Department of Obstetrics and Gynecology, Henan Province People’s Hospital, Zhengzhou, Henan 450003, China.
J Hematol Oncol. 2013 Aug 19;6:60. doi: 10.1186/1756-8722-6-60.
Neoadjuvant chemotherapy followed by cytoreduction surgery has been used where an accurate cytologic or pathologic diagnosis is usually required before the initiation of neoadjuvant chemotherapy. However, it is difficult to make definitive diagnosis of presence of cancer cells, particularly gynecologic versus non-gynecologic origin, from those ascites specimens due to the absence of specific biomarkers of gynecologic cancers. In the present study, we evaluated if, in addition to the routine morphologic diagnosis, the biomarker PAX8 could be useful in recognition of ovarian epithelial cancer cells prior to the neoadjuvant chemotherapy.
Two hundred and two cytology specimens including 120 pretreatment ovarian cancer samples, 60 benign controls, and 22 malignant non-gynecologic cases were studied. All cytology slides were morphologically reviewed in a blinded fashion without knowing corresponding pathology diagnosis, if present. A total of 168 cytology specimens with a cell block were stained with PAX8 and Calretinin. These included patients with potential for ovarian cancer neoadjuvant chemotherapy (n=96), metastatic cancers (n=22), and benign controls (n=50).
Among the 96 ascitic samples prior to neoadjuvant chemotherapy, 76 (79%) showing morphologic features consistent with cancers of ovarian primary were all PAX+/Calretinin-. The remaining 20 (21%) cases were positive for adenocarcinoma, but morphologically unable to be further classified. Among the 22 metastatic cancers into the pelvis, one case with PAX8+/Calretinin- represented a renal cell carcinoma and the remaining 21 PAX8-/Calretinin- metastatic cancers were either breast metastasis (n=4) and the metastasis from gastrointestinal tract (n=17). Among the 50 benign control pelvic washing cases, 5 PAX8+/Calretinin-cases represented endosalpingiosis (n=4) and endometriosis (n=1), 25 PAX8-/Calretinin+cases showed reactive mesothelial cells, and the remaining 20 specimens with PAX8-/Calretinin- phenotype typically contained inflammatory or blood cells without noticeable diagnostic epithelia.
PAX8 identifies all Müllerian derived benign or malignant epithelia. When combining with Calretinin, PAX8 is a sensitive marker to diagnose the carcinomas of ovarian origin, which will be ideal to be used for those patients with a possible advanced ovarian cancer prior to receiving neoadjuvant chemotherapy.
新辅助化疗后进行细胞减灭术，通常需要在开始新辅助化疗前获得准确的细胞学或病理学诊断。然而，由于缺乏妇科癌症的特异性生物标志物，从这些腹水标本中很难明确诊断癌细胞的存在，特别是妇科与非妇科来源的癌细胞。在本研究中，我们评估了除常规形态学诊断外，标志物 PAX8 是否有助于在新辅助化疗前识别卵巢上皮性癌细胞。
研究了 202 例细胞学标本，包括 120 例预处理卵巢癌样本、60 例良性对照和 22 例恶性非妇科病例。所有细胞学切片均以盲法进行形态学复查，而不了解相应的病理诊断（如果存在）。共有 168 例具有细胞块的细胞学标本用 PAX8 和钙视网膜蛋白染色。这些标本包括有卵巢癌新辅助化疗潜力的患者（n=96）、转移性癌症患者（n=22）和良性对照患者（n=50）。
在 96 例新辅助化疗前的腹水样本中，76 例（79%）表现出与卵巢原发性癌症一致的形态特征，均为 PAX+/Calretinin-。其余 20 例（21%）为腺癌阳性，但形态上无法进一步分类。在 22 例进入盆腔的转移性癌症中，1 例 PAX8+/Calretinin-为肾细胞癌，其余 21 例 PAX8-/Calretinin-转移性癌症为乳腺转移（n=4）和胃肠道转移（n=17）。在 50 例良性盆腔冲洗病例中，5 例 PAX8+/Calretinin-病例为内膜异位症（n=4）和子宫内膜异位症（n=1），25 例 PAX8-/Calretinin+病例为反应性间皮细胞，其余 20 例 PAX8-/Calretinin-表型标本通常包含炎症或血细胞，没有明显的上皮细胞。
PAX8 可识别所有 Müllerian 来源的良性或恶性上皮细胞。与 Calretinin 联合使用时，PAX8 是诊断卵巢来源癌的敏感标志物，对于那些可能患有晚期卵巢癌的患者，在接受新辅助化疗前使用该标志物非常理想。
