Rekhi Bharat, Deodhar Kedar K, Menon Santosh, Maheshwari Amita, Bajpai Jyoti, Ghosh Jaya, Shylasree Surappa Thumkur, Gupta Sudeep
Department of Surgical Pathology, Tata Memorial Hospital, Parel, Mumbai, India.
Department of Surgical Oncology (Gynaecology), Tata Memorial Hospital, Parel, Mumbai, India.
APMIS. 2018 Jan;126(1):45-55. doi: 10.1111/apm.12784. Epub 2017 Nov 20.
Clear cell carcinoma (CCC) of the ovary is an uncommon, but an aggressive epithelial ovarian cancer (EOC), which has overlapping histopathologic features with other ovarian tumours. Lately, Napsin A has been identified as its useful diagnostic immunohistochemical (IHC) marker. Fifty-eight prospectively diagnosed ovarian CCCs, 53 high-grade serous carcinomas (HGSCs), 16 endometrioid adenocarcinomas (EMACs), six mixed carcinomas, containing components of CCC and EMAC, seven metastatic mucinous adenocarcinomas and six ovarian yolk sac tumours (YSTs) were tested for Napsin A immunostaining. Fifty ovarian CCCs, 50 HGSCs, seven ovarian EMACs and five mixed carcinomas were tested for WT1 immunostaining. Napsin A was positively expressed in all 58 (100%) CCCs; was focally positive in 1 of 6 YSTs; in 1/16 EMACs and in six cases of mixed carcinomas, while it was negative in all 53 HGSCs and in seven metastatic mucinous adenocarcinomas. Other IHC markers expressed in cases of CCC ovary were CK7 (31/31) (100%), WT1 (0/50), p53 (20/26, 'wild type'), ER (4/31, focal) (12.9%), PAX8 (14/14) (100%), glypican-3 (4/10, focal) (44.4%), p16INK4 (5/5, focal) and CK20 (0/5). Various IHC markers expressed in HGSCs were WT1 (48/50) (96%), p53 (31/31, mostly 'mutation type'), CK7 (9/9) (100%) ER (13/16, variable) (81.2%) and PAX8 (14/14) (100%). IHC markers expressed in EMACs were ER (15/16) (93.7%), CK7 (2/2) (100%) and WT1 (0/7). IHC markers expressed in mixed carcinomas were CK7 (2/2) (100%), WT1 (0/2), focal Napsin A (6/6) and focal ER (5/6). The sensitivity and specificity of Napsin A for the diagnosis of CCC ovary was 100% and 90.9%, respectively. The sensitivity and specificity of WT1 for diagnosis of HGSC ovary was found to be 96% and 100%, respectively. Napsin A and WT1 are highly sensitive and specific IHC markers for diagnosing ovarian CCCs and HGSCs, respectively, and in differentiating these tumours from their mimics. Napsin A is useful in identification of component of CCC in certain EMACs.
卵巢透明细胞癌（CCC）是一种罕见但侵袭性强的上皮性卵巢癌（EOC），其组织病理学特征与其他卵巢肿瘤有重叠。最近，Napsin A已被确定为其有用的诊断性免疫组织化学（IHC）标志物。对58例经前瞻性诊断的卵巢CCC、53例高级别浆液性癌（HGSC）、16例子宫内膜样腺癌（EMAC）、6例含有CCC和EMAC成分的混合癌、7例转移性黏液腺癌和6例卵巢卵黄囊瘤（YST）进行了Napsin A免疫染色检测。对50例卵巢CCC、50例HGSC、7例卵巢EMAC和5例混合癌进行了WT1免疫染色检测。Napsin A在所有58例（100%）CCC中呈阳性表达；在6例YST中的1例呈局灶性阳性；在1/16的EMAC和6例混合癌中呈阳性，而在所有53例HGSC和7例转移性黏液腺癌中呈阴性。卵巢CCC病例中表达的其他IHC标志物有CK7（31/31）（100%）、WT1（0/50）、p53（20/26，“野生型”）、ER（4/31，局灶性）（12.9%）、PAX8（14/14）（100%）、磷脂酰肌醇蛋白聚糖-3（4/10，局灶性）（44.4%）、p16INK4（5/5，局灶性）和CK20（0/5）。HGSC中表达的各种IHC标志物有WT1（48/50）（96%）、p53（31/31，大多为“突变型”）、CK7（9/9）（100%）、ER（13/16，可变）（81.2%）和PAX8（14/14）（100%）。EMAC中表达的IHC标志物有ER（15/16）（93.7%）、CK7（2/2）（100%）和WT1（0/7）。混合癌中表达的IHC标志物有CK7（2/2）（100%）、WT1（0/2）、局灶性Napsin A（6/6）和局灶性ER（5/6）。Napsin A诊断卵巢CCC的敏感性和特异性分别为100%和90.9%。发现WT1诊断卵巢HGSC的敏感性和特异性分别为96%和100%。Napsin A和WT1分别是诊断卵巢CCC和HGSC以及将这些肿瘤与其相似肿瘤相鉴别的高度敏感和特异的IHC标志物。Napsin A有助于识别某些EMAC中CCC的成分。
