title: Alveolar soft part sarcoma and granular cell tumor: an immunohistochemical comparison study.
abstract: Although the histologic features of alveolar soft part sarcoma and granular cell tumor are typically distinctive, occasional cases show a significant morphologic overlap. Differentiating these entities is crucial because granular cell tumor is almost always benign and alveolar soft part sarcoma is invariably malignant. We evaluated a panel of immunohistochemical stains (S-100 protein, inhibin, SOX10, nestin, calretinin, and TFE3) in 13 alveolar soft part sarcomas and 11 granular cell tumors. Tissue sections were also stained by the periodic acid-Schiff method after diastase digestion (PAS-D) and evaluated for coarse cytoplasmic granularity or crystalline cytoplasmic inclusions. S-100 protein, inhibin, SOX10, and nestin each distinguished granular cell tumor and alveolar soft part sarcoma with 100% sensitivity and specificity. PAS-D staining also distinguished cases with 100% accuracy, as granular cell tumor consistently demonstrated coarsely granular, PAS-D-positive cytoplasm and alveolar soft part sarcoma showed only focal intracytoplasmic crystalline inclusions. Although all granular cell tumors were calretinin positive, so were 46% of alveolar soft part sarcomas. TFE3 was positive in 91% of granular cell tumors and all alveolar soft part sarcomas. Together with PAS-D, immunohistochemical stains for S-100 protein, inhibin, SOX10, and nestin accurately identify alveolar soft part sarcoma and granular cell tumor. Although TFE3 has been reported as a relatively specific marker for alveolar soft part sarcoma, it should be recalled that it is also expressed in most granular cell tumors.
authors.affiliation: Department of Pathology, Vanderbilt University Medical Center, Nashville, TN 37232.
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Chamberlain
authors.affiliation: Department of Pathology, Vanderbilt University Medical Center, Nashville, TN 37232.
authors.forename: Colt M
authors.initials: CM
authors.lastname: McClain
authors.affiliation: Department of Pathology, Vanderbilt University Medical Center, Nashville, TN 37232.
authors.forename: Raul S
authors.initials: RS
authors.lastname: Gonzalez
authors.affiliation: Department of Pathology, Vanderbilt University Medical Center, Nashville, TN 37232.
authors.forename: Cheryl M
authors.initials: CM
authors.lastname: Coffin
authors.affiliation: Department of Pathology, Vanderbilt University Medical Center, Nashville, TN 37232. Electronic address: justin.m.cates@Vanderbilt.Edu.
authors.forename: Justin M M
authors.initials: JM
authors.lastname: Cates
mesh_terms: D051778:Basic Helix-Loop-Helix Leucine Zipper Transcription Factors / Q000032:analysis; D064032:Calbindin 2 / Q000032:analysis; D016586:Granular Cell Tumor; D006801:Humans; D007150:Immunohistochemistry; D007265:Inhibins / Q000032:analysis*; D064231:Nestin / Q000032:analysis*; D009418:S100 Proteins / Q000032:analysis*; D055757:SOXE Transcription Factors / Q000032:analysis*; D018234:Sarcoma, Alveolar Soft Part / Q000737:chemistry* / Q000473:pathology*; D012680:Sensitivity and Specificity; D013194:Staining and Labeling
chemical_list: D051778:Basic Helix-Loop-Helix Leucine Zipper Transcription Factors; D064032:Calbindin 2; C577484:NES protein, human; D064231:Nestin; D009418:S100 Proteins; C527923:SOX10 protein, human; D055757:SOXE Transcription Factors; C069203:TFE3 protein, human; D007265:Inhibins
keywords: Alveolar soft part sarcoma; Granular cell tumor; Inhibin; Nestin; S-100 protein; SOX10