Diagnostic utility of SALL4 in primary germ cell tumors of the central nervous system: a study of 77 cases.
Primary germ cell tumors of the central nervous system (CNS) sometimes pose diagnostic difficulty. In this study we analyzed the diagnostic utility of a novel marker, SALL4, in 77 such tumors (59 pure and 18 mixed) consisting of the following tumors/tumor components: 49 germinomas, 7 embryonal carcinomas, 27 yolk sac tumors, 3 choriocarcinomas, and 14 teratomas. We also stained SALL4 in 99 primary non-germ cell tumors to test SALL4 specificity. We compared SALL4 with OCT4 in all germ cell tumors and compared SALL4 with alpha-fetoprotein and glypican-3 in all yolk sac tumors. The staining was semiquantitatively scored as 0 (no staining), 1+ (<or=30%), 2+(31-60%), 3+ (61-90%), and 4+ (>90%). Strong SALL4 staining was observed in all 49 germinomas (4+ in 48, 3+ in 1), 7 embryonal carcinomas (all 4+), and 27 yolk sac tumors (1+ in 1, 2+ in 2, 3+ in 7, 4+ in 17). SALL4 staining, 1+ weak to focally strong, was observed in 2 of 3 choriocarcinomas (in mononucleated trophoblasts) and in 9 of 14 teratomas (in primitive neuroepithelium and teratomatous glands). All germinomas and embryonal carcinomas showed strong OCT4 staining (4+ in all except 1 germinoma with 3+), whereas other germ cell tumors were negative. Out of 27 yolk sac tumors, 26 showed positive alpha-fetoprotein staining (1+ in 9, 2+ in 7, 3+ in 5, and 4+ in 5). All yolk sac tumors showed positive glypican-3 staining (1+ in 6, 2+ in 6, 3+ in 7, and 4+ in 8). The mean percentage of yolk sac tumor cells stained was 84% with SALL4, 45% with alpha-fetoprotein, and 63% with glypican-3 (P<0.01). No non-germ cell tumors showed SALL4 staining. Our results indicate that SALL4 is a novel sensitive diagnostic marker for primary germ cell tumors of the CNS with high specificity. SALL4 is a more sensitive marker than alpha-fetoprotein and glypican-3 for yolk sac tumors.
Mei
Kaiyong
K
Department of Pathology, The Second Affiliated Hospital of Guangzhou Medical College, Guangzhou, China.
Liu
Aijun
A
Allan
Robert W
RW
Wang
Peng
P
Lane
Zhaoli
Z
Abel
Ty W
TW
Wei
Lixin
L
Cheng
Hong
H
Guo
Shuangping
S
Peng
Yan
Y
Rakheja
Dinesh
D
Wang
Min
M
Ma
Joe
J
Rodriguez
Maria M
MM
Li
Jianping
J
Cao
Dengfeng
D
D000293:Adolescent; D000328:Adult; D014408:Biomarkers, Tumor / Q000032:analysis*; D016543:Central Nervous System Neoplasms / Q000737:chemistry* / Q000473:pathology; D002648:Child; D005260:Female; D053673:Glypicans / Q000032:analysis; D006801:Humans; D007150:Immunohistochemistry; D007231:Infant, Newborn; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000737:chemistry* / Q000473:pathology; D050814:Octamer Transcription Factor-3 / Q000032:analysis; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014157:Transcription Factors / Q000032:analysis*; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000032:analysis
C097353:AFP protein, human; D014408:Biomarkers, Tumor; C105937:GPC3 protein, human; D053673:Glypicans; D050814:Octamer Transcription Factor-3; C494173:POU5F1 protein, human; C472575:SALL4 protein, human; D014157:Transcription Factors; D000509:alpha-Fetoproteins