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Dasgupta S, Koljenović S, van den Bosch TPP, Swagemakers SMA, van der Hoeven NMA, van Marion R, van der Spek PJ, van Doorn HC, van Kemenade FJ, Ewing-Graham PC. Evaluation of Immunohistochemical Markers, CK17 and SOX2, as Adjuncts to p53 for the Diagnosis of Differentiated Vulvar Intraepithelial Neoplasia (dVIN). Pharmaceuticals (Basel) 2021; 14:ph14040324. [PMID: 33918187 PMCID: PMC8066509 DOI: 10.3390/ph14040324] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/26/2022] Open
Abstract
Histological diagnosis of differentiated vulvar intraepithelial neoplasia (dVIN), the precursor of human papillomavirus (HPV)-independent vulvar squamous cell carcinoma (VSCC), can be challenging, as features of dVIN may mimic those of non-dysplastic dermatoses. To aid the diagnosis, p53-immunohistochemistry (IHC) is commonly used, and mutant expression patterns are used to support a histological diagnosis of dVIN. However, a proportion of dVIN can show wild-type p53-expression, which is characteristic of non-dysplastic dermatoses. Furthermore, recent research has identified a novel precursor of HPV-independent VSCC—the p53-wild-type differentiated exophytic vulvar intraepithelial lesion (de-VIL). Currently, there are no established diagnostic IHC-markers for p53-wild-type dVIN or de-VIL. We evaluated IHC-markers, cytokeratin 17 (CK17), and SRY-box 2 (SOX2), as diagnostic adjuncts for dVIN. For this, IHC-expression of CK17, SOX2, and p53 was studied in dVIN (n = 56), de-VIL (n = 8), and non-dysplastic vulvar tissues (n = 46). For CK17 and SOX2, the percentage of cells showing expression, and the intensity and distribution of expression were recorded. We also performed next generation targeted sequencing (NGTS) on a subset of dVIN (n = 8) and de-VIL (n = 8). With p53-IHC, 74% of dVIN showed mutant patterns and 26% showed wild-type expression. Median percentage of cells expressing CK17 or SOX2 was significantly higher in dVIN (p53-mutant or p53-wild-type) and de-VIL than in non-dysplastic tissues (p < 0.01). Diffuse, moderate-to-strong, full epithelial expression of CK17 or SOX2 was highly specific for dVIN and de-VIL. With NGTS, TP53 mutations were detected in both dVIN and de-VIL. We infer that immunohistochemical markers CK17 and SOX2, when used along with p53, may help support the histological diagnosis of dVIN.
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Affiliation(s)
- Shatavisha Dasgupta
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.K.); (T.P.P.v.d.B.); (S.M.A.S.); (R.v.M.); (P.J.v.d.S.); (F.J.v.K.); (P.C.E.-G.)
- Correspondence:
| | - Senada Koljenović
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.K.); (T.P.P.v.d.B.); (S.M.A.S.); (R.v.M.); (P.J.v.d.S.); (F.J.v.K.); (P.C.E.-G.)
| | - Thierry P. P. van den Bosch
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.K.); (T.P.P.v.d.B.); (S.M.A.S.); (R.v.M.); (P.J.v.d.S.); (F.J.v.K.); (P.C.E.-G.)
| | - Sigrid M. A. Swagemakers
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.K.); (T.P.P.v.d.B.); (S.M.A.S.); (R.v.M.); (P.J.v.d.S.); (F.J.v.K.); (P.C.E.-G.)
- Department of Clinical Bioinformatics, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Nick M. A. van der Hoeven
- Department of Gynecology and Obstetrics, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands;
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands;
| | - Ronald van Marion
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.K.); (T.P.P.v.d.B.); (S.M.A.S.); (R.v.M.); (P.J.v.d.S.); (F.J.v.K.); (P.C.E.-G.)
| | - Peter J. van der Spek
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.K.); (T.P.P.v.d.B.); (S.M.A.S.); (R.v.M.); (P.J.v.d.S.); (F.J.v.K.); (P.C.E.-G.)
- Department of Clinical Bioinformatics, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Helena C. van Doorn
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands;
| | - Folkert J. van Kemenade
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.K.); (T.P.P.v.d.B.); (S.M.A.S.); (R.v.M.); (P.J.v.d.S.); (F.J.v.K.); (P.C.E.-G.)
| | - Patricia C. Ewing-Graham
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.K.); (T.P.P.v.d.B.); (S.M.A.S.); (R.v.M.); (P.J.v.d.S.); (F.J.v.K.); (P.C.E.-G.)
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