Dermawan Josephine Kam Tai, Underwood Dawn, Policarpio-Nicolas Maria Luisa
Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
Diagn Cytopathol. 2019 Jul;47(7):653-658. doi: 10.1002/dc.24162. Epub 2019 Feb 22.
The cytodiagnosis of melanoma in effusions can be challenging. Although immunohistochemical (IHC) stains such as HMB45, Melan A, and S-100 are often utilized; the role of Sry-related HMG-box gene 10 (SOX10) in the diagnosis of melanoma in effusions has not been previously reported.
A total of 14 confirmed melanoma cases diagnosed on effusion cytology (nine pleural and five peritoneal) were collected from 2000 to 2016. IHC stain for SOX10 was performed and compared with HMB45, Melan A, and S-100. To evaluate the specificity of SOX10, we stained 47 previously diagnosed nonmelanocytic malignant effusions. A cut-off of >1 positively staining cells was considered positive. The intensity of staining was graded as weak, moderate, and strong.
All 14 melanoma cases were positive for SOX10 and HMB45 (100%), compared to 12 cases (86%) using Melan A and S-100. Among 47 previously diagnosed nonmelanocytic malignant effusions (4 malignant mesotheliomas, 12 müllerian tumors, 9 breast carcinomas, 9 lung adenocarcinomas, and 13 hematologic tumors), SOX10 and HMB45 showed a specificity of 98%, whereas Melan A and S100 had a specificity of 100%.
The sensitivity of SOX10 for melanoma in effusions is comparable with HMB45 with a 100% sensitivity. In terms of staining intensity, HMB45 appeared to be superior as it showed 100% moderate to strong intensity compared to 72% for SOX10. All four markers showed near-100% specificity in differentiating melanoma from nonmelanocytic malignant effusions. A combination of HMB45 and SOX10 might be useful as the initial stains of choice in diagnosing melanoma in effusion cytology.
对积液中黑色素瘤进行细胞诊断具有挑战性。虽然常使用免疫组化（IHC）染色，如HMB45、Melan A和S - 100；但性别决定区Y相关的高迁移率族盒基因10（SOX10）在积液中黑色素瘤诊断中的作用此前尚未见报道。
收集了2000年至2016年期间经积液细胞学确诊的14例黑色素瘤病例（9例胸腔积液和5例腹腔积液）。进行了SOX10的免疫组化染色，并与HMB45、Melan A和S - 100进行比较。为评估SOX10的特异性，我们对47例先前诊断的非黑色素细胞性恶性积液进行了染色。>1个阳性染色细胞的临界值被视为阳性。染色强度分为弱、中、强三级。
14例黑色素瘤病例中，SOX10和HMB45均呈阳性（100%），而使用Melan A和S - 100时为12例（86%）。在47例先前诊断的非黑色素细胞性恶性积液（4例恶性间皮瘤、12例苗勒管肿瘤、9例乳腺癌、9例肺腺癌和13例血液系统肿瘤）中，SOX10和HMB45的特异性为98%，而Melan A和S100的特异性为100%。
SOX10对积液中黑色素瘤的敏感性与HMB45相当，敏感性为100%。在染色强度方面，HMB45似乎更优，因为其100%为中度至强强度，而SOX10为72%。所有四种标志物在区分黑色素瘤与非黑色素细胞性恶性积液方面均显示出近100%的特异性。HMB45和SOX10联合使用可能作为积液细胞学中诊断黑色素瘤的首选初始染色方法。
