The role of GLUT1 immunostaining in the diagnosis and classification of liver vascular tumors in children.
OBJECTIVE
GLUT1 is an erythrocyte-type glucose transporter protein typically expressed in cutaneous proliferating hemangioma. Immunostaining for GLUT1 is becoming valuable for predicting the outcome of vascular skin tumors. Liver vascular tumors (LVTs) are a serious challenge for pediatric surgeons because of their often severe and sometimes unpredictable clinical course. To improve therapeutic strategies, we designed this study in which we tested in pathology specimens of LVT the hypothesis that GLUT1 expression could be useful to understand and classify LVT.


METHODS
In the last 10 years, we treated 20 children with LVT. Pathology specimens from biopsy, excision, or autopsy were available in 11 of them. The paraffin sections were immunostained for GLUT1 and also for Ki-67 to assess the proportion of proliferating cells. Patients were divided into 2 groups: GLUT1-positive (n = 4) and GLUT1-negative (n = 7) that were compared for age at diagnosis, survival, and proportion of proliferating cells. Nonparametric and chi 2 tests were used for statistical analysis as appropriate.


RESULTS
Mean age at diagnosis was higher in GLUT1-positive group, although not statistically significant in comparison with GLUT1-negative (308 +/- 515 vs 70 +/- 51 days, respectively). Three of 4 children in GLUT1-positive group died versus 1 of 7 in the GLUT1-negative group (not significant). All GLUT1-positive tumors were multicentric hemangiomata without central necrosis and only 1 with large vessels. Among GLUT1-negative tumors, 5 were solitary masses and 2 were multicentric (the value of the last 2 specimens was uncertain), 2 had central necrosis, and 2 had large vessels. Proliferation index was 18% +/- 1.42% and 1.42% +/- 0.97%, respectively, in each group ( P < .05).


CONCLUSIONS
GLUT1-positive tumors have significantly higher proliferation rates than negative ones. Mortality tended to be higher in children with GLUT1-positive tumors. Positive GLUT1 immunostaining is likely specific for proliferating hemangioma, and it predicts the typical course of proliferation followed by involution.
Hernández
Francisco
F
Department of Pediatric Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain.
Navarro
Marta
M
Encinas
Jose L
JL
López Gutiérrez
Juan C
JC
López Santamaría
Manuel
M
Leal
Nuria
N
Martínez
Leopoldo
L
Patrón
Mercedes
M
Tovar
Juan A
JA
D000911:Antibodies, Monoclonal / Q000276:immunology; D014408:Biomarkers, Tumor / Q000032:analysis*; D002675:Child, Preschool; D003951:Diagnostic Errors; D051272:Glucose Transporter Type 1 / Q000032:analysis*; D006390:Hemangioendothelioma / Q000737:chemistry / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D006391:Hemangioma / Q000737:chemistry* / Q000145:classification / Q000151:congenital / Q000401:mortality / Q000473:pathology; D006394:Hemangiosarcoma / Q000737:chemistry / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D007223:Infant; D007231:Infant, Newborn; D019394:Ki-67 Antigen / Q000032:analysis; D008113:Liver Neoplasms / Q000737:chemistry* / Q000145:classification / Q000151:congenital / Q000401:mortality / Q000473:pathology; D016031:Liver Transplantation; D008940:Mitotic Index; D009336:Necrosis; D009363:Neoplasm Proteins / Q000032:analysis*; D009378:Neoplasms, Multiple Primary / Q000737:chemistry / Q000151:congenital / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies
D000911:Antibodies, Monoclonal; D014408:Biomarkers, Tumor; D051272:Glucose Transporter Type 1; D019394:Ki-67 Antigen; D009363:Neoplasm Proteins; C495677:SLC2A1 protein, human