title: Diagnostic utility of SALL4 in primary germ cell tumors of the central nervous system: a study of 77 cases.
abstract: 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.
authors.affiliation: Department of Pathology, The Second Affiliated Hospital of Guangzhou Medical College, Guangzhou, China.
authors.forename: Kaiyong
authors.initials: K
authors.lastname: Mei
authors.forename: Aijun
authors.initials: A
authors.lastname: Liu
authors.forename: Robert W
authors.initials: RW
authors.lastname: Allan
authors.forename: Peng
authors.initials: P
authors.lastname: Wang
authors.forename: Zhaoli
authors.initials: Z
authors.lastname: Lane
authors.forename: Ty W
authors.initials: TW
authors.lastname: Abel
authors.forename: Lixin
authors.initials: L
authors.lastname: Wei
authors.forename: Hong
authors.initials: H
authors.lastname: Cheng
authors.forename: Shuangping
authors.initials: S
authors.lastname: Guo
authors.forename: Yan
authors.initials: Y
authors.lastname: Peng
authors.forename: Dinesh
authors.initials: D
authors.lastname: Rakheja
authors.forename: Min
authors.initials: M
authors.lastname: Wang
authors.forename: Joe
authors.initials: J
authors.lastname: Ma
authors.forename: Maria M
authors.initials: MM
authors.lastname: Rodriguez
authors.forename: Jianping
authors.initials: J
authors.lastname: Li
authors.forename: Dengfeng
authors.initials: D
authors.lastname: Cao
mesh_terms: 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
chemical_list: 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