预后和治疗与其他卵巢肿瘤类别不同,因此准确的诊断对患者的护理至关重要。由于其罕见性,尚未充分表征原发性卵巢胚胎癌的典型蛋白标志物和基因组改变。本研究旨在建立一套用于诊断和描绘卵巢胚胎癌的敏感和特异的蛋白标志物。通过双色荧光原位杂交分析染色体 12p 异常。在一系列 6 例具有胚胎癌成分的卵巢混合生殖细胞肿瘤中,对福尔马林固定石蜡包埋组织标本进行 OCT4、CD30、SOX2 和糖蛋白 3 的免疫组织化学分析。将结果与最初误诊为胚胎癌的 4 例混合生殖细胞肿瘤进行比较。OCT4 标记了 6 例中的细胞核,其中 5 例还显示出糖蛋白 3 表达,提示存在混合卵黄囊瘤成分。SOX2 在仅 3 例胚胎癌中为阳性。在 1 例含有胚胎癌的混合生殖细胞肿瘤中,多胚瘤成分的胚状体被证明既为 OCT4 阳性,也为 CD30 阳性。2 例最初归类为胚胎癌的病例 OCT4 和 CD30 均为阴性,且糖蛋白 3 阳性。它们被重新归类为卵黄囊瘤的实性变体。另外 2 例最初归类为胚胎癌的病例 OCT4 阳性,CD30 阴性,根据免疫组织化学发现以及形态特征,被归类为具有神经外胚层分化的未成熟畸胎瘤,并被诊断为未成熟畸胎瘤。染色体 12p 改变在 6 例胚胎癌中的 5 例中被识别。总之,一组免疫组化染色比单一生物标志物在卵巢生殖细胞肿瘤的鉴别诊断中更有用。染色体 12p 荧光原位杂交结合 OCT4、CD30 和糖蛋白 3 免疫组化有助于确认卵巢胚胎癌的诊断。

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