Department of Pathology, University of California San Diego, San Diego, CA 92093, USA.
Department of Pathology, University of California San Diego, San Diego, CA 92093, USA.
Hum Pathol. 2023 Sep;139:55-64. doi: 10.1016/j.humpath.2023.07.005. Epub 2023 Jul 15.
Herein, the authors evaluate the diagnostic utility and limitations of GATA3 immunohistochemistry for the distinction of differentiated vulvar intraepithelial neoplasia (dVIN) from its potential mimics. Immunohistochemical studies for GATA3, p53, and p16 were performed on 124 pathologic vulvar tissues, inclusive of dVIN (n = 21), vulvar aberrant maturation (n = 10), high-grade squamous intraepithelial lesion (HSIL) (n = 44), and 49 non-neoplastic vulvar dermatoses of various types. GATA3 expression was scored using a modification of previously proposed criteria: pattern 0 (no significant loss of basal layer staining, >75% staining), pattern 1 (25-75% staining), and pattern 2 (<25% staining). With the exception of lichen sclerosus, 8% of which showed pattern 1 or 2 staining, all other non-neoplastic lesions showed pattern 0 expression. Aberrant GATA3 expression (i.e., patterns 1 or 2) was present in 90% of dVIN cases (2 [9.5%], 3 [14.3%], 16 [76.2%] with patterns 0, 1, and 2 respectively), 90% of vulvar aberrant maturation cases (1 [10%],7 [70%], 2 [20%] with patterns 0, 1, and 2 respectively), and 15.9% of HSIL cases (84.1% pattern 0; 2.3% pattern 1; 13.6% pattern 2). All HSIL cases were p16 positive, including the 7 pattern 1 and 2 cases. All cases of dVIN-like HSIL were pattern 0, and all (n = 2) cases of HSIL-like (basaloid) dVIN were pattern 2 (both of the latter cases displayed complete absence of epidermal staining). Only 1 dVIN case was both pattern 0 and p53-wild-type. We conclude that GATA3 is useful for the distinction of dVIN from non-neoplastic dermatoses and from HSIL, but is best used as part of a panel that includes p53 and p16 to mitigate its limitations.
本文作者评估了 GATA3 免疫组化在鉴别分化型外阴上皮内瘤变(dVIN)与其潜在模拟物中的诊断效用和局限性。对 124 例病理性外阴组织进行了 GATA3、p53 和 p16 的免疫组织化学研究,包括 dVIN(n=21)、外阴异常成熟(n=10)、高级别鳞状上皮内病变(HSIL)(n=44)和 49 种不同类型的非肿瘤性外阴皮肤病。GATA3 表达评分采用先前提出的标准进行修改:模式 0(基底细胞染色无明显缺失,>75%染色)、模式 1(25-75%染色)和模式 2(<25%染色)。除硬化性苔藓外,8%表现为模式 1 或 2 染色,所有其他非肿瘤性病变均表现为模式 0 表达。90%的 dVIN 病例(2 例[9.5%]、3 例[14.3%]、16 例[76.2%]分别为模式 0、1 和 2)存在异常 GATA3 表达(即模式 1 或 2),90%的外阴异常成熟病例(1 例[10%]、7 例[70%]、2 例[20%]分别为模式 0、1 和 2)和 15.9%的 HSIL 病例(84.1%为模式 0;2.3%为模式 1;13.6%为模式 2)。所有 HSIL 病例均为 p16 阳性,包括 7 例模式 1 和 2 病例。所有 dVIN 样 HSIL 病例均为模式 0,所有(n=2)HSIL 样(基底细胞样)dVIN 病例均为模式 2(后两者均完全缺乏表皮染色)。仅有 1 例 dVIN 病例同时为模式 0 和 p53 野生型。我们得出结论,GATA3 有助于鉴别 dVIN 与非肿瘤性皮肤病和 HSIL,但最好作为包括 p53 和 p16 的面板的一部分使用,以减轻其局限性。