Application of LEF-1 immunohistochemical staining in the diagnosis of solid pseudopapillary neoplasm of the pancreas

IF 2.9 4区医学 Q2 PATHOLOGY

Pathology, research and practice Pub Date : 2024-10-16 DOI:10.1016/j.prp.2024.155662

Saroja Devi Geetha , Atif Khan , Anam Khan , Yonah Ziemba , Karen Chau , Sunder Sham , Silvat Sheikh-Fayyaz , Arvind Rishi , Deepika Savant

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Abstract

Introduction

Solid pseudopapillary neoplasm (SPN) is a tumor of young females with gain-of-function mutation in catenin beta 1 gene involved in Wnt signal transduction pathway. Beta-catenin immunohistochemistry (IHC) is used to diagnose SPN. Lymphoid enhancer-binding factor 1 (LEF-1) has been recognized in the transactivation of Wnt pathway. We aim to study LEF-1 IHC in SPN and other pancreatic tumors and compare it with beta-catenin IHC.

Methods

We retrieved cases of SPN, pancreatic neuroendocrine tumor (PanNET), serous cystadenoma (SCA), ductal adenocarcinoma (PDAC) and acinar cell carcinoma (ACC) from 2011 to 2023. Formalin-fixed, paraffin-embedded blocks with adequate tumor were cut and stained with beta-catenin (B-Catenin-1 clone) and LEF-1 (EP310 clone) IHC. Cases were reviewed by two pathologists independently. Nuclear staining with LEF-1 and beta-catenin was considered as positive.

Results

Our cohort consisted of 111 cases [SPN = 59 (42 resections, 11 FNA, 6 biopsies), PDAC = 24, PanNET = 22, SCA = 5, ACC = 1]. For SPN cases male to female ratio was1:8. Age ranged from 9 to 81 years (average: 32 years). Pancreatic tail was the most common location (47 %) followed by head (28 %), body (19 %) and neck (6 %). Tumor size ranged from 1.0 to 12.2 cm (average: 5 cm). Among the SPN cases 57/59 demonstrated strong nuclear LEF-1 staining. 2/49 cases were negative for LEF-1 (both pathologist in agreement). All SPN tumors demonstrated nuclear staining with beta-catenin. Among the non-SPN tumors, beta-catenin showed nuclear staining in 2/52 cases (2 PDAC). The remaining 50 cases were negative for nuclear beta-catenin and demonstrated variable staining pattern with interpretation variability between the two pathologists. The sensitivity and specificity for LEF-1 were 97 % and 100 %, respectively, while for beta-catenin, they were 100 % and 96 % respectively.

Conclusion

Crisp nuclear staining of LEF-1 without background staining makes diagnostic interpretation relatively easy and accurate compared to beta-catenin IHC. This is further helpful for small biopsy samples to help differentiate SPN from mimickers such as PanNET. None of the non-SPN cases displayed nuclear LEF-1 rendering it a valuable adjunct to beta-catenin in the diagnostic evaluation of SPN.

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LEF-1 免疫组化染色在胰腺实体假乳头状瘤诊断中的应用。

导言实性假乳头状瘤（SPN）是一种年轻女性肿瘤，患者体内参与 Wnt 信号转导通路的 catenin beta 1 基因发生了功能增益突变。β-catenin免疫组化（IHC）可用于诊断SPN。淋巴增强子结合因子 1（LEF-1）在 Wnt 信号转导通路中的作用已被确认。我们旨在研究 SPN 和其他胰腺肿瘤中的 LEF-1 IHC，并将其与β-catenin IHC 进行比较：我们检索了 2011 年至 2023 年期间 SPN、胰腺神经内分泌肿瘤（PanNET）、浆液性囊腺瘤（SCA）、导管腺癌（PDAC）和尖细胞癌（ACC）的病例。切取有足够肿瘤的福尔马林固定石蜡包埋块，用β-卡替蛋白（B-卡替蛋白-1克隆）和LEF-1（EP310克隆）IHC染色。病例由两名病理学家独立审查。LEF-1和β-catenin核染色为阳性：我们的队列由 111 例病例组成[SPN = 59（42 例切除，11 例 FNA，6 例活检），PDAC = 24，PanNET = 22，SCA = 5，ACC = 1]。SPN病例的男女比例为1:8。年龄从9岁到81岁不等（平均32岁）。胰腺尾部是最常见的部位（47%），其次是头部（28%）、身体（19%）和颈部（6%）。肿瘤大小从 1.0 厘米到 12.2 厘米不等（平均 5 厘米）。在 SPN 病例中，有 57/59 例显示出较强的核 LEF-1 染色。2/49的病例LEF-1呈阴性（两位病理学家意见一致）。所有SPN肿瘤都显示出β-catenin核染色。在非 SPN 肿瘤中，2/52 的病例（2 例为 PDAC）出现了 beta 连环素核染色。其余 50 个病例的β-catenin 核染色均为阴性，染色模式各异，两位病理学家的解释也不尽相同。LEF-1的敏感性和特异性分别为97%和100%，而β-catenin的敏感性和特异性分别为100%和96%：结论：与β-catenin IHC相比，LEF-1清晰的核染色无背景染色使诊断解释相对容易和准确。这对小活检样本更有帮助，有助于区分SPN和PanNET等模仿者。没有一个非 SPN 病例显示出核 LEF-1，因此在诊断评估 SPN 时，LEF-1 是β-卡捷宁的重要辅助指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pathology, research and practice 医学-病理学

CiteScore

5.00

自引率

3.60%

发文量

405

审稿时长

24 days

期刊介绍： Pathology, Research and Practice provides accessible coverage of the most recent developments across the entire field of pathology: Reviews focus on recent progress in pathology, while Comments look at interesting current problems and at hypotheses for future developments in pathology. Original Papers present novel findings on all aspects of general, anatomic and molecular pathology. Rapid Communications inform readers on preliminary findings that may be relevant for further studies and need to be communicated quickly. Teaching Cases look at new aspects or special diagnostic problems of diseases and at case reports relevant for the pathologist''s practice.