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Ovarian sex cord-stromal tumors: an immunohistochemical study including
a comparison of calretinin and inhibin.
Deavers MT, Malpica A, Liu J, Broaddus R, Silva EG.
Department of Pathology, The University of Texas M. D. Anderson
Cancer Center, Houston, Texas 77030, USA. |
Mod Pathol. 2003 Jun;16(6):584-90. Abstract quote
Because ovarian sex cord-stromal tumors (SCST) are morphologically
heterogeneous neoplasms that are relatively infrequently encountered,
their diagnosis can be difficult. Immunohistochemical staining may be
useful for establishing the diagnosis in problematic cases.
We studied 53 ovarian SCSTs to characterize their immunohistochemical
staining pattern: 17 adult granulosa cell tumors (AGCTs), 4 juvenile
granulosa cell tumors (JGCTs), 3 sex cord tumors with annular tubules
(SCTATs), 9 Sertoli-Leydig cell tumors (SLCTs), 10 fibromas, 5 fibrothecomas
(FTs), and 5 thecomas. In 8 of the 53 cases, the tissue studied was
from a metastatic site. The immunopanel included calretinin, inhibin,
WT1, cytokeratin cocktail, epithelial membrane antigen (EMA), and cytokeratin
5/6 (CK5/6). The fibromas and FTs were also tested with CD10. The extent
of staining was assessed in a semiquantitative fashion and ranked on
a scale of 0 through 4+. All of the tumors, except for 1 metastatic
SLCT, were positive for calretinin. Forty-five of the cases (85%) stained
for inhibin; 1 metastatic AGCT, 3 fibromas, and 4 FTs were negative.
WT1 was present in 39 tumors (74%), with expression most prominent in
the SLCTs. The cytokeratin cocktail stained 23 of the 53 tumors (43%),
whereas just 1 tumor was positive for EMA (1+ in a JGCT). All tumors
were negative for CK5/6, and the 15 fibromas and FTs were negative for
CD10.
We conclude that because cytokeratin is frequently expressed by SCSTs,
in particular by granulosa cell tumors, SLCTs, and SCTATs, the inclusion
of EMA in a panel may help to exclude epithelial neoplasms. In addition,
WT1, present in normal granulosa cells, is expressed by a majority of
SCSTs. Finally, these results demonstrate that calretinin is at least
as sensitive as inhibin for ovarian SCSTs overall and that it is more
sensitive than inhibin for fibromas and FTs. |
| Immunohistochemical staining for calretinin
is useful in the diagnosis of ovarian sex cord-stromal tumours.
McCluggage WG, Maxwell P.
Department of Pathology, Royal Group of Hospitals Trust, Belfast
and The Queen's University of Belfast, Grosvenor Road, Belfast BT12
6BL, Northern Ireland. |
Histopathology 2001 May;38(5):403-8 Abstract
quote
AIMS: Ovarian sex cord-stromal tumours are a heterogeneous group of
neoplasms which may be confused morphologically with a wide variety
of tumours. Calretinin positivity has previously been demonstrated in
a small number of ovarian sex cord-stromal tumours. The aim of this
study was to investigate calretinin staining in a series of these tumours
and their histological mimics in order to determine the value of calretinin
staining in a diagnostic setting.
METHODS AND RESULTS: Seventy-two neoplasms, including 37 ovarian sex
cord-stromal tumours and 35 miscellaneous neoplasms which may enter
into the differential diagnosis, were stained with a commercially available
polyclonal antibody against calretinin. All sex cord-stromal tumours
exhibited positivity except for a single fibrothecoma. In this group
of tumours staining was generally diffuse and strong. Small numbers
of the miscellaneous group of neoplasms exhibited positivity but this
tended to be focal and weak, although this was not always the case.
There was consistent strong positive staining of granulosa cells in
follicular cysts and corpora lutea. There was also positive staining
of luteinized stromal cells in two cases of ovarian stromal hyperplasia
and hyperthecosis.
CONCLUSIONS: Calretinin is a sensitive immunohistochemical marker of
ovarian sex cord-stromal tumours and may be useful in a diagnostic setting.
However, the value is somewhat limited since occasional neoplasms which
enter into the morphological differential diagnosis may be positive.
Be that as it may, calretinin positivity may be of value in the diagnosis
of an ovarian sex cord-stromal tumour and its differentiation from other
neoplasms. In this regard, calretinin should always be used as part
of a larger panel. |
Inhibin immunohistochemical staining: a practical approach for the surgical
pathologist in the diagnoses of ovarian sex cord-stromal tumors.
Zheng W, Senturk BZ, Parkash V.
|
Adv Anat Pathol 2003 Jan;10(1):27-38 Abstract quote
Through a brief introduction of inhibin history, characteristics of
the antibody against inhibin, and normal tissue distribution of alpha-inhibin
expression, this comprehensive review focuses on a practical approach
to using alpha-inhibin in the differential diagnosis of ovarian sex
cord-stromal tumors (SCSTs). Alpha-inhibin has become a most useful
immunohistochemical marker of gonadal SCST, regardless if the tumors
are primary, recurrent, or metastatic. However, pathologic diagnosis
of individual SCST is still based largely on morphologic criteria.
Alpha-inhibin immunohistochemical (IHC) staining should be used only
when a difficult morphologic diagnosis is encountered. In this perspective,
alpha-inhibin and other properly selected markers should be ordered
at the same time. This is simply because alpha-inhibin is not specific
for SCSTs.
Caution should be exercised in the interpretation of alpha-inhibin-positive
cells, because a wide variety of primary and metastatic ovarian tumors
may contain significant numbers of alpha-inhibin-positive stromal cells.
As with other immunohistochemical stains, a panel of stains and comparison
with the corresponding hematoxylin and eosin (H&E) slides is necessary,
especially when staining patterns and cellular localization are in question.
The antibody will not help to differentiate tumors within the category
of SCST. The pattern or the intensity of staining in SCSTs does not
predict tumor behavior, although there is a tendency of loss of alpha-inhibin
expression in poorly differentiated Sertoli or Sertoli-Leydig cell tumors.
In cases where metastatic granulosa or Sertoli-Leydig cell tumors are
a concern, positive alpha-inhibin staining is diagnostic, but a negative
result does not rule out metastatic disease. Calretinin has been recently
recognized as a more sensitive, but less specific marker for SCSTs and
it may be used to recognize an inhibin-negative SCST.
In this review, we have listed nine of the most commonly encountered
clinical scenarios where alpha-inhibin and other markers could be used
in diagnostic surgical pathology of ovarian tumors. |
