p53/CK17 Dual Stain Improves Accuracy of Distinction Between Differentiated Vulvar Intraepithelial Neoplasia and Its Mimics
| Autor: | Emily R. McMullen-Tabry, Stephanie L. Skala, May P. Chan, Steven M. Hrycaj, Grace Y. Wang, Andrew P. Sciallis, Shula Schechter |
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| Rok vydání: | 2022 |
| Předmět: |
Pathology
medicine.medical_specialty Vulvar Neoplasms business.industry Squamous Intraepithelial Lesions Obstetrics and Gynecology Stain Vulvar Lichen Sclerosus Pathology and Forensic Medicine Biomarkers Tumor Carcinoma Squamous Cell Medicine Humans Female Tumor Suppressor Protein p53 business Coloring Agents Differentiated Vulvar Intraepithelial Neoplasia Carcinoma in Situ |
| Zdroj: | International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists. 41(3) |
| ISSN: | 1538-7151 |
| Popis: | Accurate diagnosis of differentiated vulvar intraepithelial neoplasia (dVIN) is challenging, in part due to the sometimes subtle nature of its atypia. Many dVIN lesions demonstrate aberrant p53 staining; however, staining patterns overlap between dVIN and benign/reactive entities. We evaluate a p53/CK17 dual stain in an initial cohort of dVIN (n=30), benign vulvar skin (n=5), lichen sclerosus (LS, n=10), lichen simplex chronicus (LSC, n=10), and pseudoepitheliomatous hyperplasia (PEH, n=10). In the initial cohort, aberrant p53 staining was seen only in dVIN (50%, 15/30). Equivocal p53 staining patterns were seen in dVIN (37%, 11/30), LS (50%, 5/10), LSC (40%, 4/10), and PEH (40%, 4/10). All 30 dVIN cases were positive for CK17 (strong partial-thickness or full-thickness staining), but positive CK17 staining was also seen in LS (70%, 7/10), LSC (50%, 5/10), and PEH (100%, 10/10). In the initial cohort, the combination of aberrant p53 and positive CK17 was seen only for dVIN (50%, 15/30). Forty cases of LS with known follow-up (20 with progression to dVIN, 20 without) were stained to assess prognostic value. Three LS cases showed aberrant p53 staining with CK17 positivity; all progressed to dVIN. Equivocal p53 staining and CK17 positivity were seen in cases with and without progression. The p53/CK17 dual stain is more diagnostically useful than either stain alone. Negative/focal staining for CK17 argues against a diagnosis of dVIN, while aberrant p53 staining with CK17 positivity strongly supports the diagnosis. |
| Databáze: | OpenAIRE |
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