Document Detail


Diagnostic utility of SALL4 in extragonadal yolk sac tumors: an immunohistochemical study of 59 cases with comparison to placental-like alkaline phosphatase, alpha-fetoprotein, and glypican-3.
MedLine Citation:
PMID:  19574883     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Extragonadal yolk sac tumors (YSTs; primary and metastatic) are rare but are malignant germ cell tumors. Pathologic diagnosis of extragonadal YSTs can be challenging without immunohistochemical markers but markers used for diagnosing these tumors such as placental-like alkaline phosphatase (PLAP), alpha-fetoprotein (AFP), and glypican-3 lack adequate sensitivity and/or specificity. In earlier studies with gonadal germ cell tumors, SALL4 has been identified as a novel diagnostic marker for YSTs and other types of primitive germ cell tumors. Here, we investigated the diagnostic utility of SALL4 in 59 extragonadal YSTs (27 primary sacrococcygeal, 15 primary nonsacrococcygeal, and 17 metastatic) by immunohistochemical staining. We also compared SALL4 with PLAP, AFP, and glypican-3. In addition, we performed immunostains for pancytokeratin, epithelial membrane antigen, and OCT4 in these tumors. Our results showed that all 59 YSTs showed strong pancytokeratin staining (70% tumor cells in 1 case, >90% tumor cells in 58) and 10 (17%) of them also showed focal epithelial membrane antigen staining (<3% tumor cells). All 59 YSTs were negative for OCT4. Strong SALL4 staining was seen in all 59 YSTs (in more than 90% tumor cells in 54 and 70% to 85% tumor cells in 5 YSTs). Only 39 of 59 (66%) YSTs showed positive PLAP staining and the staining was often focal (in less than 30% tumor cells) (28 of 39 cases). Positive AFP staining was seen in the vast majority of YSTs (56 of 59 or 95%); however, 32 (54%) YSTs showed staining in less than 30% tumor cells. Although all 59 YSTs showed positive glypican-3 staining, 18 (30%) showed staining in less than 30% tumor cells, and additional 10 (17%) showed staining in between 30% and 60% tumor cells. In these 59 YSTs, the mean percentage of tumor cells stained with PLAP was 14% (range: 0% to 90%), with AFP 35% (range 0% to 95%), and with glypican-3 57% (range: 1% to 100%), whereas the mean percentage of tumor cells stained for SALL4 was 94% (range: 70% to 100%) (P<0.001). Our results indicate that SALL4 is a novel sensitive (100% sensitivity) diagnostic marker for extragonadal YSTs. SALL4 is a more sensitive marker than PLAP, AFP, or glypican-3 for extragonadal YSTs.
Authors:
Fenghua Wang; Aijun Liu; Yan Peng; Dinesh Rakheja; Lixin Wei; Debin Xue; Debing Xue; Robert W Allan; Kyle H Molberg; Jianping Li; Dengfeng Cao
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The American journal of surgical pathology     Volume:  33     ISSN:  1532-0979     ISO Abbreviation:  Am. J. Surg. Pathol.     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2010-02-04     Completed Date:  2010-03-02     Revised Date:  2010-03-18    
Medline Journal Info:
Nlm Unique ID:  7707904     Medline TA:  Am J Surg Pathol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1529-39     Citation Subset:  IM    
Affiliation:
Department of Pathology, Guangzhou Children's Hospital, Guangzhou, China.
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MeSH Terms
Descriptor/Qualifier:
Alkaline Phosphatase / biosynthesis*
Child
Child, Preschool
Endodermal Sinus Tumor / diagnosis*,  metabolism
Female
Glypicans / biosynthesis*
Humans
Immunohistochemistry
Infant
Infant, Newborn
Isoenzymes / biosynthesis*
Male
Sensitivity and Specificity
Transcription Factors / biosynthesis*
Tumor Markers, Biological / analysis*
alpha-Fetoproteins / biosynthesis*
Chemical
Reg. No./Substance:
0/Glypicans; 0/Isoenzymes; 0/SALL4 protein, human; 0/Transcription Factors; 0/Tumor Markers, Biological; 0/alpha-Fetoproteins; 0/germ-cell AP isoenzyme; EC 3.1.3.1/Alkaline Phosphatase

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