Department of Pathology and Laboratory Medicine, Vancouver General Hospital and University of British Columbia.
Genetic Pathology Evaluation Center, Vancouver.
Am J Surg Pathol. 2018 Dec;42(12):1596-1606. doi: 10.1097/PAS.0000000000001142.
Mesonephric carcinomas of the gynecologic tract are neoplasms that are often under-recognized due to their varied morphologic appearances. Recently, GATA3 and TTF1 have been reported to be useful immunohistochemical markers for distinguishing mesonephric carcinomas from its morphologic mimics. Herein, we compared the performance of GATA3 and TTF1 to the traditional markers used for mesonephric carcinomas, CD10 and calretinin. We studied 694 cases: 8 mesonephric carcinomas (7 cervical [includes 3 mesonephric carcinosarcomas], 1 vaginal), 5 mesonephric-like carcinomas (4 uterine corpus, 1 ovarian), 585 endometrial adenocarcinomas, and 96 cervical adenocarcinomas. Mesonephric-like carcinomas were defined as tumors exhibiting the classic morphologic features of mesonephric carcinoma, but occurring outside of the cervix and without convincing mesonephric remnants. GATA3 had the highest sensitivity and specificity (91% and 94%) compared with TTF1 (45% and 99%), CD10 (73% and 83%), and calretinin (36% and 89%). GATA3, however, also stained a substantial number of uterine carcinosarcomas (23/113, 20%). TTF1 was positive in 5/5 (100%) mesonephric-like carcinomas and only 1/8 (13%) mesonephric carcinomas. In 4/6 (67%) TTF1 positive cases, GATA3 exhibited an inverse staining pattern with TTF1. In summary, GATA3 was the best overall marker for mesonephric and mesonephric-like carcinomas, but cannot be used to distinguish mesonephric carcinosarcomas from Müllerian carcinosarcomas. The inverse staining pattern between GATA3 and TTF1, suggests that TTF1 may be useful when GATA3 is negative in small biopsies where mesonephric or mesonephric-like carcinoma is suspected. The greater TTF1 positivity in mesonephric-like carcinomas suggests they may be biologically different from prototypical mesonephric carcinomas.
妇科生殖道中肾细胞癌是一种常因形态学表现多样而被低估的肿瘤。最近，GATA3 和 TTF1 被报道为鉴别中肾细胞癌与其形态模拟物的有用免疫组织化学标志物。在此，我们比较了 GATA3 和 TTF1 与用于中肾细胞癌的传统标志物 CD10 和 calretinin 的性能。我们研究了 694 例病例：8 例中肾细胞癌（7 例宫颈[包括 3 例中肾细胞癌肉瘤]，1 例阴道）、5 例中肾样癌（4 例子宫体，1 例卵巢）、585 例子宫内膜腺癌和 96 例宫颈腺癌。中肾样癌被定义为表现出经典中肾细胞癌形态特征的肿瘤，但发生在宫颈以外且没有令人信服的中肾残留。与 TTF1（45%和 99%）、CD10（73%和 83%）和 calretinin（36%和 89%）相比，GATA3 的敏感性和特异性最高（91%和 94%）。然而，GATA3 还染色了大量的子宫癌肉瘤（23/113，20%）。TTF1 在 5/5（100%）例中肾样癌中阳性，仅在 1/8（13%）例中肾细胞癌中阳性。在 4/6（67%）TTF1 阳性病例中，GATA3 与 TTF1 呈相反的染色模式。总之，GATA3 是中肾和中肾样癌的最佳标志物，但不能用于鉴别中肾癌肉瘤与 Müllerian 癌肉瘤。GATA3 与 TTF1 之间的反向染色模式表明，当怀疑存在中肾或中肾样癌时，在小活检中 GATA3 阴性时，TTF1 可能有用。TTF1 在中肾样癌中的阳性率更高，表明它们在生物学上可能与典型的中肾细胞癌不同。
