Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Mod Pathol. 2021 Nov;34(11):2036-2042. doi: 10.1038/s41379-021-00854-2. Epub 2021 Jun 19.
Epithelioid hemangioendothelioma (EHE) with YAP1-TFE3 fusion is a recently characterized distinctive variant of EHE that accounts for a small subset (<5%) of cases. It is composed of nests of epithelioid cells with voluminous pale cytoplasm and often shows focally vasoformative architecture. TFE3 immunohistochemistry (IHC) can be used to support the diagnosis; however, studies have questioned its specificity. Yes-associated protein 1 (YAP1), part of the Hippo signaling pathway, is expressed in normal endothelial cells, but becomes disrupted in EHE variant with YAP1-TFE3, such that only a small N-terminal region of YAP1 is expressed in the fusion protein. A recent study also reported YAP1 rearrangements in a subset of retiform and composite hemangioendotheliomas (RHE and CHE). In this study, we evaluated the diagnostic utility of an antibody directed against the C-terminus of YAP1 (YAP1-CT) for EHE with YAP1-TFE3, RHE, and CHE. In total, 78 tumors were included in the study: EHE variant with YAP1-TFE3 (n = 13), conventional (CAMTA1-positive) EHE (n = 20), pseudomyogenic hemangioendothelioma (n = 10), epithelioid hemangioma (n = 19), epithelioid angiosarcoma (n = 10), RHE (n = 4), and CHE (n = 2). IHC was performed using a rabbit monoclonal anti-YAP1 C-terminus antibody. EHE variant showed complete loss of YAP1-CT expression in 10 of 13 (77%) cases. All cases of RHE and CHE, with previously confirmed YAP1 rearrangements, also showed loss of YAP1-CT expression. Loss of YAP1-CT was seen in one conventional EHE (1/20; 5%). All other epithelioid vascular tumors showed retained YAP1-CT expression. Loss of expression of YAP1-CT appears to be associated with good sensitivity and specificity for EHE variant with YAP1-TFE3 fusion and may provide additional support along with TFE3 and CAMTA1 IHC in challenging cases. This marker may also be useful in the diagnosis of RHE and CHE.
上皮样血管内皮细胞瘤(EHE)伴 YAP1-TFE3 融合是一种最近被描述的独特 EHE 变体,占 EHE 病例的一小部分(<5%)。它由大量淡染胞质的上皮样细胞巢组成,常表现为局灶性血管形成结构。TFE3 免疫组化(IHC)可用于支持诊断;然而,研究对其特异性提出了质疑。Yes 相关蛋白 1(YAP1)是 Hippo 信号通路的一部分,在正常内皮细胞中表达,但在伴有 YAP1-TFE3 的 EHE 变体中被破坏,使得融合蛋白中仅表达 YAP1 的一小段 N 端区域。最近的一项研究还报道了 YAP1 重排在一小部分网状和复合血管内皮细胞瘤(RHE 和 CHE)中。在这项研究中,我们评估了针对 YAP1 C 末端的抗体(YAP1-CT)在 EHE 伴 YAP1-TFE3、RHE 和 CHE 中的诊断效用。共有 78 例肿瘤纳入研究:EHE 变体伴 YAP1-TFE3(n=13)、常规(CAMTA1 阳性)EHE(n=20)、假肌样血管内皮细胞瘤(n=10)、上皮样血管内皮瘤(n=19)、上皮样血管肉瘤(n=10)、RHE(n=4)和 CHE(n=2)。进行了兔单克隆抗 YAP1 C 末端抗体的免疫组化。EHE 变体在 13 例中的 10 例(77%)中完全丧失 YAP1-CT 表达。所有先前确认有 YAP1 重排的 RHE 和 CHE 病例也显示 YAP1-CT 表达缺失。在 1 例常规 EHE(20 例中的 1 例;5%)中可见 YAP1-CT 丧失。所有其他上皮样血管肿瘤均保留 YAP1-CT 表达。YAP1-CT 表达缺失似乎与 EHE 变体伴 YAP1-TFE3 融合具有良好的敏感性和特异性相关,并且在具有挑战性的病例中可能与 TFE3 和 CAMTA1 IHC 一起提供额外支持。该标志物在 RHE 和 CHE 的诊断中可能也有用。