Department of Pathology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9072, USA.
Incyte Diagnostics, PO Box 3405, Spokane, WA, 99220-3405, USA.
Diagn Pathol. 2024 Sep 27;19(1):129. doi: 10.1186/s13000-024-01550-w.
Distinguishing reactive atypia from dysplasia in cholecystectomy specimens can be histologically challenging. The aim of this study was to evaluate the utility of IMP3, p53, and S100P immunostains in differentiating reactive atypia from dysplasia in cholecystectomies.
Fifty-four cholecystectomies were reviewed and characterized into 5 groups: 2 normal, 29 reactive atypia, 16 low-grade dysplasia, 2 high-grade dysplasia, and 5 adenocarcinoma. IMP3, p53, and S100P immunostains were performed and evaluated. IMP3 (nuclear) and S100P (nuclear or nuclear/cytoplasmic) were categorized into negative or positive expression, and p53 was categorized into wild-type and aberrant/mutant expression. Chi-square test was used for statistical analysis.
The patients were mostly middle-aged women (mean 44, range 19-87 years, 81% female), with predominantly Hispanic White ethnicity (80%). The majority of the normal and reactive atypia cases showed negative IMP3 (100% and 75.9%, respectively) and wild-type p53 (100% and 89.7%, respectively) staining. Over half (56.3%) of the low-grade dysplasia and all the high-grade dysplasia cases showed IMP3 positivity. Aberrant p53 staining pattern was seen in half of both low and high-grade dysplasia cases. Adenocarcinoma showed IMP3 positivity in 80% and p53 aberrancy in all cases. S100P showed no statistical significance among the diagnostic categories. Significant differences in staining patterns were found between reactive atypia vs. low-grade dysplasia, and reactive atypia vs. low-grade + high-grade dysplasia using a combination of IMP3 and p53 stains (all p < 0.05).
In challenging cholecystectomies, IMP3 positivity or aberrant p53 expression may serve as a useful adjunct to support a diagnosis of dysplasia over reactive atypia.
在胆囊切除标本中鉴别反应性非典型增生与异型增生具有一定的组织学挑战性。本研究旨在评估 IMP3、p53 和 S100P 免疫组化在鉴别胆囊切除术后反应性非典型增生与异型增生中的作用。
回顾性分析 54 例胆囊切除术标本，分为 5 组：2 例正常、29 例反应性非典型增生、16 例低级别异型增生、2 例高级别异型增生和 5 例腺癌。进行 IMP3、p53 和 S100P 免疫组化染色，并进行评估。IMP3（核）和 S100P（核或核/细胞质）分为阳性或阴性表达，p53 分为野生型和异常/突变型表达。采用卡方检验进行统计学分析。
患者多为中年女性（平均年龄 44 岁，范围 19-87 岁，81%为女性），以西班牙裔白人为主（80%）。大多数正常和反应性非典型增生病例的 IMP3（分别为 100%和 75.9%）和 p53（分别为 100%和 89.7%）染色均为阴性。超过一半（56.3%）的低级别异型增生和所有高级别异型增生病例的 IMP3 阳性。低级别和高级别异型增生病例中各有一半出现异常 p53 染色模式。80%的腺癌病例 IMP3 阳性，所有病例 p53 异常。S100P 在不同诊断类别之间无统计学意义。反应性非典型增生与低级别异型增生、反应性非典型增生与低级别+高级别异型增生之间，联合使用 IMP3 和 p53 染色的染色模式差异有统计学意义（均 p<0.05）。
在具有挑战性的胆囊切除术中，IMP3 阳性或异常 p53 表达可能有助于支持异型增生的诊断，而不是反应性非典型增生。
