Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Mod Pathol. 2013 Dec;26(12):1613-9. doi: 10.1038/modpathol.2013.110. Epub 2013 Jun 14.
We investigated the role of OCT4 immunohistochemical staining in detecting germ cell tumor lymph node metastases. Retroperitoneal lymph node dissection is important for staging and treatment of testicular germ cell tumors, and OCT4 is sensitive and specific for pluripotent testicular germ cell tumors; however, micrometastases, particularly from seminoma, can be difficult to detect. We examined 262 lymph nodes in 45 retroperitoneal lymph node dissection specimens from germ cell tumor patients. Specimens were categorized as postchemotherapy and untreated retroperitoneal lymph node dissection with or without clinical suspicion, based on lymphadenopathy or elevated serum germ cell tumor markers. Sections were stained with anti-OCT4 antibody. Twenty-one additional positive lymph nodes in 12 cases were detected to harbor scattered seminoma cells, singly and in small clusters, from 256 previously considered benign in: untreated retroperitoneal lymph node dissection with clinical suspicion (13% increase), postchemotherapy retroperitoneal lymph node dissection (7%), and untreated retroperitoneal lymph node dissection without suspicion (4%). However, no patient with an entirely negative dissection specimen was reclassified as positive. OCT4 immunohistochemistry detected scattered seminoma cells and small clusters of seminoma cells in lymph nodes previously considered to be benign for an overall increase of 8%, greatest in the setting of untreated retroperitoneal lymph node dissection with clinical suspicion. However, immunohistochemistry did not convert any entirely negative specimen to positive. Future studies will be useful to determine whether the small volume of disease detected by immunohistochemistry has the same impact as routinely detected lymph node metastases.
我们研究了 OCT4 免疫组化染色在检测生殖细胞肿瘤淋巴结转移中的作用。腹膜后淋巴结清扫术对睾丸生殖细胞肿瘤的分期和治疗很重要，而 OCT4 对多能性睾丸生殖细胞肿瘤具有敏感性和特异性；然而，微转移，特别是精原细胞瘤，可能难以检测。我们检查了 45 例生殖细胞肿瘤患者的 262 个腹膜后淋巴结解剖标本。根据淋巴结病或血清生殖细胞肿瘤标志物升高，将标本分为化疗后和未治疗的腹膜后淋巴结解剖，有无临床可疑。对标本进行 OCT4 抗体染色。在 12 例中检测到 21 个额外的阳性淋巴结，这些淋巴结中存在散在的精原细胞瘤细胞，单独或成小簇存在，256 个先前被认为是良性的淋巴结中：有临床可疑的未治疗的腹膜后淋巴结解剖（增加 13%），化疗后腹膜后淋巴结解剖（7%），和无临床可疑的未治疗的腹膜后淋巴结解剖（4%）。然而，没有一个完全阴性的解剖标本被重新分类为阳性。OCT4 免疫组化检测到先前被认为是良性的淋巴结中存在散在的精原细胞瘤细胞和小簇精原细胞瘤细胞，总体增加了 8%，在有临床可疑的未治疗的腹膜后淋巴结解剖中增加最多。然而，免疫组化并没有将任何完全阴性的标本转化为阳性。未来的研究将有助于确定免疫组化检测到的少量疾病是否与常规检测到的淋巴结转移具有相同的影响。
